Clark, M., Isaacks-Downton, G., Wells, N., Redlin-Frazier, S., Eck, C., Hepworth, J. T., & Chakravarthy, B. (2006). Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. Journal of Music Therapy, 43, 247–265.
The music-listening intervention included preferred music and recommended relaxation techniques (e.g., progressive muscle relaxation, imagery, and positive self-talk). Sessions were guided by a music therapist on a 90-minute cassette. Frequency of listening (dose) varied, but duration was not reported.
The study was conducted at a comprehensive cancer center, including a Veteran's Administration facility.
Not specified
This was a randomized trial in which patients were assigned to one of the two groups: the music therapy group (n = 35) or the control group (n = 28).
Fatigue increased from baseline to the end of treatment for both groups. No significant difference in intervention effects was observed. Fatigue, depression, pain, or anxiety showed a significant relation between frequency of listening and emotional distress. Higher use of music was associated with greater reduction in treatment-related stress.
Referral to a music therapist is necessary for the delivery of the intervention.
Cioch, M., Jawniak, D., Kotwica, K., Wach, M., Manko, J., Goracy, A., . . . Hus, M. (2014). Biosimilar granulocyte colony-stimulating factor is effective in reducing the duration of neutropenia after autologous peripheral blood stem cell transplantation. Transplantation Proceedings, 46, 2882–2884.
To determine the effectiveness of biosimilar granulocyte colony-stimulating factor (G-CSF) as compared to originator G-CSF in reducing the duration of neutropenia following autologous peripheral blood stem cell transplantation (APBSCT).
The study group received biosimilar G-CSF following myeloablative chemotherapy and APBSCT. G-CSF was initiated when the absolute neutrophil count (ANC) dropped below 0.5 and continued until the ANC exceeded 1.5 for three consecutive days. Hematopoietic recovery was compared to the control group, which had received originator G-CSF.
Prospective observational with historical control comparison
The primary comparator studied was duration of G-CSF treatment. Adverse events were also compared.
There was no significant difference between the biosimilar and originator G-CSF groups with respect to duration of therapy (p=0.43). The frequency of occurrence of the most common adverse events (neutropenic fever and bone pain) were also comparable.
Biosimilar G-CSF had been previously demonstrated to have similar efficacy and safety as originator G-CSF. This study confirms the value of using biosimilar G-CSF in a post-transplantation setting.
Biosimilar G-CSF therapy has similar efficacy to originator G-CSF in patients with ABPSCT, but with significant cost savings. Because patients and caregivers are typically unable to work during the prolonged transplantation process, financial stressors are a frequent concern. Lowering medical costs helps alleviate financial concerns for patients and insurers.
Cinar, N., Seckin, U., Keskin, D., Bodur, H., Bozkurt, B., & Cengiz, O. (2008). The effectiveness of early rehabilitation in patients with modified radical mastectomy. Cancer Nursing, 31(2), 160–165.
To evaluate the effects of the early onset rehabilitation program on shoulder mobility, functional capacity, lymphedema, and postoperative complications in patients who had modified radical mastectomy
Patients were randomly assigned to either the treatment group (n = 27) or home exercise program group (n = 30). In the treatment group, specific shoulder-hand-elbow range-of-motion exercises were performed under the supervision of a physiotherapist until the drains were out, then participants followed a physiotherapy program for eight weeks. In the home exercise program group, patients received a form that demonstrated how to perform the exercises by themselves after removal of the drains. Each exercise was taught by a physiotherapist until the exercise was performed properly. Both groups were informed about skin care and other issues that they should pay attention to during daily living activities. Each patient was assessed preoperatively and then postoperatively on the fifth day and one, three, and six months after by another physiotherapist who was blinded to the groups of the patients.
The setting was a single site in Turkey that included inpatient and outpatient.
The study used a randomized controlled trial design.
There were statistically significant time-related changes in all range-of-motion measurements and functional questionnaire scores in both groups. The differences over time in flexion, abduction, and adduction movements were significantly better in the treatment group compared with the home exercise program group (p < 0.01, p < 0.001, p < 0.005, respectively). The mean range of flexion and abduction returned to almost preoperative values more quickly in the treatment group compared with the home exercise program group. The recovery of upper-extremity functional questionnaire score was also significantly better in the treatment group compared with the home exercise program group (p < 0.05). There was no statistically significant variance in circumferential difference between the groups.
Early rehabilitation started on the first postoperative day did not have an adverse effect on local infection, hematoma, and seroma formation and did not cause an increase in duration and amount of lymphatic drainage.
Nurses and clinicians should remember to refer patients with breast cancer to a rehabilitation specialist. During the postoperative period, patients should be closely monitored to increase their adaptation and compliance to an early onset exercise program.
Cimprich, B., & Ronis, D.L. (2003). An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nursing, 26, 284–292.
To determine the efficacy of a natural restorative environmental intervention in counteracting cognitive or attentional fatigue in women with newly diagnosed breast cancer
Patients were randomly assigned to an intervention protocol after the first assessment and before any treatment. Intervention was comprised of a home-based program involving 120 minutes of exposure to the natural environment per week. Assessments were done approximately 17 days before surgery and 19 days after surgery. Intervention included the following:
1. Verbatim explanation of purpose and written summary in booklet form
2. Identification and selection of preferred activities from a compiled list of possible nature activities. Each participant also received a membership to the university botanical garden.
3. A written agreement signed by the participants stating that they would carry out the selected nature activities for at least 120 minutes per week
LOCATION: Midwestern university medical center
Longitudinal, randomized study
The intervention group scored significantly better than the nonintervention group on DSF (p = 0.04), DSB (p = 0.002), TMT-A (p = 0.001), TMT-B (p = 0.02), and the total attention score (p < 0.001). Other covariates such as age, years of education, symptom distress at time 2, extent of surgery, and presence of other health problems accounted for 54% of the variance in total attention score (p < 0.001).
Intervention group showed greater recovery of a capacity to direct attention from the pretreatment to the preadjuvant therapy period as compared to the nonintervention group.
Cid, J., & Lozano, M. (2007). Lower or higher doses for prophylactic platelet transfusions: Results of a meta-analysis of randomized controlled trials. Transfusion, 47, 464–470.
INCLUSION CRITERIA:
EXCLUSION CRITERIA: Children were excluded.
HDP groups showed a longer transfusion interval compared to the LDP group (p < 0.00001). Four studies with available data showed a significant increase in the transfusion interval when a high PLT dose was transfused. All transfused platelets were less than 24 hours old in one study and less than 72 hours old in another study. In two studies, the median number of days in which platelets were transfused was 3.71 and 2.3, respectively. In four of five trials, a significant increase in the post-transfusion PLT count increment was observed in the HDP group compared to the LDP group (p < 0.01). A significant increase in the proportion of bleeding patients was observed in the HDP group versus the LDP group. However monitoring of patients for bleeding varied, and methodologic challenges were encountered when analyzing the bleeding data. In addition, two of three trials were designed to analyze the efficacy of the transfusion of an HDP or an LDP; the presence of hemorrhage was a secondary endpoint. Only one trial was designed to look at the transfusion of lower-dose PLT in terms of safety. Outcomes only were available in three trials. No significant difference was observed in the OR of bleeding in the HDP or LDP group.
Two trials are being conducted that the authors hope will provide information to clearly define the optimal dose of PLTs to transfuse prophylactically in patients with thrombocytopenia.
Chung, V.C., Wu, X., Lu, P., Hui, E.P., Zhang, Y., Zhang, A.L., . . . Wu, J.C. (2016). Chinese herbal medicine for symptom management in cancer palliative care: Systematic review and meta-analysis. Medicine, 95, e2793.
STUDY PURPOSE: To summarize the results from randomized, controlled trials (RCTs) of the effectiveness of Chinese herbal medicines (CHMs) for managing fatigue, paresthesias, chronic pain, anorexia, edema, and constipation
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Elder care, palliative care
Combining CHM with chemotherapy may improve fatigue in patients with breast cancer. Adding CHM to conventional treatment may improve pain control. CHM alone may improve constipation.
Further research needs to be performed on CHM treating cancer- and cancer treatment-related symptoms.
Chung, C., Lee, S., Hwang, S., & Park, E. (2013). Systematic review of exercise effects on health outcomes in women with breast cancer. Asian Nursing Research, 7, 149–159.
The physical, psychological, physiologic, and behavioral aspects of the patients included in most of the studies were changed significantly by the exercise interventions. Physiotherapy improved range of motion, shoulder function, and pain, regardless of the intervention dosages. The effect of the interventions on lymphedema wasn’t apparent at six months but was visible at 12 months’ follow-up. Eight weeks of aerobic exercise was effective for psychological and behavioral outcomes through 24 weeks postintervention, but no significant long-term physical health effects were apparent. Aqualymphatic therapy affected emotional and social quality of life (QOL) but not physical QOL or limb volume. Dance and movement was not effective for lymphedema or health-related QOL. It only was effective for breast cancer-related QOL. Home-based rehabilitation improved some range of motion but did not affect pain, lymphedema, or strength.
Physical therapy is beneficial for shoulder range of motion when implemented soon after surgery. Any type of structured exercise could improve shoulder mobility, range of motion, and shoulder function in a relatively short period of time. The long-term effects of physiotherapy need to be studied more extensively. Multimodal exercise and comprehensive rehabilitation, including physical therapy, had physical and psychological effects. Aerobic exercise and dance and movement had a positive psychological effect. Exercise is essential to lymphedema treatment and management.
Few of the studies included long-term follow-up to measure the effects of the interventions on lymphedema development and severity.
Informing patients with breast cancer about the importance of exercise after receiving surgery and teaching patients ways to decrease the limitations that may occur after surgery is necessary.
Chujo, M., Mikami, I., Takashima, S., Saeki, T., Ohsumi, S., Aogi, K., et al. (2005). A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence. Supportive Care in Cancer, 13, 503–514.
The intervention was a six-week structured psychosocial support group of 90 minutes led by a male psychiatrist and nurses with experience in facilitation cancer groups. Each group member received
Measurements were done at baseline, then immediately following the six-week intervention, then three months and six months later.
Eleven women refused to participate but were interested in group intervention and consented to answering questionnaires. These women were given materials after completion of the survey and the PMR tape.
The study design was quasi-experimental without a control group.
Results in the intervention group revealed significant changes in scores for tension-anxiety on POMS in the period up to three months after the intervention; no differences were noted at six months after the intervention.
Chuang, C. Y., Han, W. R., Li, P. C., & Young, S. T. (2010). Effects of music therapy on subjective sensations and heart rate variability in treated cancer survivors: a pilot study. Complementary Therapies in Medicine, 18, 224–226.
To determine the effects of music therapy on subjective sensations and physiologic parameters of heart rate variability (HRV) in treated cancer survivors.The hypothesis was that music therapy significantly affects the sensations of fatigue, comfort, and relaxation, as well as the activities of the sympathetic and parasympathetic nervous systems.
Participants were asked to sit and rest for five minutes to stabilize their heart and respiration rates when they first arrived in the group therapy room. An electrocardiogram (ECG) signal then was measured for five minutes, and fatigue, comfort, and relaxation were rated subjectively on the visual analog mood scales (VAMS) as a pretest. After participating in two hours of music therapy, the same procedure was performed again as a posttest.
The two-hour music therapy intervention consisted of three activities. In the first activity, the program aimed at establishing a rapport between therapists and participants through singing and listening. The song for the first activity was a popular Taiwanese song called ‘‘He is Our Treasure,’’ which had pleasant moderate rhythm and tempo. The second activity was to learn how to play the recorder. This activity used simple musical instrument learning to establish the participants’ self-confidence. The third activity was to perform the main five notes of a familiar melody song, ‘‘Grandfather’s Clock,’’ following the therapist’s electric keyboard accompaniment and conduct. This activity sought to encourage the participants to express themselves through playing the recorder and to create light and joyful emotions.
The study used a pre-/posttest, quasiexperimental design.
Comparison of the quantitative HRV measures at pre- and posttest revealed that the high frequency (HF) power and normalized HF power were significantly higher, and the low frequency (LF)/HF ratio and normalized LF power of HRV were significantly lower at posttest than at pretest (p < 0.05). The VAMS mean value for the fatigue level was significant lower after music therapy (p < 0.05). The VAMS mean value for relaxation level was significant higher after music therapy (p < 0.05).
In a small sample size including varied cancer diagnoses with limited information about the study participants, the assessment showed changes in fatigue, relaxation, comfort, and HRV.
Additional research is needed, including the use of psychometrically tested symptom instruments. Based on the descriptive findings in this very small initial study evaluating HRV, fatigue, and relaxation, it may not be appropriate to include it in PEP topic research. This study was completed by colleagues in a biomedical engineering school. Describing the process of how this was accomplished (e.g., surveys with nurses assisting) might be useful.
Cho, Y., Do, J., Jung, S., Kwon, O., & Jeon, J.Y. (2016). Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection. Supportive Care in Cancer, 24, 2047–2057.
To assess the benefits of standard physical therapy (PT) compared to PT with manual lymph drainage (MLD) on lymphedema incidence, shoulder function, pain, and cording in patients with breast cancer with axillary web syndrome (AWS)
PHASE OF CARE: Late effects and survivorship
This was a prospective, randomized trial of patients with breast cancer who had undergone surgery and were randomized to two therapy interventions.
All patients benefited from postoperative PT, but patients who had PT and MLD did not develop lymphedema. Measurements were not taken weekly, so when the changes in arm volume occurred cannot be identified. This study supports wearing compression during therapy. Patients are at risk for lymphedema even when engaging in supervised exercise.
Nurses need to vigilantly monitor for symptoms of pain in the ipsilateral limbs of patients with breast cancer to prevent loss of function, chronic pain, and lymphedema. As seen in this study, even pain at level 3 is significant. Patients need early PT referral to prevent arm disability and early lymphedema therapy.