Karagozoglu, S., Tekyasar, F., & Yilmaz, F.A. (2013). Effects of music therapy and guided visual imagery on chemotherapy-induced anxiety and nausea-vomiting. Journal of Clinical Nursing, 22, 39–50.
To examine effects of music and visual imagery on anxiety and chemotherapy-induced nausea and vomiting (CINV) in patients receiving chemotherapy
Patients were assigned to the control group during their second cycle of chemotherapy and to the experimental condition during the third cycle of chemotherapy. Anxiety and CINV were measured before and after chemotherapy administration. Nature paintings were used for visual imagery, and instrumental Turkish music was selected for each image. Patients selected the image that was most appealing to them and were told to imagine being in the location of the painting. Patients were given the related music CD to listen to during chemotherapy with headphones.
The study was conducted at a single site, outpatient setting in Turkey.
Patients were undergoing active antitumor treatment.
A pre- and post-test repeated measures, single-group design was used.
Anxiety declined from prechemotherapy to postchemotherapy administration in both conditions. Both pre- and postchemotherapy state anxiety levels were lower during the intervention course of treatment. CINV declined over time for both pre- and postchemotherapy administration. Both pre- and postchemotherapy CINV levels were significantly lower during the intervention condition.
This study does not provide any clear conclusions about the effects of music and visual imagery.
Findings are inconclusive regarding the efficacy of music and visual imagery for anxiety and CINV during chemotherapy administration because of numerous study design and analysis limitations.
Karadibak, D., Yavuzsen, T., & Saydam, S. (2008). Prospective trial of intensive decongestive physiotherapy for upper extremity lymphedema. Journal of Surgical Oncology, 97(7), 572–577.
To evaluate the effects of kinesiophobia, quality of life, and home exercise programs on women with upper-extremity lymphedema
All patients underwent complete decongestive physiotherapy consisting of a combination of manual lymph drainage using the Foldi method, multi-layer bandages, remedial exercise, and skin care.
The study was conducted at a single-site outpatient setting at Dokuz Eylul University Hospital.
The study used a prospective trial design.
A correlation between severity of edema and fear of activity was established. Increased fear of activity showed to decrease quality of life.
Encouraging activity and education are important for the management of lymphedema in patients after sentinel node biopsy.
Karaca, H., Bozkurt, O., Ozaslan, E., Baldane, S., Berk, V., Inanc, M., ... Ozkan, M. (2014). Positive effects of oral beta-glucan on mucositis and leukopenia in colorectal cancer patients receiving adjuvant FOLFOX-4 combination chemotherapy. Asian Pacific Journal of Cancer Prevention, 15(8), 3641–3644.
To examine the effect of oral beta-glucan on leukocytes, neutrophils, platelets, oral mucositis, and diarrhea in a group of patients with colorectal cancer who received adjuvant FOLFOX-4 and were at high risk for these side effects
Sixty-two consecutive patients admitted with colorectal cancer and treated with FOLFOX-4 between July 2009 and July 2010 were divided into two equal groups to receive beta-glucan 50 mg per day for at least one week with FOLFOX-4 for the first cycle or only FOLFOX-4. Leukocyte, neutrophil, and platelet counts were obtained, and oral mucositis and diarrhea were graded one day before and one week after chemotherapy.
A retrospective study of consecutively-admitted patients.
Oral mucositis and diarrhea were observed in six (19%) patients in the treatment group and in 13 (42%) patients in the control group. Statistical analysis could not be done because of the limited number of patients. There were no beta-glucan-induced side effects reported. There was no difference in the leukocyte and neutrophil counts before and after chemotherapy in the treatment group. The platelet count difference before and after chemotherapy was significant (p = 0.048). The difference between baseline and after chemotherapy was significant (p = < 0.01) for median leukocyte, neutrophil, and platelet counts in the control group.
Oral beta-glucan showed some effectiveness in reducing oral mucositis or diarrhea in patients receiving FOLFOX-4. Results are difficult to interpret because no statistical analysis could be performed comparing the two groups.
In this study, beta-glucan showed some relief of oral mucositis and diarrhea in participants. The study, however, was small, and statistical analysis was not possible due the number of participants enrolled. Additionally, all patients enrolled in this study were diagnosed with colorectal cancer and received FOLFOX-4 treatment, so the results may not be generalizable to other populations. At this time, other interventions should be considered to relieve symptoms associated with oral mucositis and diarrhea corresponding to chemotherapy treatment.
Kara, I., Apiliogullari, S., Oc, B., Celik, J.B., Duman, A., Celik, C., & Dogan, N.U. (2012). The effects of intrathecal morphine on patient-controlled analgesia, morphine consumption, postoperative pain and satisfaction scores in patients undergoing gynaecological oncological surgery. Journal of International Medical Research, 40, 666–672.
To compare the impact of intrathecal morphine (ITM) plus patient-controlled analgesia (PCA) versus PCA alone on morphine consumption, pain relief, and patient satisfaction after gynecologic-oncologic surgery (GOS)
Patients were randomized to an ITM plus PCA group or a PCA-only control group. Study patients received 0.3 mg ITM at the L3-L4 or L4-L4 vertebral level, and control patients received a needle puncture only. The same anesthesiologist performed all procedures. All patients received an initial morphine bolus of 0.05 mg/kg if pain was > 60 (0–100) on a Visual Analog Scale in the postanesthesia care unit. The PCA was reprogrammed for all patients to deliver a 1.5 mg bolus with a seven-minute lockout after patients were discharged from the postanesthesia care unit. Measurements were taken at 30 minutes and at one, three, six, 12, 24, and 48 hours.
Prospective, randomized, double-blinded study
Primary Measures
Pain scores were assessed using a 100 mm Visual Analog Scale (VAS, 0 mm = no pain, and 100 mm = worst pain imaginable). Patient satisfaction was measured using a 100 mm VAS (0 = very unsatisfied, and 100 = very satisfied), and cumulative PCA morphine consumption (mg) was calculated.
Secondary Measures
Patients were directly asked if they experienced nausea, vomiting, or pruritus. Rescue medication was administered for nausea and vomiting. The number of patients who verbally reported secondary measures and who received rescue medications were recorded.
Sedation was assessed using a five-point scoring scale (0 = fully awake, 1 = drowsy, closed eyes, 2 = asleep but easily aroused with light tactile stimulation or simple verbal command, 3 = asleep and aroused only by strong physical stimulation, and 4 = could not be aroused. Fatigue also was assessed on a four-point scale (0 = none, and 4 = severe). Respiratory depression was defined by a rate of less than 10 breaths per minute and was reversed by administering 0.1 mg of IV naloxone every five minutes until adequate respiration was restored.
Primary Outcomes
Patients in the ITM plus PCA group had a lower consumption of morphine (p < 0.0001 at all time points). There was no statistic difference in pain or patient satisfaction scores.
Secondary Outcomes
There was no statistic difference in sedation, nausea, pruritus, or fatigue between the two groups.
ITM plus PCA significantly reduced morphine consumption compared to PCA alone in the first 48 hours after GOS. The intervention, however, did not decrease pain scores or improve patient satisfaction. Both the intervention and the control group reported similar levels of the secondary side effects measured in this study.
ITM plus PCA may be a viable option to decrease overall morphine consumption for patients in whom this is a desired outcome as it did not increase adverse side effects. However, the addition of ITM did not improve postoperative pain scores or overall patient satisfaction in patients receiving GOS.
Kapoor, N., Naufahu, J., Tewfik, S., Bhatnagar, S., Garg, R., & Tewfik, I. (2016). A prospective randomized controlled trial to study the impact of a nutrition-sensitive intervention on adult women with cancer cachexia undergoing palliative care in India. Integrative Cancer Therapies. Advance online publication.
To assess the efficacy of a whole wheat flour mix along with local ingredients (IATTA) with counseling to enhance dietary intake, physical activity, and quality of life (QOL)
Patients in the intervention group received 14 packets of IATTA every two weeks during appointments along with 30 minutes of counseling by a qualified nutritionist at each visit. They were advised to eat the contents of one whole packet along with their daily diet. Physical activity, such as walking, was also encouraged during counseling sessions. Patients in the control group received 30 minutes of counseling only by a qualified nutritionist at each visit.
Anthropometric measurements of nutritional status, physical activity, and QOL measurements:
Fifty-one percent of patients completed the study. Patients in the intervention group tended to gain weight, but it was not statistically significant. Patients in the control group showed statistically significant weight loss (p = 0.003) and reduced MUAC (p = 0.006). Body fat increased significantly in the intervention group (p = 0.002) and decreased significantly in the control group (p = 0.032) at the end of the six-month intervention period from baseline. At the end of six months, significant energy intake increased in the intervention group (p = 0.001) with carbohydrates (p = 0.001), protein (p = 0.001), and fat (p = 0.006), respectively. Physical activity recall showed significantly reduced activity in the control group (p = 0.004). Patients in the intervention group did not show a change in physical activity. The intervention group showed a statistically significant improvement in QOL in factors such as fatigue (p = 0.002) and appetite loss (p = 0.006). The control group showed a statistically significant decrease in the domains of global health status (p = 0.018) and social functioning (p = 0.004). At the end of six months, global health status, social functioning, appetite, and fatigue showed significant differences between the two groups (p < 0.001).
Nutrition therapy and supplementation within palliative care may improve QOL and stabilize weight in patients with cancer and cachexia. Nearly 50% of patients did not complete the study, so further study is indicated.
Nutrition counseling is imperative through all phases of cancer care. Further study of nutrition counseling and intervention should include QOL measures, such as physical activity, social functioning, and pain status.
Kapoor, A., Singhal, M.K., Bagri, P.K., Nirban, R.K., Maharia, S., Narayan, S., & Kumar, H.S. (2015). Comparison of single versus multiple fractions for palliative treatment of painful bone metastasis: First study from north west India. Indian Journal of Palliative Care, 21, 45–48.
To compare pain outcomes with two different radiotherapy dosing schedules for pain associated with bone metastases
Referred patients were allocated to two different dosage groups based on the discretion of the radiation oncologist. Pain was assessed at the end of treatment and on days 8, 15, and 30 in follow-up.
Prospective study
In total, 62% of patients received a single fraction of 8 Gy and the rest had 10 fractions of 3 Gy. There were no significant differences between these groups in overall pain reduction.
Single and multiple fraction radiation therapy schedules provided similar results for the control of pain from bone metastases.
Single fraction radiotherapy for pain control appeared to be as effective as multiple fraction dosing. Single fraction dosing may provide a more practical and convenient alternative for pain control. There could be differences in adverse effects, which were not discussed in this report.
Kao, C.Y., Hu, W.Y., Chiu, T.Y., & Chen, C.Y. (2014). Effects of the hospital-based palliative care team on the care for cancer patients: An evaluation study. International Journal of Nursing Studies, 51(2), 226-235.
To evaluate the effects of the hospital-based palliative care team on care for patients with cancer
The hospital-based palliative care team visited intervention patients “regularly” during the one-week study period. Team members including physicians, nurses, chaplains, and social workers provided advice about medications and taught patients and families skills to relieve physical symptoms, provided emotional support, and assisted with truth-telling and preparation for death. Data were collected at baseline and one week later.
Quasi-experimental study with a pretest-posttest design
No significant difference was seen in anxiety and depression between the control and intervention groups after one week of palliative care. Improvement was seen in edema, fatigue, dry mouth, and abdominal distention.
Nurse interventions improved symptom management for the intervention group; however, in the short timeframe of this study emotional disturbances were not affected. Cultural implications are important here; death is a taboo topic in Chinese culture, and patients' understanding of their terminal disease is low and rarely discussed.
Palliative care consultation may benefit many symptoms of patients with cancer, but without clear interventions for depression and in this short timespan, little effect is apparent.
Kang, Y.K., Lee, S.S., Yoon, D.H., Lee, S.Y., Chun, Y.J., Kim, M.S., . . . Kim, T.W. (2010). Pyridoxine is not effective to prevent hand-foot syndrome associated with capecitabine therapy: Results of a randomized, double-blind, placebo-controlled study. Journal of Clinical Oncology, 28, 3824–3829.
To determine whether concurrent pyridoxine therapy can prevent the development of hand-foot syndrome (HFS) in patients being treated with capecitabine.
Chemotherapy-naïve patients with gastrointestinal (GI) tract cancers who were scheduled for capecitabine-containing chemotherapy were randomly assigned to concurrent oral pyridoxine (200 mg per day) or placebo. Patients were stratified by chemotherapy regimen and monitored until development of HFS with a National Cancer Institute (NCI) common toxicity criteria of grade 2 or worse, or capecitabine-containing chemotherapy ended. Patients in the placebo group who developed grade 2 or worse HFS were randomly assigned again to received pyridoxine or placebo in the next chemotherapy cycle to determine whether pyridoxine could improve HFS.
The site and setting types were not specified.
Patients were undergoing the active treatment phase of care.
This was a randomized, double-blinded, placebo-controlled trial.
Pyridoxine is not effective in the prevention of capecitabine-associated HFS.
This trial did not include pathophysiologic analysis, which could have provided additional information on the pathogenesis of capecitabine-induced HFS.
Pyridoxine prophylaxis was shown to have no effect on reducing the development or severity of HFS.
Kangas, M., Bovbjerg, D.H., & Montgomery, G.H. (2008). Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychological Bulletin, 134, 700–741.
STUDY PURPOSE: To conduct a systematic review and meta-analysis on nonpharmacologic interventions (psychosocial and exercise) for cancer-related fatigue (CRF)
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
Both psychosocial interventions and exercise showed benefit in CRF. Psychosocial interventions had a small to moderate effect on fatigue; exercise had a moderate effect. No significant differences existed in the effect of exercise on CRF between psychosocial interventions and exercise. Exercise showed a stronger effect during treatment than post-treatment, whereas psychosocial interventions showed a stronger effect post-treatment.
Both psychosocial interventions and exercise are beneficial in ameliorating CRF. A multimodal approach across all phases of treatment is best.
Provides additional support for psychosocial interventions and exercise for CRF. Because of the heterogeneity of interventions, supporting one type of psychosocial intervention or exercise regime over another is difficult. Nurses can incorporate interventions acceptable to patients.
Kangas, M., Milross, C., Taylor, A., & Bryant, R.A. (2013). A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Psycho-Oncology, 22,1665–1673.
To conduct a controlled pilot trial evaluating the efficacy of a brief early cognitive behavior therapy intervention (CBT) to reduce symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety and to prevent chronic psychological problems within the first year following diagnosis of head and neck cancer
Patients with elevated levels of PTSD, anxiety, or depression were randomized to seven individual sessions of either CBT or nondirective supportive counseling (SC). The interventions were concurrent with radiation therapy. The primary outcomes (PTSD, anxiety, and depression) and secondary outcomes (cancer-related appraisals, quality of life) were assessed at baseline, one month, six months, and one year postintervention. Researchers assessed participants by using diagnostic clinical interviews and self-report questionnaires. Participants completed the screening assessment conducted by trained psychologists and were then randomized to either a CBT or SC group. Assessors blinded to treatment group conducted follow-up assessments. Researchers conducted a random evaluation of 25% of participants to ensure clinician adherence to protocol.
A pilot randomized controlled trial design was used.
Assessors administered the following at each assessment:
In spite of randomization, the CBT group, compared to the SC group, had significantly elevated scores on the PTCI self-blame subscale. This finding was included as a covariate. Participants in both treatment interventions reported a decline in anxiety and symptoms of depression over time. The study found no significant interaction effects between the two groups in regard to world outlook and negative appraisals. However, a main effect of time was evident for the PTCI negative scale, with both groups reporting a reduction in negative self-referent appraisal scores at one and six months. Significant main effects of time were also evident for improvements in quality of life and on all four subscales in both treatment groups. This was most evident at 6 and 12 months post-therapy. There were no significant differences between groups, and effect size (Cohen’s d) was not significantly different for anxiety or depression outcomes.
The findings of this study indicate that early intervention with psychotherapy is useful in reducing anxiety and symptoms of depression and PTSD and for preventing chronic psychopathology in symptomatic patients with head and neck cancer.
Early identification and intervention for patients who are newly diagnosed with head and neck cancer may be beneficial in reducing symptoms resulting from PTSD, anxiety, and symptoms of depression related to diagnosis. Early identification and intervention may prevent chronic psychological issues in the patient population studied. This study showed that both CBT and SC had similar effects. Findings are limited by lack of a control group and the fact that, with or without treatment, all patients' anxiety levels tend to decline over time.