To examine the effects of body-mind-spirit group therapy on anxiety, depression, and holistic well-being among women with breast cancer

Patients in the control group received standard care. Patients in the experimental group received standard care plus 10 sessions of weekly group therapy, 180 minutes per session. Therapy integrated concepts and practices, such as qigong exercises of vital energy, massage, meditation, positive thinking, group mutual support, long-term survivors’ sharing, songs, home assignments, and exercises. These activities were based on traditional Chinese medicine, the Eastern philosophies of Taoism and Confucianism, and the practice of Buddhism. The goal of the activities were to manage physical, psychosocial, and spiritual distress. Sessions included qigong exercises provided for 20 minutes each week by a qigong master and body-mind-spirit group assignments that included sharing and singing. The qigong master facilitated the first 20 minutes of each session. Then the primary investigator and co-investigators, working as mental health nurses, managed the rest of each session. Co-investigators held a 90-minute focus group interview after the last group therapy session. They conducted the interview in Mandarin and transcribed it. A bilingual researcher translated the transcription.

A coinvestigator implemented the randomization so that the patients, physician, and primary investigator were blinded to the randomization process. The primary investigator conducted groups after randomization and completion of initial surveys. Participants completed a baseline questionnaire after informed consent. After two months of intervention, participants completed a postintervention questionnaire.

• The sample was composed of 28 participants: 12 in the experimental group and 16 in the control group. 
• Mean patient age in the study was 40–60 years. In the experimental group, mean patient age was 52 years (SD = 8.3 years). In the control group, mean patient age was 46.1 years (SD = 7.8 years).
• The sample was composed of female patients with breast cancer only. Those suffering ailments in addition to breast cancer or receiving other psychotherapy were excluded.
• Patients had cancer in stages I–III. The distribution of stages in groups follows: stage I, three patients in the experimental group and three in the control group; stage II, six patients in the experimental group and eight in the control group; stage III, two patients in the experimental group and three in the control group.
• The types of surgery that patients had undergone included modified radical mastectomy, conservative surgery, and radical mastectomy, with the distribution of types in groups as follows: modified radical mastectomy, seven patients in the experimental group and nine in the control group; conservative surgery, three patients in the experimental group and five in the control group; radical mastectomy, two patients in the experimental group and two in the control group.
• One patient in the experimental group and two patients in the control group experienced relapse.

• Single site
• Outpatient setting 
• Consultation room of a cancer foundation center

• Phase of care: active treatment
• Clinical applications: late effects and survivorship

Mixed-methods design incorporating a randomized controlled trial and focus-group interviews

• Beck Depression Inventory II (BDI-II)      
• State-Trait Anxiety Inventory (STAI)
• Body-Mind-Spirit Well-being Inventory (BMSWBI)

• Pre/post-test comparison of symptoms of depression in the intervention, or experimental, group and control group showed a difference in depression improvement and body-mind-spirit well-being; the difference was not significant.
• Pre/post-test comparison of symptoms of anxiety in the intervention, or experimental, group and control group showed a significant difference (p < 0.03) in state anxiety.
• Qualitative focus group interviews revealed eight domains with subthemes. The imparting information domain had seven themes: learning about appropriate diet, learning about treatment and care of breast cancer, learning how to monitor physical condition, learning to exercise, learning to practice relaxation, learning to reframe cognitive distress, and learning to practice forgiveness.
• The interpersonal learning domain had two themes: having more interpersonal interactions and obtaining support from group members.
• The catharsis domain had three themes: understanding the impact of suppressing emotions on holistic well-being, sharing suffering with group members, and learning to use projective methods to express emotions.
• The universality domain had two themes: learning that I am not the only one who suffers from cancer and learning that personal characteristics are the common cause of cancer.
• The domains of group cohesiveness and altruism each had one theme: having a sense of belonging and using one’s own successful experience to help others, respectively.
• The existential factors domain had two themes: practicing self-love and learning to view misfortune positively.

Culturally sensitive body-mind-spirit group therapy reduced anxiety among outpatients with breast cancer.

• The study had a small sample, with fewer than 30 participants.
• The researchers were not completely blinded to the randomization process because the coinvestigator implemented it.
• Forty-nine participants were enrolled in the study, but only 28 completed the study. The drop-out rate reduces the power of the study.
• Findings may have limited generalizability beyond women ages 40–60 with stage II breast cancer.
• Longer-term follow-up to study maintenance of depression improvement are needed.

Mental health nurses who provide group therapy for patients with cancer could help to enhance quality of care in psycho-ontological nursing. Further research with older and younger women — as well as with patients in stages I, III, and relapse — are suggested.

To determine the efficacy and tolerance of using a probiotic to treat functional constipation in patients receiving chemotherapy

All patients received chemotherapy appropriate for their diagnosis. Patients were divided into two groups. The treatment group received, in addition to chemotherapy, Bifidobacterium tetragenous viable bacteria tablets three times a day for four weeks.

• N = 100  
• MEDIAN AGE = 61.1 years
• MALES: 68%, FEMALES: 32%
• KEY DISEASE CHARACTERISTICS: Gastric and colorectal cancers
• OTHER KEY SAMPLE CHARACTERISTICS: Overall Wexner score was between 0–10 (72%) and 11–20 (28%).

• SITE: Single site  
• SETTING TYPE: Not specified    
• LOCATION: Jiangsu province, China

• PHASE OF CARE: Active antitumor treatment

• Patients were divided into two groups, experimental and control.

• Wexner constipation scoring system

There was significant improvement of functional constipation (p < 0.05) with the use of four Bifidobacterium tetragenous viable bacteria tablets.

Probiotics may be beneficial for some patients receiving chemotherapy who suffer from functional constipation.

• Small sample (less than 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement validity/reliability questionable
• There was no postintervention Wexner scores listed, although the authors stated that there was improvement in bowel function.

Additional research on the use of probiotics and a variety of chemotherapy regimens in patients with functional constipation needs to be completed.

To assess the safety and effectiveness of analgecine for the control of oxaliplatin-induced neurotoxicity

Patients scheduled to receive oxaliplatin as adjuvant or palliative therapy were divided into experimental and control groups. Neurotoxicity was measured at four and eight weeks/cycles. Timing and dosage of the experimental agent were not described.

• N = 82   
• AGE = 72% were older than 50 years
• MALES: 32.9%, FEMALES: 67.1%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All had either gastric or colorectal cancer. The majority had metastatic disease.

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: China

PHASE OF CARE: Active antitumor treatment

Parallel group trial

Common Criteria Criteria for Adverse Events (CTCAE), version 3.0

The occurrence rate of toxicity was lower in the experimental group at four (p = 0.043) and eight (p = 0.05) weeks, and those in the experimental group generally had lower grades of toxicity.

Analgecine may have some role as a neuroprotective agent for patients receiving oxaliplatin; however, well designed research is needed to explore this.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• It is unclear how individuals were assigned to study groups.
• The intervention was not described.

There is very limited evidence for interventions that can prevent or reduce neurotoxic side effects of chemotherapy. Additional research for analgecine is needed to determine if it has any role in this area.

To investigate the effects of intrathecal dexmedetomidine on analgesia receiving intrathecal morphine for refractory cancer-related pain

Patients were initially provided intrathecal morphine at 0.4 mg/ml at a continuous dose of 0.1 ml per hour, a bolus dose of 0.5 ml, and then pump parameters were adjusted if pain score were > 4 or more than eight bolus doses were needed on the previous day. An external catheter was connected to a computerized ambulatory delivery pump. Patients were monitored for seven days and then were crossed over to receive intrathecal morphine at the same initial dose plus dexmedetomidine at 1 mcg/ml in a continuous infusion for seven days. Daily average pain scores and other study measures were recorded at baseline and at the end of each seven-day study period.

• N = 24
• AGE = 58 years (SD = 14 years)
• MALES: 42%, FEMALES: 58%
• KEY DISEASE CHARACTERISTICS: Various tumor types; all had pain scores > 6 and systemic opioid use of more than 200 mg per day or dose-limiting side effects; the majority had nociceptive pain

• SITE: Single site  
• SETTING TYPE: Not specified  
• LOCATION: China

• PHASE OF CARE: End of life care
• APPLICATIONS: Palliative care

Double-blinded, crossover, randomized trial

• Visual Analog Scale (VAS) for pain intensity 
• Number of bolus doses required
• Numeric Rating Scale (NRS) for sleep deprivation

Pain intensity and frequency declined significantly with intrathecal morphine (p < 0.05) and then declined more with the addition of dexmedetomidine (p < 0.05). Sleep deprivation was improved in the same pattern (p < 0.05). With morphine alone, daily morphine consumption was 7.9 mg (SD = 1.1) and bolus dose frequency was 6.9 (SD = 1.3). With the addition of dexmedetomidine, morphine consumption decreased to 5.3 mg (SD = 0.8), and the frequency of bolus doses decreased to 2.8 times (SD = 0.7). The most frequent side effects were nausea, vomiting, difficulty urinating, and somnolence. Constipation decreased from baseline.

The addition of intrathecal dexmedetomidine to morphine analgesia decreased morphine consumption and improved pain control in patients with refractory cancer-related pain.

• Small sample (< 100)

Dexmedetomidine is an alpha adrenergic receptor agonist that has sympatholytic, sedative, and analgesic effects. The findings of this study suggest that the addition of this medication to morphine analgesia administered intrathecally may improve pain control and reduce morphine consumption and the number of bolus doses needed for pain control. It also demonstrated sedative effects. Refractory pain can be very difficult to manage to achieve adequate pain control. The approach studied here may provide an option for the management of refractory pain. Additional studies are needed to fully establish the safety profile and efficacy of this treatment.

To evaluate the effect of olanzapine on quality of life (QOL) during chemotherapy compared with a 5HT3 receptor antagonist

Patients receiving multiple different chemotherapy regimens were randomized to one of two groups. Group one received olanzapine 10 mg PO, azasetron 10mg IV, and dexamethasone 10 mg IV, followed by olanzapine 10 mg PO on days 2-5. The control group received azasetron 10 mg IV and dexamethasone 10 mg IV, followed by dexamethasone 10 mg IV on days 2-5. Use of breakthrough antiemetics was permitted based on clinical circumstances. It is not reported whether patients received one cycle only. Patients were not all chemotherapy naive, but this was not controlled in the sample description.

• N = 229  
• AGE = 18-74 years
• MALES: 65%-72%, FEMALES: 43%-49%
• KEY DISEASE CHARACTERISTICS: lung, breast, colorectal, lymphoma, ovarian, stomach, esophageal, teratoma, thymus, oropharyngeal, cervical, gingival, melanoma, and glioblastoma. All patients were receiving moderately or highly emetogenic chemotherapy.
• OTHER KEY SAMPLE CHARACTERISTICS: normal CBC, LFTs, metabolic profile, normal cardiac function, EKG, performance status of 2 or better, no nausea preceding 24 hours. Multiple exclusion criteria.

• SITE: Single site    
• SETTING TYPE: Not specified    
• LOCATION: Harbin Medical University, China

• PHASE OF CARE: Active antitumor treatment

• Randomized trial using random digits

• EORTC-QLQ C30 was measured on day 0 and 6. CINV was measured with Common Toxicity Criteria.

There was no significant difference in acute CINV, but delayed CINV showed complete response rates of 76.85% in the olanzapine group and 46.2% in the 5HT3 group (p < 0.05). CINV was also better controlled in five days post chemotherapy, with 85.95% in the olanzapine arm and 67.59% in the control arm. Not all patients completed QOL. Global health status, emotional functioning, social functioning, fatigue, CINV, and insomnia were improved in the olanzapine group. Pain and dyspnea improved in both groups.

CINV influences QOL for patients undergoing chemotherapy. Although olanzapine did not change CINV in the acute phase, it showed significance in the delayed CINV group. This demonstrated improvements in global health status, fatigue, and insomnia. 5HT3 antagonists were effective against acute CINV but not effective in delayed CINV.

• Risk of bias (no blinding)
• Other limitations/explanation: The authors did not identify any limitations. All data comparisons were not identified. Description of prior treatments for patients were not listed. No subgroup analysis was completed between those receiving MEC and HEC regimens. No information was provided regarding use of other antiemetics as allowed in the study protocol

Olanazapine offers another option for treatment of CINV. Other symptoms may also be controlled with this medication, such as insomnia, appetite loss, fatigue, and global health status. Nurses can consider this when standard medications are ineffective.

To examine the effects of body–mind–spirit group therapy on anxiety, depression, and well-being in women with breast cancer

The intervention was 10 group sessions based on positive psychology and forgiveness therapy to enhance physical strength, increase emotional release, and develop positive meaning of life. Specific exercises included things such as self-care planning, massage of acupuncture points, drawing, creating love cards for others, and sharing strategies.

• The study reported on a sample of 28 female patients with breast cancer.
• Most patients had stage II disease and had undergone modified radical mastectomy.
• Of the sample, 61% were married and identified as “religious,” 63% were employed, and 55% had high school or higher level of education.

• Single site
• Outpatient setting
• Taiwan

Patients were undergoing the active treatment phase of care.

A mixed-methods study design was used: randomized controlled trial with focus group interview.

• Beck Depression Inventory, second edition (BDI-II)
• State-Trait Anxiety Inventory (STAI)
• Body–Mind–Spirit Well-being Inventory (BMSWBI): 10-point scale with 56 items (alpha = 0.87–0.92)
• Qualitative analysis of verbatim transcripts of focus group interview. Interview guide used open-ended questions structured according to a published set of suggested questions.

There was no difference over time for depression or well-being. The intervention group had a greater reduction in anxiety (p = 0.03) compared to the control group, with an effect size estimate of 0.56, suggesting a medium clinical significance. Qualitative analysis demonstrated that reduced anxiety was facilitated through a group process.

Results of focus group interviews demonstrated that these effects were facilitated through a group process. There were no apparent effects of the intervention on depression or well-being.

• The study had a small sample size.
• Attrition was a problem, with a 35% drop-out rate, more in the experimental group than the control group.

Qualitative results suggest that the main effects of the intervention were associated with provision of information and the peer group interactions. It is not clear if the philosophic foundations and exercises used in the interventions were essential to these effects.

To investigate efficacy of various secondary antifungal prophylaxis regimens

Patients with hematological malignancy that had a previous diagnosis of probable or proven invasive fungal disease were reviewed retrospectively and followed for 180 days post-chemotherapy or transplantation. Antifungal prophylaxis was provided with voriconazole, itraconazole, amphotericin B, liposome, or caspofungin. Secondary prophylaxis began on the first day of conditioning or within two days before chemotherapy and was continued throughout the duration of neutropenia. It was ended when immunosuppression was finished in all patients undergoing HCT, or neutrophil recovery or failure of the prophylaxis.

• N = 164
• AGE = 51% were older than age 40 years
• MALES: 51%, FEMALES: 49%
• KEY DISEASE CHARACTERISTICS: 90% had acute leukemia. More than one-third had acute or chronic graft-versus-host disease.
• OTHER KEY SAMPLE CHARACTERISTICS: All had prior pulmonary invasive fungal disease.

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: China

• PHASE OF CARE: Multiple phases of care

• Retrospective

Not applicable.

121 patients received secondary antifungal prophylaxis. The recurrence rates were 16.5% and 46.5% in those receiving and not receiving prophylaxis, respectively (p = 0.000). There was no difference in recurrence rates according to the specific prophylactic agents used.

Findings suggest that secondary antifungal prophylaxis is beneficial in reducing the rate of recurrent fungal infections in patients with cancer.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Specific definition of fungal infection are not provided, and most only had probable infection due to lack of diagnostic data.

Secondary antifungal prophylaxis in patients who had previous invasive fungal infections was shown to be effective in reducing the rate of new fungal infections; however, it did not prevent fungal infection in all patients. Nurses need to closely monitor and assess these types of patients for signs of infection so that they can be treated aggressively when needed.

To compare effects of cardiovascular and resistance exercise on functional mobility in people with advanced cancer

Individuals were randomly assigned to either resistance or cardiovascular exercise groups. Exercise sessions were held in a hospital-based fitness facility twice weekly for 10 weeks. Both groups  participated in flexibility exercises. Sessions lasted 30–60 minutes and were supervised by oncology-trained exercise specialists. Participants completed the study assessments at baseline and one week after study completion.

• N = 52    
• MEAN AGE = 62.35 years (SD = 13.49)
• MALES: 45%, FEMALES: 55%
• KEY DISEASE CHARACTERISTICS: Multiple tumor types. All had advanced cancer determined by an oncologist to be in a terminal stage.
• OTHER KEY SAMPLE CHARACTERISTICS: More than 90% of the patients were currently receiving chemotherapy, radiation therapy, or a combination of these. Baseline mean fatigue was 37.02 on a 0–100 scale.

• SITE: Single site
• SETTING TYPE: Outpatient
• LOCATION: New England

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care

• Randomized, parallel group trial

• Short Physical Performance Battery (SPPB)
• 100 mm visual analog scale for fatigue and pain

On average, participants attended 70% of exercise sessions. SPPB scores improved in all over time (p < .001), but improved slightly more in the cardiovascular group (p = .045). Intent-to-treat analysis did not confirm this difference between groups. Fatigue declined over time in all (p = .05), with no difference between groups. There were no significant changes in pain by group or by time.

Findings show improved functional mobility and reduced fatigue over time. This study did not show a difference associated with the type of exercise provided.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Measurement validity/reliability questionable
• Other limitations/explanation: VAS score was only for fatigue. There was a 21% dropout rate and reasons for this are not described. Relatively low levels of fatigue at baseline, suggesting possible measurement floor effect.

This study suggests that both cardiovascular and resistance exercise can be used in appropriate patients with advanced disease, and findings showed that there were no significant changes in pain or fatigue with these interventions.

To determine if there was an improvement in fatigue, strength, and quality of life (QOL) in individuals within one year of treatment for an individualized physical therapist–prescribed exercise intervention.

Cancer survivors participated in an exercise class (one hour two times weekly) that included instruction and supervision in cardiovascular, strength training, and flexibility exercises. Measurement of fatigue, strength, and repetition of prescribed exercises occurred. The individualized exercise program was prescribed by a single therapist and was based on the patient’s medical history, diagnosis, age-related changes, treatment stage, and goals. Flexibility, strength, and balance assessments were conducted, and participants were retested at the conclusion of the program. Patients were encouraged to exercise two times weekly.

• Two hundred patients (91 females and 41 males) were enrolled; 132 (66%) completed the program.
• Mean age was 57.48 years. One patient was younger than 21 years and five patients were between 81 and 90 years; the majority (n = 36) were between 61 and 70 years.
• Stages of cancer were I through IV.
• Diagnoses included breast, colorectal, lung, ovarian, non-Hodgkin lymphoma, prostate, and other cancers.
• Most patients were undergoing active treatment, and most had undergone surgery, chemotherapy/hormonal, and radiation therapy.

• Single site
• Cancer Well-Fit Exercise Program at Synergy Health and Fitness Center on the campus of Exeter Hospital, Exeter, New Hampshire

This study included a pre- and posttest and a two-tailed t test. 

• Visual analog scale (VASF) to measure fatigue (Glaus reported validity and reliability but did not report the actual number)
• Jamar dynamometer to measure upper extremity strength (Bohannan reported as valid and predictive of postoperative complications and related to functional loss but did not report the actual number)
• Cybex VR2 seated leg press machine to measure lower extremity strength
• Segal tested lower-extremity muscular fitness with repetitions to fatigue for prediction, and Sale and MacDougall published data regarding repetitions to fatigue. The amount of weight lifted and the total number of repetitions performed were used to estimate a predicted one repetition maximum according to Brzycki’s regression equation.
• Short Form 36 Health Survey (SF-36) was used to measure QOL. This total score and eight subscales were analyzed pre- and post exercise intervention. They included physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, mental health, and reported health transition.

Overall fatigue improved significantly (p = 0.004). Overall lower-extremity anaerobic endurance increased significantly (p = 0.000). Overall nondominant grip strength increased significantly (p = 0.000). Overall QOL improved significantly (p < 0.01). The intervention was well tolerated in all of the diagnostic, stage, and age groups with no adverse events. The 81- to 90-year-old group had the highest completion rate, followed by the 71- to 80-year-old group. Survivors with stage IV disease had statistically significant improvement in lower extremity anaerobic endurance and QOL, whereas survivors of lung cancer had statistically significant reductions in their fatigue.

Virtually all patients with various cancer diagnoses and stages of disease, as well as a wide age range and both genders, can safely participate in and will benefit from a strength training program in terms of less fatigue, improved QOL, and increased strength. Oncology rehabilitation is necessary for survivors of cancer.

• The study lacked an appropriate control group.
• The population was primarily Caucasian, and there was limited cultural diversity.
• The study lacked randomization and control group.
• Combination exercise was used; the authors were unable to determine the most effective type of exercise for this population.

Exercise can be performed safely with careful planning. Exercise programs do not need to be restricted to those who are relatively well. Oncology rehabilitation is as necessary for survivors as cardiac rehabilitation. This study is supportive of a comprehensive exercise program.

To compare the analgesic effects of remifentanil target-controlled infusion via patient-controlled analgesia (PCA) to morphine PCA after uterine artery embolization

Nineteen patients were randomized into either the remifentanil group or the morphine group. Pain was evaluated every 15 minutes for 2 hours after the procedure and then at 4, 8, 12, and 16 hours after the procedure. Hemodynamic stability and respiratory stability were also measured.

• The sample was composed of 19 patients.
• Information about the age of patients is unavailable.
• All patients were female.
• All patients had a leiomyomata.
• All patients underwent uterine artery embolization.
   

• Single site
• Inpatient
   

Phase of care: active treatment

Double-blinded randomized controlled trial

• Numeric pain scale, 0–10    
• etCO₂ readings, SpO₂ measurements, respiratory rate/minute, to measure respiratory stability
• Heart rate, measures of blood pressure, to measure hemodynamic stability
   

• During the first four hours after surgery, pain scores were significantly lower (p < 0.02) in the remifentanil group than in the morphine group. After that, morphine and remifentanil showed similar effectiveness in controlling pain.
• One patient in the remifentanil and morphine groups, respectively, needed rescue pain therapy.
• Respiratory and hemodynamic stability were not significantly different between the groups.

The study concludes that, in the first four hours after surgery, remifentanil was more effective than morphine in reducing pain scores and that remifentanil PCA was as safe as morphine PCA.

The study had a small sample size, with fewer than 30 patients.

Further studies should evaluate the ability of remifentanil to control pain after uterine artery embolization.