Holland, J.C., Morrow, G., Schmale, A., Derogatis, L., Stefanek, M., Berenson, S., . . . Feldstein, M. (1991). A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. Journal of Clinical Oncology, 9, 1004–1011.
The 10-day study had two arms: alprazolam 0.5 mg three times a day or progressive muscle relaxation three times a day.
A randomized controlled trial (nonblinded) design was used.
There was significant decrease in anxiety (HARS, ABS, SCL-90 subscale) and depression (SCL-90 subscale) in both treatment arms (p < 0.001). There was minimal change in pulse and blood pressure.
Hökkä, M., Kaakinen, P., & Pölkki, T. (2014). A systematic review: Non-pharmacological interventions in treating pain in patients with advanced cancer. Journal of Advanced Nursing, 70, 1954–1969.
PHASE OF CARE: End of life care
APPLICATIONS: Palliative care
Interventions included massage or aromatherapy massage (five studies), physical therapy and massage (one study), transcutaneous electrical nerve stimulation (TENS, one study), acupuncture (one study), reflexology (one study), warm water footbath (one study), biofeedback-assisted relaxation (one study), and varied strategies of relaxation and imagery with nature sounds (one study). The effectiveness of massage was mixed, TENS had the potential to reduce pain on movement, acupuncture reduced pain immediately after the intervention but the benefit was transient, reflexology showed no effect, relaxation with biofeedback was beneficial, and psychoeducational and behavior strategies had only a short-term effect. Most studies were found to have a relatively high risk of bias.
There was insufficient evidence to draw firm conclusions about the effectiveness of nonpharmacologic interventions to reduce pain among patients with advanced cancer.
Treating pain is a high priority among patients with advanced cancer receiving palliative care. The effectiveness of many nonpharmacologic interventions is unclear and warrants additional well-designed research. Most of the evidence involved studies in inpatient settings. Additional research among outpatients and those receiving palliative care in the home is needed. Nonpharmacologic interventions are generally low-risk. The identification of approaches than can facilitate reductions in pain would be beneficial for patients with cancer-related pain.
Hogan, R. (2009). Implementation of an oral care protocol and its effects on oral mucositis. Journal of Pediatric Oncology Nursing, 26, 125–135.
To review current knowledge and provide guidance to clinicians regarding care for the prevention of mucositis, particularly pediatric patients
The databases searched and search keywords were not stated.
This study has clinical applicability to pediatrics.
Experts generally agree that oral care is important and that oral care instructions should include brushing teeth 2–3 times per day, flossing, rinsing with a bland agent such as sterile water, using fluoride therapy, and using mouth moisturizers. These measures are recommended regardless of hematologic status. Experts recommend changing toothbrushes frequently. Dental assessments should be performed at initial diagnosis. This report provides a summary of the oral care guidelines of four organizations.
This report provides general recommendations for oral hygiene but no specific review of evidence or evidence quality.
This report provides a general overview and supports the development and implementation of specific protocols based on evidence for oral care.
Hofmann, S.G., Sawyer, A.T., Witt, A.A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183.
To provide a quantitative, meta-analytic review of the efficacy of mindfulness-based therapy (MBT) for improving anxiety and mood symptoms in clinical populations
MBT was moderately effective for improving anxiety (Hedges’s g = 0.63) and mood symptoms (Hedges’s g = 0.59) from pre- to post-treatment in the overall sample. Eight studies met criteria for elevated levels of depression symptoms at pretreatment; none of these involved patients with cancer.
The effects of MBT on depression and anxiety related to chronic conditions, such as cancer, might be smaller than expected, because patients may experience physical symptoms listed on depression or anxiety scales as a result of their physical condition or as a side effect of medical treatment.
MBT is a promising intervention in the treatment of anxiety and mood problems in patients with medical diagnoses, including cancer.
Hoffman, A.J., Brintnall, R.A., Given, B.A., von Eye, A., Jones, L.W., & Brown, J.K. (2016). Using perceived self-efficacy to improve fatigue and fatigability in postsurgical lung cancer patients: A pilot randomized controlled trial. Cancer Nursing, 40, 1–12.
To design and test the feasibility and acceptability of a postsurgical intervention with exercise for patients with non-small cell lung cancer to promote perceived self-efficacy for fatigue self-management targeting cancer-related fatigue (CRF) severity and its associated fatigability
Participants performed warm-up exercises designed for the patient population. Wii walking was self-paced and comfortable for participants with the Wii exercise equipment, creating a virtual environment in a town of happy people providing encouragement to continue. Patients started walking five minutes each day for five days during week 1 and increased by five-minute intervals per day until a goal of 30 minutes per day of Wii walking was reached by week 6. The nurse assessed each participant’s readiness to advance the walking prescription. Participants also completed balance exercises five days a week from weeks 1 to 6 from a menu of predetermined Wii balance exercises, which used a gaming format. Data were recorded in the participants' daily diaries and confirmed by research staff as recorded in the Wii Fit Plus.
Two-arm, randomized, controlled trial to compare the impact of a six-week rehabilitative CRF self-management exercise intervention post-surgical hospital discharge. The control group used a Wii-based walking and balance home program at home.
Feasibility: Rates of recruitment, adherence, retention, and monitoring of adverse events
Acceptability: 15-item acceptability questionnaire developed by the researchers
Efficacy:
Functional status:
Feasibility and acceptability: Recruitment, vulnerable population, adherence, and acceptability goals were exceeded. No adverse events were reported.
Efficacy: At week 6, interval scores for CRF, CRF self-management, walking, balance, and fatigability were significantly different (p < 0.001) between the intervention group and control group. Participants exceeded minimum walking-balance exercise behaviors during the six-week study period. Functional performance decreased postsurgery in both the control and intervention groups. Improvement occurred in weeks 1–6 for both groups but improved more slowly in the control group versus the intervention group.
A home- and Wii-based exercise and balance program for patients with lung cancer postsurgery is a feasible, acceptable, safe, and effective method to improve fatigue and fatigability in this patient population.
Early rehabilitation exercise and balance interventions for patients undergoing surgery for non-small cell lung cancer are feasible, acceptable, and safe. Additional research is needed to determine factors to enhance adherence to exercise and balance interventions beyond the immediate postsurgical period (six weeks) and to determine their effects on prognosis and functional (physical and mental) capacity.
Hoffman, A. J., Brintnall, R. A., Brown, J. K., von Eye, A., Jones, L. W., Alderink, G., . . . Vanotteren, G. M. (2014). Virtual reality bringing a new reality to postthoracotomy lung cancer patients via a home-based exercise intervention targeting fatigue while undergoing adjuvant treatment. Cancer Nursing, 37, 23–33.
To explore the efficacy of a virtual reality home-based exercise program for managing fatigue during adjuvant therapy in patients with postthoracotomy lung cancer.
Patients were initially provided self-management education for fatigue and a Nintendo Wii system for walking and balance exercise in the home. Nurses initiated the program in a home visit, performed follow-up at two weeks, and contacted patients via telephone for reinforcement at three and six weeks in the initial study. This report involved extension of the initial study for an additional 10 weeks while patients were receiving adjuvant therapy. Patients wore a pedometer to record the number of steps per day and were to use the program five days per week.
Patients were undergoing the active antitumor treatment phase of care.
This was a prospective trial.
Adherence to the exercise protocol declined slightly from the previous six-week study to an overall adherence of 87.6% (range 59%–100%). All patients reported unmanaged symptoms unrelated to the exercise at some point in the 10 weeks. Fatigue scores increased slightly from weeks 6 to 14 and then declined further. Self-efficacy for walking and self-management were relatively stable. There was high variability in the average walking steps per day from the pedometers.
Results suggested continued feasibility and overall efficacy of the virtual reality home-based exercise and balance program tested. Findings showed that, over longer periods of time, program adherence declined and was more variable. Some of this variability in exercise adherence and fatigue scores may be associated with periods of adjuvant chemotherapy and radiation therapy.
The use of a home virtual reality–based approach to facilitate exercise among patients with cancer is a promising approach for self-management of fatigue. Larger well-designed research using this approach is warranted.
Hoffman, A. J., Brintnall, R. A., Brown, J. K., Eye, A. v., Jones, L. W., Alderink, G., . . . Vanotteren, G. M. (2013). Too sick not to exercise: using a 6-week, home-based exercise intervention for cancer-related fatigue self-management for postsurgical non-small cell lung cancer patients. Cancer Nursing, 36, 175–188.
To evaluate the feasibility, safety, acceptability, and effects of a home-based exercise intervention.
Patients were screened for inclusion, and baseline measures were obtained prior to surgery. Each patient was assigned a primary nurse for the duration of the study to ensure continuity of care. Prior to surgery, participants were taught approaches to increase self-efficacy in self-management of fatigue and were prepared to participate in the exercise intervention after surgery. Within three days of hospital discharge, patients were contacted by telephone and screened for readiness to start exercise. When ready, a home visit was scheduled to set up the exercise equipment (the Nintendo Wii Fit Plus), the particpant was educated in the exercise intervention, and teaching for self-management was reinforced. The exercise intervention provided a virtual reality scenario for walking. After week 2, another home visit was performed, and telephone contacts were made at three and six weeks. Patients completed study tools at the end of six weeks via mail.
Patients were undergoing the active antitumor treatment phase of care.
This was a prospective, single-group, feasibility trial.
Mean adherence to the exercise intervention was 96.6% (range 90%–100%). Participants reported a high level of satisfaction with the exercise intervention. Overall decline in fatigue was seen from postsurgery to the end of the study. All participants stated that the intervention helped them to manage their fatigue. Fifty percent of those approached for participation consented and completed the study.
Use of the Nintendo Wii Fit Plus sytem for a home-based exercise intervention was shown to be feasible and effective in helping patients self-manage fatigue in this small study.
Findings suggested that use of home virtual reality exercise programs, such as the Nintendo Wii Fit Plus system, can be a feasible and effective way to promote exercise for the self-management of cancer-related fatigue.
Hoffman, A.J., Brintnall, R.A., von Eye, A., Jones, L.W., Alderink, G., Patzelt, L.H., & Brown, J.K. (2014). Home-based exercise: Promising rehabilitation for symptom relief, improved functional status and quality of life for post-surgical lung cancer patients. Journal of Thoracic Disease, 6, 632–640.
To describe the effects of a postsurgical home exercise intervention implemented immediately after hospital discharge on cancer-related fatigue (CRF), other symptoms, functional status, and quality of life (QOL) in individuals with non-small cell lung cancer (NSCLC)
Patient education in a hospital regarding exercise was followed by a home visit from a nurse educated on warm-up exercises, light intensity exercise such as walking, and balance exercises with a Wii. Patients were instructed to increase walking to goal of 30 minutes a day in week 6.
Pilot study
Cancer-related fatigue decreased below presurgery levels after six weeks of exercise intervention.
Home-based exercise may reduce cancer-related fatigue in patients with NSCLC postsurgery.
Hoffman, C. J., Ersser, S. J., Hopkinson, J. B., Nicholls, P. G., Harrington, J. E., & Thomas, P. W. (2012). Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. Journal of Clinical Oncology, 30, 1335–1342.
The intervention consisted of an eight-week MBSR program closely following the Kabat-Zinn method. The intervention involved 2- to 2.25-hour classes and a 6-hour retreat. Home practice was recommended for 45 minutes, six to seven days per week. Outcomes were measured at baseline, weeks 8 to 12, and weeks 12 to 14. A wait-list control group received usual care.
The study used a randomized, controlled trial design.
MBSR significantly improved mood and reduced confusion.
Although further study is needed to measure MBSR and its impact on depression and anxiety, in this sample, home-based practice was feasible and improved mood. In practice and education, nurses can promote components of MBSR, such as breathing, yoga, relaxation, meditation, seeking support resources, and gentle stretching.
Hoff, P.M., Saragiotto, D.F., Barrios, C.H., del Giglio, A., Coutinho, A.K., Andrade, A.C., . . . van Eyll, B. (2014). Randomized phase III trial exploring the use of long-acting release octreotide in the prevention of chemotherapy-induced diarrhea in patients with colorectal cancer: The LARCID trial. Journal of Clinical Oncology, 32(10), 1006–1011.
To evaluate the efficacy and safety of long-acting release (LAR) octreotide for the prevention of chemotherapy-induced diarrhea (CID)
This prospective, randomized clinical trial compared the administration of octreotide LAR 30 mg IM every four weeks beginning with first-cycle to the administration of a physician’s choice of medication in a group of patients with colorectal cancer starting adjuvant or first-line treatment. Patients received combination chemotherapy with fluorouracil, capecitabine, and/or irinotecan. Treatment with octreotide LAR was continued for six months or until chemotherapy discontinued or until the patient developed unacceptable toxicity related to the study drug (whichever occurred first). The choice for the treatment for diarrhea for both arms was at the physicians' discretion, but the control group could not receive octreotide LAR. Patients were stratified according to the use of irinotecan.
Randomized, multi-centered, open-labeled, phase III trial
139 patients were randomly assigned. Most received a fluorouracil (treatment 98.5%, control 98.6%) or oxaliplatin (treatment 76.5%, control 63.4%) containing regimen. The rate of diarrhea was 76.1% in the treatment group (n = 68) and 78.9% in the control group (n = 71). Treatment with octreotide LAR did not prevent or reduce the severity of chemotherapy-induced diarrhea.
There was no benefit in using octreotide LAR prophylactic in patients with colorectal cancer starting adjuvant or first-line treatment with combination chemotherapy containing fluorouracil, capecitabine, and/or irinotecan.
There was no benefit in using octreotide LAR prophylactic in patients with colorectal cancer starting adjuvant or first-line treatment with combination chemotherapy containing fluorouracil, capecitabine, and/or irinotecan. This has also been evaluated in other studies that have looked at octreotide LAR using escalation doses of 30 or 40 mg, and the results were similar. Per the authors of this study, the short-acting octreotide remains the formulation of choice in the treatment of CID.