Kyphoplasty
Kyphoplasty involves the use of a balloon to help restore the shape of a damaged vertebra and the injection of cement. The procedure can re-establish the vertebra’s height and may relieve pain. (Johns Hopkins Medicine, 2019).
Johns Hopkins Medicine. (2019). Health: Kyphoplasty. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ky…
Doxycycline Mouthwash
Doxycycline is a tetracycline antibiotic that prevents the growth and spread of bacteria. It is used to treat a variety of infections; for example, pneumonia; infections spread by ticks, infected animals, or contaminated water or food; anthrax; and plague. Doxycycline is used with other medications to treat acne (American Society of Health-System Pharmacists, 2019).
American Society of Health-System Pharmacists. (2019). Doxycycline. Retrieved from https://medlineplus.gov/druginfo/meds/a682063.html
Yun, Y.H., Kim, Y.A., Lee, M.K., Sim, J.A., Nam, B.H., Kim, S., . . . Park, S. (2017). A randomized controlled trial of physical activity, dietary habit, and distress management with the Leadership and Coaching for Health (LEACH) program for disease-free cancer survivors. BMC Cancer, 17, 298-017-3290-9.
Study Purpose
To assess if cancer survivors’ physical activity, dietary habits, and distress management would benefit from a Leadership and Coaching for Health (LEACH) program
Intervention Characteristics/Basic Study Process
Participants were randomly assigned to the LEACH Program (LP) intervention group or the usual care (UC) control group.
LP group received a one-hour health education workshop (topics covered included physical activity, dietary habits, and distress management), a three-hour leadership workshop, and individual telephone coaching for 24 weeks. A total of 16 tele-coaching sessions were held: 30 minutes per week for 12 sessions, 30 minutes per 2 weeks for 2 sessions, and 30 minutes per month for 2 sessions.
The UC group was asked to continue their usual care and received a health education booklet on dietary habits, physical activity, and distress management, as well as a four-hour lecture on physical activity, dietary habits, distress management, and a screening for a second cancer.
Patient evaluations took place at baseline, 3 months, 6 months, and 12 months.
Sample Characteristics
- N = 206 cancer survivors
- AGE: 20 years or older
- MALES: 42 (20.39%)
- FEMALES: 164 (79.61%)
- CURRENT TREATMENT: Immunotherapy
- KEY DISEASE CHARACTERISTICS: Cancer survivors who completed primary cancer treatment within the last 24 months for breast, stomach, colon (other than rectal), and lung cancer within 18 months of completion of primary treatment.
- OTHER KEY SAMPLE CHARACTERISTICS: Platelet count of greater than or equal to 100,000/mm3, have serum hemoglobin of greater than or equal to 10 g/dl, and have not already met two or more behavioral goals aimed for in the study.
Setting
- SITE: Multi-site
- SETTING TYPE: Not specified
Phase of Care and Clinical Applications
PHASE OF CARE: Survivorship
Study Design
12 month randomized control trial, patients evaluated at 0, 3, 6, and 12 months.
Measurement Instruments/Methods
Cancer registry from 10 South Korean teaching hospitals; questionnaire based on the “Rules for National Cancer Prevention: Dietary Practice Guideline” and the Korean National Health and Nutrition Examination Survey data; METs (kcal/kg per week) for physical activity; Post-Traumatic Growth Inventory; Seven Habit Profile; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; Diener’s Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Impact of Events Scale-Revised; Medical Outcomes Study Social Support Survey; Ten Rules for Highly Effective Health Behavior
Results
There was no significant difference between the two groups; UC and LP for primary or secondary outcomes.
For primary outcome, UC and LP groups did not significantly differ in intake of fruit and vegetable intake, and physical activity, but differed at 12 months in post-traumatic positive growth (p = 0.065).
For secondary outcomes, from baseline to 3 months, the LP group showed a greater decrease in the anxiety score (p = 0.025), a greater increase in social functioning score (p = 0.018), and a greater decrease in appetite loss (p = 0.048) and financial difficulties (p = 0.036).
From baseline to 12 months, the LP group showed a decrease in fatigue (p = 0.065) and an increase in number of 10 Rules for Highly Effective Health Behavior adhered to by patients. Patient subjective cancer-induced stress in response to specific traumatic events, scored between UC and LP groups, were marginally significant from baseline to 12 months (p = 0.068).
Conclusions
Participants’ primary behaviors of physical activity and dietary habits did not change due to this program. Participants’ management of their anxiety, social functioning, and symptoms did somewhat improve.
Limitations
- Intervention expensive, impractical, or training needs
- Subject withdrawals ≥ 10%
- Other limitations/explanation: Dropout rate of 42 before baseline with an additional 55 by the end of the study. At 12 months, the final number of participants was 151, down from 248 at randomization.
Nursing Implications
Long-term cancer survivors partnering with healthcare professionals may be helpful in reducing distress and anxiety in cancer survivors who recently completed cancer treatment. Increased education and training is needed for the long-term cancer survivors to coach.
Sun, F.K., Hung, C.M., Yao, Y., Lu, C.Y., & Chiang, C.Y. (2017). The effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy. Cancer Nursing, 40, E39-E48.
Study Purpose
To measure the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in patients with breast cancer receiving chemotherapy
Intervention Characteristics/Basic Study Process
Two interventions. (a) muscle relaxation techniques using CD at least two times daily for 12 weeks, three visits in the hospital by the researcher who trained them in the practice of the MRT, and understood the techniques. (b) Therapeutic walking with a pedometer provided to patients. Walking technique and pedometer use taught by researcher. Asked to walk 90-120 minutes per week or three times per week for at least 30 minutes per session. Record steps, walking time, strength for 12 weeks. Control group: no intervention.
Sample Characteristics
- N = 87
- MEAN AGE: 54.1 years
- FEMALES: 100%
- CURRENT TREATMENT: Chemotherapy
- KEY DISEASE CHARACTERISTICS: Breast cancer
- OTHER KEY SAMPLE CHARACTERISTICS: Half had stage II breast cancer, half had been diagnosed for more than 1 year and had finished their chemotherapy. Most were not in relapse, had no psychiatric history, and were not using medication for depression.
Setting
- SITE: Multi-site
- SETTING TYPE: Multiple settings
- LOCATION: Surgical outpatient, surgical unit hospital in south Taiwan
Phase of Care and Clinical Applications
- PHASE OF CARE: Active anti-tumor treatment
- APPLICATIONS: Elder care
Study Design
Randomized control study
Measurement Instruments/Methods
- Center for Epidemiological Studies Depression Scale
- Beck Scale for Suicidal Ideation
- World Health Organization Questionnaire on Quality of Life
Results
The results showed no significant difference in any outcome variable in the pretest. The results of the post-test indicated that the two groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638, p < 0.05). The patients with breast cancer who participated in the three-month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE = 37) than those who did not (RC = 51.16).
Conclusions
No difference in groups on pretesting (initially). After intervention, the group with the intervention scored significantly differently only on the depression scale.
Limitations
- Small sample (< 100)
- Intervention expensive, impractical, or training needs
Nursing Implications
Nursing staff could teach and encourage the use of muscle relaxation techniques, as well as therapeutic walking to reduce depressive symptoms for patients undergoing chemotherapy.
Cheng, K.K.F., Lim, Y.T.E., Koh, Z.M., & Tam, W.W.S. (2017). Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database of Systematic Reviews, 8, CD011152.
Purpose
- STUDY PURPOSE: To determine if home-based, multidimensional survivorship (HBMS) programs help maintain or improve breast cancer survivors’ quality of life
- TYPE OF STUDY: Systematic review and meta-analysis
Search Strategy
- DATABASES USED: Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, World Health Organization’s International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov
- YEARS INCLUDED: (Overall for all databases) Final search results were 2006-2016
- INCLUSION CRITERIA: RCTs and quasi-RCTs using articles that appeared in peer-reviewed journal articles published in English, interventions with more than one of these components: educational, physical, and psychological interventions that were home-based, including delivery in-person, through telephone calls, Internet or multi-media, a validated instrument used to assess health related quality of life as an outcome
- EXCLUSION CRITERIA: Studies without a control group, women with stage IV breast cancer, lack of home-based component of intervention, lack of trained personnel or healthcare professional delivering intervention, lack of separate breast cancer survivors analysis, lack of quality-of-life assessments, lack of description of intervention
Literature Evaluated
- TOTAL REFERENCES RETRIEVED: 29,198
- EVALUATION METHOD AND COMMENTS ON LITERATURE USED: 29,198 studies were originally found by electronic search, and 25,907 were left after duplication removal. 25,740 articles were removed after exclusion and inclusion criteria, leaving 174 articles for full-text assessment. Further screening using inclusion and exclusion left 26 studies; 25 journal articles and 1 dissertation (8 ongoing studies) (1998-2015).
Sample Characteristics
- FINAL NUMBER STUDIES INCLUDED: 26
- TOTAL PATIENTS INCLUDED IN REVIEW: 2,272
- KEY SAMPLE CHARACTERISTICS: Women aged 18 years and older with a breast cancer diagnosis between stages 0-III and within 10 years of the completion of primary cancer treatment (surgery, chemotherapy, radiation therapy).
Phase of Care and Clinical Applications
PHASE OF CARE: Survivorship
Results
- Home-based multidimensional survivorship (HBMS) programs positively improve quality of life short-term, as measured by FACT-B and EORTC-C30 questionnaires (FACT-B: mean difference (MD) = 4.55, 95% CI [2.33, 6.78], 7 studies, 764 participants; EORTC: MD = 4.38, 95% CI [0.11, 8.64], 6 studies, 299 participants)
- HBMS may reduce anxiety, fatigue, and insomnia as measured by HADS, BFI, and ISI. HBMS programs may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) = -1.01, 95% CI [-1.94, -0.08], 5 studies, 253 participants). There was no evidence of improvements in depression after HBMS (MD of HADS = -1.36, 95% CI [-2.94, 0.22], 4 studies, 213 participants). HBMS programs may also decrease fatigue (MD = -1.11, 95% CI [-1.78, -0.45], 3 studies, 127 participants) and insomnia (MD = -1.81, 95% CI [-3.34, -0.27], 3 studies, 185 participants)
- Quality of life with educational, psychological, or physical intervention components showed no difference in improvement.
- Improvement of physical, emotional, and functional quality of life was most effective with group-based intervention.
Conclusions
HBMS programs in breast cancer survivors were found to provide beneficial short-term improvement of breast cancer-specific quality of life and global quality of life. Also, immediately after the intervention, a reduction in anxiety, fatigue, and insomnia was assessed.
Limitations
- Mostly low-quality/high-risk of bias studies
- High heterogeneity
- Low sample sizes
- Sample bias
Nursing Implications
Group-based intervention was shown to be the most effective mode of delivery toward improving physical, emotional, and functional quality of life
Kozik, T.M., Hickman, M.C., Schmidt, S., Connolly, T.F., Paustenbach, K., Vosti, P., & Bhattacharyya, M. (2018). An exercise program to improve depression and sleep disorders in oncology patients: The SAD study. European Journal of Oncology Nursing, 37, 19–22.
Study Purpose
To evaluate the effect of a structured supervised outpatient exercise program on insomnia and depression in patients with cancer.
Intervention Characteristics/Basic Study Process
Patients were referred by their oncologist office to the program. Participants were consented, administered two instruments before and after, and then participated in a 90-minute structured, supervised exercise program two days per week. The exercise consisted of a warm-up, cardiovascular circuit training, strength training, and cool down. The program was for 10 weeks.
Sample Characteristics
- N = 75
- MEAN AGE: 59 years (SD = 10)
- MALES: 23.1%
- FEMALES: 59.7%
- CURRENT TREATMENT: Combination of radiation therapy and chemotherapy
- KEY DISEASE CHARACTERISTICS: Currently on treatment for any type of cancer
- OTHER KEY SAMPLE CHARACTERISTICS: Older than age 18, excluded if within 8 weeks of surgery, within 6 months of treatment, cognitive issues excluded
Setting
- SITE: Multi-site
- SETTING TYPE: Outpatient
- LOCATION: 40-facility Catholic healthcare system in Stockton, California
Phase of Care and Clinical Applications
PHASE OF CARE: Active anti-tumor treatment
Study Design
- Descriptive observational study
- Patients consented and enrolled
Measurement Instruments/Methods
- Insomnia measured with Athens Insomnia scale (AIS)
- Depression measured with Zung Self-Rating Depression Scale (ZSDS)
- Both tests administered on the first and last day of the 10-week program
Results
75 patients were enrolled and 40 completed the 10-week program. The study demonstrated a significant improvement in insomnia. Baseline scores (mean = 9.5; SD = 3.7) compared to final scores (mean = 6.3; SD = 3.5) showed (t = 4.468; p = 0.01). The significance level of 0.05 is over the 90%. The depression scores were also seen as significantly different from baseline (mean = 37.4; SD = 9.7) and final scores (mean = 33; SD = 9.7) (t = 2.427; p = 0.01). The significance of 0.05 is about 80%. The study team also evaluated those who did not complete the program and there was no difference. Depression scores at baseline were higher for those who did not complete the program.
Conclusions
This study showed improvement in depression and insomnia in patients with cancer who participated in a structured, supervised exercise program.
Limitations
- Small sample (< 100)
- Baseline sample/group differences of import
- Risk of bias (no control group)
- Risk of bias (no blinding)
- Risk of bias (no random assignment)
- Findings not generalizable
- Subject withdrawals ≥ 10%
Nursing Implications
Nurses should assess patients for insomnia and depression and provide appropriate referrals to structured exercise programs. The cost is low and many cancer centers have existing exercise programs for fatigue which could be combined with the mental health benefits. Nurses could encourage and participate in development of these programs with their healthcare and community fitness centers where none currently exist.
Fuller, J.T., Hartland, M.C., Maloney, L.T., & Davison, K. (2018). Therapeutic effects of aerobic and resistance exercises for cancer survivors: A systematic review of meta-analyses of clinical trials. British Journal of Sports Medicine, 52, 1311.
Purpose
- STUDY PURPOSE: To evaluate the effects of exercises and aerobic on cancer survivors
- TYPE OF STUDY: Meta analysis and systematic review
Search Strategy
- DATABASES USED: Web of Science, Scopus, Cochrane Library, CINAHL, Medline
- YEARS INCLUDED: 1988-2017
- INCLUSION CRITERIA: Adult diagnosed with cancer
- EXCLUSION CRITERIA: Not specified
Literature Evaluated
- TOTAL REFERENCES RETRIEVED: 65 articles for 140 meta-analyses reported
- EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Umbrella review following PRISMA
Sample Characteristics
- FINAL NUMBER STUDIES INCLUDED: 65
- TOTAL PATIENTS INCLUDED IN REVIEW: Not specified. Each category (cardiovascular fitness = 8,306 (55-1,310), muscle strength = 10,367 (241-1,244), fatigue = 59,233 (78-5,603), quality of life = 24,893 (78-2,357), depression = 13,538 (78-2,929); some patients are not reported in few articles.
- SAMPLE RANGE ACROSS STUDIES: See above in parenthesis for each category.
- KEY SAMPLE CHARACTERISTICS: Different type of cancer
Phase of Care and Clinical Applications
PHASE OF CARE: Not specified or not applicable
Results
The effects of exercises on thousands of patients in 140 meta-analyses are reviewed. The beneficial effect is statistically significant in 75% of the meta-analyses. The effect for cardiovascular fitness and muscle strength are classified as moderate, and the effect on fatigue, quality of life, and depression are classified as small. The incidence of exercise-related adverse event is very low (3.5%). The large majority of the studied cancer population are patients with breast cancer.
Conclusions
The study shows how exercises have an important role in the well-being of patients and survivors. It would be interesting to have another meta-analyses on different cancer populations and at different stages of the disease/treatment. It would also be interesting to have the results by gender.
Limitations
- Low sample sizes
- This study is mostly about patients with breast cancer
Nursing Implications
Nurses should encourage patients to have a physical activity. Cardiovascular markers and muscular fitness is improved with exercises as well as depression, fatigue, and quality of life to a lesser extent. In addition, it is relatively easy to find information on how to exercise.
Fisher, H.M., Jacobs, J.M., Taub, C.J., Lechner, S.C., Lewis, J.E., Carver, C.S., . . . Antoni, M.H. (2017). How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer. General Hospital Psychiatry, 49, 37-43.
Study Purpose
To determine the effectiveness of physical activity following surgery for breast cancer in improving depression and quality of life
Intervention Characteristics/Basic Study Process
Participants were randomized between a CBSM (cognitive behavioral stress management) intervention group (which corresponds to a 2 hours per week meeting for 10 consecutive weeks) and a single-day psychoeducational control group. The CBMS intervention consist in a structured intervention with relaxation and cognitive behavioral therapy, coping effectiveness training, assertiveness, and anger management.
Sample Characteristics
- N = 240
- AVERAGE AGE: 50.3 years
- FEMALES: 100%
- CURRENT TREATMENT: Other
- KEY DISEASE CHARACTERISTICS: Non-metastatic breast cancer; surgery for primary breast cancer in the 2-10 weeks prior to enrollment.
- OTHER KEY SAMPLE CHARACTERISTICS: More than 50 % have completed a college degree; more than 75% are married or partnered. Exclusion: Diagnosis of stage IV breast cancer or other cancer, except skin cancer
Setting
- SITE: Single site
- SETTING TYPE: Not specified
- LOCATION: Miami, Florida
Phase of Care and Clinical Applications
PHASE OF CARE: Active anti-tumor treatment
Study Design
Randomized control trial
Measurement Instruments/Methods
7-item Perceived Interference Subscale of the 12-item Fatigue Symptom Inventory, IBS for depression, 7-Item Functional Well-Being Subscale of the Functional Assessment of Cancer Therapy (FACT-B)
Results
Both the control and the intervention arm saw significant changes in clinician-rated depression and depressed mood (control: standardized B = 0.15; B = 0.29, p = 0.049; p < 0.001) (intervention: standardized B = 0.14; B = 0.29, p < 0.001;p < 0.001) with regard to FRDI; however, there were no significant changes in functional QOL with either arms with regard to FRDI.
Conclusions
The study shows that a moderate physical activity improves fatigue, depression, and quality of life for patients with breast cancer , and nurses should make a point of encouraging this. Future replications are needed, the sample chosen may already have the awareness of the health benefits of physical activity before the study was enacted.
Limitations
- Key sample group differences that could influence results
- Findings not generalizable
- Other limitations/explanation: The limitation can be seen in the fact that the data have been collected in a group of White, highly motivated, well-educated women. Those results should not be generalized to an entire population.
Nursing Implications
Nurses should encourage physical activity in patients with breast cancer.
Lundt, A., & Jentschke, E. (2019). Long-term changes of symptoms of anxiety, depression, and fatigue in cancer patients 6 months after the end of yoga therapy. Integrative Cancer Therapies, 18, 1534735418822096.
Study Purpose
To examine the long-term changes of anxiety, depression, and fatigue in patients with cancer six months after a yoga intervention
Intervention Characteristics/Basic Study Process
Gentle hatha yoga provided to the participants in small groups under supervision and guidance. 60 minutes once a week for 8 weeks total. Participants also received a CD and a printed manual to motivate training at home.
Sample Characteristics
- N = 58
- AVERAGE AGE: 58 years
- MALES: 10%
- FEMALES: 90%
- KEY DISEASE CHARACTERISTICS: 55% breast cancer, remaining other cancers (lymphoma, leukemia, colorectal cancer, ovarian cancer, and endometrial cancer)
Setting
- SITE: Single site
- SETTING TYPE: Inpatient
- LOCATION: Germany
Phase of Care and Clinical Applications
PHASE OF CARE: Active anti-tumor treatment
Study Design
Prospective observational one group pre-/post-test design
Measurement Instruments/Methods
Self-reported Generalized Anxiety Disorder Scale (GAD-7) to measure anxiety, Patient Health Questionnaire (PHQ-2) to measure depression, European Organization for Research and Treatment of Cancer QOL (EORTC) Questionnaire-Fatigue scale to measure fatigue
Results
There was a statistically significant reduction in the anxiety, depression, and fatigue levels after six months from the baseline. A small time effect on anxiety (SES = 0.22, CI [-0.3, 0.47]) and fatigue (SES = 0.27, CI [-0.11, 0.13]) indicating slight nonsignificant increase of symptoms. No time effect found in terms of depression (SES = 0.01, CI = [-0.11, 0.13]).
Conclusions
Although the study shows reduction in outcomes, studies with larger sample sizes with better study designs (i.e., RCT) are needed to confirm the findings.
Limitations
- Small sample (< 100)
- Risk of bias (no control group)
- Risk of bias (no blinding)
- Risk of bias (no random assignment)
- Risk of bias (sample characteristics)
- Key sample group differences that could influence results
- Questionable protocol fidelity
Nursing Implications
Yoga appears to have some benefit in reducing the symptoms of anxiety, depression, and fatigue, and the benefits may be lasting. Additional research with randomized studies will be important to confirm these results.