The study was conducted to determine if vitamin E (alpha-tocopherol) could improve cognitive function in patients with nasopharyngeal carcinoma and temporal lobe radionecrosis.

Participants were administered 1,000 IU of vitamin E twice daily for one year. Assessments were conducted prior to the initiation of vitamin E dispensal and after the completion of one year of treatment.

• The total number of study participants was 29.
• There were 19 participants in the treatment group and 10 in the control group.
• Participants had stable nasopharyngeal cancer without recurrence for more than five years. They had no mental, speech, or psychiatric problems.  
• The control group was matched for age, education, radiation dose, amount of time since radiation, and lesion volume.
• The mean age of the treatment group was 57.95 ± 9.32 years.
• The mean age of the control group was 57.1 ± 13.91 years. 
• The control group was 50% male and 50% female.
• The treatment group was 75% male and 25% female.

The study was a single-site project at the neurology clinic of Queen Elizabeth Hospital in Hong Kong.

The study employed a pre- and post-test design with a treatment and control group.

• Cantonese version of the Mini-Mental State Examination (MMSE) for global cognitive functioning
• Chinese version of the Category Fluency Test for expressive language ability
• Hong Kong List Learning Test (HKLLT) for verbal memory
• Visual Reproduction subtest of the Wechsler Memory Scale III (WMS-VR) for visual memory
• Computerized reaction time test, developed by author A. Chan, for sustained attention
• Computerized Cognitive Flexibility Test, developed by author A. Chan, for cognitive flexibility
• Questionnaire on cognitive function. The questionnaire had 8 subjective items assessing attention, reading, writing, memory, visual motor ability, expressive ability, planning, and computation skills. Scores ranged from 8 to 40, points with higher scores indicating better perceived performance.

There was no significant difference in cognitive performance at baseline between the two groups. In the treatment group, there was significant improvement from baseline on

• global cognition as measured by the MMSE (p = 0.035)
• verbal memory as measured by the HKLLT (p = 0.036) 
• visual memory as measured by the WMS-VR (p = 0.007), including immediate recall (p = 0.001) and 30-minute delayed recall (p = 0.000).

Improved executive function was also measured in the treatment group, as seen in average reaction times (p = 0.001) and scores on the Cognitive Flexibility Test (p = 0.04); these improvements were not found in the treatment group. No significant differences were found in sustained attention for either group. There was a slight, but not statistically significant, increase in participant ratings after one year of treatment for the treatment group. The control group reported a slight worsening of function on their subjective ratings (p = ns).

Vitamin E may be a promising complementary intervention for improvement in verbal and visual memory, global cognitive function, and cognitive flexibility.

• The study had a small sample size.
• There was no randomization, blinding, or placebo.
• Gender may have impacted some test results, as there are known gender differences in neuropsychological test performance. The treatment group had three times more men than women.

• FINAL NUMBER STUDIES INCLUDED = 13
• TOTAL PATIENTS INCLUDED IN REVIEW = 1,138
• SAMPLE RANGE ACROSS STUDIES = 20–210 patients
• KEY SAMPLE CHARACTERISTICS: Most studies included only women with breast cancer. All participants received chemotherapy with or without radiation therapy or hormonal therapy. Most participants were aged about 55 years. The majority of studies were conducted in the United States. Most outcomes were evaluated in the short-term (i.e., less than three months).

PHASE OF CARE: Late effects and survivorship

Risk of bias was high in 11 studies but unclear in  two studies that evaluated psychostimulants.

Pharmacologic interventions: No improvements in cognitive function were found using psychostimulants (four studies) or ginkgo biloba. Patients reported better cognitive function using epoetin alfa with doses titrated for hemoglobin levels (p < 0.05). However, a death caused by a cerebrovascular accident was noted.

Nonpharmacologic interventions: Small-group memory training improved self-reported cognitive function, and both memory and speed of processing after small-group training improved immediate and delayed recall (p < 0.05). Home-based online executive function training improved verbal function and attention (p < 0.05). Speed-feedback therapy during biking improved executive and motor function (p < 0.05). Cognitive behavioral therapy-based interventions (two studies), Tibetan sound meditation, and hatha yoga did not improve cognitive function.

The pharmacologic studies reviewed did not support the use of psychostimulants or ginkgo biloba to improve cognitive function after chemotherapy for breast cancer. Epoetin alfa was not recommended for practice because of safety concerns. The nonpharmacologic studies reviewed provided some evidence that cognitive training and speed-feedback therapy might improve cognitive function for breast cancer survivors.

The risk of bias was high for most studies. Therefore, although positive results were found, well-designed, prospective RCTs need to be completed to confirm these findings. It is unclear how sustainable the positive results of the cognitive training and exercise interventions might be because follow-up was limited to less than three months.

This systematic review provided limited support for cognitive training and structured exercise to improve cognitive function after chemotherapy for breast cancer. Cognitive training is currently categorized as likely to be effective for cognitive impairment.

To determine the feasibility of using a combination of relaxation techniques and patient education (multidimensional psychoeducational intervention package) to alleviate (chemotherapy-induced nausea and vomiting (CINV) while estimating the effect size and assessing the research design feasibility and stability of the Morrow Assessment of Nausea and Emesis (MANE) and the Chinese version of the State-Trait Anxiety Inventory (STAI) in children

Two intervention groups and two matching control groups were followed for 60 days. Patients randomly were assigned to the relaxation (progressive muscle relaxation [PMR] and guided imagery [GI]) or the education group. Patients in the relaxation group received six sessions of daily PMR and GI training (days 0–5, 30 minutes per session) and daily self-practice for two months with a PMR and GI audiotape. Patients in the education group received two 30-minute sessions of patient and parent education on days 1 and 2 (risk assessment, antiemetic use, and meal planning). The usual care also was given to participating patients, which included antiemetic ondansetron intravenously as needed and diet advice (i.e., avoid spicy and greasy food, eat easily swallowed and digested food).

• N = 40 (10 relaxation, 10 education, and two control groups of 10 each)
• MEAN AGE = 8.6 years (range = 4–11 years)
• MALES (%): Not stated, FEMALES (%): Not stated 
• KEY DISEASE CHARACTERISTICS: Receiving chemotherapy; chemotherapy-naïve; able to understand Chinese; no brain metastasis; and no advanced-stage cancer

• SITE: Single site    
• SETTING TYPE: Multiple settings    
• LOCATION: Hong Kong

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Exploratory pre- and post-test control group pilot study

• Eight instruments were used.
• The occurrence of nausea and vomiting (primary) was assessed using the Morrow Assessment of Nausea and Emesis (MANE).
• The use of antiemetics was obtained from medical records.
• Child and parent anxiety was assessed using the Chinese version of the State-Trait Anxiety Inventory (STAI).
• Physiologic indices such as caloric intake (food diary), changes in body weight (measured daily before breakfast), performance status (0-100 Play Performance Scale), satisfaction with care (child and parent self-reported four-point Likert scale), pulse, and blood pressure (for group 1 only) were measured.
• Group 1 self-rated the usefulness of the intervention (child and parent), activity log, and daily PMR and GI practice.

Because of the small sample size, the findings were not confirmatory. A significant reduction in vomiting as a possible result of the relaxation exercise was reported on day 3 (the day most patients in the study experienced CINV and a lowered performance status and satisfaction with care). From days 2–7, fewer patients in both intervention groups vomited compared with the control groups. Anticipatory nausea and vomiting was experienced by 40% of patients prior to chemotherapy. The study was feasible, but it took 18 months to recruit 20 patients. Patients and parents prefered relaxation to the education intervention. MANE and STAI scales were easy to understand in Chinese, and there were no difficulties with completion.

Relaxation and education could reduce vomiting. Anticipatory nausea and vomiting also may be alleviated with relaxation techniques. The early intake of antiemetics controlled and decreased patients' experience of CINV.

• Small sample (< 30)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias(sample characteristics)
• Key sample group differences that could influence results
• Findings not generalizable
• Other limitations/explanation: The patients' anxiety levels were not stratified. Historical controls were used. Chemotherapy was of low emetogenicity. Two intervention groups were used to compare the effects of relaxation alone and education alone without a four-group factorial design. The study depended on patients' self-practice of PMR and adherence was not discussed.

Relaxation and patient education (major components of a combined psychoeducational interventions) are potential helpful for CINV and are accepted techniques. However, preventive measures provided before the commencement of chemotherapy are more helpful. Patients preferred relaxation for anxiety reduction over education.

To assess the feasibility of using relaxation and patient education

Patients were placed in group 1 or 2 (no randomization information). Group 1 received training of progressive muscle relaxation (PMR) and guided imagery (GI) with audiotapes daily on days 0–5, then practiced daily for two months. Group 2 received two 30-minute patient/parent education sessions on day 0 and day 2 focusing on risk assessment, antiemetic use, and meal planning. All subjects completed instruments at baseline (prior to chemotherapy), then daily for seven more days. At one and two months after the intervention, anxiety, compliance with PMR and GI (group 1 only), satisfaction with care, and quality of life were assessed. Pulse and blood pressure were reported in the findings but not listed in the procedure.

• N = 40–20 historical controls
• MEAN AGE = 8.6 years
• AGE RANGE = 4–11 years
• MALES: Not reported
• FEMALES: Not reported
• KEY DISEASE CHARACTERISTICS: The majority of children (n = 20) had acute lymphocytic leukemia, and 12 children had osteosarcoma. The remaining diagnoses were not reported.

• SITE: Single site
• SETTING TYPE: Hospital
• LOCATION: Hong Kong

• PHASE OF CARE: Active treatment
• APPLICATIONS: Pediatrics

• Clinical trial with pre and post-test design

• Morrow Assessment of Nausea and Emesis (MANE)
• Chinese version of A-State scale of the State-Trait Anxiety Inventory
• Play performance scale for children
• Physiological indices of caloric intake and changes in body weight
• Use of antiemetics
• Satisfaction with care—4-point Likert-type scale from 0 (unsatisfactory) to 3 (extremely satisfactory)
• Self-rating of intervention usefulness—6-point Likert-type scale from 0 (not at all useful) to 5 (extremely useful)
• Health diary to record PMR and GI practice

At baseline, group 1 had significantly lower anxiety than group 2 (p = 0.032). Group 1 had less vomiting on day 3 compared to the control group (p = 0.036). No significant differences of antiemetic use existed between the intervention and control groups. No significant differences existed in body weight, chemotherapy-induced nausea and vomiting (CINV), antiemetic use, quality of life, and caloric intake between groups. The health diaries indicated that the patients practiced PMR 3–4 times weekly at home with no significant changes in blood pressure or pulse. Patient and parents reported that the interventions were moderately useful.

This study is poorly designed, and the findings should be used cautiously. The authors reported that PMR and education can reduce CINV; however, no conclusions should be made except that further research is warranted.

• Small sample
• No randomization reports
• No discussion on how historical control cases were identified or what information was collected
• No discussion on how the intervention was performed in younger children
• No report on how blood pressure, pulse, body weight, and caloric intake were measured and recorded
• Whether data were provided by the child or parent is unclear
• Parents’ anxiety and satisfaction of care were discussed in the findings but not described in the procedure
• No discussion of missing data

The study is of too poor a quality to provide any implications for nurses. Well-designed research in this area is needed.

To examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue compared with usual care

A 40-minute educational intervention consisted of preparatory information; discussion of symptom experience; exploration of means of, and goals associated with, symptoms; advice on self-care strategies; and training and practice in progressive muscle relaxation. The educational package consisted of an audiotape and leaflets as well as discussion on the selected symptoms and their self-care management.

• The study reported on a sample of 140 patients.
• No data on patient age were provided, but inclusion criteria stipulated that participants be age 16 or older.
• The sample was 83% male and 17% female.
• Patients were diagnosed with stage 3 or 4 lung cancer and were scheduled to receive palliative radiation therapy.
• Mean duration of cancer illness was 4.4 months.
• Chest and mediastinum were the major sites of radiation therapy.
• Of the sample, 87% were married and 54% were retired.

• Single site
• Hong Kong

Patients were undergoing the active treatment phase of care.

A pre/post-test randomized controlled trial design was used.

• Visual analog scale to measure intensity of breathlessness
• Piper Fatigue Scale: 23-item intensity subscale (Chinese version)
• State-Trait Anxiety Inventory: 20-item A-state scale (Chinese version)
• Short Form-34 Health Survey functional ability subscale (Chinese version)

Univariate tests on anxiety showed a significant difference (p = 0.001) in the pattern of change over the course of time, with a very small effect size (partial eta² = 0.051).

Findings suggest that interventions such as those tested in the current study, including progressive muscle relaxation, education, and counseling, have significant effects on patterns of symptom change over time.

• Between-group differences were not analyzed or reported.
• The study yielded very small effect sizes.
• The study had no attentional control.
• The control group had more advanced stage of cancer (p < 0.05) compared to the intervention group and therefore had much higher attrition rates (42% versus 11%).
• Results reported gave information about pattern changes over time, but data provided did not give clear information regarding the direction of change associated with the intervention.

Progressive muscle relaxation and education may be helpful in managing anxiety, fatigue, and breathlessness in patients with cancer, but effects may be small.

To assess effects of interventions that orient patients and carers to a cancer care facility and to the services provided

• Databases searched were Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PsycINFO. Investigators also searched reference lists and abstracts from relevant proceedings. Specific journals were searched separately.
• Authors provide an extensive listing of search terms and specific search language for each database. In addition to all relevant terms for cancer, key terms included patient education, patient information, mass communications, audio, video, cassette, tape, dvd, compact disc, media, multi media, internet, website, pamphlet, booklet, and phone or print material.
• Studies were included in the review if they were randomized controlled trials (RCTs) and quasi-RCTs that compared the effect that orientation achieved in an intervention group with the effect achieved in a control group or compared one orientation intervention with another orientation intervention.

Initial searching identified 14,319 records. Investigators assessed 21 full-text articles for eligibility, and the systemaic review included a sample of four. Two studies were included in meta-analysis. Study quality was assessed using guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.

• The final sample of four studies involved 631 patients.
• Sample sizes were 31–304 and included new patients, over 18 years of age, with cancer.
• All studies allowed family and carers to receive the intervention along with the patient.
• Various diagnoses were represented.

• Studies were generally of low to very low overall quality.
• Components of the oreitnation programs were information about the healthcare team, a clinic tour, information about the facility (parking, hours of operation, etc.), description of clinical procedures, information about supportive services available, treatment-related information, and question-and-answer sessions.
• Formats used were written materials in all studies and videotape in one study. Interventions were delivered via mail or face-to-face. Timing of orientation varied. Intervention intensity could only be measured by length of time taken for reading or watching a video or duration of face-to-face interactions.

Effects of Interventions

• Knowledge and understanding: Two studies reported better knowledge and understanding with the intervention or risks, benefits, and side effects of treatment. Pooled analysis of these results gave a mean difference (MD) of –0.18, 95% CI –1.02 through 0.66.
• State anxiety: Two trials measured effect on state anxiety. Pooled analysis showed MD of –9.77, 95% CI –24.96 through 5.41. In one of these trials, there was a significant difference in trait anxiety between study groups at baseline.
• General anxiety: One trial measured general anxiety by using the Brief Symptom Inventory and found no differences between groups.
• Mood disturbance: Two trials evaluated general distress. Analysis showed significant difference in favor of the intervention group (MD = –8.96, 95% CI –11.79 through –6.13).
• Symptoms of depression: Three studies reported positive benefits of the intervention on symptoms of depression. Postintervention meta-analysis showed no difference in depression scores (MD = –0.4, 95% CI –2.95 through –2.15).

This review shows that orientation programs may reduce distress in patients with cancer at the beginning of their involvement with a cancer care facility, but the quality of the evidence is low. Orientation programs may have some effect on general distress and symptoms of depression; however, findings do not show significant effects on anxiety.

These findings are limited by the small number of trials included, low quality of studies, and high heterogeneity found related to some outcomes.

Orientation of the patient, the patient's family, and those who care for the patient may help to reduce a patient's symptoms of depression and level of distress; however, this study does not reveal strong support for these outcomes. The most effective format and timing of orientation approaches are unclear.

The purpose of the study was to evaluate the efficacy of sustained-release chlorhexidine (CHX) dressings versus standard dressings.

All adult patients admitted under the hematology service that were to receive chemotherapy and had a tunneled cuffed central intravascular catheter inserted were eligible for inclusion. After insertion, all tunneled intravascular catheters were randomized, but they were treated in the same manner with a sterile gauze and porous adhesive dressings until the exit site was dry and free from ooze. Those randomized to standard catheter exit-site treatment (control group) received no dressing in accordance with BCHS guidelines. The CHX group (intervention group) were treated with CHX dressings consisting of a 2.5 cm hydrophilic polyurethane foam disk containing CHX gluconate in a sustained-release formulation. These were applied to the exit site as soon the oozing had stopped following intravascular catheter insertion, and changed as needed or weekly until the catheter was removed. The same treatment was continued for the life of the catheter but if an intravascular catheter was removed and replaced, the new catheter was randomized. Exit site and tunnels were routinely examined on a weekly basis.

The primary endpoint of this study was the development of exit-site and/or tunnel infection. The secondary endpoint was removal of the catheter for infection. In total, 114 tunneled intravascular catheters in 95 patients were randomized from August 1998 to December 2001.

• The total sample consisted of 95 patients.
• Mean age of the control group was 49 years (range = 16–70); mean age of the CHX group was 50 years (range = 15–68).
• Chemotherapy infusion was a key disease characteristic
• Total catheters in the control group were 43. 
• Total catheters in the CHX group were 52. 
• Malignancies: acute nyeloid leukemia (17% control, 17% CHX), non-Hodgkin lymphoma (9% control, 11% CHX), myeloma (5% control, 9% CHX), acute lymphoblastic leukemia (3% control, 6% CHX), breast (2% control, 1% CHX), chronic myeloid leukemia (2% control, 1% CHX). Other malignancies (amyloidosis, Ewing sarcoma, renal cell carcinoma, myelodysplasia and aplastic anemia) accounted for 6% of the CHX group.
   

A single-site inpatient hematology unit

• There were multiple phases of care
• Clinical applications were for late effects and survivorship
   

Prospective, randomized

 All patients received a 10F vascular catheter with a surecuff tissue ingrowth, vitacuff antimicrobial cuff inserted percutaneously by a radiologist using the Seldinger technique.

Definitions used:

• Exit site infection: redness, pain, and tenderness at the exit site less than 2 cm from the skin along the intravascular catheter of sufficient degree to warrant antimicrobial therapy as judged by the attending medical team.
• Tunnel infection: pain, tenderness, and swelling over the subcutaneous tunnel more than 2 cm from the exit site.
• Bacteraemia: presence of one or more species of organism in two sets of blood cultures within 24 hours (both sets from peripheral vein or one set from peripheral vein and one from central catheter).
• Intravascular catheter-related bacteraemia: evidence of bacteraemia in the presence of fever but no recognized focus of infection, with the same organism recovered from the catheter tip as from the blood cultures or exit site.
• Suspected intravascular catheter infection: positive blood cultures drawn in the presence of fever (single measure higher than 38.5ºC or two measures higher than 38ºC) with no other recognized focus of infection, causing the catheter to be removed prematurely.
• Intravascular catheter infection: suspected catheter infection in which the culture of the tip yielded more than 15 colonies of the same organism as was found in the blood cultures drawn from either the catheter or from the periphery.
• Neutropenia: less than 0.5 x 10⁹ neutrophils/L

This study has shown  that the use of CHX dressings was associated with less exit site infections (OR = 0.13, 95% CI [0.04, 0.37], p < 0.001). The rate of premature catheter removal for these infections was reduced approximately three fold in the CHX group (OR = 0.23, 95% CI [0.07, 0.77]). The failures of the CHX dressing group were associated either with a very early occurrence after insertion of the catheter, suggesting that the infecting organisms were implanted at the time of catheter insertion, or with delays in application of the CHX dressing. Positive blood cultures occurred in fewer patients in the control group (p < 0.01) with less isolates of gram-positive organisms in the control group (p < 0.05).

This study demonstrated that use of the sustained-release CHX dressing was associated with reduced extralumenal catheter infections; however, it was not associated with fewer blood stream infections.

• Small sample size (less than 100 participants)
• There was a risk of bias favoring the CHX group because the clinical team was not blinded to treatment. 
• Results were reported in terms of patients and various time points and could have been more  clear if reported in terms of total or cumulative patient catheter days. 
• No results of defined outcomes such as suspected catheter infection, etc., were reported. 
• It is unclear how immunosuppressed the sample was in order to draw relevant conclusions.
   

Sustained-release CHX dressings may help to reduce some central line-associated infections in patients with cancer who are at risk and in whom other aspects of catheter insertion and care are in place.  Further well-designed research in this area is warranted.

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?
 

• Databases used were MEDLINE, Embase, CINAHL, and PsycINFO.
• Key words were exp psychosocial support, exp affective symptoms, and words connected to identify prostate cancer–based research.
• Studies that reported randomized clinical trials; described relevant interventions and outcomes; included at least 80% patients with prostate cancer or partners of patients with prostate cancer, or had separate analysis of prostate cancer patient data; and were published between December 31, 1999, and December 1, 2009 were included in the search.
• Studies that were not prostate cancer–specific or did not meet the 80% guideline; had irrelevant outcomes to study; lacked a randomized control trial or clear description of the trial; and were nonresponsive to systematic review questions were excluded.

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.   
 

• A total of 21 studies were included in the review.
• Sample range across studies was 32–526 participants (e.g., 263 couples).
• Of the 21 studies, 16 reported patient data only, 4 reported patient and caregiver/spouse data, and 1 reported caregiver/spouse data only. 
• Mean age of participants was 67 years.
• Most patients had localized prostate disease, with 76% undergoing surgery and 48% receiving radiation therapy to treat malignancy.
• Interventions were mostly supportive, with focus on education, cognitive reframing, or coping skills. Major focus for interventions included stress management, uncertainty, cancer/treatment information, symptom management (bowel/urinary function, sexual function), coping skills, and marital/relationship communication. Outcomes assessed included quality of life, mood, anxiety and depression, marital satisfaction, uncertainty, coping skills, symptom distress (fatigue, bowel/urinary function, sexual function), and caregiver strain.

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.

• The authors did not report results from several studies due to “noninterpretable” data.
• Most studies included North American men with high school or higher education and with localized disease.
• High attrition rates and small sample sizes limited the discovery of significant intervention effects.
• Lack of ethnically diverse samples, limited samples with men with advanced disease, and samples that included only heterosexual men all affect generalizability of findings.
• Key words used for the search may have limited the studies accessed.

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.

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.

• N = 132 caregivers   
• MALES: 12%, FEMALES: 88%
• KEY DISEASE CHARACTERISTICS: Various tumor types; disease stages and phase of care not reported
• OTHER KEY SAMPLE CHARACTERISTICS: 42% of caregivers were spouse or partner.

• SITE: Multi-site  
• SETTING TYPE: Home  
• LOCATION: Australia

• Randomized, two-group trial

• Distress Thermometer
• Brief Symptom Inventory-18
• Impact of Event Scale 
• Post-traumatic Growth Inventory for perceived positive life changes 

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.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Measurement/methods not well described
• Other limitations/explanation: With some instruments, whether only subscales were used in the study is not clear.

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.

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 reported on a sample of 134 patients.
• Median age was 72 years (range 34-93) for the methylnaltrexone group and 70 years (range 39-98) for the placebo group.
• The sample was 57% female (n = 36) and 43% male (n = 27) in the methylnaltrexone group, and 56% female (n = 40) and 44% male (n = 31) in the placebo group.
• Patients had advanced illness, such as terminal cancer or other end-stage diseases with a life expectancy of at least one month, and opioid-induced constipation.
• More than 50% of the study participants had a diagnosis of terminal cancer.

• Multi-site
• Inpatient
• 27 nursing homes, hospice sites, and palliative care centers
• United States and Canada

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.

• Global Clinical Impression of Change (GCIC)
• National Cancer Institute common toxicity criteria (NCI CTC), version 2.0
• Numeric pain rating scale (0 = no pain and 10 = worst possible)
• Modified Himmelsbach Withdrawal Scale

• Median time to BM was 0.5 hours in the methylnaltrexone group and 2 hours in the placebo group (p = 0.013).
• More patients in the methylnaltrexone group (75%) than the placebo group (29%) had a laxation response to at least one of the doses (p < 0.0001).
• In the methylnaltrexone group, 73.5% of patients on day 7 and 67.9% on day 14 rated their bowel status as better on the GCIC scale.
• During the study, fewer patients in the methylnaltrexone group than the placebo group reported use of some major classes of laxatives.
• The most common adverse events (AEs) among methylnaltrexone users were abdominal pain, flatulence, and vomiting. Most AEs were Grade 1 or Grade 2 on the NCI CTC.
• Mean total opioid withdrawal scores were unchanged.

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.