Ferrer, A.J. (2007). The effect of live music on decreasing anxiety in patients undergoing chemotherapy treatment. Journal of Music Therapy, 44, 242–255.
To investigate the effects of live music on anxiety levels of patients undergoing treatment with chemotherapy
Possible participants were approached by the researcher at the beginning of a chemotherapy treatment session. Consenting patients completed questionnaires and were randomly assigned to the control group or to receive live music. The live music consisted of 20 minutes of singing with guitar accompaniment. During the intervention, patients were encouraged to sing along and to request other preferred songs. Control group patients completed questionnaires but had no other contact with the researcher. After 20 minutes, both groups completed a second questionnaire.
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A randomized controlled trial design was used.
Mean anxiety declined in the experimental group, and increased in the control group. These changes were significantly different between groups (p = 0.009). Responses regarding fear (p = 0.047), relaxation (p = 0.004), and fatigue (p = 0.001) also showed a similar difference. There were no significant differences in heart rate or blood pressure changes between groups. Many patients in the experimental group were involved in the music with hand clapping, etc. Patients who received the music therapy stated that it made the time pass more quickly.
Use of live music may be helpful to patients who are receiving chemotherapy to manage anxiety related to the treatment.
Findings suggest that distractions such as live music as provided here can be helpful to patients during chemotherapy. This is a low-risk intervention that might be of benefit for some patients.
Ferrell, B.R., Grant, M., Chan, J., Ahn, C., & Ferrell, B.A. (1995). The impact of cancer pain education on family caregivers of elderly patients. Oncology Nursing Forum, 22(8), 1211–1218.
Pain-related instruction was given by a nurse with 10 years’ experience in oncology and 2 years’ experience in cancer pain management.
Audiotapes of verbal content were left with patients and caregivers at the end of each of the first two sessions. Each session was approximately one hour long, with five total visits—three to provide information and two for follow-up. Cost was $50 per patient to purchase nondrug intervention equipment such as cold packs, massagers, and relaxation tapes. Caregivers and patients were present at each visit.
The study design was quasi-experimental with major limitations.
Significant improvements were found in quality of life (psychological well-being, social well-being, and total quality of life) from pre- to postintervention.
The intervention was associated with improvements in caregivers’ knowledge about pain and their experience caring for patients in pain.
The study had no randomization, post-test mean scores were not provided, and significance testing was not supplied. Caregiver burden scores were reported only at baseline.
Ferreira Chacon, J.M., Hato de Almeida, E., de Lourdes Simoes, R., Lazzarin Ozorio, V., Alves, B.C., Mello de Andrea, M.L., . . . Biernat, J.C. (2011). Randomized study of minocycline and edetic acid as a locking solution for central line (port-a-cath) in children with cancer. Chemotherapy, 57, 285–291.
The purpose of the study was to evaluate the efficacy of using heparin versus M-EDA for locking central venous catheters and preventing infection.
Prospective blood cultures were obtained at the beginning of the study and at each chemotherapy session at weekly or monthly intervals according to each chemotherapy protocol. Aseptic technique was used to collect 10 ml of blood for each culture. Cultures obtained from the catheters also were obtained with catheter removal. Primary outcome was positive blood culture or clinical evidence of bacteremia or sepsis associated with the catheter, regardless or whether blood cultures were positive or negative. The catheter-locking solution had the same volume as each catheter’s priming solution. It was slowly introduced (in at least 10 seconds) after each chemotherapy session, and remained in the catheter lumen until the next session.
Single-site inpatient/outpatient facility in Sao Paulo, Brazil
Prospective, randomized study
Blood cultures
A total of 762 serial prospective blood cultures were obtained, 387 from group 1 and 375 from group 2. In group 1, 19 blood cultures were positive and infection incidence was 73.1% (19 of 26 ports); in group 2, five blood cultures were positive and the incidence rate was 20.8% (5 of 24 ports). This difference was significant (p = 0.0001). The colonization of catheters was 5.7 times greater in group 1 than group 2. The mean time free of catheter infection in group 1 was 4.72 months, significantly shorter than in group 2, where it was 9.69 months (p = 0.002). The chances of hospitalization were two times greater for children in the heparin group. There were no side effects observed from either treatment.
The results of this study suggest a significant benefit for children using M-EDTA as a CVC lock as opposed to straight heparin for prevention of catheter-associated infections. The EDTA is a strong cation with chelating properties that destroys the buildup within the lumen. Minocycline is a great broad spectrum antibiotic that is never used for anything but orally for acne.
The nurse would not be able to use this without a physician's order, unless it was SOP for that facility. If it were SOP, then nurses could use the solution to flush and lock the CVCs.
This approach shows great promise and would be simple to implement in a clinical setting. Further research is warranted to provide additional support for its efficacy.
Ferreira, E.B., Vasques, C.I., Gadia, R., Chan, R.J., Guerra, E.N., Mezzomo, L.A., . . . Dos Reis, P.E. (2017). Topical interventions to prevent acute radiation dermatitis in head and neck cancer patients: A systematic review. Supportive Care in Cancer, 25, 1001–1011.
STUDY PURPOSE: To evaluate the effects of topical agents in the prevention of radiodermatitis
TYPE OF STUDY: Systematic review
PHASE OF CARE: Active antitumor treatment
Four studies evaluated trolamine. Other interventions were aloe vera, olive oil, Lianbai liquid, sucralfate, Na-SOS, hyaluronic acid, and dexpanthenol. No strong evidence showed differences between topical treatments and control interventions.
The evidence was insufficient to support the use of any of the topical interventions examined.
Insufficient evidence shows the effectiveness of topical agents for the prevention of radiodermatitis.
Ferrante, J.M., Chen, P.H., & Kim, S. (2008). The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: A randomized controlled trial. Journal of Urban Health, 85, 114–124.
To examine the effectiveness of a patient navigator after a suspicious mammogram in urban minority women in improving the time to diagnosis, decreasing anxiety, and increasing satisfaction
Women with suspicious mammogram findings were identified from radiology logs and contacted to participate. Women were told that the hospital was conducting a study to better understand their experience, in order to blind participants. Patients were randomly assigned to control/usual care or usual care plus patient navigation (intervention group). The navigator provided patients with emotional and social support, helped make appointments and arrive for appointments, facilitated financial assistance applications, provided information on resources and support systems, and facilitated interaction with healthcare providers and staff. The navigator had a bachelor’s degree in social relations and previous experience in counseling and community outreach, and was previously a volunteer for a breast cancer support group. The navigator underwent additional training and had ongoing mentoring with an oncology social worker. Study instruments were administered at the time of study enrollment and one month after resolution—either determination of benign diagnosis or initiation of cancer treatment.
Patients were undergoing the diagnostic phase of care.
A randomized, single-blind, controlled trial design was used.
Women in the intervention group had a shorter time to diagnosis (p = 0.001). Women in the intervention group had significantly lower anxiety at follow-up (p < 0.001) and a significantly greater reduction in anxiety from baseline to follow-up (p < 0.001). Baseline anxiety scores were similar in both groups. While anxiety declined in the intervention group, in the control group, anxiety scores were increased at follow-up compared to baseline. Satisfaction scores were significantly higher in the intervention group (p < 0.001). There were no differences between groups in demographic findings, and results indicated that effectiveness of the intervention did not differ associated with demographic characteristics. The mean time to diagnosis was 14.3 days in the intervention group, compared to 33.9 days in the control group.
The use of a patient navigator was effective to improve timeliness of diagnosis, reduce anxiety, and increase satisfaction in this group of patients.
Findings show that patient navigation is an effective strategy to improve timeliness of diagnosis, anxiety, and satisfaction in a group of poor urban minority patients. Findings also show that many of these types of patients refused to participate, suggesting predominance of issues such as mistrust in this population. This suggests that assistance to this group of patients remains a challenge. Future research in this area needs to incorporate mechanisms to study those patients who also do not speak English. Larger sample sizes in this area of research are needed to further examine differences in outcomes based on demographic characteristic of potential relevance.
Fernandez-Lao, C., Cantarero-Villanueva, I., Fernandez-de-Las-Penas, C., del Moral-Avila, R., Castro-Sanchez, A.M., & Arroyo-Morales, M. (2012). Effectiveness of a multidimensional physical therapy program on pain, pressure hypersensitivity, and trigger points in breast cancer survivors: A randomized controlled clinical trial. Clinical Journal of Pain, 28, 113–121.
To evaluate the effects of an eight-week multidimensional physical therapy program, including strengthening exercises and recovery massage, on neck and shoulder pain, pressure hypersensitivity, and the presence of active trigger points (TrPs) in breast cancer survivors
Forty-four breast cancer survivors were randomly assigned to one of two groups: the CUIDATE group, which received a multidimensional physical therapy program, or the control group, which received usual care treatment for breast cancer. The CUIDATE program consisted of 24 hours of individual physical training (aerobic, mobility, stretching, and strengthening exercises) and 12 hours of physical therapy recovery interventions (stretching, massage) three times per week for 90 minutes. The program was supervised by two physical therapists with clinical experience in the management of patients with different cancer conditions. Each group had approximately six to eight patients. Outcomes were assessed at baseline and after the eight-week program by a blinded assessor. Control group patients followed usual care recommended by the oncologist in relation to a healthy lifestyle. They received a printable dossier from the oncologist that outlined recommendations related to nutrition, lifestyle behaviors, and exercise.
The study was a randomized, controlled, clinical trial.
The CUIDATE group demonstrated an estimated improvement for neck pain of –56 mm [95% confidence interval (CI), –71 –40, p < 0.001; effect size 2.72, 1.94–3.44] and for shoulder/axillary pain of –56 mm [95% CI, –74 –38, p < 0.001; effect size 2.45, 1.66–3.23]. Improvements also were noted for pressure pain thresholds levels: Patients within the CUIDATE program showed a greater reduction of active muscle TrPs compared with the control group (p < 0.01).
An eight-week supervised multidimensional program including strengthening and endurance exercises, relaxation, and massage as major components was effective for improving neck and shoulder pain and reducing widespread pressure hyperalgesia in breast cancer survivors compared with usual care treatment.
Almost all cancer survivors experience one or more cancer-related symptoms that impact their quality of life. Among these symptoms, localized pain is the most frequent impairment after breast cancer treatment (20%–65%). There is evidence that breast cancer survivors may present with changes in nociceptive pain from damage to the small nerve fibers during surgery.
There is also evidence showing that physical therapy, including exercise and massage interventions, may be beneficial for improving physical function in breast cancer survivors. Nurses can provide patient education regarding the use of a multidimensional physical therapy program to activate exercise-induced hypoalgesia in breast cancer survivors. Physical therapy interventions may be clinically useful in minimizing pain and persistent hypersensitivity after medical treatment in this cancer population.
Fernandez-Feito, A., Lana, A., Baldonedo-Cernuda, R., & Mosteiro-Diaz, M.P. (2015). A brief nursing intervention reduces anxiety before breast cancer screening mammography. Psicothema, 27, 128–133.
To determine if a brief nursing intervention could reduce anxiety prior to screening mammography
Women received an intervention protocol consisting of face to face general information about screening as well as emotional support by discussing other topics related to the examination and anxiety. The intervention took about 10 minutes. Anxiety was assessed before the mammography. Anxiety also was assessed among women receiving usual care. The results from both groups were compared.
Randomized, controlled trial
Women in the experimental group had a significantly lower mean state anxiety score (p < 0.001) and a 60% likelihood of having lower anxiety (OR -0.40, 95% CI 0.25, 0.65). There were no differences between the groups in trait anxiety or expectations of pain from the procedure.
A brief psychoeducational intervention prior to a screening mammography appears to be effective in reducing anxiety associated with the screening mammography.
A brief psychoeducational intervention providing information about mammography and breast cancer and giving women the opportunity to express anxiety concerns was associated with lower anxiety. In this study, the intervention took only 10 minutes, suggesting that it could be a practical approach to care. By spending a little time educating women and providing them the opportunity to express concerns, nurses can help reduce the anxiety that may be associated with screening mammographies.
Fernandes, R., Mazzarello, S., Stober, C., Vandermeer, L., Dudani, S., Ibrahim, M.F., . . . Clemons, M. (2016). Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: A systematic review. Breast Cancer Research and Treatment, 161, 1–10.
STUDY PURPOSE: To determine whether colony-stimulating factors or antibiotic prophylaxis are optimal choices for the prevention of febrile neutropenia in patients receiving docetaxel-cyclophosphamide chemotherapy
TYPE OF STUDY: Systematic review
PHASE OF CARE: Active antitumor treatment
Hospital admission because of febrile neutropenia (FN) occurred in a median of 13% of patients, and 7.5%, on average, had delays in chemotherapy because of FN. DC chemotherapy was associated with median FN rates of 6.6% with and 31.3% without primary prophylaxis.
FN prophylaxis was associated with lower FN rates; however, the study results could not differentiate the efficacy of antibiotics versus colony-stimulating factors.
Patients receiving DC chemotherapy benefit from primary FN prophylaxis. Insufficient evidence exists to determine the comparative efficacy of prophylaxis with antibiotics versus colony-stimulating factors.
Ferguson, S.E., Malhotra, T., Seshan, V.E., Levine, D.A., Sonoda, Y., Chi, D.S., . . . Abu-Rustum, N.R. (2009). A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery. Gynecologic Oncology, 114(1), 111–116.
To evaluate the effect of bupivacaine-morphine patient-controlled epidural analgesia (PCEA) versus IV morphine patient-controlled analgesia (PCA) on pain at rest and during coughing and on time to potential discharge, length of hospital stay, nausea, vomiting, pruritus, and overall patient satisfaction
Control group received IV morphine PCA 1 mg/hour basal rate with rescue dose of 1 mg every 10 minutes as needed by PCA. The women in the treatment arm had thoracic epidural morphine-bupivacaine PCEA 100 mcg/ml with 0.05% bupivacaine basal rate 4 mg/hour with rescue boluses of 4 ml every 30 minutes. In both treatment arms, therapy was titrated to ensure adequate pain control with treatment of any side effects.
Prospective randomized trial
Visual analog scale (VAS), a 10-point pain scale regarding side effects
For the first six postoperative days, women treated with PCEA morphine-bupivacaine had less pain at rest and during coughing than did women treated with conventional IV PCA. The incidence and severity of adverse effects were not significantly different between groups.
Nurses must be knowledgeable about postoperative care, the complications associated with abdominal surgery, and optimization of perioperative PCEA.
Ferguson, C.M., Swaroop, M.N., Horick, N., Skolny, M.N., Miller, C.L., Jammallo, L.S., . . . Taghian, A.G. (2016). Impact of ipsilateral blood draws, injections, blood pressure measurements, and air travel on the risk of lymphedema for patients treated for breast cancer. Journal of Clinical Oncology, 34, 691–698.
To investigate the relative merits of the current guidelines advising patients to avoid ipsilateral blood draws, injections, blood pressure measurements, trauma, and wearing compression sleeve for air travel to reduce the risk of developing lymphedema
Patients with newly diagnosed breast cancer from 2009–2014 were prospectively screened for lymphedema in bilateral arms using an optoelectronic perimeter, an infrared light to measure arm circumference and volume. Participants were measured at preoperative baseline, postoperatively, and after chemotherapy and/or radiation therapy at regular follow-up oncology visits. (Regular means between three to seven months.) Patients were also measured at their request. At each measure, patients completed a questionnaire and reported on blood draws, injections, blood-pressure readings, trauma, and frequency and length of flights. A total of 3,040 measurements were made.
PHASE OF CARE: At start of breast cancer, up to six months of follow-up
A prospective screening study to assess for lymphedema in patients with newly diagnosed breast cancer from 2009 to 2014
The researchers used an optoelectronic perimeter to calculate bilateral arm volumes preoperatively, postoperatively, again after chemotherapy and/or radiation therapy, and at regular follow-up oncology visits (every three to seven months). The relative volume change (RVC) formula was used to quantify limb volume changes in unilateral limb involvement, and the weight-adjusted volume change (WAC) formula was used to quantify limb volume changes for bilateral limb involvement. Lymphedema was defined as RVC or WAC scores greater than or equal to 10%. Patients completed the questionnaire regarding limb risk behaviors, including blood draws, blood pressures, injections, and trauma.
No association of nonprecautionary limb behaviors and the development of lymphedema existed among patients with breast cancer in this prospective study. ALND, BMI greater than or equal to 25, RLND, and cellulitis were associated with increases in limb volume.
Although most lymphedema precautionary behaviors are “expert opinion,” this study does not dismiss the need for such affected limb precautionary behaviors. Continue with all such precautionary behaviors. Just as all patients do not develop lymphedema, patients develop lymphedema from an array of activities.