Li, M., Kennedy, E.B., Byrne, N., Gerin-Lajoie, C., Katz, M.R., Keshavarz, H., . . . Green, E. (2016). Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psycho-Oncology. Advance online publication.
STUDY PURPOSE: To provide an evidence-based review to update treatment guidelines for depression in patients with cancer. Conducted analysis of pharmacologic and collaborative care interventions
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Palliative care
All interventions examined had at least a short-term benefit for the treatment of depression. Pharmacologic interventions can be associated with adverse events, and psychological interventions had short-term efficacy but no long-term efficacy. Collaborative care interventions showed persistent benefit.
Pharmacologic, psychological, and collaborative care interventions demonstrated at least a short-term benefit for the treatment of depression among patients with cancer at various treatment phases. Collaborative care interventions showed strong and sustained effectiveness, suggesting that the integration of depression treatment into oncology settings can improve patient outcomes.
Li, X.J., Dai, Z.Y., Zhu, B.Y., Zhen, J.P., Yang, W.F., & Li, D.Q. (2014). Effects of sertraline on executive function and quality of life in patients with advanced cancer. Medical Science Monitor, 20, 1267–1273.
To determine the impact of sertraline on executive function and quality of life in patients with advanced stage cancer and depression
At baseline, patients were evaluated for high levels of depressive symptoms. Patients with high levels were assigned to the intervention group. Patients in the intervention group were prescribed sertraline hydrochloride at 25–75 mg daily for 12 weeks. The dose of sertraline was evaluated two weeks after initiation and titrated to a therapeutic level as necessary. All patients were assessed at baseline prior to the initiation of sertraline in the intervention group and at 12 weeks. Participants were restricted from taking medications that might affect their cognitive functioning for greater than three days.
Controlled trial with a pre- and post-trial design
At baseline, patients with depressive symptoms had significantly higher scores indicating lower executive functioning than non-depressed patients on total errors, perseverative errors, nonperseverative errors, and categories achieved (p < 0.01), but not failure to maintain set as measured by the WCST. In addition, these patients had greater anxiety (p < 0.01) as measured by the HAM-A and poorer quality of life (p < 0.01) in all eight dimensions measured by the SF-36. At the 12-week follow-up, although patients in the intervention group had decreased HAM-D and HAM-A scores, scores were still significantly higher than in the control group (p < 0.05). In contrast, there were no longer any significant differences in executive functioning between groups. Similarly, because patients in the intervention group had improved scores on the SF-36 (p < 0.05), there were no longer any significant differences in quality of life between groups.
Sertraline may improve executive functioning and quality of life in patients with cancer. This improvement may be mediated by improvements in depressive symptoms.
Sertraline may improve executive function and quality of life in patients with advanced stage cancer and depression. However, more research with larger sample sizes, randomized group assignments, and longer follow-up is warranted to determine whether the intervention is effective and sustainable.
Li, Q., Xu, Y., Zhou, H., & Loke, A.Y. (2015). A couple-based complex intervention for Chinese spousal caregivers and their partners with advanced cancer: An intervention study. Psycho-Oncology. Advance online publication.
To evaluate the acceptability and feasibility of a couples-based coping intervention, Caring for Couples Coping with Cancer (4Cs), and to gather preliminary data on the efficacy of the intervention
A convenience sample of couples received the 4Cs intervention, a couples-based intervention delivered weekly for six weeks by a researcher or therapist to small groups of couples (three to eight). The couples received semistructured instruction using information via didactic instruction, group sharing and group interaction. Sessions were supplemented using the guidebook Live With Love: Hope for the Best, Prepare for the Worst. Assessments were made at baseline and upon completing the six-week intervention.
Nonrandomized, pre- and postintervention study
The 4Cs cancer program for couples was easy to recruit for, had relatively low drop-out rate, and was well-tolerated by the participants. The couples showed significant increases in self-efficacy (p < 0.01), the DCI (p < 0.05), the PCS of SF12 (p < 0.05), and positive emotions on benefit finding (p < 0.05). Participants also experienced a significant decrease in overall CRCP (p < 0.05) and anxiety (p < 0.01).
The 4Cs program was feasible to administer to couples facing cancer and appeared to have preliminary data supporting its benefit for the emotional health and coping of couples dealing with cancer.
The 4Cs couples-based intervention shows promise for improving couple efficacy, coping, physical health, and positive emotions. Larger, multisite, randomized, controlled trials of this intervention are needed.
Li, Q., & Loke, A.Y. (2014). A systematic review of spousal couple-based intervention studies for couples coping with cancer: Direction for the development of interventions. Psycho-Oncology, 23, 731–739.
STUDY PURPOSE: To explore the existing interventions for spousal couples coping with cancer in terms of type of intervention, contents, approach, and outcome measurements, and to identify directions for the development of interventions
DATABASES USED: Science Citation Index Expanded, PsycInfo, MEDLINE via OVIS SP, CINAHL
KEYWORDS: intervention; program; therapy; cope; coping; cancer; oncology; carcinoma; couple; partner; spouse
INCLUSION CRITERIA: Published in English or Chinese within the four databases searched; couple-based interventions; studies had to focus on couple-based interventions; outcome measures included the patients with cancer and their spousal caregivers
EXCLUSION CRITERIA: Commentaries, editorials, literature reviews, conference proceedings
Of the 17 articles reviewed, interventions were focused mainly on patient caregiving and caregiver self-care, usually lasted for six weeks using a face-to-face group mode., and had follow-up around three months. The outcomes measures were grouped into three main dimensions: dyadic appraisal, dyadic coping, and dyadic adjustments. Positive outcomes were reported for these interventions, including improvements in communications, dyadic coping, quality of life of the patients and their partners, psychosocial distress, sexual functioning, marital satisfaction, and caregiver self efficacy. The majority of interventions were delivered to individual couples face-to-face. Attrition rate ranged from 6%–34%, with an average of 20%. Interventions were grouped as skills training (n = 11), counseling (n = 6), and psychoeducation (n = 2). Skills training and psychoeducation were most often provided together.
The findings highlighted the positive outcomes of couple-based interventions that focus on couples coping with cancer. Although all studies focused on the couple's communication and relationship, only 40% focused on the subject of the caregiver's self-care. All of the intervention studies included in the review reported positive outcomes to some extent, including quality of life, psychosocial distress, sexual functioning, and marital satisfaction of the patients and their partners.
Future couple-based intervention research should focus on patients with cancer whose spouse is an active caregiver and provide intervention and assessment of both partners as a unit (dyad). Findings from this review show that couple-based interventions had multiple benefits for patients and caregivers. The high attrition rates seen suggest that the most acceptable timing, duration, and method of delivery is not clear. Although benefit was shown, what factors would indicate those couples who would be most likely to benefit from couples interventions is not clear, and findings do not clarify which approaches are most beneficial.
Li, X.M., Zhou, K.N., Yan, H., Wang, D.L., & Zhang, Y.P. (2012). Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: A randomized clinical trial. Journal of Advanced Nursing, 68, 1145–1155.
To evaluate the effects of music therapy on anxiety in women undergoing breast cancer surgery
Patients admitted to the hospital for mastectomy were randomly assigned to receive either music therapy or usual care. Patients in the intervention group listened to music they selected through a headphone connected to an MP3 player during their hospital stay. Music was provided twice daily for 30 minutes per session. The total time in the hospital receiving therapy was an average of 13.6 days following radical mastectomy and 18.9 days for chemotherapy. Assessments were done at baseline on the day before surgery, the day before hospital discharge, on second hospital admission for chemotherapy, and on a third hospital admission for chemotherapy.
Patients were undergoing active antitumor treatment.
A randomized controlled trial design was used.
State Anxiety Inventory
Pretest results showed that patients had moderate to severe anxiety levels prior to surgery. Mean post-test anxiety scores were lower in the experimental group, on the first post-test 4.57 points, and increasing across time to 9.69 points lower at the final post-test (p < 0.0001). Mean anxiety scores declined over time in all patients.
Findings suggest that listening to music can be beneficial in reducing anxiety during treatment for breast cancer.
Listening to music is a simple and low-cost intervention that may be helpful for some patients in reducing anxiety associated with cancer treatment.
Li, W.H., Chung, J.O., & Ho, E.K. (2011). The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing, 20, 2135–2143.
To examine the effectiveness of play, consisting of virtual reality computer games, in reducing anxiety and symptoms of depression in children hospitalized for cancer treatment
Children hospitalized for cancer treatment were invited to participate in the study. Patients received 30 minutes of a play intervention, consisting of virtual reality gaming, five days per week. Play was in a small-group setting that included no more than four patients. A historical comparison group was used in the study. Study measures were obtained at hospital admission and at day 7.
Prospective, single-blind trial with historical control comparison
ANOVA showed a main effect for time, suggesting significantly lower anxiety and depression symptoms in the group that participated in the play intervention. There were no significant differences in baseline scores between groups. In both groups, anxiety scores declined between baseline and day 7.
Play involving virtual reality may reduce symptoms of depression in children hospitalized for cancer treatment.
Findings suggest that use of virtual reality play may help pediatric inpatients being treated for cancer. Further well-designed research in this area is warranted. It is unclear if virtual reality is more effective than other means of distraction.
Li, Y., Klippel, Z., Shih, X., Wang, H., Reiner, M., & Page, J.H. (2016). Trajectory of absolute neutrophil counts in patients treated with pegfilgrastim on the day of chemotherapy versus the day after chemotherapy. Cancer Chemotherapy and Pharmacology, 77, 703–712.
To compare absolute neutrophil count (ANC) and febrile neutropenia (FN) in patients who receive pegfilgrastim on the same day of chemotherapy versus the next day
Data from a prior randomized, controlled trial was pooled for analysis. The trajectory of ANC and incidence of FN and related events were analyzed.
ANC at nadir was significantly lower in those who received same-day pegfilgrastim (p = 0.003). Time to nadir was slightly lower in those with same-day pegfilgrastim (p = 0.019). ANC at nadir was much lower among those who got same-day treatment (0.27 compared to 0.74 x 109/l, p < 0.001). Risk of grade 4 neutropenia was higher among those who got same-day treatment (odds ratio [OR] = 0.23, 95% CI [0.1, 0.49]). No significant difference existed between groups in incidence of FN as defined for this pooled analysis; however, the actual incidence was lower among those who received next-day treatment. ANC recovery was faster in those who received next-day pegfilgrastim.
Patients who received pegfilgrastim the day after chemotherapy had less severe ANC suppression and more rapid ANC recovery. No clear differences in incidence of FN were reported.
Initial trials were not designed to capture the incidence of FN and infections, so pooled analysis capability was limited.
This study adds to the body of evidence supporting the administration of pegfilgrastim as recommended, one to three days after chemotherapy.
Lhomme, C., Brault, P.H., Bourhis, J.H., Pautier, P., Dohollou, N., Dietrich, P.Y., . . . Hayat, M. (2001). Prevention of menstruation with leuprorelin (GnRH agonist) in women undergoing myelosuppressive chemotherapy or radiochemotherapy for hematological malignancies: A pilot study. Leukemia and Lymphoma, 42, 1033–1041.
Nineteen bleeding episodes occurred in 11 patients. Three patients required additional treatment, including additional nomegestrol acetate, methylergometrine, and/or platelet transfusions. Eleven episodes of spotting and six episodes of moderate bleeding not requiring treatment occurred in 10 patients. The majority of bleeding episodes were short with a median of three days (1–23). Seventeen patients had no clinically or therapeutically relevant bleeding. There was no premature termination because of toxicity. There was one subcutaneous nodule at injection site and eight superficial hematomas.
Le, Q.T., Kim, H.E., Schneider, C.J., Murakozy, G., Skladowski, K., Reinisch, S., … Henke, M. (2011). Palifermin reduces severe mucositis in definitive chemoradiotherapy of locally advanced head and neck cancer: A randomized, placebo-controlled study. Journal of Clinical Oncology, 29, 2808–2814.
To evaluate the efficacy and safety of palifermin in the reduction of oral mucositis (OM) associated with definitive chemoradiotherapy for locally advanced head and neck cancer (HNC)
The study was conducted in a multi-institutional setting.
Patients were undergoing the active treatment phase of care.
This was a randomized, placebo-controlled study.
The incidence of severe OM was significantly lower in patients receiving palifermin than those receiving placebo (54% versus 69%). In the palifermin arm, the median time to severe OM was delayed, median duration of severe OM was shortened, and the incidence of xerostomia at grade 2 or more was lower, favoring palifermin; however, the differences were not significant after multiplicity adjustment.
Opioid analgesic use, average mouth and throat soreness scores, and chemoradiotherapy compliance were not significantly different between treatment arms.
Adverse events were similar between arms. The most common study drug related adverse events were rash, flushing, and dysgeusia. After median follow-up of 25.8 months, overall survival and progression-free survival were similar between the treatment arms.
There was no mention as to whether the study was blinded to the researchers.
Oral mucositis is a severe complication of treatment for head and neck cancer, and effective treatment strategies are still needed. Although palifermin reduced severe functional OM, its role in the management of locally advanced HNC during chemotherapy remains unclear. Effective treatment strategies to manage OM associated with high-dose chemoradiotherapy still are needed.
Lew, M.W., Kravits, K., Garberoglio, C., & Williams, A.C. (2011). Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects. The International Journal of Clinical and Experimental Hypnosis, 59(4), 406–423.
To test the feasibility of hypnosis as a preoperative intervention; to explore the effects of preoperative hypnosis on anxiety and pain
Investigators gathered baseline assessments of pain, nausea, vomiting, distress, and anxiety. The hypnosis intervention was a 15-minute scripted hypnotic experience provided, within an hour before surgery, in the preoperative holding area of the operating suite. Investigators collected data and interviewed patients postsurgery. Data pertaining to historical controls were obtained from medical records matched for age, date, and type of procedure.
Active treatment
Prospective pre- and postdesign with historical control comparisons; mixed method
Postintervention measures showed a decrease in anxiety, worry, and nervousness; however, authors did not report significant pre- and poststudy differences. The hypnosis group had a higher prevalence of postoperative pain and nausea than did the historical group.
Providing a hypnosis intervention preoperatively appears to be feasible. Results reported do not provide substantial evidence of the efficacy of hypnosis in preventing postoperative pain and nausea.
This study suggests that providing a hypnosis intervention preoperatively can be feasible. The impact of such an intervention cannot be determined from this study.