Dobrila-Dintinjana, R., Trivanovic, D., Zelic, M., Radic, M., Dintinjana, M., Petranovic, D., . . . Matijasic, N. (2013). Nutritional support in patients with colorectal cancer during chemotherapy: Does it work? Hepato-Gastroenterology, 60, 475–480.
To determine if dietary counseling, oral nutrition, and megestrol acetate affect nutritional status and survival in patients with advanced cancer
Consecutive patients were given nutritional counseling, 400 mg per day megestrol, oral supplements of 600 kcal per day, and a product containing eicosapentaenoic acid with an additional 600 kcal. Prospective patients were then compared to historical controls when nutritional supplements were not available in the country. Patients were followed for up to 24 weeks.
Prospective and observational with a historical control comparison
This study reports a higher prevalence of diarrhea and water retention in patients receiving nutritional intervention. It reports a lower prevalence of loss of appetite at 12 weeks in those given the intervention compared to historical controls (p = .0046) and improvement of appetite by 12 weeks in the intervention group (p = .0046). Survival curve analysis showed improved survival among those who received the intervention (p = .022)
Oral dietary supplements and nutritional counseling may benefit patients with advanced colorectal cancer.
Dietary counseling and provision of oral nutritional supplements may be of benefit to patients.
Doan, T.N., Kirkpatrick, C.M., Walker, P., Slavin, M.A., Ananda-Rajah, M.R., Morrissey, C.O., . . . Kong, D.C. (2016). Primary antifungal prophylaxis in adult patients with acute lymphoblastic leukaemia: A multicentre audit. The Journal of Antimicrobial Chemotherapy, 71, 497–505.
To investigate practices for antifungal prophylaxis and incidence of invasive fungal disease (IFD)
A retrospective chart review was conducted to collect data on patients from beginning of induction to completion of consolidation regarding the use of antifungal prophylaxis and IFD outcomes. Cost analysis was included.
PHASE OF CARE: Active antitumor treatment
Retrospective
European Organization for Research and Treatment of Cancer (EORTC) criteria for proven, possible, or probable IFD
Ninety-eight percent had neutropenia ranging from 18–45 days in duration. Prophylactic antifungal agents were given to 85% of patients. The only significant difference between those who developed IFD and those who did not was the use of antifungal prophylaxis. Those receiving prophylaxis had a lower incidence of proven or probable IFD (2.6%) than others (21.4%) (p = 0.024). IFD incidence was highest in patients receiving BFM95 treatment (hyper-CVAD: hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Cost of care for those with IFD was significantly higher from hospitalization, diagnostic testing, and antifungal treatment costs (p < 0.001).
The use of antifungal prophylaxis was associated with a lower incidence of IFD and associated healthcare costs.
Antifungal prophylaxis in at-risk patients was shown to be effective in reducing the incidence of IFD and associated healthcare costs.
Do, J., Cho, Y., & Jeon, J. (2015). Effects of a 4-week multimodal rehabilitation program on quality of life, cardiopulmonary function, and fatigue in breast cancer patients. Journal of Breast Cancer, 18, 87–96.
To examine effects of a rehabilitation program
Patients were randomly assigned to an early exercise group or a delayed exercise group. Participants attended rehabilitation sessions five times per week for four weeks. Sessions involved the use of upper and lower extremity stretching, aerobic, and strengthening exercises. During weeks 1–4, the early exercise group participated, and during weeks 4–8, the delayed group participated. Patients were evaluated at baseline and at two, four, six, and eight weeks.
Randomized, parallel group trial with repeated measures
Patients in both groups showed significant improvements in all measures except body image (p < 0.001). The greatest improvements were shown during the period of time that individuals were participating in the exercise sessions in both groups. There was no significant difference between groups.
The exercise combinations used here were effective in reducing fatigue and improving quality of life among participants
The findings of this study add to the already extensive body of evidence that various forms of exercise are beneficial to reduce fatigue in patients with cancer. This study showed effects specifically during the time in which participants were exercising, suggesting the need for ongoing involvement in activity to maintain effectiveness
Do, J.H., Kim, W., Cho, Y.K., Lee, J., Song, E.J., Chun, Y.M., & Jeon, J.Y. (2015). Effects of resistance exercises and complex decongestive therapy on arm function and muscular strength in breast cancer related lymphedema. Lymphology, 48, 184–196. Retrieved from https://journals.uair.arizona.edu/index.php/lymph/article/view/18835
To examine the effects of adding resistance exercise to complete decongestive therapy (CDT) on arm volume, function, strength, and quality of life
Patients were randomized to intervention and control groups. The control group received CDT alone for one to two weeks, and those with severe lymphedema also had bandaging. The intervention received the same CDT, as well as exercise using resistance bands. Resistance exercises included isolated shoulder movements five times per week for eight weeks with three sets of 10 repetitions of exercises. Study assessments were conducted at baseline and after eight weeks. Arm volume measurement was taken at two weeks.
PHASE OF CARE: Late effects and survivorship
Randomized, two group trial
Both groups showed improvement in quality of life scores and arm volumes with no significant differences between groups. Arm disability scores were significantly lower in the intervention group post-treatment (p = 0.001).
The addition of resistance exercise to CDT improved arm function, reduced disability, and did not have any adverse effects on arm lymphedema volume.
The findings support the addition of moderate intensity resistance exercise to CDT for the management of lymphedema. Resistance exercise was associated with improved function, less arm disability, and no adverse effects on lymphedema volume. Nurses can recommend that patients use moderate exercise of this sort. Resistance exercise can be done with resistance bands—an inexpensive and practical way to achieve this intervention.
Dirksen, S. R., & Epstein, D. R. (2008). Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Journal of Advanced Nursing, 61, 664–675.
The intervention was delivered by a master’s prepared nurse and consisted of four weekly classes and two weeks of treatment conducted through individual weekly telephone sessions. Each class followed a standard format using a treatment manual. The cognitive-behavioral therapy (CBT) intervention consisted of stimulus control instructions, sleep restriction therapy, sleep education, and hygiene content, including cognitive strategies. The aim of the stimulus control interventions was to shape cognitions to reassociate the bed and bedroom with rapidly falling asleep or falling back to sleep. The aims of stimulus control were to acquire a consistent sleep pattern, strengthen the bed and bedroom as cues for sleep, and weaken them as cues for activities that interfere with sleep. Sleep restriction therapy was based on the observation that people with insomnia spend too much time in bed attempting to sleep. The treatment focused on developing a sleep-wake schedule that consolidates sleep and limits it to a specific time by restricting the amount of time spent in bed. Sleep education and hygiene consisted of giving basic information about sleep processes and functions, developmental sleep changes, circadian rhythms, individual sleep needs, sleep deprivation, and supportive information. Dysfunctional cognitions that may contribute to sleep difficulty were also challenged.
This was a randomized, controlled trial with assignment to either CBT for insomnia or a control group that received education about sleep and sleep hygiene.
Profile of Mood States Fatigue/Inertia Subscale (POMS-F/I)
Women in the intervention group demonstrated significantly lower fatigue compared to those in the control group. The authors concluded that because mediation analyses indicated that the intervention had no direct effect on any of the psychosocial outcomes, that the intervention had an indirect effect on the outcome of fatigue due in part to improvements in sleep quality (both groups demonstrated improvements in mean scores for insomnia severity across the course of the study, and in a study reported elsewhere, they also demonstrated significant improvements in other sleep outcome indicators and favorable changes in actigraphy).
A modest amount of continuing education, as well as access to some instructional materials for patients, are needed to prepare health care professionals to deliver CBT interventions for insomnia.
Dirican, A., Andacoglu, O., Johnson, R., McGuire, K., Mager, L., & Soran, A. (2010). The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 19(5), 685–690.
To evaluate the short-term benefits of low-level laser therapy (LLLT) when added to the conventional management of breast cancer-related lymphedema (BCRL)
All patients had experienced at least one conventional treatment modality, such as complex physical therapy, manual lymphatic drainage, or pneumatic pump therapy. LLLT was added to patients' ongoing therapeutic regimen. All patients completed two cycles of LLLT. Assessment took place before and after the first and second cycle of LLLT sequentially.
The study took place in an outpatient setting at the University of Pittsburgh Medical Center.
The study used a quasi-experimental design.
The difference between sums of the circumferences of the affected and unaffected arms decreased 54% and 73% after the first and second cycles of LLLT, respectively. Eighty-two percent of patients 14 out of 17 experienced decreased pain with motion by an average of 40% and 62.7% after the first and second cycle of LLLT, respectively. Scar mobility increased in 13 (76.4%) and shoulder range of motion improved in 14 (82.3%) patients after LLLT. One patient developed cellulitis during LLLT.
Patients with BCRL received additional benefits from LLLT when used in conjunction with standard lymphedema treatment, including reduction in limb circumference, pain, increase in range of motion and scar mobility.
Further studies with appropriate sample size and control groups are necessary to assess the long-term effects of LLLT in combination with conventional treatments as well as the effect of the repetitive application.
DiPalma, J.A., Cleveland, M.B., McGowan, J., & Herrera, J.L. (2007b). A randomized, multi-centered, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. American Journal of Gastroenterology, 102, 1436–1441.
To compare the safety and efficacy of polyethylene glycol (PEG) versus placebo over a six-month treatment period in patients with chronic constipation.
PEG 3350 (Miralax®) laxative 17 g or placebo was administered daily for six months. Patients were randomly assigned in a 2:1 ratio to PEG or placebo. This was a subjects mixed study. Medication was administered in 8 oz of juice or another beverage. Bisacodyl 10 mg (5 mg tablets) was used as rescue medication for severe discomfort related to constipation. Fiber was prohibited. Other nonconstipating medications were allowed.
50 centers in the United States
This was a double-blind, placebo-controlled, parallel, randomized controlled trial.
PEG is safe and effective in management of constipation in adults and older adults for up to six months.
The study focused on chronic constipation and lacked focus on cancer or opioid-induced constipation.
DiPalma, J.A., Cleveland, M.B., McGowan, J., & Herrera, J.L. (2007a). A comparison of polyethylene glycol laxative and placebo for relief of constipation from constipating medications. Southern Medical Journal, 100, 1085–1090.
To compare the safety and efficacy of polyethylene glycol (PEG) 3350 (Miralax®) versus placebo for treatment of constipation in patients with chronic constipation.
PEG 3350 laxative 17 g or placebo was administered daily for 28 days. Use of nonconstipating medications was allowed, but the use of fiber or other laxatives was not permitted. Patients received a 4 L jug containing Crystal Light® with or without study medication. The mixture was reconstituted by unblinded study personnel; investigators remained blinded. A daily bowel diary was used to share bowel movement (BM) experiences and answer questions related to study efficacy and safety criteria. Laboratory evaluation was repeated at study conclusion.
Four centers in the United States
This was a double-blind, placebo-controlled, parallel, randomized controlled trial.
PEG is safe and effective in treating constipation in patients taking constipating medications.
DiPalma, J.A., Cleveland, M.V., McGowan, J., & Herrera, J.L. (2006). An open-labeled study of chronic polyethylene glycol laxative use in chronic constipation. Alimentary Pharmacology and Therapeutics, 25, 703–708.
To extend the safety data of polyethylene glycol used for chronic treatment of chronic constipation.
Polyethylene glycol laxative was administered as a single daily dose of 17 g for 12 months.
This was a randomized, open-label, single-treatment study.
Polyethylene glycol laxative is safe and effective for treating constipation in adult and older adult patients for periods up to 12 months, with no evidence of tachyphylaxis.
Dionne-Odom, J.N., Azuero, A., Lyons, K.D., Hull, J.G., Tosteson, T., Li, Z., . . . Bakitas, M.A. (2015). Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: Outcomes from the ENABLE III randomized controlled trial. Journal of Clinical Oncology, 33, 1446–1452.
To assess the impact of early versus delayed (three months after patient diagnosis) initiation of palliative care for patients with advanced cancer on rural informal caregivers’ quality of life, burden (objective, demand, and stress), and depression
Caregivers were assigned to a palliative care intervention immediately following random assignment to groups (early or delayed) or three months after assignment. The telephone-based intervention, informed by authors’ earlier work sensitive to rural access issues, involved conversations between trained advanced practice palliative care nurse coaches and caregivers. Each coach provided three evidence-based content sessions delivered weekly in a scripted format. Each patient received a different coach than the family caregiver to support the open sharing of feelings about the caregiving experience. Coaches contacted their assigned caregivers on the telephone at least monthly to respond to emerging issues until patient death. Coaches encouraged caregivers to participate in patient palliative care consultations if acceptable to patient and called a caregivers when their family members died. All nurse coaches met weekly with study's primary investigator to support study integrity. To identify group differences on desired outcome measures, all caregivers completed three questionnaires at baseline and every six weeks until week 24.
Randomized, controlled trials with a wait-control design
More than 30% of participants did not complete all the follow-up assessments although the authors used appropriate statistics to confirm there was no significant relationship of attrition and measured characteristics of caregivers. The early intervention group showed a decline in depression scores from baseline compared to the delayed group (d –0.32, p = 0.02). There were no differences between the groups in quality of life or burden scores. Among the caregivers of patients who died, results for depression (p = 0.02) and stress burden (p = 0.01) were better in the early intervention group. All measures showed decline somewhat in both groups.
Study data support that well-educated, white, female caregivers experience improved quality of life, less depression, and less burden with early involvement in palliative care programs distinct from similar patient programs. More studies of minority populations, male caregivers, and low literacy populations receiving similar programs could increase the generalizability of the current study's findings.
Nursing knowledge and the clinical competency of support provision for early palliative care programs to family caregivers and patients challenged by end-of-life issues is important. The American Nurses Association Code for Nurses supports the ethical responsibility of nurses to ensure that both groups receive evidence-based programs tailored to patients and caregiver groups to meet current healthcare goals for person-centered care.