Dalton, J. A., Keefe, F. J., Carlson, J., & Youngblood, R. (2004). Tailoring cognitive-behavioral treatment for cancer pain. Pain Management Nursing, 5, 3–18.
Participants received standard cognitive-based therapy, profile-tailored cognitive-based therapy, or usual care. Those in both therapy groups received 5- to 50-minute sessions. Standard cognitive-based therapy includes comprehensive cognitive and behavioral therapy that evaluates thoughts, feelings, and behaviors. It uses six to eight treatment strategies to teach patients to understand the relationship between pain, suffering, and emotions; to use symptom coping skills, problem-solving, relaxation, and self control; and to modify cognitive distortions associated with emotional distress. Profile-tailored cognitive-behavioral therapy (CBT) matched patient scores on the Biobehavioral Pain Profile (BPP) to specific CBT modules: environmental influences, loss of control, health care avoidance, past and current experience, physiological responsitivity, and thoughts of disease progression.
One inpatient and three outpatient cancer centers in the Southeastern United States
Participants were undergoing the active treatment phase of care.
The study was a randomized trial.
Profile of Mood States (POMS) Symptom Distress Scale
No significant effects on fatigue were found.
Dahlen, T., Kalin, M., Cederlund, K., Nordlander, A., Bjorkholm, M., Ljungman, P., & Blennow, O. (2016). Decreased invasive fungal disease but no impact on overall survival by posaconazole compared to fluconazole prophylaxis: A retrospective cohort study in patients receiving induction therapy for acute myeloid leukaemia/myelodysplastic syndromes. European Journal of Haematology, 96, 175–180.
To investigate the effects of changing from floconazole to posaconazole on the incidence of invasive fungal disease (IFD) and survival
Data were obtained from medical records for analysis. From 2008 to March 2011, primary antifungal prophylaxis was fluconazole 100–200 mg daily. In 2011, prophylaxis was changed to posaconazole 200 mg three times per day. Fungal prophylaxis in most cases was done only during neutropenia. Wards were not equipped with HEPA filters. Bacterial prophylaxis with ciprofloxacin was used during neutropenia in 80%–90% of patients. In 283 patients, comparison of results with posaconazole versus fluconazole was done.
PHASE OF CARE: Active antitumor treatment
Retrospective cohort comparison
IFD was defined according to the revised 2008 European Organization for Research and Treatment of Cancer (EORTC) definitions.
The incidence of IFD was signficantly lower at day 100 and at the end of patient follow-up (p < 0.01). The incidence of aspergillosis (p = 0.01) and invasive candidiasis (p < 0.05) were also lower in those given posaconazole. Antifungal therapy was more common in the fluconazole group (p < 0.01). There was no difference in overall survival at day 100 or at the end of follow-up.
The use of posaconazole for primary antifungal prophylaxis was more effective for reduction in IFD compared to fluconazole.
Posaconazole was shown to be more effective than fluconazole for the prevention of IFD in high-risk patients; however, the retrospective nature and other design factors limit the validity of this study. A variety of research is aimed at the determination of the most effective antifungal agents for prophlyaxis. Additional research is needed to determine if specific antifungals are more effective overall.
Daeninck, P., Gagnon, B., Gallagher, R., Henderson, J.D., Shir, Y., Zimmermann, C., & Lapointe, B. (2016). Canadian recommendations for the management of breakthrough cancer pain. Current Oncology, 23, 96–108.
RESOURCE TYPE: Evidence-based guideline
Not clearly listed in article. Article focused on the consensus points and education points. Prior to those sections, a general section regarding the literature was included.
Understanding BTCP is vital for nurses to adequately manage pain. Nurses need to be aware of the available guidelines since they are usually at the sharp end of managing pain. With this knowledge, nurses can educate patients and families regarding the proper use of medications to manage pain, specifically BTCP.
Dadu, R., Zobniw, C., & Diab, A. (2016). Managing adverse events with immune checkpoint agents. Cancer Journal, 22, 121–129.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Expert opinion
Literature review of common checkpoint inhibitors adverse events. No quality review provided.
Further education needs to be available on the toxicity profile related to immune checkpoint inhibitors, and obtaining a detailed personal and family history of autoimmune diseases, other comorbidies, concurrent medications, PE, and medications of patients is important prior to starting therapy.
da Costa Miranda, V., Trufelli, D. C., Santos, J., Campos, M. P., Nobuo, M., da Costa Miranda, M., . . . del Giglio, A. (2009). Effectiveness of guaraná (Paullinia cupana) for postradiation fatigue and depression: results of a pilot double-blind randomized study. Journal of Alternative and Complementary Medicine, 15, 431–433.
To evaluate the effectiveness of guaraná in fatigue and depression in 36 patients with breast cancer undergoing adjuvant radiotherapy.
Patients were randomized to 75 mg guaraná daily or placebo for two weeks, and then switched to the opposite treatment for the last two weeks of radiotherapy. Randomization was centralized by a pharmacist.
Patients were recruited at Faculdade de Medicina da Fundação do ABC.
The study was a randomized, controlled crossover trial.
No significant differences existed between the two groups on any of the scales. In addition, no side effects were reported from the guaraná.
This study showed no effect from guaraná on fatigue for this population.
The study used patients who reported no fatigue at the beginning of the study.
A currently fatigued population may be worth exploring with guaraná. Patients using guaraná for fatigue should be educated about the research findings.
da Silva Leal, N.F., Carrara, H.H., Vieira, K.F., & Ferreira, C.H. (2009). Physiotherapy treatments for breast cancer-related lymphedema: A literature review. Revista Latino-Americana De Enfermagem, 17(5), 730–736.
To present physiotherapy modalities applied for lymphedema therapy through a systematic literature review
Databases searched were Latin American and Caribbean Literature (LILACS), PubMed, and SciELO, covering periods from 1981–2009, 1951–2009, and 2001–2004, respectively. Also, data from physiotherapy textbooks were surveyed. Search keywords were post mastectomy lymphedema, physiotherapy upper limb lymphedema, complex decongestive physiotherapy, and manual lymphatic drainage. Inclusion and exclusion criteria were not described.
No description was provided of the total number of studies reviewed initially, of how identified articles were assessed, or hwo studies were selected and evaluated.
Physiotherapy used for lymphedema treatment includes complex decongestive therapy (CDT), pneumatic compression (PC), high-voltage electrical stimulation (HVES), and laser therapy. Better results are obtained with combined techniques. CDT is the most used protocol, and its association with PC has demonstrated efficacy. The new techniques HVES and laser demonstrate satisfactory results.
CDT has the strongest scientific support. Its application together with PC has demonstrated efficacy, and new techniques with satisfactory results are being studied, such as HVES and laser therapy. Combined physiotherapy techniques produce the most beneficial effects.
Clinicians should select the best combination based on a detailed assessment of individual cases.
da Costa Miranda, V., Trufelli, D.C., Santos, J., Campos, M.P., Nobuo, M., da Costa Miranda, M., … del Giglio, A. (2009). Effectiveness of guarana (Paullinia cupana) for postradiation fatigue and depression: Results of a pilot double-blind randomized study. Journal of Alternative and Complementary Medicine, 15, 431–433.
To evaluate the effectiveness of guarana in the treatment of the fatigue and depression of patients with breast cancer who are undergoing adjuvant radiation therapy
Guarana, a plant native to the central Amazon, is known for its stimulant properties. The study involved three phases. Investigators randomized patients at the start of adjuvant radiation treatment (RT) to either guarana or placebo (phase 1). Halfway through RT, crossover occurred from placebo to guarana and vice versa (phase 2). Protocol terminated at end of the 28th RT (phase 3) for both groups. Assessments occurred three times, once at the start of each phase. The total time of the trial was 35 days. A dose of 75 mg/day guarana was administrated.
Active treatment
Double-blind randomized design with crossover
Findings did not support the use of guarana for the treatment of depression or fatigue in cancer patients.
Due to the limitations noted, this study does not support valid nursing conclusions.
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.