Williams, J.E., Peacock, J., Gubbay, A.N., Kuo, P.Y., Ellard, R., Gupta, R., . . . Ross, J. (2015). Routine screening for pain combined with a pain treatment protocol in head and neck cancer: A randomised controlled trial. British Journal of Anaesthesia, 115, 621–628.
To compare the effectiveness of a pain management protocol with usual care
Patients who were referred for pain control were screened for worst pain severity on a 10-point numerical scale, and those who scored four or more were randomized to usual care or the experimental protocol group. The protocol treatment was individualized to the patient based on assessments. Protocols included the formulation of a pain treatment plan, weekly reassessments, the provision of an educational brochure, a discussion with a pain control doctor, and a referral to palliative care or other services as needed. Patients were followed for three months. Usual care patients could be referred to the pain control group but were not proactively scheduled for ongoing weekly assessments. Study assessments were done at baseline and at one and two months.
Single-blinded, randomized, controlled trial
There were no significant differences between the groups in pain measures throughout the study. Patient satisfaction was higher in the study group. The mean cost of pain treatment was significantly higher in the study group. The analysis showed a low probability of the intervention being cost-effective. Pain scores declined significantly over time in both groups.
The protocol did not demonstrate any significant benefit over usual care.
The findings of this study did not show a benefit of the specific protocol approach with weekly reassessments in the clinic as used here. This study did show that pain screening could be implemented and combined with good usual care to reduce pain severity.
Williams, S. A., & Schreier, A. M. (2005). The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Applied Nursing Research, 18, 138–147.
Patients were given a 20-minute audiotape that provided information about exercise and relaxation to manage anxiety, fatigue, and sleep problems. A printed self-care diary (SCD) of self-care behaviors that mirrored the audiotape was also provided. Participants were instructed to listen to the audiotape 12 to 24 hours before the start of chemotherapy cycles and as often as desired during the course of treatment. Patients in the control group received the standard education and care given to all patients during chemotherapy, whereas the experimental group received standard education and care, the audiotape, and the printed SCD.
Patients were undergoing the active treatment phase of care.
This was a randomized study; patients were randomly assigned to either the control or experimental group.
SCD
A higher percentage of women in the control group reported fatigue compared to the experimental group. Although the experimental group increased the number of self-care behaviors to address fatigue compared to the control group, this difference was not statistically significant.
Williams, S., & Dale, J. (2006). The effectiveness of treatment for depression/depressive symptoms in adults with cancer: A systematic review. British Journal of Cancer, 94, 372–390.
To perform a systematic review of studies regarding the efficacy of psychotherapeutic and antidepressant interventions for cancer patients with depression or symptoms of depression
The total number of references retrieved was 164. Authors conducted analysis according to the methodological-quality instrument developed Bo, Cho, and Bero.
The final number of included studies was 24. The sample range across studies of pharmacologic intervention was 892 (range = 40–549); of psychotherapeutic intervention, 2,518 (range = 36–450). Studies related to multiple disease sites.
Some evidence indicates that antidepressants are effective in reducing symptoms of depression in patients with cancer. Overall tolerability of antidepressants appeared to be good. Cognitive behavioral therapy was effective in reducing symptoms of depression. Another intervention that might be effective is the use of social support groups.
Findings suggest that antidepressants, cognitive behavioral interventions, and support-group interventions can have a positive impact on symptoms of depression in patients with cancer. Variability in findings suggests that these interventions are likely to be of most benefit to patients who actually have clinically meaningful symptoms of depression. Further research regarding the efficacy of antidepressants in the included patients is needed. Studies should include data about co-interventions for depression.
Williams, S., & Dale, J. (2006). The effectiveness of treatment for depression/depressive symptoms in adults with cancer: A systematic review. British Journal of Cancer, 94(3), 372–390.
To review systematically the efficacy of psychotherapeutic and antidepressant interventions for cancer patients with depression or symptoms of depression
Some evidence suggests that antidepressants are effective in reducing symptoms of depression in patients with cancer, and overall tolerability of antidepressants appeared to be good. Cognitive behavioral therapy was effective in reducing symptoms of depression. An intervention that might be effective is the social-support group.
Findings suggest that antidepressants, cognitive behavioral interventions, and support group interventions can have a positive impact on symptoms of depression in patients with cancer. Variability in findings suggests that these interventions are likely to be of most benefit to patients who actually have clinically defined symptoms of depression. There is a need for further research of the efficacy of antidepressants in the patients studied. Studies in this area should include data regarding use of any cointerventions for depression.
Williams, S.A., & Schreier, A.M. (2004). The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer [Online exclusive]. Oncology Nursing Forum, 31, E16–E23.
To determine the effectiveness of audiotapes on self-care behaviors, state anxiety, and the use of self-care behaviors and to describe the occurrence and intensity of common side effects in patients with breast cancer
Two 20-minute audiotapes provided information on nutritional management of side effects, exercise, and relaxation techniques along with written transcripts that were professionally developed at a fifth-grade reading level. All participants received standard education for the clinic but not standardized education. The experimental group received audiotapes and transcripts via mail and were provided with a cassette player if they did not have one at home. All participants were interviewed three times via telephone.
The study reported on 70 women with newly diagnosed stage I or II breast cancer starting the first cycle of chemotherapy treatment. Most of the women were receiving docorubicin and cyclophosphamide.
The setting was outpatient chemotherapy clinics operated by a university center in satellite clinics in rural areas of southeastern United States that covered 29 counties.
The design was an experimental, randomized, clinical trial.
Willems, R.A., Bolman, C.A., Mesters, I., Kanera, I.M., Beaulen, A.A., & Lechner, L. (2016). Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: Randomized controlled trial. Psycho-Oncology. Advance online publication.
To present the short-term effects of a web-based computer-tailored intervention on quality of life, anxiety, depression, and fatigue in cancer survivors
A stand-alone web-based computer-tailored intervention (Cancer Aftercare Guide: KNW) was applied that aims to increase cancer survivor quality of life by providing personalized information and support on specific topics by promoting lifestyle changes. The eHealth intervention was based on principles of the problem-solving theory (PST) and cognitive behavioral theory (CBT). The KNW consists of eight training modules on topics of return to work, fatigue, anxiety, depression, social relationship and intimacy, physical activity, diet, and smoking cessation. After online registration, the computer randomly assigned participants to the intervention or waiting control group. Both groups had to complete questionnaires at 3, 6, and 12 months from baseline. The 6 and 12 month measures revealed the effectiveness. Participants filled in baseline questionnaires, modules were selected by the program, and the information was tailored to the participant, resulting in a personalized action plan. After 30 days, participants were invited to a second session to evaluate goal attainment and to set new goals.The program was unrestricted so that participants could self-select modules they wished to use and skip assignments.
Randomized, controlled trial comparing the KNW intervention with a waiting list control group
With the exception of treatment type, the intervention and control group were comparable. Participants in the intervention group used an average of 2.22 modules from first login to last use of 10.67 weeks. The authors indicated that the KNW intervention had a significant effect on increasing emotional and social functioning (p = 0.022, p = 0.011) and decreased depressions and fatigue (d = 0.019, p = 0.007, d = 0.020, p = 0.02) six months after baseline. The only effect for fatigue occurred in participants who used the module Fatigue (p = 0.009). No significant differences existed between groups for anxiety. For those who used the therapist face-to-face component, available effect sizes ranged from 0.26 to 0.38.
While the use of the web-based intervention showed statistically significant results, the effect sizes for depression, anxiety, and social functioning were extremely small. The module use and program were not fully automated and offered direct therapist contact. The authors reported substantially higher effect sizes with therapist contact, raising the question of overall effectiveness of the web-based content.
eHealth interventions, such as web-based PST or CBT approaches, may be useful for improving quality of life in cancer survivors. Further research is necessary to target the desired information and to provide support specifically for fatigue, anxiety, and depression in cancer survivors. The findings showed much greater size of effects with direct therapist intervention, suggesting that an eHealth system may be best used as an initial step in a multicomponent intervention with additional steps, in which increasing intervention is provided based upon patient need and response.
Wilkinson, S., Barnes, K., & Storey, L. (2008). Massage for symptom relief in patients with cancer: Systematic review. Journal of Advanced Nursing, 63, 430–439.
To assess the evidence regarding massage as a means of improving the physical and psychological well-being of patients with cancer
After elimination of duplicates from the initial search, investigators considered 1,321 references. Of these, investigators chose 10 studies for analysis, using the Jadad scoring approach and CONSORT Statement to appraise study quality. Investigators also used sample size and duration of follow-up to evaluate studies. Given the range of massage techniques and patients, meta-analysis was impossible. Three investigators reviewed studies independently.
The authors stated that results were inconclusive; however, reported results showed that massage had a preponderantly positive effect in regard to anxiety reduction.
Two studies included in the review used a crossover design, and one of these showed significant results after massage but not after the control period. This suggests that crossover design may be particularly applicable to this area of research and that the effects of massage are immediate and time sensitive.
Wilkinson, S.M., Love, S.B., Westcombe, A.M., Gambles, M.A., Burgess, C.C., Cargill, A., . . . Ramirez, A.J. (2007). Effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer: A multicenter randomized controlled trial. Journal of Clinical Oncology, 25, 532–539.
The intervention was a four-week course of one-hour aromatherapy massage offered in National Health Service cancer care settings in the United Kingdom. Patients were recruited and randomized to the intervention group or the control group. The primary variable was change in anxiety and/or depression between full case and borderline and noncase at 10 weeks postrandomization. Diagnostic assessments were tape-recorded, and regular consensus meetings were held to ensure consistency of the diagnostic rating. The secondary variable was self-reported anxiety using the State Subscale of the State Anxiety Inventory (SAI).
Four cancer centers and one hospice in England (National Health Service cancer care settings)
A longitudinal, randomized controlled trial design was used.
State Anxiety Inventory (SAI)–State Subscale measured at 6 and 10 weeks
Patients receiving aromatherapy massage experienced a significant improvement in anxiety at two weeks after intervention, and this was maintained at six weeks after intervention. The reduction of anxiety (by SAI) in the patients receiving usual care plus aromatherapy massage was at a confidence interval of 95% (p = 0.04) both at 6 weeks and 10 weeks.
The results of this trial suggest that aromatherapy massage is an effective therapeutic option for the short-term management of mild to moderate anxiety in patients with cancer.
The study required specialized training in aromatherapy massage.
Wilkes, E.A., Selby, A.L., Cole, A.T., Freeman, J.G., Rennie, M.J., & Khan, Z.H. (2011). Poor tolerability of thalidomide in end-stage oesophageal cancer. European Journal of Cancer Care, 20, 593–600.
To test the hypothesis that thalidomide is superior to placebo in terms of weight gain in patients with cachexia caused by esophageal cancer
Patients with advanced esophageal cancer who were not in active disease treatment were recruited at multidisciplinary team meetings at an individual site and randomly assigned to receive either placebo or 200 mg of thalidomide daily. Total body weight, lean body mass, resting energy expenditure measurements, and blood samples (complete blood count, biochemistry, tumor necrosis factor [TNF]-alpha, and interleukin 1-beta) were taken at baseline and after six weeks of therapy. At two and four weeks, triceps skinfold thickness, mid-arm circumference, disease progression symptoms, adverse drug reactions, Karnofsky Performance Status score, and Piper Fatigue Scale questionnaire data were collected.
The study site was not stated, but it appears to be a single site in an outpatient setting located in the United Kingdom.
A randomized, placebo-controlled trial design was used.
At the end of the six-week study period, neither lean body mass nor total body weight changed from baseline in the treatment or in the placebo group. Mid-arm muscle circumference did not show changes at two or four weeks. None of the body composition endpoints showed any significant difference between groups (p > 0.05). The placebo group had a statistically significant increase in resting energy expenditure (p = 0.04), which was not shared with the treatment group.
Survival was not different between the two groups. The median Karnofsky performance score was 10 points higher at baseline for the placebo group and did not change during the study, but this was not significant. The treatment group's median Karnofsky score dropped by 10 points. The Piper fatigue score did not change in either group.
TNF-alpha scores remained the same for both groups pre- and post-treatment. The interleukin 1-beta scores increased in the placebo arm.
Patients with advanced esophageal cancer taking thalidomide to increase body weight or lean muscle mass did not benefit positively from the intervention. There were many treatment arm drop-outs, mostly due to drug toxicity. All but two study arm patients who were able to complete the study required a dose reduction of thalidomide. Forty-seven percent of treatment patients were unable to complete the six-week study, whereas 94% of the placebo arm patients did complete it.
In this small study, the benefit of thalidomide for patients with advanced esophageal cancer was eclipsed by the drug’s adverse reactions and side effects. Quality of life was not enhanced and was actually negatively impacted. Although patients with advanced disease are often concerned about anorexia and weight loss, this study did not demonstrate benefit to the introduction of thalidomide in the end stages of life for patients with esophageal cancer.
Wilcock, A., Walton, A., Manderson, C., Feathers, L., El Khoury, B., Lewis, M., . . . Tattersfield, A. (2008). Randomised, placebo controlled trial of nebulised furosemide for breathlessness in patients with cancer. Thorax, 63(10), 872-875.
The objective of the study is to assess the benefit of nebulized furosemide on breathlessness and respiratory function in patients with cancer.
Patients were assigned to receive 40 mg nebulized furosemide, nebulized 0.9% saline, and no treatment on three consecutive days in random order. Subjects were familiarized with the equipment and surrounding on day one of study and underwent assessments before and after administration of the assigned treatment. Spirometry was administered before and after nebulizer treatments. Following 10 minutes of rest, subjects underwent a reading test and arm exercise test and then rated their sensation of breathlessness intensity on a Borg scale. On nontreatment days, patients also underwent spirometry before and after the arm exercise test. Patients finally were asked if they had perceived benefits from the nebulized saline or furosemide treatments and whether they noted a difference between the two.
The study was conducted on a single-site, inpatient palliative care unit in England.
Patients were undergoing end-of-life and palliative care.
All 13 patients who completed the arm exercise test experienced increased breathlessness, but no significant difference between exercise duration and Borg score at maximum equivalent workload between the furosemide, saline, and no treatment group were observed. Average score at maximum equivalent workload indicated no significant difference among the three treatments. Six of 15 patients perceived improved ventilation following nebulized treatment, with 3 preferring saline, 1 preferring furosemide, and 2 finding either treatment equally beneficial.
Results do not support benefit of nebulized furosemide in patients with cancer-related breathlessness.
Results do not support the use of nebulized furosemide in the management of dyspnea.