Lindemalm, C., Strang, P., & Lekander, M. (2005). Support group for cancer patients. Does it improve their physical and psychological wellbeing? A pilot study. Supportive Care in Cancer, 13, 652–657.
A residential, rehabilitative, psychoeducational intervention was conducted over a six-day period, followed by a four-day follow-up/booster intervention two months after the initial visit. Members of the intervention team included oncologists, social workers, art therapists, massage therapists, and a person trained in qigong and visualization; all had several years of experience and were trained according to the method of Grahn (1993). During the intervention period, patients received information about cancer, risk factors, treatment, psychological effects, and coping mechanisms. Physical exercise, relaxation training, qigong, and art therapy were mixed with educational lectures. Social activities, such as concerts and visits to museums and restaurants, were provided, along with opportunities for peer support. The residential rehabilitation environment was chosen for its beautiful and restful surroundings.
The intervention venue was a residential rehabilitation setting selected specifically to deliver the intervention.
Patients were undergoing the long-term follow-up phase of care.
The study was uncontrolled—fatigue was evaluated immediately after the first six-day intervention, with follow-up at 3, 6, and 12 months postintervention.
Norwegian fatigue questionnaire—an 11-item measure with two factors: physical fatigue and mental fatigue. The total score is created by totaling the 11 items.
At the conclusion of the intervention, there were statistically significant differences in fatigue reflected on most of the single-item scores on the Norwegian fatigue scale, as well as a statistically significant difference in the scores on the physical and mental fatigue factors. Only the improvement in physical fatigue remained statistically significant at three-month follow-up, and there were no significant improvements in fatigue noted at the 6- and 12-month postintervention time points.
The program requires the involvement of several skilled professionals.
Lindemalm, C., Strang, P., & Lekander, M. (2005). Support group for cancer patients. Does it improve their physical and psychological wellbeing? A pilot study. Supportive Care in Cancer, 13, 652–657.
The residential, rehabilitative, psychoeducational intervention was conducted over a six-day period, followed by a four-day follow-up/booster intervention two months after the initial visit. Members of the intervention team included oncologists, social workers, art therapists, massage therapists, and a person trained in qigong and visualization; all had several years of experience and were trained according to the method reported by Grahn (1993). During the intervention period, participants received information about cancer, risk factors, treatment, psychological effects, and coping mechanisms. Physical exercise, relaxation training, qigong, and art therapy were mixed with educational lectures. Social activities, such as concerts and visits to museums and restaurants, were provided, along with opportunities for peer support. The residential rehabilitation environment was chosen for its beautiful and restful surroundings.
Residential rehabilitation setting selected specifically for the intervention
Patients were undergoing the long-term follow-up phase of care.
This was an uncontrolled study. Fatigue was evaluated immediately after the first six-day intervention, with follow-up at three, six, and 12 months postintervention.
The Norwegian fatigue questionnaire, an 11-item measure with two factors (physical and mental fatigue), was used. The total score was created by summing the 11 items.
At the conclusion of the intervention, there were statistically significant differences in fatigue reflected on most of the single-item scores on the Norwegian fatigue scale, as well as a statistically significant difference in the scores on the physical fatigue and mental fatigue factors. Only the improvement in physical fatigue remained statistically significant at three-month follow-up, and there were no significant improvements in fatigue at the six- and 12-month postintervention time points.
Lindblad, K., Bergkvist, L., & Johansson, A.C. (2016). Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents: A randomized controlled trial. Supportive Care in Cancer, 24, 2523–2531.
To evaluate the effects of interferential therapy and long-wave diathermy at high power (ITH) compared to long-wave diathermy at low power (LDL) on peripheral neuropathy (PN) pain, sensory, and motor symptoms among adults with chronic chemotherapy-induced peripheral neuropathy (CIPN) symptoms in the lower extremities who completed chemotherapy treatment for various cancers
Three-group, sham-controlled, randomized, controlled trial
There were no significant between-group differences at the 12-week and 37-week follow-ups in all outcomes: self-reported pain, discomfort, paresthesia/numbness, or balance, or in objectively measured balance. At the 12- and 37-week follow-ups, both groups reported significantly improved CIPN discomfort (p < 0.05), zones of paresthesia (p < 0.003), and subjective balance (p ≤ 0.025). Only the LDL group experienced improved pain at 12 weeks (p = 0.017), but neither group had significant improvements in pain at 37 weeks. Only the intervention group demonstrated significantly improved balance at 12 and 37 weeks, based on the objective measures (p ≤ 0.04).
This randomized, controlled trial provides no evidence to support the efficacy of interferential therapy and ITH compared to LDL once per week for 12 weeks for pain, CIPN discomfort, patient-reported balance, and objectively measured balance among participants with physician-diagnosed chronic CIPN.
No evidence supports the efficacy of interferential therapy and long-wave diathermy, and, currently, this intervention should not be recommended to patients with heterogeneous types of painful and nonpainful CIPN. However, evidence shows that CIPN symptoms and balance may recover for some patients by one year after completing treatment with neurotoxic chemotherapy. Additional studies of nursing interventions for CIPN are needed.
Linardou, H., & Gogas, H. (2016). Toxicity management of immunotherapy for patients with metastatic melanoma. Annals of Translational Medicine, 4, 272.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Expert opinion level only. The evidence is derived only from initial drug clinical trials.
Limited research evidence regarding interventions to prevent and manage side effects of immunotherapies exists, and most relies on corticosteroid treatment with increased dosing according to the severity of the side effects. Nurses need to be aware that diarrhea, in particular, with immunotherapy can lead to severe colitis, which can be life-threatening and require surgical removal of the colon. Patients need to be taught to report side effects promptly, and patients need to be monitored closely for these adverse events, with prompt intervention.
Lin, L. C., Que, J., Lin, L. K., & Lin, F. C. (2006). Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. International Journal of Radiation Oncology, Biology, Physics, 65, 745–750.
To determine whether zinc supplementation can accelerate the healing of mucositis and dermatitis after radiation therapy (RT).
There were two randomized groups: the experimental (group A) received 25 mg of zinc three times per day and the control (group B) received the placebo (n = 48).
The principle researcher was blinded. Evaluation and grading of mucositis and dermatitis was performed weekly during treatment andtwo weeks after completion of RT, including the weekends.
Chi-Mei Foundation Medical Center Tainan, Taiwan, China
The study was a randomized, double-blind, placebo-controlled trial.
Radiation Therapy Oncology Group (RTOG) scores for dermatitis
Oral zinc supplementation may delay the onset and reduce the severity of radiodermatitis.
The treatment design for the timing of the study was standard practice; it is not certain if one could correlate the study information to modern treatment delivery.
Lin, L.C., Que, J., Lin, L.K., & Lin, F.C. (2006). Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: A double-blind, randomized study. International Journal of Radiation Oncology, Biology, Physics, 65(3), 745–750.
Zinc – 25 mg versus placebo, 3x/day for 2 months
Patients started capsules on first day of RT and continued until completion of RT.
Block randomization
The study was comprised of 100 patients, 50 zinc, 50 placebo, with a mean age of 50–51 years.
RT dose 180–200 cGy daily in five weekly fractions
41-42% patients receiving RT + chemo
Jan 2003 – Aug 2004
Double-blind, randomized, placebo-controlled study
RTOG acute morbidity scoring
Serum zinc levels were higher in the zinc group: 20.5 versus –1.5 (p = 0.02).
Grade 2 mucositis appeared earlier in the placebo group (p = 0.017 and larger proportion of patients).
Grade 3 mucositis also earlier and larger proportion of patients, p = 0.0003.
Results not as significant for patients receiving concurrent chemo.
Oral analgesics prescribed for pain.
Recommend continuing treatment out past end of RT as patients in both groups had similar recoveries.
Need to determine optimal dose.
Lin, M.F., Hsieh, Y.J., Hsu, Y.Y., Fetzer, S., & Hsu, M.C. (2011). A randomised controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. Journal of Clinical Nursing, 20, 988–999.
To identify patients in high-anxiety states and to test the effects of a music intervention
Cancer and its treatment provoke a series of changes in the emotional sphere of patient anxiety. In addition, there is a subgroup of patients who are in a high-anxiety state. These patients, when identified, obtain the most benefits from music or verbal relaxation. This study consisted of 98 patients in three groups: the music therapy group, which received 60-minute, single-music sessions; the verbal relaxation group, which received 30 minutes of guided relaxation; and the control group, which received usual care. Because patients were asked to rate their anxiety preintervention, the study also was able to test the intervention's effects on those in high-anxiety states.
Randomized, controlled trial
All groups experienced a significant decline in anxiety. The music intervention group experienced a greater decrease in poststate anxiety (p = .005). Physiologic indicators also changed in patients with high-anxiety states in the music therapy group. This study highlighted the need to target patients in high-anxiety states and to offer additional support, relaxation, and interventions such as music therapy to this population.
Music intervention and relaxation therapy reduces chemotherapy-induced anxiety.
This study highlighted the need to identify patients in high-anxiety states pretreatment. This population can then be offered additional interventions. Music and relaxation can reduce anxiety during chemotherapy. Most infusion centers offer personal music devices or allow patients to bring their own. Music can be offered via headphones if a patient desires. This intervention can be recommended safely.
Lin, S.J., Hatoum, H.T., Buchner, D., Cox, D., & Balu, S. (2012). Impact of 5-HT3 receptor antagonists on chemotherapy-induced nausea and vomiting: A retrospective cohort study. BMC Health Services Research, 12, 215.
To study the effect of step-therapy policy requiring an older 5-HT3 receptor antagonist (RA) prior to palonosetron on the risk of chemotherapy-induced nausea and vomiting (CINV) associated with hospital or emergency department (ED) admissions
Patients with a diagnosis of breast or lung cancer and receiving moderately emetogenic chemotherapy (MEC) (cyclophosphamide, carboplatin) or highly emetogenic chemotherapy (HEC) (cisplatin) were selected from the PharmMetrics claims dataset (providing drug name, quantity dispensed, and length of supply) between January 2005 and June 2008. CINV events were followed for six months from initial chemotherapy administration through ICD-9-CM codes. Study duration was six months from the index chemotherapy date, and antiemetics investigated included dolasetron, granisetron, ondansetron, and palonosetron. Patients were divided into two groups: those initiated with palonosetron and maintained on the drug for the duration of the study and those who began therapy with one of the older 5-HT3 RAs and maintained on the initial drug or alternated between any 5-HT3 RAs. The use of dexamethasone was assessed for both groups. CINV events were calculated using paid and filed claims with ICD-9 codes for nausea, vomiting, or dehydration, and those with hospital admissions were selected.
The study was conducted in multiple settings in the United States. Specific sites were not reported.
All patients were in active antitumor treatment.
This was a longitudinal, retrospective cohort study.
Patients with breast or lung cancer receiving MEC who were initiated and maintained on palonosetron were at significantly lower risk for potentially costly CINV versus those on older 5-HT3 RAs. More studies indicating the impact of step-therapy policy are necessary.
Patients with breast or lung cancer undergoing MEC or HEC who are initiated and maintained on palonosetron experience fewer CINV events compared to patients receiving older 5-HT3 RAs. Nurses should be aware that palonosetron is more expensive than older 5-HT3 RAs, and, thus, patients with low economic status or who are self-insured may not be able to pay for this drug. The reduced antiemetic claims noted here suggest that cost may be equivalent because palonosetron requires fewer doses.
Lua, P.L., Salihah, N., & Mazlan, N. (2015). Effects of inhaled ginger aromatherapy on chemotherapy-induced nausea and vomiting and health-related quality of life in women with breast cancer. Complementary Therapies in Medicine, 23, 396–404.
To assess the effectiveness of inhaled ginger essential oil in reducing the incidence of chemotherapy-induced nausea and vomiting (CINV) in patients with breast cancer as a complementary intervention to standard antiemetic care, and to assess the patients’ quality of life (QOL) related to their health following aromatherapy
An aromatherapy necklace was worn by the participants for five days, 24 hours/day, after receiving highly emetogenic chemotherapy. It was used for patients to inhale at least three times a day. Patients were assigned to two groups: For course 1, Group 1 had a ginger fragrance oil (placebo) in the necklace while Group 2 had ginger essential oil. For course 2, Group 1 had the ginger essential oil while Group 2 used the fragrance oil. Standard antiemetics were also given prior to chemotherapy—IV granisetron and IV dexamethasone in addition to scheduled take-home medications of oral granisetron, oral dexamethasone, and oral metoclopramide. Data were collected at baseline, on days 1–5, and on day 8.
The use of ginger essential oil inhalation significantly lowered the VAS nausea score during the acute phase (p = 0.04) compared to the placebo, but its effect was not sustained over time. No appreciable effect on vomiting was revealed. Inhaled ginger essential oil positively affected the global health status from baseline.
Inhaled ginger essential oil did not demonstrate significant reductions in CINV and may not be effective as complementary therapy for CINV overall. It may be a useful adjunct for nausea symptoms.
No evidence suggested that the use of inhaled ginger essential oil is effective in improving CINV control, but it may be helpful in improving QOL during treatment. Further research is warranted as nausea control continues to be a challenge.
Lin, J.X., Fan, Z.Y., Lin, Q., Wu, D.H., Wu, X.Y., Chen, Y.R., . . . Wan, X.B. (2014). A comparison of dioctahedral smectite and iodine glycerin cream with topical mouth rinse in treatment of chemotherapy induced oral mucositis: A pilot study. European Journal of Oncology Nursing. Advance online publication.
To compare the efficacy of dioctahedral smectite and iodine glycerin (DSIG) cream to a topical mouth rinse in the treatment of chemotherapy-induced oral mucositis
After oral mucositis (OM) developed, patients were randomized to receive DSIG or a topical rinse solution administered by two nurses. Nurses were not blinded to the intervention. The DSIG cream consisted of 3 g of dioctahedral smectite and 10 ml of iodine glycerin. The cream was applied to oral mucosa four times per day for one hour during each application while the patient was fasting. The topical mouth solution consisted of saline 400 ml, gentamicin 640,000 u, and vitamin B12 500 mg. Patients rinsed with the solution four times per day and gargled the solution for one minute with each application. Both treatments were administered for five consecutive days. Data were collected daily once OM was identified and continued for five days.
Randomized, controlled trial
Both groups of patients had OM of similar severity on day 1 of the study. Over the five days of the study, when compared to a topical rinse solution, DSIG improved the severity of OM. Patients who received DSIG healed faster than those who received the topical rinse. DSIG is a promising treatment for chemotherapy-induced OM, and additional studies to compare DSIG to other available OM treatments and to study the efficacy of DSIG over a longer period of time are needed. Studies also are needed to determine whether DSIG has a role in the prevention of chemotherapy-induced OM.
DSIG may be a useful intervention for patients who already developed chemotherapy-induced OM. Patients who received the DSIG treatment had less severe OM than those who received a topical rinse solution, and they had a faster rate of healing and more thorough healing. Nurses can conduct physical assessments of patients to determine the extent to which OM is present and educate patients about the various options for OM treatment.