Colella, J., Scrofine, S., Galli, B., Knorr-Mulder, C., Gejerman, G., Scheuch, J., . . . Sawczuk, I. (2006). Prostate HDR radiation therapy: A comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA. Urologic Nursing, 26, 57–61.
To examine the effectiveness of two different types of patient-controlled analgesia (PCA)—peripheral (IV) versus epidural in an effort to develop best practice in pain management for this population
The phase 1 control group with PCA had the following mean ratings for pain: back, 2.7; foley catheter, 3.4; perineal interstitial catheter, 3.0.
The phase 2 experimental group with PCEA had the following mean ratings for pain: back, 0.5; foley catheter, 0.6; perineal interstitial catheter, 0.7.
PCA was associated with increased pain intensity. Foley pain was worse with arthritis and obesity. Back pain increased, interstitial pain decreased, and pain increased with the number of catheters. The PCEA group experienced significantly less pain at five-points-of-pain assessment from the control group.
Patients with PCA had greater pain and less pain relief.
Colagiuri, B., & Zachariae, R. (2010). Patient expectancy and post-chemotherapy nausea: A meta-analysis. Annals of Behavioral Medicine, 40, 3–14.
To evaluate the relationship between patient expectations of postchemotherapy nausea and subsequent reports of nausea
Databases searched were MEDLINE, PsycINFO, and CINAHL.
Search keywords were expectancy, expectations, placebo effects or placebo responses with chemotherapy and nausea or emesis.
Studies were included if they
Studies were excluded if they focused only on anticipatory nausea.
The authors independently coded the sample characteristics, the independent and dependent variables, and whether the study met the inclusion criteria for each study. Differences were discussed, and a final assessment negotiated for each study. A global effect size was calculated for each study. No formal scoring was used to assign a quality score to each study. Publication bias was addressed using the Egger test and calculations of failsafe.
This meta-analysis confirmed that nausea expectations and experience of post-chemotherapy nausea are positively correlated. The discussion also identified research methods, such as incorporating expectancy-based manipulations that consider the source of the patient’s expectations, actively investigating the possible moderators of the association between expectancy and post-chemotherapy nausea (e.g., age, anxiety), and measuring the expectancies before the first chemotherapy administration.
Prechemotherapy assessment needs to include patient expectations regarding the experience of postchemotherapy nausea. If a patient expects that he or she will experience nausea, additional evidence-based interventions to minimize nausea should be used prior to and during chemotherapy administration.
Cohen, L., Warneke, C., Fouladi, R. T., Rodriguez, M. A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253–2260.
The Tibetan yoga (TY) intervention involved seven weekly sessions with a yoga instructor who used imagery and exercise and included four aspects: controlled breathing and visualization, mindfulness, two types of posture, and daily practice. Outcomes were psychological adjustment, sleep, and fatigue.
Patients were undergoing the active treatment and long-term follow-up phases of care.
The study used a prospective, quasiexperimental design with two groups, including a wait-list control.
Pittsburgh Sleep Quality Index (PSQI)
The TY group reported significantly lower sleep disturbances scores (total PSQI) at follow-up (5.8 for TY versus 8.1 for the wait-list control). At follow-up, the TY group reported better subjective sleep quality, shorter latency, longer duration, and use of fewer sleep medications.
Cohen, M., & Fried, G. (2007). Comparing relaxation training and cognitive-behavioral group therapy for women with breast cancer. Research on Social Work Practice, 17, 313–323.
To compare the effectiveness of a cognitive-behavioral therapy (CBT) group intervention versus a relaxation and guided imagery (RGI) group training intervention.
The intervention groups received nine 90-minute weekly sessions, and the control group received standard care. The outcomes measured were psychological distress, sleep, fatigue, and health locus of control.
Oncology center in northern Israel
Patients were undergoing the active treatment phase of care.
This was a randomized, controlled trial.
GSI and perceived stress decreased in both intervention groups but not in the control group. Means of fatigue symptoms and sleep difficulties decreased in both intervention groups but only significantly in the RGI group. External health locus of control decreased more in the CBT group. No differences were observed among groups in internal locus of control. Participants in the RGI group reported significantly higher self-practice adherence at home than did those in the CBT group.
A study design with four groups—CBT, RGI, combined CBT and RGI, and control—could shed light on whether combining CBT and RGI is more advantageous than delivering either intervention individually.
Cohen, L., Warneke, C., Fouladi, R. T., Rodriguez, M. A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253–2260.
There were two groups:
Randomization was performed using minimization.
Yoga sessions consisted of exercises in controlled breathing, visualization, and mindfulness with Tsa lung and Trul khor poses. Patients attended seven weekly sessions with a Tibetan yoga instructor. Written materials were provided.
Patients were undergoing the active treatment and long-term follow-up phases of care.
The study was a randomized, clinical trial.
No significant differences were found in fatigue.
Cohen, M., & Fried, G. (2007). Comparing relaxation training and cognitive-behavioral group therapy for women with breast cancer. Research on Social Work Practice, 17, 313–323.
Patients attended 90-minute weekly sessions for a total of nine weeks. The cognitive-behavior (CB) component of the intervention emphasized learning to identify negative thinking patterns and restructure them into more adaptive, stress-reducing patterns. Mental distraction, problem-solving, and decision-making strategies were also covered. The behavioral component emphasized activity scheduling, graded task assignment, behavioral distraction, and behavioral experiment techniques. Homework exercises were assigned, and written material was provided for the application of CB strategies. Relaxation and guided imagery (RGI) participants practiced deep breathing and autogenic relaxation. Each relaxation experience lasted 20 to 30 minutes, and after sessions, participants discussed their sensations, feelings, and experiences to identify and work on problems identified in the relaxation process. Strategies to overcome sleep problems were also discussed and practiced. Participants were given RGI audio cassettes for further use at home. Group size consisted of six to eight participants. Questionnaires were completed at preintervention, postintervention, and at a four-month follow-up.
The study included 114 women with early stage breast cancer (stages I and II) who were 2 to 12 months postsurgery and were receiving chemotherapy or radiotherapy.
CB Group
RGI Group
Control Group
The study was conducted at a large oncology department in northern Israel.
Patients were undergoing the active treatment phase of care.
The study was a randomized, controlled trial with three groups:
• CB (n = 38)
• Relaxation and guided imagery (n = 39)
• Control (n = 37).
Fatigue Symptom Inventory (FSI)
Means of the fatigue symptoms declined in both intervention groups between pre- and posttest time points, but only the decline in the RGI group was statistically significant. Similar results were observed at the four-month follow-up, and fatigue means remained significantly lower in the RGI group compared to the CB and control groups.
Study participants may have been more motivated or suffered from less psychological distress than those who did not agree to participate; therefore, the generalizability of the results is questionable. Four-month follow-up may have been too short. The authors did not measure the compliance of patients in the intervention protocols (i.e., using audiotapes on their own time).
Cohen, M., & Kuten, A. (2006). Cognitive-behavior group intervention for relatives of cancer patients: A controlled study. Journal of Psychosomatic Research, 61, 187–196.
To compare the effectiveness of a cognitive behavioral (CB) group intervention for relatives of patient with cancer with a control group
The cognitive behavioral (CB) intervention consisted of nine structured, 90-minute group sessions. Individual groups had five to seven participants and were conducted by a senior social worker with psycho-oncology experience as well as training in group therapy and CB therapy. Participants were provided written materials at every session and audiocassettes or compact discs for home practice of relaxation with guided imagery. The CB intervention had a cognitive and a behavioral component. Cognitive techniques were taught to identify and challenge negative and automatic thinking patterns and beliefs. Participants were taught to restructure thoughts into more adaptive patterns, reframe, problem-solve, and find alternative strategies to use with recurrent and stressful situations. Behavioral techniques taught were relaxation, guided imagery, and deep breathing.
Active antitumor treatment
A repeated measures, controlled trial design was used.
There were significant group X time interactions for all of the psychosocial variables in the CB group but not in the control group. Significant main group effects were for psychological distress, psychosocial adjustment, and sleep problems but not for perceived support in the CB group but not the control group. Significant main time effect was for sleep difficulties and psychosocial adjustment. The between group effect size difference was 0.11–0.18.
There were significant improvements in perceived support from time 1 to time 3 (p < 0.0001) for the CB group but not for the control group.
Reliable Change Index (RCI) is a measure of clinical significance. RCI (6.5) showed clinically significant improvement in psychological distress from preintervention to follow-up in 30.8% (n = 16) of the participants in the CB group as compared to 3.9% (n = 2) of the participants in the control group. Psychological adjustment, sleep problems, and perceived support levels for the CB group were also clinically significant (for PAIS, RCI = 2.2; for sleep difficulties, RCI = 14.8; for perceived support, RCI = 3.2).
On average, the amount of thought monitoring was performed 2.7 (SD = 2.5) times per week at time 2 and 1.9 (SD = 1.7) times per week at time 3. Relaxation with guided imagery was performed 3.4 (SD = 3.8) (time 2) to 2.3 (SD = 2.9) times per week (time 3).
The results from this study indicate that the CB group intervention was effective in reducing psychological distress and sleep problems, and improving psychological adjustment for relatives of patients with cancer who participated. The CB intervention had a long-term effect that was maintained over the four-month follow-up.
Greater preintervention distress and a greater amount of home-practice thought monitoring and relaxation/guided imagery compliance were significant predictors of the total change in participants’ level of distress.
The CB intervention was administered by a social worker who was highly experienced and familiar with psycho-oncology, group therapy, and CB therapy. Consequently, the study social worker was highly prepared to administer this CB group intervention. This indicates that the individual administering the CB intervention should be highly trained to replicate the successes of this research.
The CB group intervention can be effective for improving psychological distress, psychological adjustment to illness, and sleep difficulties of relative caregivers of patients with cancer. This intervention can have both short-term and long-term psychosocial effects. Nurses can provide referrals for a CB intervention for highly distressed caregivers or those who are having sleeping problems and issues with adjustment to their relatives’ illness.
Further research is needed to replicate this study using a randomized controlled design. Additionally, an abbreviated CB intervention for relatives of patients with cancer needs to be developed for caregivers who have time constraints.
Cohen, L., Warneke, C., Foulacli, R.T., Rodriguez, M.A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253–2260.
Yoga intervention was a seven-week Tibetan yoga (TY) program provided to patients with lymphoma who were undergoing active treatment or who had concluded treatments within the past 12 months. The TY intervention consisted of stress-reduction techniques, including:
TY classes were conducted by an experienced TY instructor. After each class, participants were given an audiotape that walked them through all of the techniques. They were encouraged to practice the techniques at least once per day.
Patient characteristics used for group assignment were the type of cancer (Hodgkin or non-Hodgkin lymphoma), the status of treatment (active treatment or completed), gender, age, and baseline state anxiety scores. The allocation process was concealed from investigators. Patients were randomized and notified of their group assignment by telephone. Three separate cohorts of patients were assigned to either the TY group (n = 20) or the wait group (n = 19). The wait group was offered the program three months after the last follow-up assessment was completed. (One participant dropped out of study before attending any classes; therefore, 19 were evaluated.)
Measures were taken at baseline, one week, one month, and three months after the last session.
The study reported on 39 patients with lymphoma.
A randomized controlled trial design was used.
There were no statistical differences between groups on the measures of psychological adjustment (intrusion or avoidance, state anxiety and depression) and fatigue. However, the TY program reduced patients’ sleep disturbances (p < 0.004).
Cochrane, B.B., Lewis, F.M., & Griffith, K.A. (2011). Exploring a diffusion of benefit: Does a woman with breast cancer derive benefit from an intervention delivered to her partner? Oncology Nursing Forum, 38, 207–214.
To provide preliminary data on the diffusion of psychosocial benefit (anxiety, depressed mood, and marital quality) for women diagnosed with breast cancer when only their partners received a psychoeducational intervention focused on the breast cancer experience
Five group sessions focusing on stress-reduction and interpersonal communication were delivered to the patient’s partner. The program focused on enhancing partner adjustment to the breast cancer experience and skill training to enhance the diagnosed woman’s perceived support. Sessions focused on stress-reduction strategies, enhancing listening skills, and resisting a tendency to fix or reassure prematurely, along with nonverbal strategies to enhance their interpersonal connection.
Patients were undergoing the diagnosis phase of care.
A pre/post-test design was used.
Average patient state anxiety score improved from 44.1 preintervention to 31 postintervention (p = 0.01).
There is preliminary support for a diffusion of benefit to the diagnosed woman when a psychoeducational intervention is delivered to her partner in terms of depression and anxiety.
Findings may not be applicable to other socioeconomic or education level groups.
Clover, A., & Ratsey, D. (2002). Homeopathic treatment of hot flushes: A pilot study. Homeopathy, 91, 75–79.
The study intended to evaluate the efficacy of homeopathy in managing menopausal symptoms.
Six homeopathic medications were “most prescribed”: Amyl nitrosum, Calcium carbonate, Lachesis, Natrum mur, Pulsitilla, and Sepia.
Thirty-one (31) participants completed the initial consultation and one follow-up visit. Three groups of subjects were included:
The study was an uncontrolled, pilot outcome study of homeopathic treatment of hot flashes, stratified for breast cancer (yes versus no) and tamoxifen use (yes versus no).
Questionnaires assessing frequency and severity of hot flushes and changes in conventional medications that might influence hot flushes were completed at initial consultation and at follow-up visits.
The number of participants that reported improvement in hot flush frequency and severity were as follows: Group 1: 8 (73%), 8 (73%) Group 2: 6 (86%), 6 (86%) Group 3: 10 (77%), 10 (77%). There was a “clinical impression of useful benefit.\"
Study limitations included small sample size (31 participants), failure to indicate age of participants or cause of menopausal symptoms, use of unvalidated questionnaire,i nconsistent follow-up, no descriptions of homeopathic medications.