Fish, J.A., Ettridge, K., Sharplin, G.R., Hancock, B., & Knott, V.E. (2014). Mindfulness-based cancer stress management: Impact of a mindfulness-based programme on psychological distress and quality of life. European Journal of Cancer Care, 23, 413–421.
To explore the impact of mindfulness-based cancer stress management (MBCSM) programs on depression, anxiety, and stress in individuals affected by cancer with a secondary aim to evaluate the impact of MBCSM on quality of life and spiritual well-being
Four MBCSM programs were run for clients experiencing psychological distress related to cancer diagnoses. Each group consisted of 9–13 participants. The program consisted of eight, two-hour, weekly sessions in which mindfulness exercises were provided by an experienced counselor trained in mindfulness-based cognitive therapy. Participants also were asked to complete 40 minutes of meditation per day with the aid of notes, practice CDs, and home worksheets. A three-hour follow-up session was offered six weeks after the completion of the program. The program was modified to incorporate elements of the mindfulness-based stress reduction program developed by Jon Kabat-Zinn in 1990. Session 4 specifically included education about the psychoneuroimmunology of stress and an exploration of the cancer survivorship experience within the context of anxiety, depression, and stress.
Single-group, quasiexperimental study of participants directly and indirectly affected by cancer
Exploratory analysis indicated that there were no significant differences between baseline scores across sociodemographic groups. A series of Friedman tests indicated that there were significant differences in the levels of global psychological distress over time. Scores were significantly higher at baseline than postintervention for levels of global distress, anxiety, and depression. Global quality of life and spiritual well-being improved significantly over time. Emotional well-being and functional well-being were significantly higher postintervention than at the baseline assessment, which was maintained from baseline to follow-up (p = .001 and p = .001, respectively). Physical well-being improved from baseline to postintervention, which was determined to be significant at follow-up (p = .012). Mindfulness scores changed significantly over time. The level of mindfulness was significantly lower at baseline than postintervention, which was maintained through follow-up (p = .001).
Overall, the results of this study were positive with significant improvements in participants' levels of global distress, anxiety, and depression from baseline to postintervention. Improvements in psychological distress were sustained up to three months postintervention. This supports preliminary research on the effectiveness of mindfulness-based therapy in the treatment of cancer-related psychological distress.
Mindfulness training should be considered for patients with cancer to improve their levels of distress, anxiety, and depression. Mindfulness programs require trained personnel, and the program should involve an intervention over time with opportunity for follow-up over time.
Fiorentino, L., McQuaid, J. R., Liu, L., Natarajan, L., He, F., Cornejo, M., . . . Ancoli-Israel, S. (2009). Individual cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover pilot study. Nature and Science of Sleep, 2010, 1–8.
To examine the effects of six individual cognitive-behavioral therapy (CBT) sessions on sleep.
Individual CBT treatment consisted of six, one-hour weekly sessions comprised of education, behavioral components (sleep restriction, stimulus control, adhering to the sleep hygiene rules, and training in progressive muscle relaxation techniques), and cognitive interventions to counteract maladaptive thought. It also included homework assignments (sleep diaries and practicing behavioral and cognitive strategies) followed by six weeks of no-treatment follow-up. Data were collected at baseline and at the end of the first and second six-week components, and daily diary data were recorded during the treatment phase.
Patients were undergoing the long-term follow-up phase of care.
This was a randomized, controlled, crossover pilot study.
After six weeks, objective data (actigraphy) showed statistically significant differences in change scores between the treatment condition group and the delayed treatment control condition group on total sleep time, wake after sleep onset, number of awakenings per night, and percent of time asleep. There was a significant decrease in insomnia in the treatment group compared to the control group. Follow-up at six weeks showed continued improvement with a clinically significant decrease in PSQI scores. Cohen’s d effect size estimate for PSQI was large (d = 0.8).
These preliminary results suggest that individual CBT is appropriate for improving sleep in survivors of breast cancer.
If found to be effective, the intervention is potentially useful in several different settings.
Finnegan-John, J., Molassiotis, A., Richardson, A., & Ream, E. (2013). A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integrative Cancer Therapies, 12, 276–290.
To appraise the evidence of the effectiveness of complementary and alternative medicine (CAM) interventions in reducing cancer-related fatigue (CRF).
Databases searched were Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, British Nursing Index, and Evidence-Based Medicine Reviews (EBMR).
The specific MEDLINE search strategy was provided.
Studies were included in the review if
Studies were excluded from the review if they were psychosocial interventions.
In total, 2,398 references were retrieved. The Jadad scale was used to appraise study quality.
Patients were undergoing multiple phases of care.
During treatment, the intervention that seemed to be the most effective was hypnosis (one study), whereas ginseng provided promising results (one study). Massage, multivitamins, herbs, yoga, relaxation therapy, and combined education and acupuncture were less effective. Sound and reliable conclusions could not be drawn due to the poor quality of the studies and varying interventions, timings, and dosages. Most studies did not describe processes to ensure intervention integrity, and the “dose” was often not well reported.
Evidence from the trials reviewed was not sufficient to support the use of the interventions examined.
Current evidence suggests a very limited role of CAM to contribute to improvement in fatigue among patients with cancer.
Finnane, A., Janda, M., & Hayes, S.C. (2015). Review of the evidence of lymphedema treatment effect. American Journal of Physical Medicine and Rehabilitation, 94, 483–498.
STUDY PURPOSE: To evaluate evidence from systematic reviews for the treatment of lymphedema
Compression therapy alone and combined with manual lymphatic drainage was supported by strong evidence. Preliminary evidence suggested that a range of other treatments also are beneficial.
CDT and compression bandaging alone or with manual lymphatic drainage were effective in managing lymphedema. Ongoing maintenance is needed to keep these gains, and nurses need to educate patients regarding this ongoing need.
Fink, D.J., Wechuck, J., Mata, M., Glorioso, J.C., Goss, J., Krisky, D., & Wolfe, D. (2011). Gene therapy for pain: Results of a phase I clinical trial. Annals of Neurology, 70, 207–212.
To assess the safety of the herpes simplex virus (HSV)–based gene transfer platform (dose escalation)
To evaluate the delivery of vector-mediated delivery of PENK on pain and on concurrent use of opioid medication
NP2, an HSV vector, was injected intradermally into the dermatome(s) corresponding to the radicular pattern of pain: Pain relief was a secondary measure evaluated by a numeric rating scale (NRS) and the Short Form McGill Pain Questionnaire (SF-MPQ) on day 0 prior to doing and on postdosing days 1, 3, 7, 10, 14, 21, and 28. An SF-12 Short-Form Health Survey and complete Eastern Cooperative Oncology Group (ECOG) performance status were also completed on days 0 and 28. Concurrent opiate analgesic use was recorded on postdosing days 1, 3, 7, 10, 14, 21, and 28. Phase I dose escalation was administered as 10 intradermal injections of approximately 100 microliters (total 1.0 ml) distributed within the dermatome corresponding to the radicular distribution of the pain in a single session on study day 0. The first cohort (four patients) was given a dose of 1 x 10^7 plaque-forming units (pfu) and monitored for four weeks. A second cohort (three patients) was given 1 x 10^8 pfu, and a third cohort (three patients) was given 1 x 10^9 pfu. Patients were observed for at least 12 hours after dosing before being discharged and were scheduled for reexamination at 1, 3, 7, 10, 14, 21, and 28 days postdosing and monthly thereafter. The primary outcome was safety, so patients received a full evaluation for adverse events, physical examination, vital signs, mucositis evaluation, and labs.
The study was a phase I trial.
Treatment was well-tolerated with no significant adverse effects attributable to the agent. The adverse events that were deemed as possibly related to treatment were all mild in severity and resolved. These included transient injection site erythema and pruritus, and one patient who had a transient elevation in body temperature. Those enrolled in the lowest dose of NP2 reported no changes in pain. Those enrolled in higher doses (cohorts 2 and 3) reported pain relief of approximately 50% on day 1 after dosing.
NP2 vector appears to be safe, and the method has potential to improve intractable pain. Pain relief was difficult to interpret due to the small number of patients and no control group.
Further investigation of this novel treatment is needed.
Filshie, J., Bolton, T., Browne, D., & Ashley, S. (2005). Acupuncture and self-acupuncture for long-term treatment of vasomotor symptoms in cancer patients—Audit and treatment algorithm. Acupuncture in Medicine, 23, 171–180.
Describe the effects of acupuncture and self-accupuncture on hot flash frequency and intensity
The study enrolled 182 females ages 35 to 83 and 12 men ages 49 to 79 years of age.
Researchers performed a retrospective audit of electronic charts.
The primary outcome measurement was hot flash frequency and intensity. Participants used both traditional acupuncture and self-accupuncture.
The average pre-treatment hot flash count was 16 per day. When acupuncture was added, the chart audit showed that 114 (79%) subjects achieved a 50% or greater reduction in hot flashes.
Filshie, J., Penn, K., Ashley, S., & Davis, C.L. (1996). Acupuncture for the relief of cancer-related breathlessness. Palliative Medicine, 10, 145–150.
An open pilot study to evaluate the possible therapeutic effect of acupuncture on breathlessness in patients with cancer
A nurse observer remained with the patient for the first 90 minutes of the study.
Compared to pretreatment levels, significant changes existed in breathlessness, relaxation, and anxiety VAS scores up to six hours after acupuncture, with p values of < 0.005, < 0.005, and < 0.001, respectively. No correlation was found between the anxiety score on the HADS and the effect of acupuncture on breathlessness (r = –0.14). A significant decrease existed in respiratory rate sustained for 90 minutes following acupuncture (p < 0.02). No significant changes in pulse rate or oxygen saturation (p > 0.1) were found.
Treatment contamination is a possibility, considering the nurse‘s presence and communication following the intervention. Whether the acupuncture or the individual care was more effective is unclear.
Further investigation in a randomized study is warranted.
Fillion, L., Gagnon, P., Leblond, F., Gélinas, C., Sayard, J., Dupuis, R., . . . Larochelle, M. (2008). A brief intervention for fatigue management in breast cancer survivors. Cancer Nursing, 31, 145–159.
The intervention was comprised of four weekly group meetings lasting 2.5 hours and a 5- to 15-minute telephone “booster session.” For one hour, participants were supervised by a kinesiologist or trained research nurse in walking training. A personal exercise program was established for each participant. Participants were encouraged to perform and keep records of their home-based assignments. Participants signed a contractual agreement to comply with recommendations, which were revised each week during the walking session. Participants were provided with ambulatory devices to help monitor their progress. The walking training was followed by a 1.5-hour session of psychoeducative and fatigue management techniques. Outcomes were assessed at baseline, postintervention, and at three-month follow-up.
University hospital in Quebec City, Canada
Participants were undergoing the active treatment phase of care.
This was a randomized, controlled trial.
At baseline, participants had moderate-intensity fatigue and energy levels. Women who received the intervention showed a significantly lower level of fatigue at follow-up compared with women in the control group. Similarly, women who received the intervention experienced statistically significant higher energy levels than the participants in the control group postintervention, particularly at the three-month follow-up.
Figueiredo, A.L., Lins, L., Cattony, A.C., & Falcao, A.F. (2013). Laser therapy in the control of oral mucositis: A meta-analysis. [Laser terapia no controle da mucosite oral: um estudo de metanalise]. Revista Da Associacao Medica Brasileira, 59, 467–474.
STUDY PURPOSE: To conduct a meta-analysis and systematic review to determine if laser therapy (LT) is effective in preventing oral mucositis (OM) during oncotherapy
TYPE OF STUDY: Meta-analysis and systematic review
DATABASES USED: LILACS, MEDLINE, Cochrane electronic
KEYWORDS: “laser therapy”, “oral mucositis” used in all databases
INCLUSION CRITERIA: Oncotherapy-induced and diagnosed OM, low-intensity laser was the form of treatment with specific wavelength between 632 and 1,064 nm, randomized trial with control group
EXCLUSION CRITERIA: No specific exclusion criteria referenced; however, OM grade ≥ 3 was used as a cutoff in all the scales to properly evaluate the preventative value of LT.
TOTAL REFERENCES RETRIEVED: 12 prospective, randomized studies met criteria out of 149 initial retrieved studies
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale was used to evaluate the methodology of the studies included. BioEstat 5.0 was used for the meta-analysis. Literature was further evaluated using a standardized form that included study design, country of origin, year of publication, and authors. The patients’ data were analyzed for gender and age, type of cancer treatment, control group treatment, and LT specifics (e.g., wavelength, power, dose, irradiation time, and number of sessions per week).
FINAL NUMBER STUDIES INCLUDED = 12
SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Total sample of 527 patients; 276 of these patients underwent LT, and 251 patients were in the control group. Final meta-analysis resulted in a total sample of 293 patients.
KEY SAMPLE CHARACTERISTICS: 53% of the patients had hematologic malignancy; 47% had head and neck cancer.
PHASE OF CARE: Multiple phases of care
Out of the 12 studies included for review, 7 of them showed (through meta-analysis) that LT is almost 10 times more effective in preventing OM ≥ grade 3 than treatment without the use of LT.
The authors determined that the data supported the effectiveness of LT in the prevention of OM ≥ grade 3. They note that additional studies with larger sample sizes are still required to fully evaluate the total effectiveness of this intervention.
Age range was not listed in this review, nor was prior radiation or chemotherapy exposure. Dental health and evaluation prior to oncotherapy and LT were not referenced in this review. Due to multiple variances in the control group's non-LT prevention measures, the number of studies was much smaller than the number the initial search results returned.
This study, even with the limitations of its size and characteristics, is a good starting point for further investigation into LT to prevent severe OM in patients with cancer undergoing chemotherapy, radiation, or both. LT appears to be a promising intervention. If severe OM can be prevented, then pain and infection, which quickly result from OM, can be prevented, too. Thus, this study has larger implications in overall care and quality of life in patients with cancer. Nurses can begin to address the study and the use of LT in their own institutions.
Fife, D., Rayhan, D.J., Behnam, S., Ortiz, A., Elkeeb, L., Aquino, L., . . . Kelly, K.M. (2010). A randomized, controlled, double-blind study of light emitting diode photomodulation for the prevention of radiation dermatitis in patients with breast cancer. Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [Et Al.], 36(12), 1921–1927.
To further evaluate the efficacy of light emitting diode (LED) photomodulation in lessening radiation dermatitis
Patients in both arms of the study received a complete course of radiation therapy (RT) for breast cancer. Patients were assigned randomly to the treatment or control group. In the treatment arm, patients received LED treatment immediately before and after each RT treatment. The LED treatment consisted of using the GentleWaves Select 590 nm high-energy LED array, with the panel being placed 2 cm from the patients skin. The treatment lasted 35 seconds. At the completion of RT, patients received seven additional daily treatments over the following two weeks. The control group received sham treatments in which the GentleWaves Select machine was placed on the skin in the same manner as the treatment arm and for the same duration of 35 seconds, but the on button was not pressed to deliver the LED treatment. All patients also used Aquaphor applied three to four times a day during the duration of the study.
The study took place in the Department of Radiation Oncology at the University of California Irvine Medical Center.
Patients were undergoing the transition phase of care after initial treatment. The study has clinical applicability for late effects and survivorship.
The study used a single-center, double-blind, randomized, placebo-controlled design.
In the LED treatment arm (N = 18), no patients had a grade 0 reaction, 6 (33%) had grade 1 reactions, and 12 (66.7%) had grade 2 reactions; no grade 3 or 4 reactions developed. In the sham treatment arm (N = 15), 1 (6.6%) had a grade 0 reaction, 4 (26.7%) had grade 1 reactions, 9 (60%) had grade 2 reactions, and 1 (6.7%) had a grade 3 reaction. Two patients (11.1%) in the LED arm and one (6.7%) in the sham arm had to interruption to treatment.
LED photomodulation did not provide statistically significant differences between the two groups.
No firm conclusions regarding efficacy of LED light for prevention of radiodermatitis can be drawn from this study.