D'Souza, V., Blouin, E., Zeitouni, A., Muller, K., & Allison, P.J. (2013). An investigation of the effect of tailored information on symptoms of anxiety and depression in head and neck cancer patients. Oral Oncology, 9, 431–437.
To investigate if providing tailored information to patients with advanced head and neck cancer decreases patients' symptoms of anxiety and depression
Patients at one study site received the intervention, and patients at another study site did not receive the intervention and were treated as a control group. The tailored information used was a multimedia tool that included a patient booklet; interactive computer software; computer animation describing cancer spread, staging, and surgical procedures; and a take-home DVD. The purpose of the packet was to educate patients about diagnostic and adjuvant procedures, nutrition, and speech and swallowing practice. Another component was a database. The database could receive and store patient input and could print information that could be given to the patient. The intervention was provided at the hospital by a nurse who was available to address patients' questions and concerns. The control intervention was usual care provided by a nurse practitioner who provided verbal information and pamphlets and met with some patients in an ad hoc manner. Data were collected at baseline. Outcomes were assessed at three months and six months.
Active antitumor treatment
Nonrandomized controlled trial
Over time, anxiety was lower in the intervention group (p = 0.001), and there was a significant group-by-time effect (p = 0.025). Anxiety did not decline in the control group over time. Over time, depression declined in both groups (p = 0.001), and there were no group differences in depression. Findings were grouped by low, borderline, and high anxiety levels according to HADS results. In the low-anxiety group, patients reported lower levels of anxiety over time than did controls (p = 0.003). In the borderline group, there were no significant differences between study groups. Among those who had clinical levels of anxiety at baseline, patients had lower levels of anxiety at three months (p = 0.014) and six months (p = 0.005). Among those with clinical depression in the control group, depression initially increased at three months and then decreased toward baseline,
Findings demonstrate that the providing information can have an effect on anxiety. It cannot be determined if the nature of the multimodal intervention was a critical factor or whether providing information in any form would be helpful, since there was no random patient assignment and patients in the control group received information in an inconsistent, ad hoc manner.
Findings suggest that providing information to patients may help reduce patients' anxiety but not their symptoms of depression. This study used a package of information; such a package may be a practical means of ensuring that the information patients receive is consistent. Multiple limitations in this study prevent the drawing of firm conclusions about the effectiveness of the method studied.
D'Silva, S., Poscablo, C., Habousha, R., Kogan, M., & Kligler, B. (2012). Mind-body medicine therapies for a range of depression severity: A systematic review. Psychosomatics, 53(5), 407–423.
To perform a systematic review of evidence related to the use of mind-body therapies to address various symptoms of depression
Among studies that included patients with cancer, six studies involved yoga and one examined relaxation and guided imagery. Among the yoga studies, three showed positive results with yoga alone or in combination with other supportive therapies, two showed negative results, and the results of one were equivocal. Relaxation and guided imagery were associated with postive results. Across all studies involving various medical illnesses, 74% associated mind-body therapies with positive results.
Mind-body therapies appear to be effective in reducing symptoms of depression.
The individualized attention provided to patients via mind-body therapies may be beneficial in reducing symptoms of depression.
Currow, D.C., Agar, M., Smith, J., & Abernethy, A.P. (2009). Does palliative home oxygen improve dyspnoea? A consecutive cohort study. Palliative Medicine, 23(4), 309-316.
The objective of the study is to identify the benefit of home oxygen therapy on breathlessness within a palliative care program.
Data were collected (from face-to-face clinical encounters) from a consecutive cohort of 5,862 patients seen by a regional community palliative care program. Patients who were prescribed home oxygen concentrators by referral to palliative care for symptomatic breathlessness were the population of interest. Breathlessness was assessed before and one week after oxygen prescription and before and two weeks after oxygen prescription as a way to explore benefits of home oxygen on an extended time frame.
Four hundred and thirteen patients were included for analysis and were found to have data collection points during the week before and at least one week after home oxygen prescription, and 230 comprised available breathlessness scores during the week before and at least two weeks after home oxygen prescription. The average age was 69.69 years, with a median age of 72 years and a range of 0-108 years. The sample was comprised of 2,552 (43.4%) females and 3,310 (56.6%) males. Of the sample, 5,386 (91.9%) identified with cancer diagnoses. Of the 413 patients included for analysis, 384 (93.1%) identified cancer diagnoses as their “life-limiting illness.\" Patients were prescribed home oxygen concentrators after referral to palliative care for symptomatic breathlessness.
The study was conducted in an inpatient setting at Silver Chain Hospice Care Service (SPHCS), a regional community palliative care program covering all the metropolitan area of Perth, Western Australia.
Descriptive, retrospective
Symptom Assessment Scale (SAS)-0-10 scale, although the anchors for each end of the scale for dyspnea were not identified
No significant improvement in SAS was observed one week after oxygen prescriptions (mean = 5.1, SD = 2.6, median = 5, range = 0-10, P value = 0.28). Where data were available for 230 individuals on home oxygen therapy, mean SAS dyspnea score was 5.4 (SD = 2.5, median = 4, range = 0-10), and no significant improvement in breathlessness scores was noted two weeks after use of home oxygen (mean = 5.2, SD = 2.5, median = 5, range = 0-10, P = 0.35). Sub-group analysis based on primary underlying diagnosis associated with breathlessness for people prescribed home oxygen showed no remarkable difference among individual response rates.
No significant clinical improvement in breathlessness was observed among this palliative care population.
The study had no group without oxygen for comparison. Pulse oximetry and dyspnea rating were not consistently measured after application of oxygen therapy, allowing only for assumed or indeterminable benefits of oxygen therapy. Authors reported that the sample size as too small for the differences in the primary cause of breathlessness to be fully explored. Generalizability was broadly reflective of palliative care patients admitted on a referral basis in “resource-rich” community settings and may not reflect the experience of individuals not referred for symptom management support. The post-hoc analysis design presents limitations in data selected to report and the use of a uni-dimensional measure of breathlessness that may not reflect the complete experience or distress the symptom causes in some individuals.
More data and studies regarding the symptomatic benefits of home oxygen therapy and the relationship between hypoxemia, breathlessness, changes in functional status, and the way in which oxygen is prescribed are needed.
Currow, D.C., Plummer, J.L., Cooney, N.J., Gorman, D., & Glare, P.A. (2007). A randomized, double-blind, multi-site, crossover, placebo-controlled equivalence study of morning versus evening once-daily sustained-release morphine sulfate in people with pain from advanced cancer. Journal of Pain Symptom Management, 34, 17–23.
Each participant took one placebo and a 24 hour-dose of sustained-release morphine daily, 12 hours apart. For one week participants took the active dose in the morning; for one week they took the active dose in the evening. For each participant, the study lasted 17 days. The time of administration was randomized in double-blind manner. The study was completed over 12 months.
The sample was composed of 42 people with advanced cancer who were suffering from opioid-responsive pain and who were taking stable opioid doses. Twenty-six of the 42 completed the study, providing adequate power (80%) for analysis.
Patients in the sample were in five regional palliative care programs in Australia.
Randomized multisite double-blind, placebo-controlled crossover equivalence and effectiveness study that comprised broad inclusion criteria
This study suggests that once-daily sustained-release morphine can be administered, to people with significant opioid-responsive pain and advanced cancer, with equal overall effect in the morning or the evening.
The findings regarding nausea may be a statistical rather than a clinical finding—a Type I error. Of the 42 randomized patients, 16 withdrew. Nine withdrew from the am-pm arm and seven withdrew from the pm-am arm. In the am-pm arm, three cited efficacy as the reason for withdrawal. In the pm-am arm, one cited efficacy as the reason for withdrawal. The difference in withdrawals, am-pm vs. pm-am, was not significant (p = 0.97). Authors questioned whether the study should have been powered to show a smaller difference, though the patients were already optimized on opioids.
Patients in the study population suffered typical end-of-life pain. Future researchers should define a subgroup (e.g., those with poorly controlled pain, those on high doses of opioids, those who are still trying to function at work). Other than in regard to nausea, secondary measures indicated no differences relating to administration time. Future research could assess effects on sleep patterns, quality of life, activities of daily living, and fatigue.
Currin, J., & Meister, E.A. (2008). A hospital-based intervention using massage to reduce distress among oncology patients. Cancer Nursing, 31(3), 214–221.
To determine if 15 minutes of therapeutic massage is associated with reduction in patient-expressed levels of pain, fatigue, and emotional and physical distress during hospitalization
Patients were recruited over a three-year period. The same social worker assessed the four domains of distress evaluated; assessments were done pre- and postmassage. All patients served as their own controls. Before the massage, the massage therapist asked the patient which parts of the body to massage. The most frequently chosen area was feet and legs or back, neck, and shoulders. The massage therapist provided each patient with a 10–15 minute Swedish massage. A CD player provided the same music to all patients.
Observational
The study used MacDonald’s scale, modified, for patient evaluation of massage therapy (rating on a 1–5 point Likert scale, Cronbach's alpha = 0.850).
Authors found significant reductions relating to each of the four dimensions measured. Mean pain scores declined (p = 0.000, effect size = 0.7270), fatigue scores declined (p = 0.000, effect size = 0.714), physical distress declined (p =.000, effect size = 0.756), and emotional distress declined (p = 0.000, effect size = 0.6810). Posthoc analysis did not reveal that the main effect was affected by interactions with possible covariates.
Results demonstrated that massage therapy was associated with reduction of physical and emotional distress, pain, and fatigue in a broad range of hospitalized patients.
Nurses must consider the possibility that patients have preconceptions or privacy concerns regarding massage therapy. Authors suggested that some patients might be more comfortable with the intervention if it were called a back rub rather than a massage. Nurses in settings that offer massage should incorporate information about the intervention and allow patients to discuss their preconceptions and concerns. Findings suggest that a brief massage can relieve distress during hospitalization. Nurses should consider reinstituting the back rub as a standard nursing intervention.
Currin, J., & Meister, E. A. (2008). A hospital-based intervention using massage to reduce distress among oncology patients. Cancer Nursing, 31, 214–221.
Massage therapists who were specially trained in massage therapy for patients with cancer discussed the massage intervention process with patients and asked them which parts of their body they would like to have massaged. Massage sessions lasted 10 to 15 minutes, using Swedish massage. The most common areas for massage chosen by patients were the feet and leg or back, neck, and shoulder areas. Once patients were enrolled in the study, oncology social workers met with patients to perform a baseline assessment of pretreatment outcomes. After the massage intervention, the oncology social worker met with the patient to assess posttreatment outcomes.
Patients were hospitalized at a major university hospital in southeastern Georgia.
Patients were undergoing the active treatment phase of care.
The study used a nonrandomized, single-group, pre-/posttest, repeated-measures design.
A modified version of MacDonald’s Patient Evaluation of Massage Experience Scale was used.
The massage therapy intervention resulted in a statistically significant decline in fatigue mean scores (p < 0.001), which was observed between pre- and posttest treatment evaluations.
Cuomo, A., Russo, G., Esposito, G., Forte, C.A., Connola, M., & Marcassa, C. (2014). Efficacy and gastrointestinal tolerability of oral oxycodone/naloxone combination for chronic pain in outpatients with cancer: An observational study. American Journal of Hospice and Palliative Medicine, 31, 867–876.
To evaluate the efficacy and tolerability of prolonged-released (PR), fixed-dose oxycodone-naloxone
Patients were prescribed an oral PR oxycodone-naloxone combination for pain control at a dose according to level of pain, age, health status, and previous opioid use.
The reported pain at baseline was severe (VAS = 70.9, SD = 7.8, range = 55–94). Less than a fourth of patients reported somatic or visceral pain only. The majority of patients (73.3%) complained of mixed neuropathic and nociceptive pain. At the first visit, 37.6% of patients reported one to four BTCP episodes (mean = 0.9 + 1.2) during background treatment. The mean baseline BFI score was 43.2 + 14.8, indicating that some degree of bowel dysfunction was already present before starting the new PR oxycodone-naloxone treatment. Almost all (97.6%) patients had abnormal baseline BFI values (i.e. > 28.8, 26), and 41% of patients were already taking laxatives.
This combination was a highly effective analgesic in ambulatory outpatients with cancer experiencing chronic pain. Combination PR oxycodone-naloxone was not associated with adverse effects on bowel function and was equally efficacious and well-tolerated in and opioid-naive and -experienced patients and in young and old patients alike.
This study may provide useful guidance for the daily management of outpatients with advanced cancer experiencing chronic pain. The long-term effectiveness of fixed-combination PR oxycodone-naloxone deserves additional investigation.
Cunha, C. B., Eduardo, F. P., Zezell, D. M., Bezinelli, L. M., Shitara, P. P., & Correa, L. (2012). Effect of irradiation with red and infrared laser in the treatment of oral mucositis: A pilot study with patients undergoing chemotherapy with 5-FU. Lasers in Medical Science 27(6), 1233-40.
To verify the efficacy of 660 nm laser associated with 780 nm laser in reducing the severity of oral mucositis (OM)
Investigators conducted two interviews before beginning treatment for OM and one interview after the therapies. In the first interview, patients were asked about demographics, medical and laboratory data, and types of food ingested. Oral health status was evaluated, and the oral cavity was examined. Oral hygiene was reviewed.
Following the first interview, participants were divided into one of three groups.
This study was conducted in Brazil. The site and setting type were not specified.
This was a pilot study, prospective trial.
Symptoms of OM were classified according to a system validated by Monopoli et al. and applied by Vera-Llonch et al. The name of the tool was not given. Assessment was performed by a dental surgeon. This system was based on a grading system with the following grades.
A faces visual scale was used to assess satisfaction with the results of treatment with a happy face meaning \"satisfied\" (i.e., I feel no pain, I am able to eat better, I can speak better, I am satisfied, I like the treatment) and a sad face meaning “dissatisfied\" (i.e., I feel pain, I cannot eat, I cannot speak, I am not satisfied, I don’t like the treatment).
Consistency of food eaten was measured; however, no tool was specified.
The red laser group (Group 2) and the red laser plus infrared laser group (Group 3) had statistically significant differences in comparison to the CG group (Group 1) (p = 0.0190).
Statistically significant changes were found in the consistency of the foods ingested, favoring Group 3 (p < 0.001).
Satisfaction with oral condition was significantly different from the initial to the final evaluation with regard to Groups 1 and 2 (p < 0.001). No statistical difference was found in Group 3 from the initial to the final evaluation (p = 0.491).
A statistically significant difference was found between the CG and the red laser groups in OM scores but not necessarily in the severity of the OM lesions. The addition of laser light emission in the red region with infrared emission was found to be advantageous for the treatment of OM. The study provided support for the use of good oral hygiene alone in reducing the grade of OM.
Using good oral hygiene alone is still the cornerstone of OM prevention and treatment. The addition of laser therapy may be helpful. Laser therapy may not be available in all settings. This study did not substantially add to evidence in this area. This study was too small to make definitive decisions regarding laser therapy, but it provides promising results.
Cummings, G.G., Olivo, S.A., Biondo, P.D., Stiles, C.R., Yurtseven, O., Fainsinger, R.L., & Hagen, N.A. (2011). Effectiveness of knowledge translation interventions to improve cancer pain management. Journal of Pain and Symptom Management, 41, 915–939.
To determine the effectiveness of interventions to facilitate uptake of new knowledge by healthcare practitioners, patients, and family caregivers to improve cancer pain management. Primary outcomes of interest were change in behavior or practice of healthcare professionals or patients and caregivers. Secondary outcomes included change in patient quality of life or satisfaction with treatment.
Databases searched were CINAHL, MEDLINE, EMBASE, AMED, Web of Science, Cochrane Database of Clinical Trials and Cochrane Database of Systematic Reviews, National Cancer Institute of Canada, Canadian Cancer Society, American Cancer Society, American Society of Clinical Oncology, European Association for Palliative Care, and other websites.
An extensive listing of specific search terms and operators is provided. Main search terms included pain, analgesia, cancer, practice guidelines, evidence based medicine, and organizational innovation.
Studies were included in the review if they
Case reports, cross-sectional studies, or noncontrolled pre-post studies were excluded.
A final sample of 26 studies was included: 16 examined interventions for patients only, 4 focused on family caregivers, and 5 investigated effects of interventions targeted to health professionals. One study compared a solo intervention for patients only, and a dyad intervention for patients and their significant others, within the same study.
Interventions targeting health professionals (5 studies)
Interventions targeting patients and caregivers (21 studies)
Meta-analysis results
Interventions targeting patients and caregivers
Intervention dose and intensity
Knowledge translation interventions aimed at healthcare professionals have demonstrated change in practitioner behavior and attitude, but have not demonstrated an effect on patient pain outcomes measured. There is some evidence to suggest that higher intensity and “dose” of these interventions, indicating amount of time spent in education, inclusion of follow-up, patient/family contact, and longer duration of follow- up, tend to be more effective.
Knowledge translation interventions aimed at patients and caregivers have been associated with improvement in patients’ least and average pain scores, but not other pain measures. These findings need to be viewed with caution, since studies included showed high heterogeneity, and the timing, dosage, and intensity of the interventions varied.
Educational and knowledge translation interventions regarding pain management that are aimed at the patient and caregiver have been shown to be effective in improving some measures of pain intensity, and have often, but not always, resulted in improved knowledge, attitudes, and skills related to pain management. Elements of success included more intensive education such as involvement of a multidisciplinary team in face-to-face education, locally constructed education materials, standardized approaches, and patient follow-up to reinforce the education. Pain management educational programs should be constructed to include key elements that are likely to improve outcomes.
Culos-Reed, S. N., Robinson, J. W., Lau, H., Stephenson, L., Keats, M., Norris, S., . . . Faris, P. (2010). Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Supportive Care in Cancer, 18, 591–599.
To investigate the effects of a physical activity intervention for men receiving androgen deprivation therapy (ADT) on physical activity behavior, quality of life (QOL), and fitness.
Patients were randomly assigned to either the intervention or a wait-list control group. Assessments were performed in both groups at baseline, after completion of the 16-week activity intervention, and two and six months postintervention. The exercise program included a home-based portion and weekly group sessions of an individualized program provided by a certified fitness professional. Exercises were tailored to ability but consisted mostly of walking, stretching, and resistance exercises with a Thera-Band. A physioball and Thera-Band were provided to each patient for use in the home-based activity. Home exercise was suggested three to five times per week. Group sessions were conducted weekly for 16 weeks and monthly thereafter until completion of all follow-up measures. These included a group-based workout with individualized feedback, education, and group discussion. Discussion focused on common concerns, goal setting, monitoring behavior, overcoming barriers, role of a positive attitude, social support, relapse prevention, and nutrition.
The study used a randomized, controlled, repeated measures design.
The physical activity intervention was associated with an overall increase in reported physical activity. There were no significant effects seen in QOL or fatigue.