Chambers, S.K., Pinnock, C., Lepore, S.J., Hughes, S., & O'Connell, D.L. (2011). A systematic review of psychosocial interventions for men with prostate cancer and their partners. Patient Education and Counseling, 85, e75–e88.
To update a prior systematic review and address the following two clinical questions: (1) Do psychological and cognitive interventions improve psychological adjustment in men with prostate cancer? and (2) Do such interventions alleviate partner distress and improve quality of life in those men?
A total of 195 references were retrieved.
Following a literature search of chosen databases, two reviewers independently reviewed studies identified as relevant to the two study questions. Reviewers used previously published PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and national (Australian) research criteria to assess studies for inclusion in the systematic review. Study quality was poor, with few studies using double blinding, adequate concealment of treatment allocation, intention-to-treat analysis, and incorporating statements on allocation sequences for study participants. A higher proportion of studies completed after 2005 had sufficient concealment of allocation sequence than those completed before 2005. However, later studies had exclusions that were more likely to cause bias than earlier studies. Some of the 21 studies used in the systematic review did not include useful data to evaluate the intervention, did not collect baseline data, nor provide evidence of significant differences between intervention and usual care groups.
Transition phase after active treatment
Fourteen studies provided relevant information to answer the patient question (1). These studies indicated that group cognitive behavioral programs, with focus on stress management and long-term, nurse-led education and support, positively influenced improved quality of life for patients with prostate cancer. Men with localized disease experienced physical quality-of-life benefits (but not mental quality-of-life, mood, or cancer worry benefits) when exposed to stress management and education at the time of surgery. Four studies provided useful information to answer the caregiver/partner question (2): patient/caregiver dyads exposed to a psychoeducation intervention with a focus on coping skills reported improved quality of life. Nonsignificant or inconsistent results on intervention effects on patient uncertainty, hopelessness, and depression were found across studies. One study improved caregiver physical quality of life, uncertainty, and symptom distress in the short term, but patients did not experience significant benefits from the intervention.
Group cognitive behavioral interventions focused on stress management, led by an expert in psychology, and nurse-led psycho-educational interventions seem to support better psychological adjustment and quality of life of patients with prostate cancer with localized disease. Coping skills interventions appear to help patient/partner adjustment, although evidence remains limited to guide oncology practice. Limitations in studies used for this systematic review include limited samples of diverse individuals, those with advanced disease, and gay men needed to guide effective and equitable interventions and healthcare policy. Although common in North America and Australia, more peer-led interventions, particularly with late-stage survivors of prostate cancer, need to exist based on evidence of their success in decreasing patient isolation and providing information and emotional support. Additional studies must be conducted to validate effective ways, including healthcare structural and process change, to meet the emotional and quality-of-life needs of survivors of prostate cancer at various phases of the disease process and their caregivers.
Continued nursing research to identify successful and cost-effective programs to improve the quality of life of patients with prostate cancer and their partners must occur. This systematic review found inconsistent findings that advocate for rigorous studies that can offer guidelines for effective family-based and home programs using a variety of formats at various phases of prostate cancer.
Chambers, S.K., Girgis, A., Occhipinti, S., Hutchison, S., Turner, J., McDowell, M., . . . Dunn, J. C. (2014). A randomized trial comparing two low-intensity psychological interventions for distressed patients with cancer and their caregivers. Oncology Nursing Forum, 41(4), E256–E266.
To compare the effectiveness of nurse- and psychologist-delivered psychoeducational interventions for distressed patients and caregivers who had called a cancer helpline seeking support
Individuals who called the helpline were randomized to a five-session psychologist intervention using a cognitive behavioral approach or a single nurse-delivered session for education and support for self-management. All sessions were provided by telephone. Those in the single-session group were mailed a self-management resource kit, including written advice about stress management, problem solving, healthy lifestyle, and mobilizing support networks, along with an audio CD about relaxation exercises. All participants completed a baseline distress thermometer, and those who had a score of 7 or greater also received a follow-up phone call after the nurse session three weeks later. Study measures were obtained at baseline and at 3, 6, and 12 months. Caregivers and patients were not dyads because helpline calls were done individually.
Of the patients and caregivers, 93% completed the single-session intervention and 53% completed all five psychologist interventions. In the nurse arm, the mean intervention duration was 46.51 minutes, and the psychologist mean session duration was 46.43 minutes. Distress-related outcomes decreased over time, and positive adjustment increased over time in both groups. Effects size over 12 months was 0.19 in the nurse intervention group and 0.2 in the psychologist group. Cancer-specific distress decreased significantly over time for caregivers (p < .001), and positive adjustment increased (p < .001) with no significant difference between groups. Thirty-five percent of those in the nurse group received a follow-up phone call because of their distress score, and 3% were referred for additional support services.
Both the brief nurse contact for psychoeducation and self-management support and the telephonic CBT approach interventions provided by a psychologist were associated with reduction in distress and improvement in positive adjustment among caregivers of patients with cancer who had contacted a cancer helpline.
Findings suggest that caregivers, as well as patients, can benefit from a single-session nursing psychoeducational session provided by telephone and supported by self-management resource materials. Findings also showed that five telephonic sessions provided by a psychologist with a CBT approach also were helpful. Specifically, cancer-related distress can be approached effectively with a short, practical telephonic intervention for patients who identified a need for support by calling a helpline. Although this study has some design limitations in terms of sampling frame, it is very applicable for a real-world situation.
Chamberlain, B.H., Cross, K., Winston, J.L., Thomas, J., Wang, W., Su, C., & Israel, R.J. (2009). Methylnaltrexone treatment of opioid-induced constipation in patients with advanced illness. Journal of Pain and Symptom Management, 38, 683-690.
To describe laxative response to subcutaneous methylnaltrexone in patients with advanced illness and opioid-induced constipation.
Patients were randomly assigned to receive either methylnaltrexone 0.15 mg/kg or placebo subcutaneously every other day for two weeks. Patients were permitted to continue their baseline laxatives. By day 8, the study drug dose (methylnaltrexone or placebo) could be doubled if patients had fewer than three rescue-free bowel movements (BMs).
The study has clinical applicability for the end-of-life and palliative phases of care.
This was a post-hoc analysis of a two-week double-blind, randomized, placebo-controlled study.
Methylnaltrexone 0.15 mg/kg administered subcutaneously every other day was effective in relieving opioid-induced constipation.
Sixteen percent of patients (10 of 62) in the methylnaltrexone group and 24% (17 of 71) in the placebo group did not complete the study.
Subcutaneous methylnaltrexone 0.15 mg/kg appears to be effective in relieving opioid-induced constipation in a timely and predictable manner without reducing pain control or producing symptoms of opioid withdrawal. If an individual does not respond to the first dose, they may still receive some benefit with additional doses. However, the response rate decreased to 25% for individuals receiving a third dose in this study. Reasons for constipation other than opioid use may need to be looked for in nonresponders.
Challapalli, V., Tremont-Lukats, I.W., McNicol, E.D., Lau, J., & Carr, D.B. (2005). Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database of Systematic Reviews, 19(4).
STUDY PURPOSE: To assess lidocaine given in different doses in comparison with a placebo, diphenhydramine as a placebo, and active controls (morphine sulfate, ketamine, or amantadine). Mexiletine was compared to an inactive placebo and an active placebo (amitriptyline and gabapentin). Tocainide was used in one trial against carbamazepine. Pain was rated on an 11-point numeric rating scale (NRS).
DATABASES USED: MEDLINE 1996–2004; EMBASE 1980–2002; CancerLit through December 2002; Cochrane Central Register of Controlled Trials through the second quarter of 2004; System for Information on Grey literature in Europe (SIGLE) and LILACS 1996–2001; hand searches of conference proceedings, textbooks, original articles, and reviews
Intravenous lidocaine and its oral analog mexiletine were more effective than a placebo in decreasing neuropathic pain, were safe, and were as effective as other analgesics. The treatment effect was similar for both drugs. The analgesic effect was clinically important.
More than one half of the 29 trials were of low or fair methodological quality. One third did not adequately describe the method for random allocation, and 80% did not estimate the number of participants needed to have statistical power. However, some of these deficiencies could be because of incomplete reporting. Five trials did not describe exclusion criteria.
There is a need to study specific diseases and patient satisfaction to assess if statistically significant pain relief is clinically meaningful.
Chakrabarty, J., Vidyasagar, M., Fernandes, D., Joisa, G., Varghese, P., & Mayya, S. (2015). Effectiveness of pranayama on cancer-related fatigue in breast cancer patients undergoing radiation therapy: A randomized controlled trial. International Journal of Yoga, 8, 47–53.
To determine the effectiveness of pranayama yoga on fatigue during radiation therapy
Patients were randomized to receive only radiation therapy with routine care or to perform pranayama during radiation therapy. Those in the yoga group performed pranayama morning and evening five days per week for six weeks under supervision. Fatigue was assessed at the beginning and end of radiation therapy.
PHASE OF CARE: Active antitumor treatment
Randomized, controlled trial
Cancer fatigue scale
Post-test fatigue scores in the intervention group were lower (p = 0.001), and the intervention group had a significant decline in fatigue score (p = 0.001); however, all scores continued to be in the range of mild fatigue only.
Pranayama may be helpful to prevent or reduce fatigue during treatment with radiation therapy.
Participation in yoga during cancer treatment may be helpful to combat symptoms of fatigue. This is a low-risk intervention that nurses can suggest to patients to manage fatigue.
Chaftari, A. M., Hachem, R. Y., Ramos, E., Kassis, C., Campo, M., Jiang, Y., . . . Raad, I. I. (2012). Comparison of posaconazole versus weekly amphotericin B lipid complex for the prevention of invasive fungal infections in hematopoietic stem-cell transplantation. Transplantation, 94, 302–308.
To evaluate once weekly intravenous (IV) amphotericin B lipid complex (ABLC) given at a dose of 7.5 mg/kg as an alternative to posaconazole oral suspension (200 mg three times per day with food) for antifungal prophylaxis in hematopoietic stem cell transplantation (HSCT) recipients.
Patients were randomized to either the ABLC arm (N = 22) or posaconazole arm (N = 24). All patients were at risk for invasive fungal infection due to intensive chemotherapy for treatment of acute leukemia or lymphoma with a prolonged period of neutropenia expected or they were in the early phase after allogeneic HSCT. Patients were given ABLC 7.5 mg/kg once weekly over four to six hours or posaconazole oral suspension 200 mg three times daily with a high fat content meal for the duration of neutropenia. The study evaluated adverse events through the end of prophylaxis and up to two weeks thereafter. Study endpoints were the incidence of invasive fungal infections and drug-related toxicities. ABLC was discontinued if the creatinine level increased to two times the baseline or greater.
Patients were undergoing the active antitumor treatment phase of care.
This was a prospective, randomized, open-label, single-institution study.
Toxicities were measured using grades 1–4 based on Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Patient tolerability of the drug was also measured. Compliance to oral posaconazole and fatty meal intake were measured based on patient diary entries. Infusion-related toxicity (ABLC) was reported and recorded by the infusion nurse. Creatinine clearance for ABLC administration was calculated using Cockcroft-Gault formula. All patients were evaluated for clinical signs and symptoms and radiologic and mycological findings suggestive of invasive fungal infection during the study period (the duration of neutropenia).
Both groups were comparable for the rate of occurrence of neutropenia and its duration, steroid usage, tacrolimus therapy, and tacrolimus blood levels during prophylaxis. Both groups were comparable for the development of graft-versus-host disease. Nineteen patients in the ABLC arm and 20 patients in the posaconazole arm developed adverse events, including 18 drug-related events in the ABLC arm (nephrotoxicity, hypokalemia, hypomagnesemia, fever, chills, and headache) and 17 in the posaconazole arm (increase in liver function tests, hypokalemia, hypomagnesemia, nausea, vomiting, and diarrhea). The discontinuation rate from adverse events was 15 of 19 in the ABLC arm versus 8 of 20 in the posaconazole arm (p = 0.009). Lower creatinine clearance was noted in the ABLC arm (p = 0.006). Patients receiving ABLC experienced more chills (p = 0.04). Median duration of prophylaxis was significantly longer in the posaconazole arm (p = 0.04). One patient in the ABLC arm developed an invasive fungal infection compared to none in the posaconazole arm. The study was stopped early because the interim data analysis suggested that there was more than a 70% chance that the nephrotoxicity rate of the ABLC group was greater than 50%.
High weekly doses of IV ABLC may not be appropriate antifungal prophylaxis in allogeneic HSCT recipients due to potential nephrotoxicity, although it could be useful in less complex patients, such as those receiving therapy for leukemia (non-HSCT). Oral posaconazole can have erratic absorption, but it was shown to be safer than weekly ABLC in this study. Better prophylaxis is needed in patients who cannot tolerate oral medications.
* The findings are generalizable only to HSCT/hematologic malignancy patients, and only those with hematologic malignancies were included in the sample.
Because posaconazole is such an effective antifungal agent for prophylaxis (reinforced here), nurses must be vigilant in patient education. Patients must be given instructions to take the drug during or within 20 minutes of a full meal (preferably with high fat content) or liquid nutritional supplement or with an acidic carbonated beverage (i.e., ginger ale). There are many restrictions, and patient education is key to taking this drug and ensuring its efficacy.
Chaberny, I. F., Ruseva, E., Sohr, D., Buchholz, S., Ganser, A., Mattner, F., & Gastmeier, P. (2009). Surveillance with successful reduction of central line-associated bloodstream infections among neutropenic patients with hematologic or oncologic malignancies. Annals of Hematology, 88, 907–912.
The purpose of the study was to introduce prospective surveillance for nosocomial infections to improve prevention measures and reduce central line-associated blood stream infections (CLABSIs) in patients with hematologic malignancies.
Surveillance was performed for 18 months, after which the incidence rates for CLABSIs were calculated. Ward staff were then presented with the data and trained on measures to reduce CLABSIs according to national and international guidelines. During this time, they also implemented the use of chlorhexidine silver sufadiazine-coated catheters. Surveillance was then conducted for an additional 18 months.
Active treatment
This was a prospective surveillance (pre/post design) study.
During the first study period (prior to intervention), CLABSIs occurred at a rate of 24.3 per 1,000 neutropenic days. This rate was notably higher than the median of the comparator group (17.7 per 1,000 neutropenic days) during the same study period. Following intervention, the CLABSI incidence rate dropped to 16.2 per 1,000 neutropenic days, which was below the median of the comparator group (17.7 per 1,000 neutropenic days). The reduction was significant (odds ratio = 0.58; 95% confidence interal [0.34-0.99]).
Strict adherence to hand hygiene and other preventive guidelines when handling central lines in neutropenic patients can have a positive impact on lowering the incidence of CLABSIs.
As part of the intervention, staff education included demonstrating that CLABSI incidence rates at the facility were higher than at comparable centers. This approach provides motivation for changes in nursing practice.
Cerrone, R., Giani, L., Galbiati, B., Messina, G., Casiraghi, M., Proserpio, E., . . . Gardani, G. (2008). Efficacy of HT 7 point acupressure stimulation in the treatment of insomnia in cancer patients and in patients suffering from disorders other than cancer. Minerva Medica, 99, 535–537.
To evaluate the efficacy of HT 7 point acupressure for the treatment of insomnia in patients with cancer as compared to patients with medical illnesses other than cancer.
Patients were included if they reported sleeping disorders lasting at least three months, lacked response to benzodiazepine drugs, reported no chronic pain, and had no current drug therapy inhibiting the induction of sleep. Acupressure devices (H7 insomnia control, Consultream s.as., Como, Italy) were applied to both wrists starting at 10 pm each night for at least two weeks.
Not specified
The phase of care was not stated.
The study was a prospective, single-group trial.
Sleep quality improved in the first 10 days for 15 of 25 patients (60%). A greater number of oncology patients had improvements in sleep quality (79%) than those with other medical illnesses (36%), but this did not represent a statistical difference (no test statistic reported by the authors).
HT 7 improved insomnia in patients with cancer and other medical illnesses.
Further information is needed to accurately draw conclusions regarding the usefulness of acupressure in oncology patients.
Cerchietti, L.C., Navigante, A.H., Lutteral, M.A., Castro, M.A., Kirchuck, R., Bonomi, M., … Uchima, P. (2006). Double-blinded, placebo-controlled trial on intravenous L-alanyl-L-glutamine in the incidence of oral mucositis following chemoradiotherapy in patients with head-and-neck cancer. International Journal of Radiation Oncology, Biology, Physics, 65, 1330–1337.
Patients were randomized to receive IV L-alanyl-L-gluatime 0.3 g/kg (30 infusions in 5 patients) or 0.4 mg/kg (25 infusions in 5 patients), administered at a rate of 0.1 g/kg body weight/h. The principal endpoint was incidence of mucositis (mean of three highest scores by Objective Mucositis Assessment Score (OMAS) and highest grade on World Health Organization [WHO] scale).
The study used a two-step design. Patients were randomized first to different doses of the glutamine intervention, then to placebo (double-blind).
OMAS and WHO grading scale were used.
Measurement using both mucositis scales indicated a significant difference in intensity of mucositis.
Cerchietti, L. C., Navigante, A. H., Peluffo, G. D., Diament, M. J., Stillitani, I., Klein, S. A., & Cabalar, M. E. (2004). Effects of celecoxib, medroxyprogesterone, and dietary intervention on systemic syndromes in patients with advanced lung adenocarcinoma: a pilot study. Journal of Pain and Symptom Management, 27, 85–95.
Systemic-immune metabolic syndrome (SIMS) implies dysregulation of psychoneuroimmunoendocrine homeostasis, resulting in cachexia, anorexia, chronic nausea, early satiety, fatigue, tumor fever, cognitive changes, and superinfections (i.e., increased cytokines may increase cachexia-anorexia syndrome [CAS] and mediate anorexia).
The study included 15 adult outpatients with stage IIIb or IV lung adenocarcinoma.
Patients were included if they
The study was conducted in a community outpatient setting in Argentina.
The study used a pilot, open-label, uncontrolled convenience sample design.
Weekly measurements included
Cost of medications, polymeric diet, and cost of cytokine measurements should be considered.