Kloke, M., Cherny, N., & ESMO Guidelines Committee. (2015). Treatment of dyspnoea in advanced cancer patients: ESMO Clinical Practice Guidelines. Annals of Oncology, 26(Suppl. 5), v169–v173.
RESOURCE TYPE: Consensus-based guideline
PROCESS OF DEVELOPMENT: Relevant literature was selected by the authors; not based on a systematic review
Not specified
Provides very basic recommendations for dyspnea management in patients with advanced disease.
Kligler, B., Homel, P., Harrison, L. B., Sackett, E., Levenson, H., Kenney, J., . . . Merrell, W. (2011). Impact of the Urban Zen Initiative on patients' experience of admission to an inpatient oncology floor: a mixed-methods analysis. Journal of Alternative and Complementary Medicine, 17, 729–734.
To evaluate the impact of the Urban Zen Initiative (UZI) on quantitative and qualitative measures of the experiences of patients admitted for inpatient oncology care.
The UZI model consists of five focus points: the physical space surrounding patients, holistic nursing techniques, yoga with trained therapists, a navigator for patients, and audiovisual yoga materials at the bedside. All patients received the intervention; therefore, the investigators collected preintervention information about patients who were receiving standard care prior to the UZI intervention. Preintervention data were the basis of the control comparison. The investigators measured the outcomes immediately after admission and immediately before discharge.
Patients were undergoing the active treatment phase of care.
The study used a quasiexperimental design with historical control groups.
UZI may improve components of mood in an inpatient oncology setting. More work is needed to assess the real impact.
Providing a multifaceted healing environment, such as the UZI, within inpatient oncology settings could improve mood and perceived health status in patients with cancer. To facilitate the care process, nurses should assess patients' physical spaces; promote relaxation techniques, such as yoga breathing; and support patients.
Klemm, P. (2012). Effects of online support group format (moderated vs peer-led) on depressive symptoms and extent of participation in women with breast cancer. Computers, Informatics, Nursing: CIN, 30(1), 9–18.
To evaluate the effects, in women with breast cancer, of moderated and peer-led online support group format on symptoms of depression and degree of participation
Investigator distributed recruitment material via postal mail, online, or through nonprofit organizations or the media. Interested women contacted the investigator after receiving or seeing recruitment material. Participants were placed into a moderated or peer-led group, in groups of 15 according to time of recruitment. All online support was accessed via a university-owned web page devoted to the work. Participants could not access groups to which they were not assigned. Moderators were master's-prepared social workers with experience with online and telephone help for people with cancer and their caregivers. Investigators obtained study measures at baseline and at 6, 12, and 16 weeks. The group was maintained for 12 weeks.
Longitudinal two-group design
Center for Epidemiological Studies Depression Scale (CESD)
At the end of the study, findings revealed no significant effects, on symptoms of depression, in regard to group, time, or time by group format. CESD scores in peer-led groups declined slightly at all study time points but were not significantly different from the scores of moderator-led groups. In both groups, symptoms of depression were mild. More messages were posted and read in moderated groups than in peer-led groups.
The study showed no effect of peer- or moderator-led online support groups on symptoms of depression in women with breast cancer.
This study does not provide strong support for the effectiveness of either peer-led or moderated online support groups on symptoms of depression; however, at baseline the depression scores of most participants were fairly low, and study groups were not balanced on baseline depression symptoms. It is not clear if such support efforts are beneficial to individuals who do not have a high level of depression symptoms. This finding could have influenced study results. Research in this area should stratify samples on the basis of the level of symptoms at baseline.
Klein, P.J., Schneider, R., & Rhoads, C.J. (2016). Qigong in cancer care: A systematic review and construct analysis of effective Qigong therapy. Supportive Care in Cancer, 24, 3209–3222.
STUDY PURPOSE: To assess the strength of evidence addressing qigong therapy in supportive cancer care and describe the definition of effective qigong therapy in supportive cancer care
TYPE OF STUDY: Systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Elder care
For the purpose of the reviewer’s comments, results were limited to the primary symptom of fatigue and two common concurrent symptoms, depression and fatigue. Five of the 11 studies included fatigue as an outcome measure. Measures improved significantly in groups using some form of qigong or tai chi intervention in four studies and showed no difference in the fifth study. Mixed benefits on depression were reported. No significant differences in sleep were reported. Constructs of qigong therapy were identified as slow, gentle, repetitious, flowing, weight-bearing movements, breath regulation, mindfulness, meditation, energy cultivation, and relaxation.
The authors reported growing research evidence that the practice of qigong has benefits for managing fatigue and improving quality of life in individuals with cancer. However, outcomes on mediation of inflammation/immune support, depression, anxiety, stress, mood, sleep, systolic blood pressure, and survival rate were reported as mixed, and, as only 4 or the 11 studies included samples from the U.S. (N = 389 of 831 participants included in the review [47%]), the validity of the conclusion is questionable for a broader to application to general supportive care across all populations with cancer.
Logically consistent operational and conceptual definitions of qigong are needed for future research. Additional evidence is needed prior to recommending qigong to be integrated into cancer care. Access to trained qigong practitioners is needed for application to research across broad populations of patients with cancer.
Klein, J., & Griffiths, P. (2004). Acupressure for nausea and vomiting in cancer patients receiving chemotherapy. British Journal of Community Nursing, 9, 383-387.
Databases searched were MEDLINE, Embase, AMED, the Cochrane Database, Cancerlit, and CINAHL.
Search keywords were adult patients receiving chemotherapy, with nausea and vomiting duration or intensity measured as outcomes.
Two randomized controlled trials were identified involving 482 patients. The studies compared acupressure to no intervention control. However, the second study did not meet inclusion criteria, as transcutaneous electrical nerve stimulation (TENS) of antiemetic point was used.
Results suggested that acupressure may decrease nausea in patients receiving chemotherapy, but further work is required before conclusively advising patients on the efficacy of acupressure in preventing and treating chemotherapy-induced nausea and vomiting (CINV).
Klair, J.S., Girotra, M., Hutchins, L.F., Caradine, K.D., Aduli, F., & Garcia-Saenz-de-Sicilia, M. (2016). Ipilimumab-induced gastrointestinal toxicities: A management algorithm. Digestive Diseases and Sciences, 61, 2132–2139.
RESOURCE TYPE: Expert opinion
INCLUSION CRITERIA: Ipilimumab, colitis, perforation, metastatic melanoma
The authors developed an algorithm for caring for patients who develop diarrhea with ipilimumab treatment. Three case studies were outlined. In one study, a patient developed autoimmune colitis after an infectious diarrhea workup was negative, was treated with high-dose glucocorticoids, and improved. Another patient presented with bloody diarrhea, leukocytosis, negative stool cultures, and negative C-difficile. A colonoscopy showed severe active colitis with ulcerations that were inflammatory based on biopsy and pathology. The patient was treated with infliximab and improved. The third patient presented with nausea/vomiting, and diarrhea for one week, had negative stool and C-difficile cultures, no leukocytosis, and a normal erythrocyte sedimentation rate. Autoimmune colitis was noted on a sigmoidoscopy. The patient improved with glucocorticoids.
Case study of three patients, each with a different presentation. Two of the patients were octogenarians, and both developed more severe symptoms than the third patient, who was 51 years. Patient comorbidities were not identified.
Nurses need to carefully assess gastrointestinal symptoms in patients receiving ipilimumab to minimize complications.
Kitazaki, T., Fukuda, Y., Fukahori, S., Oyanagi, K., Soda, H., Nakamura, Y., & Kohno, S. (2015). Usefulness of antiemetic therapy with aprepitant, palonosetron, and dexamethasone for lung cancer patients on cisplatin-based or carboplatin-based chemotherapy. Supportive Care in Cancer, 23, 185–190.
To evaluate the effectiveness of a combination of aprepitant, palonosetron, and dexamethasone during the acute and delayed phase of chemotherapy-induced nausea and vomiting (CINV) in patients with lung cancer receiving carboplatin-based, moderately emetogenic chemotherapy or cisplatin-based, highly emetogenic chemotherapy
This study was a prospective trial.
Patients who received carboplatin or cisplatin-based chemotherapy had CINV, even with prophylaxis including aprepitant, palonosetron, and dexamethasone. There was no difference in CINV rates between patients who received carboplatin and those who received cisplatin-based chemotherapy. This study did not compare this regimen to any other prophylaxis, so it is difficult to draw a conclusion regarding the usefulness of this regimen for CINV prophylaxis for moderately or highly emetogenic chemotherapy.
Kitayama, H., Tsuji, Y., Sugiyama, J., Doi, A., Kondo, T., & Hirayama, M. (2015). Efficacy of palonosetron and 1-day dexamethasone in moderately emetogenic chemotherapy compared with fosaprepitant, granisetron, and dexamethasone: A prospective randomized crossover study. International Journal of Clinical Oncology, 20, 1051–1056.
To determine the best antiemetic drug combinations for patients receiving moderately emetogenic chemotherapy (MEC)
Chemotherapy-naïve patients with a mix of malignancies receiving MEC were randomized to two treatment groups. Group A received palonosetron plus one day of dexamethasone and group B received fosaprepitant, granisetron, and dexamethasone on day 1. The primary endpoint was complete response (CR, no emesis and no rescue drugs). The secondary endpoints were complete control (CC, no vomiting, no use of rescue drugs, and no more than mild nausea), total control (TC, no nausea), and therapy chosen by patients. CR, CC, and TC were measured in the acute, delayed, and overall phases for five days. Data on chemotherapy-induced nausea and vomiting (CINV) were collected on days 2 and 5 following chemotherapy.
Prospective, single-blinded, randomized crossover study
There were no significant differences in the efficacy of the two protocols, and no significant difference in CC or TC during the acute, delayed, or overall period was found. Nausea scores were not reported although their collection was reported. These results suggest that palonosetron and dexamethasone have the same efficacy as fosaprepitant, granisetron, and dexamethasone.
The combination of palonosetron and dexamethasone was as effective as triple-drug antiemetic regimens for patients receiving MEC.
The data from this study were not strong enough to affect nursing care; however, because of the similar efficacy of the study drugs, additional studies should be investigated.
Kitamura, H., Takahashi, A., Hotta, H., Kato, R., Kunishima, Y., Takei, F., . . . Sapporo Medical University Urologic Oncology Consortium. (2015). Palonosetron with aprepitant plus dexamethasone to prevent chemotherapy-induced nausea and vomiting during gemcitabine/cisplatin in urothelial cancer patients. International Journal of Urology, 22, 911–914.
To evaluate the antiemetic potential of palonosetron, aprepitant, and dexamethasone in patients with urothelial cancer receiving gemcitabine and cisplatin chemotherapy
Patients received one of two antiemetic regimens, ondansetron or granisetron plus dexamethasone, or palonosetron, aprepitant, and dexamethasone, and over one cycle of chemotherapy were evaluated for chemotherapy-induced nausea and vomiting (CINV) events, rescue medications needed, and food intake.
Patients in the palonosetron, aprepitant, and dexamethasone group had significantly fewer episodes of CINV, anorexia, and rescue medication used compared to the ondansetron or granisetron plus dexamethasone group during the first cycle of chemotherapy (p = 0.012) and overall during chemotherapy (p = 0.0019).
The use of palonosetron plus aprepitant and dexamethasone results in significantly fewer episodes of CINV, anorexia, and rescue medications used in people with urothelial cancer treated with gemcitabine and cisplatin as compared to another commonly used antiemetic regimen, ondansetron or granisetron plus dexamethasone.
Palonosetron, aprepitant, and dexamethasone may offer more relief from CINV in people being treated with gemcitabine and cisplatin chemotherapy.
Kissane, D.W., McKenzie, M., Bloch, S., Moskowitz, C., McKenzie, D.P., & O'Neill, I. (2006). Family focused grief therapy: A randomized, controlled trial in palliative care and bereavement. American Journal of Psychiatry, 163, 1208–1218.
To examine the efficacy of family focused grief therapy on psychosocial functioning in families of patients who are terminally ill
Patients and relatives in several palliative care centers and hospices were recruited for the study. Families were randomly assigned to receive the focused grief therapy or usual care stratified based on recruitment site. Usual care consisted of standard palliative care provided by homecare programs, which involved counseling when deemed clinically appropriate. Focused grief therapy was provided by qualified family therapists who had received standardized training in the intervention. Clinical supervision of the therapists was provided throughout the trial, and fidelity to the intervention was independently evaluated from review of audiotaped sessions. Family focused grief therapy typically included four to eight sessions of 90 minutes provided across 9–18 months. It included exploration of family cohesion, communication, and handling of conflict. Families were assigned to functional classes: dysfunctional (sullen or hostile) or intermediate. Data at baseline and follow-up at 6 and 13 months postbereavement were obtained from relatives by a research assistant.
A randomized controlled trial design was used.
Among all participants, those receiving the study intervention had significantly greater change in mean score of the Brief Symptom Inventory (BSI) (0.12, p = 0.02). BSI showed a nonsignificant improvement at 13 months in the intervention group than in the control group. Grief phenomena diminished similarly in both groups. There was no significant difference in social adjustment in both groups. There were no other significant differences between groups. Among family members who were most distressed, differences were greater, with 0.83 improvement in the BSI (p < 0.01), Beck Depression Inventory (p < 0.01), and the Bereavement Phenomenology Questionnaire (p = 0.05). In both the intervention and control groups, the general patterns of change in outcomes measures showed overall decline in symptoms over time. Families with intermediate functioning who received the intervention had a larger reduction in conflict level at six months than intermediate families in the control group (p = 0.03). Hostile families that received the intervention deteriorated more than hostile control families over the 13 months of bereavement (p = 0.001). Intermediate families received an average of 7 sessions, sullen families received an average of 6.4 sessions, and hostile families received an average of 9.4 sessions.
Family focused grief therapy appeared to have some benefit for the most distressed family members in terms of reduction of symptoms; however, these changes were not accompanied by improvement in family functioning. This intervention may protect against pathologic grief in highly distressed individuals. Among hostile families, the intervention was counterproductive
Family focused interventions to mitigate grief issues may be helpful in some families for highly distressed individuals; however, among the most dysfunctional families, this type of intervention might be counterproductive. Additional research is needed to determine the appropriate role of this therapy approach in palliative care.