Ling, C.C., Lui, L.Y., & So, W.K. (2012). Do educational interventions improve cancer patients' quality of life and reduce pain intensity? Quantitative systematic review. Journal of Advanced Nursing, 68(3), 511–520.
To complete a systematic review to evaluate the effect of patient education on the pain intensity, pain interference, and quality of life of patients with cancer
The search retrieved 68 references. Authors considered 23 references. Authors evaluated studies on the basis of methodological quality assessment; two independent reviewers assessed all studies by using the Jadad scoring system. In the event of a discrepancy, a third reviewer evaluated the study. Data were obtained by means of the PICO (participants, interventions, comparison, and outcomes) approach. The study employed six different instruments to measure quality of life across four studies; two instruments were used to evaluate pain (three studies used the Brief Pain Inventory).
Clinical applications: late effects and survivorship, palliative care
Pain scores decreased as a result of the educational interventions in each study, but effects of education on quality of life were not statistically significant.
A limited number of studies evaluating effects of education on cancer pain and quality of life are available. Based on available studies, education about pain has little effect on quality of life in the specified patient population.
Ling, W., Lui, L.Y.Y., So, W.K.W., & Chan, K. (2014). Effects of acupuncture and acupressure on cancer-related fatigue: A systematic review. Oncology Nursing Forum, 41, 581–592.
PHASE OF CARE: All phases
Seven out of eight acupuncture studies showed improvement in CRF, but only four reached statistic significance. All four acupressure studies showed significant improvement. The four studies that showed improvement during initial treatment determined that results could be maintained for as many as 12 weeks. However, the maintenance study did not determine any extra benefit. Three studies reported no side effects. In other studies, adverse events were identified as minor and transient. Four studies used acupressure. These showed positive results. However, three studies were underpowered, and the comparability of study groups was questionable.
Acupuncture and acupressure may be helpful in reducing fatigue. However, because of multiple methodologic flaws in studies reviewed, no firm conclusions can be made regarding the effectiveness of these interventions.
Acupuncture and acupressure appear to be safe and may be effective. Therefore, this intervention may be suggested for patients with CRF. Additional research is needed to confirm their effectiveness.
Lindquist, H., Enblom, A., Dunberger, G., Nyberg, T., & Bergmark, K. (2015). Water exercise compared to land exercise or standard care in female cancer survivors with secondary lymphedema. Lymphology, 48, 64–79. Retrieved from https://journals.uair.arizona.edu/index.php/lymph/article/view/18783
To determine if water exercise was more effective than land exercise and the current standard of care to reduce limb volume, body mass index (BMI), and perceptions of swelling in female cancer survivors with secondary lymphedema
Physical exercise does not worsen lymphedema and, based on the results from this study, female cancer survivors with secondary arm lymphedema experience decreased volume, BMI, and self-reported frequency of swelling after water exercise compared to land exercise. Conclusions about the value of land or water exercise as an intervention for female cancer survivors with secondary leg lymphedema cannot be drawn from this study because of the small number of subjects in that group.
Water exercise can be beneficial to female cancer survivors with secondary arm lymphedema. Further interdisciplinary research is needed to design studies that will lead to the development of guidelines/protocols specific to exercise for cancer survivors with secondary arm and leg lymphedema.
Lindemalm, C., Mozaffari, F., Choudhury, A., Granstam-Björneklett, H., Lekander, M., Nilsson, B., . . . Mellstedt, H. (2008). Immune response, depression and fatigue in relation to support intervention in mammary cancer patients. Supportive Care in Cancer, 16, 57–65.
To examine the effect of a support intervention on immune function and levels of depression, anxiety, and fatigue in patients with breast cancer after completion of surgery and adjuvant treatment
A total of 41 women were chosen from an ongoing prospective randomized study. The first patients in each stratum of treatment were chosen for current study. Twenty-one women received adjuvant combined radio-chemotherapy (CT-RT), and 20 women received radiotherapy (RT). Eleven CT-RT patients and 10 RT patients were randomized to the support group, while 10 CT-RT and 10 RT patients served as controls. The support intervention consisted of educational lectures about cancer etiology, risk factors, treatment, psychological and physical effects, and coping. Exercise, relaxation training, qigong, and art therapy were also included. The intervention was provided for one week and then for another four days two months later. Study measures were obtained at baseline, 2 months, 6 months, and 12 months.
Patients were in the transition phase after initial treatment.
A randomized controlled trial design was used.
There was no significant immune effect from the support intervention. More patients in the support group had higher anxiety scores at the start of the intervention compared to the nonsupport group. The mean value anxiety score in the support group was also higher compared to the nonsupport group and improved significantly over time. Low levels of depression were reported in both groups, with no significant difference in depression scores. There was no significant difference in fatigue, but fatigue significantly improved over time in all patients. There were no significant differences in study measures between groups.
The support intervention had no effect on depression or immune parameters. There was no difference in improvement of anxiety and fatigue over time associated with the intervention.
Findings do not support effectiveness of the intervention tested here. Results show that depression, anxiety, and fatigue improved significantly over time.
Lindemalm, C., Mozaffari, F., Choudhury, A., Granstam-Björneklett, H., Lekander, M., Nilsson, B., . . . Mellstedt, H. (2008). Immune response, depression and fatigue in relation to support intervention in mammary cancer patients. Supportive Care in Cancer, 16(1), 57-65.
To examine the effect of a support intervention on immune function and levels of depression, anxiety, and fatigue in breast cancer patients after completion of surgery and adjuvant treatment
Authors chose 41 women from an ongoing prospective randomized study. The first patients in each stratum of treatment were chosen for the current study. Of the 41 women, 21 received adjuvant combined radiochemotherapy (CT-RT) and 20 women received radiotherapy (RT). Eleven women (CT-RT) were randomized to the support group, and 10 women (RT) were randomized to the support group. Ten CT-RT and 10 RT patients served as controls. The support intervention consisted of educational lectures about cancer etiology risk factors, treatment, psychological and physical effects, and coping. Exercise, relaxation training, qigong, and art therapy were also included. The intervention was provided for one week and, two months later, for another four days. Study measures were obtained at baseline, 2 months, 6 months, and 12 months.
Phase of care: transition phase after initial treatment
Randomized controlled trial
The support intervention had no effect on depression or immune parameters. The intervention did not appear to cause any difference in improvement of anxiety and fatigue over time.
Findings do not support effectiveness of the intervention tested here. Results show that levels of depression, anxiety, and fatigue reduced significantly over time.
Lindemalm, C., Strang, P., & Lekander, M. (2005). Support group for cancer patients. Does it improve their physical and psychological wellbeing? A pilot study. Supportive Care in Cancer, 13, 652–657.
A residential, rehabilitative, psychoeducational intervention was conducted over a six-day period, followed by a four-day follow-up/booster intervention two months after the initial visit. Members of the intervention team included oncologists, social workers, art therapists, massage therapists, and a person trained in qigong and visualization; all had several years of experience and were trained according to the method of Grahn (1993). During the intervention period, patients received information about cancer, risk factors, treatment, psychological effects, and coping mechanisms. Physical exercise, relaxation training, qigong, and art therapy were mixed with educational lectures. Social activities, such as concerts and visits to museums and restaurants, were provided, along with opportunities for peer support. The residential rehabilitation environment was chosen for its beautiful and restful surroundings.
The intervention venue was a residential rehabilitation setting selected specifically to deliver the intervention.
Patients were undergoing the long-term follow-up phase of care.
The study was uncontrolled—fatigue was evaluated immediately after the first six-day intervention, with follow-up at 3, 6, and 12 months postintervention.
Norwegian fatigue questionnaire—an 11-item measure with two factors: physical fatigue and mental fatigue. The total score is created by totaling the 11 items.
At the conclusion of the intervention, there were statistically significant differences in fatigue reflected on most of the single-item scores on the Norwegian fatigue scale, as well as a statistically significant difference in the scores on the physical and mental fatigue factors. Only the improvement in physical fatigue remained statistically significant at three-month follow-up, and there were no significant improvements in fatigue noted at the 6- and 12-month postintervention time points.
The program requires the involvement of several skilled professionals.
Lindemalm, C., Strang, P., & Lekander, M. (2005). Support group for cancer patients. Does it improve their physical and psychological wellbeing? A pilot study. Supportive Care in Cancer, 13, 652–657.
The residential, rehabilitative, psychoeducational intervention was conducted over a six-day period, followed by a four-day follow-up/booster intervention two months after the initial visit. Members of the intervention team included oncologists, social workers, art therapists, massage therapists, and a person trained in qigong and visualization; all had several years of experience and were trained according to the method reported by Grahn (1993). During the intervention period, participants received information about cancer, risk factors, treatment, psychological effects, and coping mechanisms. Physical exercise, relaxation training, qigong, and art therapy were mixed with educational lectures. Social activities, such as concerts and visits to museums and restaurants, were provided, along with opportunities for peer support. The residential rehabilitation environment was chosen for its beautiful and restful surroundings.
Residential rehabilitation setting selected specifically for the intervention
Patients were undergoing the long-term follow-up phase of care.
This was an uncontrolled study. Fatigue was evaluated immediately after the first six-day intervention, with follow-up at three, six, and 12 months postintervention.
The Norwegian fatigue questionnaire, an 11-item measure with two factors (physical and mental fatigue), was used. The total score was created by summing the 11 items.
At the conclusion of the intervention, there were statistically significant differences in fatigue reflected on most of the single-item scores on the Norwegian fatigue scale, as well as a statistically significant difference in the scores on the physical fatigue and mental fatigue factors. Only the improvement in physical fatigue remained statistically significant at three-month follow-up, and there were no significant improvements in fatigue at the six- and 12-month postintervention time points.
Lindblad, K., Bergkvist, L., & Johansson, A.C. (2016). Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents: A randomized controlled trial. Supportive Care in Cancer, 24, 2523–2531.
To evaluate the effects of interferential therapy and long-wave diathermy at high power (ITH) compared to long-wave diathermy at low power (LDL) on peripheral neuropathy (PN) pain, sensory, and motor symptoms among adults with chronic chemotherapy-induced peripheral neuropathy (CIPN) symptoms in the lower extremities who completed chemotherapy treatment for various cancers
Three-group, sham-controlled, randomized, controlled trial
There were no significant between-group differences at the 12-week and 37-week follow-ups in all outcomes: self-reported pain, discomfort, paresthesia/numbness, or balance, or in objectively measured balance. At the 12- and 37-week follow-ups, both groups reported significantly improved CIPN discomfort (p < 0.05), zones of paresthesia (p < 0.003), and subjective balance (p ≤ 0.025). Only the LDL group experienced improved pain at 12 weeks (p = 0.017), but neither group had significant improvements in pain at 37 weeks. Only the intervention group demonstrated significantly improved balance at 12 and 37 weeks, based on the objective measures (p ≤ 0.04).
This randomized, controlled trial provides no evidence to support the efficacy of interferential therapy and ITH compared to LDL once per week for 12 weeks for pain, CIPN discomfort, patient-reported balance, and objectively measured balance among participants with physician-diagnosed chronic CIPN.
No evidence supports the efficacy of interferential therapy and long-wave diathermy, and, currently, this intervention should not be recommended to patients with heterogeneous types of painful and nonpainful CIPN. However, evidence shows that CIPN symptoms and balance may recover for some patients by one year after completing treatment with neurotoxic chemotherapy. Additional studies of nursing interventions for CIPN are needed.
Linardou, H., & Gogas, H. (2016). Toxicity management of immunotherapy for patients with metastatic melanoma. Annals of Translational Medicine, 4, 272.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Expert opinion level only. The evidence is derived only from initial drug clinical trials.
Limited research evidence regarding interventions to prevent and manage side effects of immunotherapies exists, and most relies on corticosteroid treatment with increased dosing according to the severity of the side effects. Nurses need to be aware that diarrhea, in particular, with immunotherapy can lead to severe colitis, which can be life-threatening and require surgical removal of the colon. Patients need to be taught to report side effects promptly, and patients need to be monitored closely for these adverse events, with prompt intervention.
Lin, L. C., Que, J., Lin, L. K., & Lin, F. C. (2006). Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. International Journal of Radiation Oncology, Biology, Physics, 65, 745–750.
To determine whether zinc supplementation can accelerate the healing of mucositis and dermatitis after radiation therapy (RT).
There were two randomized groups: the experimental (group A) received 25 mg of zinc three times per day and the control (group B) received the placebo (n = 48).
The principle researcher was blinded. Evaluation and grading of mucositis and dermatitis was performed weekly during treatment andtwo weeks after completion of RT, including the weekends.
Chi-Mei Foundation Medical Center Tainan, Taiwan, China
The study was a randomized, double-blind, placebo-controlled trial.
Radiation Therapy Oncology Group (RTOG) scores for dermatitis
Oral zinc supplementation may delay the onset and reduce the severity of radiodermatitis.
The treatment design for the timing of the study was standard practice; it is not certain if one could correlate the study information to modern treatment delivery.