Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer

Psychoeducational Intervention for Pain, Psychological Distress, Hope, and Post-traumatic Growth Among Breast Cancer Patients During Chemotherapy: A Pilot Randomized Controlled Trial

BACKGROUND

Chemotherapy is associated with many side effects, including pain and psychological distress, which affect patients' physical and psychological health.

AIM

The aim of this study was to elucidate the efficacy of a pain management intervention (POLA) to promote pain, psychological distress, hope and post-traumatic growth in breast cancer patients, also, to undertake a preliminary evaluation of the intervention.

METHODS

A pilot randomized controlled trial was conducted in an Iranian hospital involving 42 breast cancer (BC) patients during chemotherapy. The intervention group received a 6-week group therapy (90 minutes per session) administered by a psychologist. Meanwhile, the comparison group received standard care. patients' Pain, psychological distress, hope and post-traumatic growth were measured at 3 time points (baseline, week 6, and 12 weeks postintervention).

RESULTS

The study design was found to be feasible, with a recruitment rate of 61.64% and an attrition rate of 6.66%. Compared to the control group, the intervention group showed a significant reduction in pain, psychological distress, depression, anxiety, and stress, as well as a notable improvement in hope and post-traumatic growth (p < .01). These differences remained significant at follow-up (p < 0.05). The study population found the intervention acceptable, as evidenced by a high attendance rate of 90% and adherence rate of 90.47%.

CONCLUSION

Psychoeducational intervention positively affects the pain, psychological distress, hope and post-traumatic growth of BC patients during chemotherapy.

Identifying central symptom clusters and correlates in patients with lung cancer post-chemotherapy: A network analysis

Objective

This study aims to investigate the network structures of symptoms and symptom clusters in patients with lung cancer post-chemotherapy, with a focus on identifying the central symptom cluster. Understanding the central cluster is crucial for targeted and effective symptom management.

Methods

Symptom occurrence and severity were assessed using the Memorial Symptom Assessment Scale (MSAS). Principal component analysis (PCA) was employed to explore symptom clusters, while network analysis unveiled the network structure and pinpointed the central symptom cluster.

Results

The study included 512 patients with lung cancer. Four distinct symptom clusters emerged: sickness behavior, psychological, lung cancer-specific, and epithelial. The sickness behavior symptom cluster was identified as the central symptom cluster.

Conclusions

This research designates the sickness behavior symptom cluster as central in post-chemotherapy patients with lung cancer, offering valuable insights for clinical nurses in devising more effective symptom management strategies.

Trial registration

ChiCTR2300070944 (Chinese Clinical Trial Register).

Developing a multivariable prediction model of global health-related quality of life in patients treated for rectal cancer: a prospective study in five countries

PURPOSE

Rectal cancer and its treatment have a negative impact on health-related quality of life (HRQoL). If risk factors for sustained low HRQoL could be identified early, ideally before the start of treatment, individualised interventions could be identified and implemented to maintain or improve HRQoL. The study aimed to develop a multivariable prediction model for global HRQoL 12 months after rectal cancer treatment.

METHODS

Within COLOR II, a randomised, multicentre, international trial of laparoscopic and open surgery for rectal cancer, a sub-study on HRQoL included 385 patients in 12 hospitals and five countries. The HRQoL study was optional for hospitals in the COLOR II trial. EORTC QLQ-C30 and EORTC QLQ-CR38 were analysed preoperatively and at 1 and 12 months postoperatively. In exploratory analyses, correlations between age, sex, fatigue, pain, ASA classification, complications, and symptoms after surgery to HRQoL were studied. Bivariate initial analyses were followed by multivariate regression models.

RESULTS

Patient characteristics and clinical factors explained 4-10% of the variation in global HRQoL. The patient-reported outcomes from EORTC QLQ-C30 explained 55-65% of the variation in global HRQoL. The predominant predictors were fatigue and pain, which significantly impacted global HRQoL at all time points measured.

CONCLUSION

We found that fatigue and pain were two significant factors associated with posttreatment global HRQoL in patients treated for rectal cancer T1-T3 Nx. Interventions to reduce fatigue and pain could enhance global HRQoL after rectal cancer treatment.

TRIAL REGISTRATION

This trial is registered with ClinicalTrials.gov No. NCT00297791.

Behavioral interventions and symptom cluster change in adults with chronic obstructive pulmonary disease and insomnia

BACKGROUND

People with chronic obstructive pulmonary disease (COPD) and insomnia experience multiple co-occurring symptoms, but no studies have examined symptom cluster change over time in this population.

OBJECTIVES

This study explored longitudinal patterns of symptom cluster profiles for adults with COPD and insomnia and evaluated whether behavioral interventions were associated with changes in symptom cluster profiles.

METHODS

This study included 91 adults with COPD and insomnia who participated in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) and COPD education. The pre-specified symptom cluster included insomnia, dyspnea, fatigue, anxiety, and depression. Latent profile analysis identified participant groups with distinct symptom cluster profiles at baseline, immediately post-intervention, and at 3-month follow-up; latent transition analysis then estimated the probability of group membership change over time. Multinomial logistic regression was used to determine whether the interventions were associated with changes in symptom cluster profiles.

RESULTS

Three groups were identified at each of three time-points: Class 1 (low symptom burden), Class 2 (intermediate), and Class 3 (high). Classes 1 and 2 showed less movement to other classes (16 % and 38 %, respectively), whereas Class 3 showed greater transition (64 %). The CBT-I intervention was significantly associated with movement to a lower symptom burden group (Class 3 to 2 or 2 to 1).

CONCLUSIONS

CBT-I, with or without COPD education, shows promise as a tailored intervention to reduce symptom burden in the study population. Study findings will facilitate development of interventions to reduce the severity of multiple co-occurring symptoms in people with COPD and insomnia.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: A Behavioral Therapy for Insomnia Co-existing with COPD; Identifier: NCT01973647.

Sleep quality among non-hospitalized COVID-19 survivors: a national cross-sectional study

Objectives

Insomnia is a common symptom after COVID-19 infection; however, its current evidence was among hospitalized COVID-19 patients. This study aimed to assess the prevalence of insomnia and identify its association with depression and anxiety among non-hospitalized COVID-19 recovered population.

Methods

We conducted a cross-sectional online survey of 1,056 COVID-19 survivors within 6 months of initial COVID-19 infection and retrieved did not require hospitalization. The Insomnia Severity Index, and Depression Anxiety and Stress Scale-14 were used. Multivariate logistic regression was used to examine the associations between depressive and anxiety score, and participants' insomnia level.

Results

The prevalence of insomnia was 76.1%, and among those, 22.8% of participants scored for severe insomnia. One third of participants reported worse sleep quality, shorter sleep duration, and harder to fall asleep, half reported more awaken nights after COVID-19 infection. Participants with depressive (OR 3.45; 95%CI 1.87-6.34) or anxiety (OR 3.93; 95%CI 2.52-6.13) had significantly higher odds of developing insomnia. Other risk factors of insomnia included pre-existing chronic conditions and higher education level, while COVID-19 symptoms and duration were not significantly associated.

Conclusion

Our study highlights the substantial burden of insomnia among non-hospitalized COVID-19 survivors and the significant association of depression and anxiety on the development of this long-term effect of COVID-19. These findings underscore the need for comprehensive interventions that address both sychological and sleeping health in this population.

Effectiveness of a Multimodal Nursing Intervention on Quality of Sleep, Fatigue, and Level of Depression Among Indonesian Patients With Gynecological Cancer: A Pilot Study

BACKGROUND

The use of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important in providing holistic care. However, limited studies have reported on integrating nonpharmacological interventions to improve physical and psychological symptoms of women with gynecological cancer.

OBJECTIVE

The aim of this study was to examine the effect of a multimodal nursing intervention (MNI) on sleep quality, fatigue, and level of depression among Indonesian women with gynecological cancer.

METHODS

The quasi-experimental nonequivalent group design involved 50 patients in 2 groups and used convenience sampling. An experimental group (n = 25) received MNI including progressive muscle relaxation and a counseling session; the control group received routine hospital care (n = 25). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), depression levels by the Beck Depression Inventory-II, and fatigue by the Piper Fatigue Scale (PFS). Pretest data were collected after 3 days of hospital admission; posttest data were gathered after the intervention.

RESULTS

The PSQI ( P = .000), Beck Depression Inventory-II ( P = .008), and PFS ( P = .000) changed significantly in the intervention group; the PSQI ( P = .000) and PFS ( P = .000) in the control group changed significantly. The PSQI ( P = .00) and PFS ( P = .000) scores differed significantly between the 2 groups before and after the intervention. The effect size of the MNI for difference scores before and after the intervention was medium effect size.

CONCLUSIONS

The role of nonpharmacological modalities in managing symptoms experienced by patients with cancer is increasingly important to providing holistic care.

IMPLICATION FOR PRACTICE

Gynecology nurses can lead the implementation of MNI to decrease patient fatigue and depression and to increase sleep quality.

Nursing Support for Pain in Patients With Cancer: A Scoping Review

Pain is subjective, warranting tailored responses in pharmacotherapy and nursing support. Despite this, the evidence for suitable nursing support for pain is not well established in terminally ill patients such as those with cancer; therefore, it is necessary to provide support in consideration of changes in physical symptoms and quality of life. However, interventional studies for such patients are often difficult. There have been no comprehensive studies to date on non-pharmacological support that can be implemented by nurses. Therefore, with the aim of examining nursing support applicable at the end of life, this scoping review comprehensively mapped nursing support for pain in cancer patients at all stages of the disease. This study complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Arksey and O'Malley framework. All available published articles from the time of database establishment to January 31, 2022, were systematically searched for in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), CENTRAL, and the Ichushi Web database of the Japanese Society of Medical Abstracts. Overall, 10,385 articles were screened, and 72 were finally included. Both randomized controlled trials (RCTs) (n = 62) and non-RCTs (n = 10) were included. Twenty-two types of nursing support were identified. Eighteen of them showed positive results; five of them were provided only to terminally ill patients, three of which were effective, namely, comfort care, foot bath, and combined therapy. It is important to examine the applicability of types of nursing support in clinical practice in the future.

Symptom Clusters in Survivorship and Their Impact on Ability to Work among Cancer Survivors

BACKGROUND

Cancer survivors often experience a range of symptoms after treatment which can impact their quality of life. Symptoms may cluster or co-occur. We aimed to investigate how symptoms and symptom clusters impact the ability to work among cancer survivors.

METHODS

We used symptom severity data and ability to work data routinely collected from cancer survivors attending a survivorship clinic after primary treatment with curative intent. We defined symptom clusters using single linkage and a threshold on the rescaled distances of <10. We then conducted a logistic regression to examine how symptoms and symptom clusters were related to the ability to work.

RESULTS

We analysed data from 561 cancer survivors, mean age 58 years and 1.5 years post diagnosis, with mixed diagnoses including breast (40.5%), colorectal (32.3%), and haematological cancers (15.3%). Limitations to work ability were reported by 34.9% of participants. Survivors experiencing pain, emotional, and cognitive symptom clusters were 14-17% more likely to report limitations in their ability to work. Older survivors and those with a higher stage disease were more likely to report limitations in their ability to work.

CONCLUSION

A better understanding and management of symptom severity and symptom clusters may help the sizable proportion of cancer survivors experiencing symptoms to participate in work after treatment.

The effectiveness of progressive muscle relaxation technique in reducing cancer-related pain among palliative care patients: A randomized controlled trial

Purpose

Cancer-related pain (CRP) is a common and distressing symptom experienced by many patients receiving palliative care. The purpose of this trial was to evaluate the effectiveness of the progressive muscle relaxation (PMR) technique in reducing CRP in patients receiving palliative care.

Methods

A total of 148 patients diagnosed with cancer and receiving palliative care were randomly allocated to either an intervention or control group. The intervention group received a 4-week daily course of PMR technique, while the control group received only usual care. Data was collected using a demographic and clinical characteristics form, as well as the Brief Pain Inventory (BPI). Blind evaluations were conducted prior to the start of the intervention (T0), at the end of the 4-week PMR intervention (T1), and at 1-month follow-up (T2).

Results

The results of this trial demonstrated a significant decrease in pain intensity scores for the PMR group compared to the control group at both T1 and T2 (p < 0.05). Furthermore, the PMR group also exhibited significant improvements in pain interference with general activity, mood, relations with others, sleep, and enjoyment of life scores compared to the control group at both T1 and T2 (p < 0.05).

Conclusion

The results of this trial suggest that the PMR technique may be an effective intervention for reducing pain intensity and improving pain interference with life activities in cancer patients receiving palliative care. However, further research is needed to provide more robust evidence for the effectiveness of this intervention.Clinical trial registration number: NCT04436705. Registered at ClinicalTrials.gov.

Patterns of patient-reported symptoms and association with sociodemographic and systemic sclerosis disease characteristics: a scleroderma Patient-centered Intervention Network (SPIN) Cohort cross-sectional study

Background

Systemic sclerosis is a heterogenous disease in which little is known about patterns of patient-reported symptom clusters. We aimed to identify classes of individuals with similar anxiety, depression, fatigue, sleep disturbance, and pain symptoms and to evaluate associated sociodemographic and disease-related characteristics.

Methods

This multi-centre cross-sectional study used baseline data from Scleroderma Patient-centered Intervention Network Cohort participants enrolled from 2014 to 2020. Eligible participants completed the PROMIS-29 v2.0 measure. Latent profile analysis was used to identify homogeneous classes of participants based on patterns of anxiety, depression, fatigue, sleep disturbance, and pain scores. Sociodemographic and disease-related characteristics were compared across classes.

Findings

Among 2212 participants, we identified five classes, including four classes with "Low" (565 participants, 26%), "Normal" (651 participants, 29%), "High" (569 participants, 26%), or "Very High" (193 participants, 9%) symptom levels across all symptoms. Participants in a fifth class, "High Fatigue/Sleep/Pain and Low Anxiety/Depression" (234 participants, 11%) had similar levels of fatigue, sleep disturbance, and pain as in the "High" class but low anxiety and depression symptoms. There were significant and substantive trends in sociodemographic characteristics (age, education, race or ethnicity, marital or partner status) and increasing disease severity (diffuse disease, tendon friction rubs, joint contractures, gastrointestinal symptoms) across severity-based classes. Disease severity and sociodemographic characteristics of "High Fatigue/Sleep/Pain and Low Anxiety/Depression" class participants were similar to the "High" severity class.

Interpretation

Most people with systemic sclerosis can be classified by levels of patient-reported symptoms, which are consistent across symptoms and highly associated with sociodemographic and disease-related variables, except for one group which reports low mental health symptoms despite high levels of other symptoms and substantial disease burden. Studies are needed to better understand resilience in systemic sclerosis and to identify and facilitate implementation of cognitive and behavioural strategies to improve coping and overall quality of life.

Funding

National Institute of Nursing Research (F31NR019007), Canadian Institutes of Health Research, Arthritis Society Canada, the Lady Davis Institute for Medical Research, the Jewish General Hospital Foundation, McGill University, Scleroderma Society of Ontario, Scleroderma Canada, Sclérodermie Québec, Scleroderma Manitoba, Scleroderma Atlantic, Scleroderma Association of BC, Scleroderma SASK, Scleroderma Australia, Scleroderma New South Wales, Scleroderma Victoria, and Scleroderma Queensland.

A Web-Based Dyadic Intervention to Manage Psychoneurological Symptoms for Patients With Colorectal Cancer and Their Caregivers: Protocol for a Mixed Methods Study

BACKGROUND

Patients with colorectal cancer (CRC) receiving chemotherapy often experience psychoneurological symptoms (PNS; ie, fatigue, depression, anxiety, sleep disturbance, pain, and cognitive dysfunction) that negatively impact both patients' and their caregivers' health outcomes. Limited information is available on PNS management for CRC patient and caregiver dyads.

OBJECTIVE

The purposes of this study are to (1) develop a web-based dyadic intervention for patients with CRC receiving chemotherapy and their caregivers (CRCweb) and (2) evaluate the feasibility, acceptability, and preliminary effects of CRCweb among patient-caregiver dyads in a cancer clinic.

METHODS

A mixed methods approach will be used. Semistructured interviews among 8 dyads will be conducted to develop CRCweb. A single-group pre- and posttest clinical trial will be used to examine the feasibility, acceptability, and preliminary effects of the intervention (CRCweb) among 20 dyads. Study assessments will be conducted before (T1) and after intervention (T2). Content analysis will be performed for semistructured interviews. Descriptive statistics will be calculated separately for patients and caregivers, and pre-post paired t tests will be used to evaluate treatment effects.

RESULTS

This study was funded in November 2022. As of April 2023, we have obtained institutional review board approval and completed clinical trial registration and are currently recruiting patient-caregiver dyads in a cancer clinic. The study is expected to be completed in October 2024.

CONCLUSIONS

Developing a web-based dyadic intervention holds great promise to reduce the PNS burden in patients with CRC receiving chemotherapy and their caregivers. The findings from this study will advance intervention development and implementation of symptom management and palliative care for patients with cancer and their caregivers.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05663203; https://clinicaltrials.gov/ct2/show/NCT05663203.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/48499.

An acceptance and commitment therapy-based intervention for opioid use disorder risk in individuals with cancer: A treatment development study

This paper describes the iterative development of an evidence-based behavioral intervention for individuals with cancer at risk for opioid use disorder, using the National Institutes of Health Stage Model for Behavioral Intervention Development. Adult patients with cancer from an outpatient palliative care clinic at an academic cancer center, with moderate to high risk of opioid misuse, were enrolled in a treatment development study that aimed to increase psychological flexibility. In this intervention, psychological flexibility is the posited mechanism of change for reduction of opioid use disorder risk. Patients completed baseline (pre-intervention) assessments, a six-session behavioral intervention based in Acceptance and Commitment Therapy, post-intervention assessments, and a semi-structured exit interview. Ten patients with moderate to high risk of opioid misuse completed the intervention. Patients rated the intervention as highly acceptable and were generally highly satisfied. Patients reported finding the coping skills helpful (e.g., mindfulness, cognitive defusion) and reported a preference for more sessions. These treatment development efforts have implications for the development and design of acceptance- and mindfulness-based, targeted interventions for individuals with cancer, receiving palliative care and at risk for opioid use disorder. Specifically, this six-session behavioral intervention to increase psychological flexibility was acceptable to patients and ready to be studied in a pilot RCT.

The Effect of Thai Massage on the Severity of Pain in Patients with Unstable Angina: A Randomized Controlled Clinical Trial

Introduction: Chest pain is an unpleasant and the most common symptom in patients suffering from unstable angina. This study was implemented to investigate the effect of Thai massage on severity of pain in patients with unstable angina. Methods: This study was a randomized controlled clinical trial that carried out on 70 patients with unstable angina who had been hospitalized in hospital affiliated to Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran. The participants were allocated randomly to either the intervention (n=35) or control group (n=35) between August 1, 2016 and April 30, 2017. The patients in the intervention group received routine care beside and Thai massage with the duration of 30 minutes in two consecutive days. The patients in the control group received routine care. The intensity of pain was assessed by using the numeric rating scale, five minutes before and immediately, 15, 30 and 60 minutes after the intervention. The independent t-test and repeated measures analysis of variance (ANOVA) were used to analysis data through SPSS 13. Results: After the intervention, the severity of pain was significantly diminished by about four measurement points (P=0.001) with the linear pattern of pain reduction. Nonetheless, in the control group, no statistically significant difference in the intensity of pain was found. Conclusion: This study showed that Thai massage as non-invasive approach, concomitant with standard nursing care, has the potential to decrease chest pain. Nurses should be taught about pain relief methods for improving the quality of patient care.

Experience of living with symptom clusters in postoperative pancreatic cancer patients

OBJECTIVE

The purpose of this study was to describe symptom clusters (SCs), and symptom experiences in early postoperative patients with pancreatic cancer who are recovering at home.

METHODS

From October 2021 and April 2022,15 patients following pancreatic cancer surgery were recruited from a tertiary hospital in Jiangsu Province by maximum variation sampling. Semi-structured interviews were performed to collect data and thematic analysis was conducted to analyze the data.

RESULTS

Three themes were extracted from the data. The first theme "difference in symptom perception and cognition" illustrated factors such as patient knowledge, expected recovery status, and risk perception could influence patient symptom experience. Most patients actually reported fewer and less severe symptoms than previous studies. The second theme "the results of symptom cluster" demonstrated anorexia-distress SC, bowel-digestive related SC and sleep disturbance related SC, and anorexia-distress SC should be considered as the priority SC given its multidimensional significance for patients. The last theme described the patient's positive attitudes, behaviours and barriers to coping with symptoms, namely "symptom self-management experience".

CONCLUSION

There are differences in the perception and interpretation of SCs in postoperative pancreatic cancer patients. Understanding the meaning of individual differences in the experience of symptoms can assist patients in the management of SCs. Medical staff should combine patient self-management strategies and evidence-based data to provide appropriate support at different stages to improve patient symptom management and quality of life.

Self-administered Meditation Application Intervention for Cancer Patients With Psychosocial Distress: A Pilot Study

BACKGROUND

We explored the use of a novel smart phone-based application (APP) for delivery and monitoring of meditation to treat mood symptoms experienced by cancer patients.

METHODS

We assessed the feasibility of using a meditation delivery and tracking APP over 2-weeks and its impact on cancer patients' self-reported anxiety and depression. Outpatients reporting depression and/or anxiety were recruited and randomized to the APP or waitlist control group. Assessments included an expectancy scale, exit survey, mood rating before and after each meditation, and the Edmonton Symptom Assessment Scale (ESAS-FS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) at baseline and after 2-weeks. The primary aim was to assess feasibility; secondary aims included satisfaction with the APP, association between meditation frequency and length with self-reported symptoms, and change in symptom measures (symptoms, anxiety, depression, and sleep).

RESULTS

Our study included 35 participants (17 meditation group; 18 controls) who were primarily female (94%) with breast cancer (60%). The 61% enrollment rate and 71% adherence rate met pre-specified feasibility criteria. Most meditation group participants described the APP as "Useful" to "Very Useful" and would "Probably" or "Definitely" recommend its use. Mixed model analysis revealed a statistically significant association between meditation length (5, 10, or 15 minutes) and change in anxiety, with 15-minute sessions associated with greater reductions in anxiety. In the exit survey, more meditation group vs. control group participants reported improved focus, mood, and sleep. Study groups differed significantly by ESAS fatigue score change; the meditation group decreased a median of 1.5 pts (IQR 2.5) and the control group increased a median of 0.5 points (IQR 2). The meditation group, but not the control group, experienced statistically significant improvement in ESAS fatigue, depression, anxiety, appetite, and physical, psychological, and global distress. Change in PSQI and HADS anxiety and depression scores did not reveal any statistically significant between-group differences.

CONCLUSIONS

This pilot study demonstrated the feasibility and acceptability of a meditation APP for cancer patients. Meditation APP users reported improvement in several measures of symptom distress. Future studies should explore ways to enhance the APP's usability and clinical benefit.

Effectiveness comparisons of various psychosocial therapies for cancer-related fatigue: A Bayesian network meta-analysis

OBJECTIVES

The purpose of this network meta-analysis (NMA) is to compare the effect of several psychosocial therapies on CRF critically.

METHODS

We applied systematic strategies based on eight databases, namely the Cochrane Central Register of Controlled Trials, PubMed, Embase, PsycINFO, China Biology Medicine (CBM), Wan Fang database, VIP, and China National Knowledge Infrastructure (CNKI) database to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs). Studies, including adult patients (≥18 years) diagnosed with cancer, were eligible regardless of cancer stage and current treatment. We carried out an expression analysis for comparing the efficacy of various psychosocial therapies using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently.

RESULTS

We identified 41 RCTs including six different psychosocial interventions (4422 participants), namely cognitive-behavioral therapy (CBT), mindfulness-based stress reduction therapy (MBSR), psychoeducational therapy (PE), stress management therapy (SMT), meditation therapy (MT) and comprehensive therapy (CT). Our NMA results showed that three psychosocial intervention therapies were effective for CRF in cancer patients. The most effective psychosocial intervention was MBSR (SMD = -1.23, CrI: -1.88, -0.59, SUCRA = 83.33%), followed by PE (SMD = -0.86, CrI: -1.53, -0.18, SUCRA = 58.51%) and CBT (SMD = -0.84, CrI: -1.31, -0.37, SUCRA = 57.67%).

CONCLUSIONS

Our study showed that MBSR was most likely to be the best psychosocial intervention to relieve CRF in cancer patients. Medical staff should pay attention to applying MBSR to cancer patients in future clinical care.

HIV Symptom Clusters are Similar Using the Dimensions of Symptom Occurrence and Distress

CONTEXT

People living with HIV infection (PLWH) in the United States continue to experience a high symptom burden despite improvements in antiretroviral therapy.

OBJECTIVES

The purpose of this study was to determine if the number and types of symptom clusters differed based on whether symptom occurrence rates or distress ratings were used to create the clusters.

METHODS

Data from 2,000 patients with complete symptom occurrence rates and distress scores on the 20-item HIV Symptom Index from their first ambulatory clinic visit at one of six national HIV centers of excellence in the Center for AIDS Research Network of Integrated Clinical Systems were used in these analyses. Exploratory factor analysis was used to create the symptom clusters.

RESULTS

The same four symptom clusters (i.e., gastrointestinal, psychological, pain, body image) were identified using occurrence rates and distress ratings. For both dimensions of the symptom experience, the psychological, pain, and body image clusters each had the same symptoms. For the gastrointestinal cluster, four symptoms loaded on the occurrence dimension and six symptoms loaded on the distress dimension.

CONCLUSION

The number and types of symptom clusters were relatively similar across the occurrence and distress dimensions of the symptom experience. Symptom clusters in PLWH may provide insights into the development of targeted interventions for multiple co-occurring symptoms.

Stability of Symptom Clusters in Patients With Gynecologic Cancer Receiving Chemotherapy

BACKGROUND

Patients with gynecologic cancer undergoing chemotherapy experience multiple co-occurring symptoms. Understanding how symptom clusters change over time is essential to the development of interventions that target multiple co-occurring symptoms.

OBJECTIVE

The aim of this study was to assess the relative stability of symptom clusters across a chemotherapy cycle in patients with gynecologic cancer.

METHODS

This is a longitudinal, descriptive study. Eligible patients (n = 232) were English-speaking adults (≥18 years old) with gynecologic cancer. Data were collected in the week before patients' second or third cycle of chemotherapy (T1) and at 1 (T2) and 2 (T3) weeks after chemotherapy. Three dimensions of the symptom experience (occurrence, severity, and distress) were assessed using a modified version of the Memorial Symptom Assessment Scale. Symptom clusters for each dimension and time point were identified through exploratory factor analysis.

RESULTS

A 5-factor solution was selected for each exploratory factor analysis. Hormonal, respiratory, and weight change clusters were identified across all dimensions and time points. A psychological symptom cluster was identified at T1 for occurrence and severity and at T2 and T3 for all 3 dimensions. A gastrointestinal symptom cluster was identified at T1 for occurrence and at T2 and T3 for all 3 dimensions. The hormonal, respiratory, psychological, and weight change symptom clusters exhibited common symptoms across dimensions and time points.

CONCLUSIONS

Hormonal, respiratory, weight change, and psychological symptom clusters are relatively stable across a cycle of chemotherapy in patients with gynecologic cancer.

IMPLICATIONS FOR PRACTICE

Clinicians need to assess patients for multiple co-occurring symptoms and initiate multimodal interventions.

A Randomized Controlled Pilot Study of Yoga Skills Training Versus an Attention Control Delivered During Chemotherapy Administration

CONTEXT

It is important to address fatigue and co-occurring symptoms during chemotherapy to preserve quality of life in patients with gastrointestinal (GI) cancer.

OBJECTIVE

To conduct a randomized controlled pilot study of a Yoga Skills Training (YST) intervention compared to an attention control (AC) among adults diagnosed with GI cancer.

METHODS

YST consisted of four 30-minute sessions delivered individually during chemotherapy plus home practice. AC provided empathic attention plus home diaries. Patient-reported (PROMIS T-score) assessments of fatigue, depressive symptoms, sleep disturbances, and psychological stress (Perceived Stress Scale) were collected at chemotherapy visits: baseline, Week 8, Week 10 and Week 14, and analyzed using a mixed effects model. Inflammatory cytokines were assessed at baseline and Week 10.

RESULTS

Forty-four of 77 adults approached agreed to participate (57%; YST n = 23; AC n = 21). Participants' mean age was 58 years and 48% were men. Participants randomized to YST reported a larger decline in fatigue (-2.4 difference, d = 0.30) and depressive symptoms (-2.5 difference, d = 0.30) than AC participants from baseline to Week 10 and sleep disturbances at Week 8 (-3.9 difference, d = 0.50). Differences in magnitude of change in symptoms were consistent with or exceeded a minimally important difference. Psychological stress decreased more in the AC at Week 10 (d = 0.30). Reductions in inflammatory cytokines (IL-6, sTNF R1) were larger in the YST group than AC.

CONCLUSION

YST showed promise for improving fatigue, depressive symptoms, sleep disturbances, and inflammation. YST is also feasible and reaches patients underrepresented in yoga research (i.e., GI cancer, men), thus warranting further examination.

Effects of nurse-led nonpharmacological pain interventions for patients with cancer: A systematic review and meta-analysis

PURPOSE

The purposes of this study were to review the types of nurse-led nonpharmacological pain interventions (NPI) offered to cancer patients and/or family caregivers, and to determine a comprehensive and robust estimate of the effect size of nurse-led NPI for cancer patients on various pain-related outcomes.

DESIGN

Systematic review and meta-analysis. Studies assessing nurse-led NPIs targeting cancer patients and published between January 2008 and December 2020 were identified by searching multiple literature databases, including MEDLINE^® , EMBASE, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL^® .

METHODS

This review was conducted in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-analyses guidelines. The selected randomized clinical trials were independently assessed for methodological quality. The effect sizes (ESs) of treatment were presented as standardized mean differences (Hedges' g) and 95% confidence intervals (CIs).

FINDINGS

A meta-analysis was performed to analyze data from 22 randomized clinical trials. Three types of nurse-led NPI were offered, mainly to cancer patients but also to some caregivers: music, physical, and psycho-educational interventions. The dose and duration of nonpharmacological interventions varied widely. The study participants ranged in age from 44.1 to 67.3 years. Meta-analysis indicated that, although these interventions had small effects in long-term (g = 0.24, 95% CI: 0.06-0.43, p = 0.011) to medium effects in short-term (g = 0.43, 95% CI: 0.32-0.53, p < 0.001), they significantly reduced patients' pain, increased their knowledge of pain management, reduced barriers to pain management and pain coping, and improved other physical and emotional symptoms. The significance of the ES differed according to the type of intervention, with psycho-educational and physical NPIs having a significant but medium short-term ES, whereas music NPI had a significant but large short-term ES. Only psycho-educational NPIs had significant long-term effects.

CONCLUSION

The combined ES showed that these nurse-led NPIs were significantly effective in both the short and long-term. Types of intervention as a potential moderator were associated with short-term and long-term effects of nonpharmacological interventions on patient outcomes.

CLINICAL RELEVANCE

Research-tested interventions should be provided to help patients cope effectively with pain.

Development of A Nurse-Led Educational Intervention Program in Managing the Nutrition Impact Symptom Cluster in Patients with Nasopharyngeal Carcinoma following the Medical Research Council Framework

Objective:

This article aimed to report the experience of developing a complex nurse-led, theory-driven, and evidence-based educational intervention program intended to manage the nutrition impact symptom cluster experienced by patients with nasopharyngeal carcinoma (NPC) during radiotherapy, based on the Medical Research Council (MRC) framework.

Methods:

The “development” and “feasibility and piloting” phases of the MRC framework were used to guide the intervention development. The development phase included identifying the evidence base through a systematic review, exploring the relevant and guiding theory to enhance the effectiveness of the intervention and conducting a qualitative study to identify the intervention modelling. For the feasibility and piloting phase, we conducted a pilot study to examine the feasibility and estimate the effectiveness of the intervention.

Results:

The systematic review revealed that nurse-led educational interventions were used commonly for symptom cluster management, with promising effectiveness. The theoretical foundation was provided by the Theory of Unpleasant Symptoms, which indicates that an educational intervention can help patients to manage symptom cluster by influencing psychological, situational, and physiological factors. The qualitative study further provided contents of the intervention based on the perspectives of NPC patients and health professionals. The resulting program involves a nurse-led, family caregiver involvement, educational intervention with two sessions that uses a booklet as a medium. The pilot study found that conducting the educational intervention program was feasible and it also had some favorable effects on managing the nutrition impact symptom cluster in NPC patients.

Conclusions:

The MRC framework provided a strong structure with which to develop a complex intervention for nutrition impact symptom cluster management through a theory-driven and evidence-based approach. The evaluation of the intervention, the delivery process and the mediation mechanism of change using a rigorous randomized controlled trial design is recommended.

The prevalence and risk of symptom and function clusters in colorectal cancer survivors

PURPOSE

Our purpose was to describe the prevalence and predictors of symptom and function clusters in a diverse cohort of colorectal cancer survivors.

METHODS

We used data from a cohort of 909 adult colorectal cancer survivors. Participants were surveyed at a median of 9 months after diagnosis to ascertain the co-occurrence of eight distinct symptom and functional domains. We used factor analysis to identify co-occurring domains and latent profile analysis (LPA) to identify subgroups of survivors with different symptom and function clusters. Multinomial logistic regression models were used to identify risk/protective factors.

RESULTS

Factor analysis demonstrated a single underlying factor structure that included all eight health domains with depression and anxiety highly correlated (r = 0.87). The LPA identified three symptom and function clusters, with 30% of survivors in the low health-related quality of life (HRQOL) profile having the highest symptom burden and lowest functioning. In multivariable models, survivors more likely to be in the low HRQOL profile included being non-White, female, those with a history of cardiac or mental health conditions, and chemotherapy recipients. Survivors less likely to be in the low HRQOL profile included those with older age, greater financial well-being, and more spirituality.

CONCLUSION

Nearly one-third of colorectal cancer survivors experienced a cluster of physical and psychosocial symptoms that co-occur with clinically relevant deficits in function.

IMPLICATIONS FOR CANCER SURVIVORS

Improving the identification of risk factors for having the highest symptom and lowest function profile can inform the development of clinical interventions to mitigate their adverse impact on cancer survivors' HRQOL.

Effect of non-pharmacological interventions on anxiety, depression, sleep quality, and pain after orthopedic surgery: A protocol for systematic review and network meta-analysis

BACKGROUND

Patients after orthopedic surgery often experience the pain, anxiety, depression, and sleep disturbances, which can be greatly reduced by non-pharmacologic interventions as alternative therapies. Randomized controlled trials of nonpharmacologic interventions for anxiety, depression, sleep quality, and pain in patients after orthopedic surgery have been reported, but the results may be conflicting. Evidence to determine the optimal non-pharmacological intervention with a high efficacy is limited. This study aims to assess the effects of non-pharmacologic interventions on the bone anxiety, depression, sleep quality, and pain in patients after orthopedic surgery through a network meta-analysis, thus providing guidance in clinical application.

METHODS

A systematic search of randomized controlled trials reporting the effects of non-pharmacological interventions on anxiety, depression, sleep quality and pain after orthopedic surgery published before October 2021 will be searched in Wanfang, VIP Information Chinese Journal Service Platform, China National Knowledge Infrastructure, Chinese BioMedicine Literature Database, Pubmed, Embase, Cochrane, and Web of science. Two reviewers will be independently responsible for study selection, quality appraisal, and data extraction. Stata 14.0 software will be used to perform the network meta-analysis.

RESULTS

The findings of this research will be reported in a recognized journal.

CONCLUSION

This meta-analysis will provide the stronger evidence for non-pharmacological interventions on alleviating bone anxiety, depression, sleep quality, and pain in patients after orthopedic surgery, which will help clinicians and decision makers in their choices.Open Science Framework registration number: DOI 10.17605/OSF.IO/2SCBD.

Are mind-body therapies effective for relieving cancer-related pain in adults? A systematic review and meta-analysis

OBJECTIVE

To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain.

METHODS

We searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias.

RESULTS

We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I²  = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality.

CONCLUSIONS

Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.

Effect of Progressive Muscle Relaxation on Sleep Quality and Side Effects of Chemotherapy in Children with Cancer: Randomized Clinical Trial

BACKGROUND: Sleep disturbance affects quality of life in children receiving chemotherapy. AIM: The aim of this study was to identify the effect of progressive muscle relaxation on the sleep quality and side effects of chemotherapy in children with cancer. METHODS: This study used randomized clinical trial with single blind method, where 30 children were allocated randomly to the control group and intervention group. The intervention group received progressive muscle relaxation twice a day, in the morning and evening, 15 minutes each session for 7 days. Control group received routine nursing care. RESULTS: The study concluded there was no significant difference in the two groups on fatigue and pain. However, progressive muscle relaxation had significant relation to decreased sleep quality score. CONCLUSION: Relaxation therapy, particularly progressive muscle relaxation, may be one of the nursing cares to improve sleep quality and reduce the side effects of chemotherapy in children with cancer.

Managing the nutrition impact symptom cluster in patients with nasopharyngeal carcinoma using an educational intervention program: A pilot study

PURPOSE

This study aimed to test the feasibility and estimate the effectiveness of a theory-driven and evidence-based educational intervention program to manage the nutrition impact symptom cluster in patients undergoing radiotherapy for nasopharyngeal carcinoma (NPC).

METHODS

A pilot randomized controlled trial was performed. Forty patients were divided equally into the intervention and control groups. The patients in the intervention group attended 2 face-to-face individual instructional sessions to enhance their knowledge and skills in managing the cluster. The study outcomes were the severity of the nutrition impact symptom cluster, body weight, symptom interference, and quality of life (QOL). A generalized estimating equation model was used to compare the differences in the outcome variables between the groups over 3-time points.

RESULTS

The consent rate for the study was 95.2%, and the attrition rate was 5.0%. Although no significant differences between the groups were detected from T1 to T3, favorable effects on relieving the cluster itself (B [95% confidence interval (CI)] = -0.844 [-2.261, 0.572], p = 0.243, Cohen's d [95% CI] = -0.37 [-1.00, 0.28]) and improvements in physical well-being (B [95% CI] = 0.833 [-3.965, 5.632], p = 0.734, Cohen's d [95% CI] = -0.15 [-0.78, 0.49]) and in head and neck cancer-specific QOL (B [95% CI] = 0.061 [-4.061, 4.182], p = 0.977, Cohen's d [95% CI] = -0.05 [-0.68, 0.59]) were observed in the intervention group compared with the control.

CONCLUSIONS

The educational intervention program is feasible and has promising effects on relieving the cluster.

A Proposed Theory of Symptom Cluster Management

Background

Symptom cluster management is in its early stages in many chronic and debilitating illnesses. The development of a proposed theory should be an initial step in advancing this area of interest.

Objective

This article presents the development of a Proposed Theory of Symptom Cluster Management.

Methods

The concept analysis, statement synthesis, and theory synthesis by Walker and Avant were used in the development of this proposed theory. A search from July to September 2020 for published empirical and theoretical articles was conducted in scientific databases, expanded on the web, and secondary references from identified articles.

Results

The Proposed Theory of Symptom Cluster Management is both a descriptive and explanatory theory. The defining characteristics of symptom cluster management include the basic and effectiveness components. Antecedents for symptom cluster management include socio-demographic characteristics, symptom cluster characteristics, individual clinical characteristics, individual illness factors, and situational factors or symptom experience. The consequences are clustered as personal-related, health-related, social-related outcomes, and existential outcomes. Measurement tools for the antecedents and outcomes in symptom cluster management and the analytical and statistical strategies were considered. Relational statements were also identified. Theoretical assertions were advanced.

Conclusion

The Proposed Theory of Symptom Cluster Management may provide a holistic approach because it integrates both the symptom cluster and management strategies. The concepts, statements including the complete representation of the proposed theory identified in this article, may provide cues to policymakers and clinical researchers towards the development of tailored interventions and programs.

The Effect of Nonpharmacological Interventions on Managing Symptom Clusters Among Cancer Patients: A Systematic Review

BACKGROUND

Cancer patients often experience multiple concurrent and related symptoms, or symptom clusters. Research increasingly indicates that targeting a symptom cluster as an overall entity instead of individual symptoms could be more effective and efficient in improving patients' quality of life. Various nonpharmacological interventions are used to manage symptom clusters in cancer patients during and after treatment, but the effect of such interventions is uncertain.

OBJECTIVE

To provide a summary of such interventions and evaluate their effects in terms of symptom cluster severity, quality of life, and functional ability of patients with cancer.

METHODS

A comprehensive literature search of 5 English and 2 Chinese electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, and Wanfang) was combined with hand searching, to identify eligible research studies from 2001 to January 2018. Two reviewers carried out data selection, data extraction, and quality appraisal independently. A narrative approach was used to summarize data.

RESULTS

Thirteen randomized controlled trials, involving 1490 patients, were included in the review. The methodological quality of the studies was generally fair. Nonpharmacological interventions can reduce the severity of symptom clusters, especially the pain-fatigue-sleep disturbance, cognitive, and gastrointestinal clusters, and improve both quality of life and functional ability.

CONCLUSIONS

While symptom cluster interventions are potentially useful in cancer care, further well-designed research is needed to test them rigorously on various types of cancer symptom clusters.

IMPLICATIONS FOR PRACTICE

Nonpharmacological interventions are shown to be effective in managing cancer-associated symptom clusters and could be considered as part of the existing healthcare services for cancer patients.

Evaluation of the sexual quality of life and sexual function of cervical cancer survivors after cancer treatment: a retrospective trial

OBJECTIVE

The purpose of this study was to explore the factors influencing the sexual quality of life of patients with cervical cancer who underwent radical hysterectomy.

METHODS

This multicenter retrospective cohort study was conducted from June 2013 to June 2018 at nine hospitals in China. In total, 204 women diagnosed with stage IA to stage IIB cervical cancer who underwent radical hysterectomy completed the questionnaire. Sexual function was measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ). All analyses were performed with R version 3.4.3 statistical software packages. A two-sided significance level of 0.05 was used to evaluate the statistical significance.

RESULTS

The mean sexual quality of life score was 37.21 ± 17.28, where a higher PISQ score indicates a better sexual quality of life, and we identified the factors associated with sexual dysfunction. The average follow-up time was 29.0 ± 16.0 months. In addition to radical hysterectomy, 182 (89.2%) patients underwent ovarian suspension, 93 (45.6%) underwent chemotherapy, and 74 (36.3%) underwent concurrent radiotherapy. The univariate analysis confirmed that age represents a protective factor for sexual function (odds ratio (OR) 6.0, 95% confidence interval (CI) 1.1-10.8, p = 0.017). The patients who underwent ovarian suspension were more likely to experience a good sexual quality of life (OR - 7.2, 95% CI [- 14.8, - 0.4], p = 0.035) compared to those who did not undergo ovarian suspension. A significant negative association was observed between radiotherapy and the behavioral-emotive, physical and partner-related domains of the PISQ (behavioral-emotive, OR - 1.5, 95% CI [- 2.6, - 0.4], p = 0.011; physical, OR - 0.9, 95% CI [- 1.5, - 0.3], p = 0.006; partner-related, OR - 0.7, 95% CI [- 1.3, 0.0], p = 0.043). Chemotherapy and radiotherapy were common risk factors for sexual dysfunction, and radiotherapy exerted a stronger effect than chemotherapy.

CONCLUSIONS

This study shows that the sexual function of cervical cancer patients tends to be related to age, radiotherapy, and chemotherapy. However, across these factors, patients with preserved ovaries tend to return to a satisfactory sexual quality of life after recovering from surgery.

Living with Metastatic Cancer: A Roadmap for Future Research

Simple Summary

Although people with metastatic cancer are living longer with their disease, they are faced with challenges that can interfere with their quality of life. These challenges include worsening disease, survival time, symptoms, distress, and financial problems. The aim of this review paper is to describe a framework to guide future efforts to address these challenges. The framework includes the risk factors (predisposing factors), triggers (precipitating factors), and responses (perpetuating factors) that contribute to the onset and maintenance of problems in living with metastatic cancer. We conclude by suggesting areas for future work to prevent problems, manage triggers, and reduce unhelpful responses.

Abstract

Living with metastatic cancer, or metavivorship, differs from cancer survivorship and has changed as novel treatments have increased survival time. The purpose of this narrative review is to describe factors that impact challenges in metavivorship within a conceptual framework to guide future research. This review focuses on the specific metavivorship outcomes of progressive disease, survival time, symptoms, distress, financial toxicity, and quality of life. We describe the predisposing, precipitating, and perpetuating (3P) model of metavivorship. Understanding the biological, psychological, and social 3P factors that contribute to the development and maintenance of challenges in metavivorship provides a roadmap for future research. Implications of this model include prevention by targeting predisposing factors, management of precipitating factors after onset of metastatic disease, and treatment of perpetuating factors to reduce symptoms and improve quality of life during the chronic phase of metavivorship. This can be accomplished through biopsychosocial screening efforts, monitoring of patient-reported outcomes, education and communication interventions, interdisciplinary symptom management, advance care planning, and behavioral interventions to cultivate psychological resilience.

Nonpharmacological Interventions for Pain Management in Lung Cancer Patients: A Systematic Review

Background:

The presence of lung cancer is almost always associated with pain, a symptom that causes severe distress in patients. Although many pharmacological methods are available to manage pain in this oncologic population, the medications often cause undesirable sideeffects and inadequate relief. Nonpharmacological interventions can be used as adjuvants to pharmacological interventions in reducing pain and increasing quality of life.

Objectives:

The purpose of this review is to compare the efficacy of nonpharmacological interventions in reducing pain in lung cancer patients.

Materials and Methods:

This is a systematic review study guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis Protocol. Interventions identified in the present systematic review have been categorized as physical treatment, technologybased, cognitive behavioral, coping, and coaching.

Results:

Results indicate that the nonpharmacological interventions such as physical treatment interventions, selfmanagement and coaching interventions, cognitive behavioral interventions, and technologybased interventions or coping skills interventions had limited and shortterm effects on alleviating pain among the patients. However, previous studies have provided limited evidence regarding nonpharmacologic therapy due to the lack of a comparison group, small sample sizes, and lack of longterm followup periods to determine whether sustained effects are feasible.

Conclusion:

Healthcare professionals should consider additional research on the added advantage of utilizing the nonpharmacological interventions as an adjunct option while managing pain in lung cancer patients.

Efficacy of the complementary therapies in the management of cancer pain in palliative care: A systematic review

OBJECTIVE

to synthesize the knowledge and to critically evaluate the evidences arising from randomized controlled trials on the efficacy of the complementary therapies in the management of cancer pain in adult patients with cancer in palliative care.

METHOD

a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search for articles in the MEDLINE, ISI Web of Knowledge, CENTRAL Cochrane, and PsycINFO databases, as well as the manual search, selection of studies, data extraction, and methodological assessment using the Cochrane Bias Risk tool were performed independently by two reviewers.

RESULTS

eight hundred and fifteen (815) studies were identified, six of them being selected and analyzed, of which three used massage therapy, one study used a combination of progressive muscle relaxation and guided imaging, and another two studies used acupuncture. Most of the studies had an uncertain risk of bias (n=4; 67%).

CONCLUSION

while the evidence from the studies evaluating the use of massage therapy or the use of progressive muscle relaxation and guided imaging for the management of cancer pain in these patients demonstrated significant benefits, the other two studies that evaluated the use of acupuncture as a complementary therapy showed contradictory results, therefore, needing more research studies to elucidate such findings.

Patient-centred, self-administered acupressure for Chinese advanced cancer patients experiencing fatigue and co-occurring symptoms: A pilot randomised controlled trial

OBJECTIVES

To evaluate the feasibility and potential effects of patient-centred self-administered acupressure for alleviating fatigue and co-occurring symptoms among Chinese advanced cancer patients receiving treatment.

METHODS

Thirty advanced cancer patients who screened positive for moderate/severe fatigue with symptoms of insomnia and/or pain were recruited from a hospital in Hong Kong. They were randomly assigned (1:1) to receive a 4-week patient-centred self-administered acupressure intervention or health education. Fatigue (primary outcome) and secondary outcomes (sleep quality, pain, fatigue-sleep disturbance-pain symptom cluster severity, anxiety, depression and quality of life) were measured by questionnaires and actigraphy.

RESULTS

Twenty-four participants (80%) completed the study. Adherence to self-administered acupressure practice was satisfactory, with all retained participants attending all sessions and 90.9% practising acupressure daily. All completers rated the class as very enjoyable or quite enjoyable. Fatigue, pain, symptom cluster severity, anxiety, depression and quality of life appeared to improve from baseline to post-intervention in the intervention group. Among these outcomes, only the between-group difference in anxiety post-intervention was significant. The group × time interaction effect was nonsignificant for all outcomes.

CONCLUSIONS

Patient-centred self-administered acupressure appears to be feasible and acceptable among advanced cancer patients. A fully powered trial is warranted to confirm the intervention effect.

The Effects of Progressive Relaxation Exercises following Lumbar Surgery: A Randomized Controlled Trial

BACKGROUND AND AIM

This study aimed to examine the effect of progressive relaxation exercises on anxiety, pain, and sleep quality among patients who underwent surgery for lumbar disc hernia.

MATERIALS AND METHODS

This randomized, non-blinded, parallel-group clinical trial was conducted with 97 patients who had a lumbar microdiscectomy. On the first, second, and third day of the postoperative period, routine nursing care was performed on the control group, while additional progressive relation exercises were performed on the experimental group.

RESULTS

When the experimental and control groups were compared regarding SAI, VAS-P, and VAS-S scores before the surgery, no differences were found (p > 0.05); however, there were significant differences in the scores obtained on the mornings of the second and third days after the surgery (p < 0.05).

CONCLUSIONS

Progressive relation exercises used as a supportive nursing intervention were found to reduce pain and anxiety and increase sleep quality.

A Feasibility Study of an Uncertainty Management Intervention for Patient-Partner Dyads Experiencing Breast Cancer

OBJECTIVES

To examine the feasibility, acceptability, and effects of a dyad-based uncertainty management intervention for breast cancer, including tailored information and coping skills training.

SAMPLE & SETTING

16 patient-partner dyads experiencing breast cancer were enrolled from a midwestern comprehensive cancer center.

METHODS & VARIABLES

A single-group pre-/post-test design was used, and descriptive statistics and Cohen's d were calculated. Measures were completed before the intervention and during each treatment cycle. Feasibility, acceptability, fidelity, uptake, and outcome variables (uncertainty, dyadic coping, family functioning) were included.

RESULTS

16 dyads were enrolled during a 13-month period; 15 dyads completed the training for the study, and 13 dyads completed all study activities. Overall, participants reported satisfaction with the intervention. Small to medium effect sizes were observed across the outcomes.

IMPLICATIONS FOR NURSING

This study highlights the need for nurses to help couples manage uncertainty related to new cancer treatment. Tailored interventions can allow nurses to use their time efficiently by focusing on individuals' actual needs.

Associations between symptom severity and treatment burden in people living with HIV

AIM

To examine the association between symptoms severity and treatment burden in people living with HIV.

DESIGN

Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross-sectional study examining physical activity patterns.

METHODS

We analysed data from 103 men and women using self-report data collected between March 2016 - February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS-29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire-13.

RESULTS

Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task-specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task-specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms.

CONCLUSION

Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression.

IMPACT

People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self-management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self-management of HIV and other co-morbid conditions.

Symptom Clustering and Its Effect on Functional Status in Lymphoma Patients

Aim

The study aimed to determine the effect of symptom clustering and its effect on functional status in patients with lymphoma.

Method

This descriptive study was conducted with 109 patients with lymphoma in the Hematology Clinic, Hematology Outpatient Clinic, and Chemotherapy Day Unit of a university hospital. Personal information form, Memorial Symptom Assessment Scale to assess symptoms, and the Functional Assessment of Cancer Therapy-Lymphoma to assess functional status were used in data collection. Frequency, percentage, arithmetic mean, significance test of difference between two means, Mann-Whitney U test, one-way analysis of variance, Kruskal Wallis analysis of variance, Pearson's correlation test, Cronbach's alpha internal consistency test, and cluster analysis were used to evaluate the data.

Results

According to the Memorial Symptom Assessment Scale, the most common psychological symptoms in these patients were sleep disturbance, feeling sad and worried; whereas, their physical symptoms were pain, nausea, and dry mouth. Based on the results of the Functional Assessment of Cancer Therapy-Lymphoma Scale, it was found that the functional lives of the patients were negatively affected due to pain, low energy, feeling sad, worrying about the deterioration of the condition, fatigue and pain in certain parts of the body. In the frequency and severity subscales of Memorial Symptom Assessment Scale, gastrointestinal system symptoms were collected more intensively in the first clusters. Physical and psychological symptoms were regularly distributed in the distress subscale.

Conclusion

As the symptom frequency, severity and distress subscales of Memorial Symptom Assessment Scale increased in lymphoma patients, their functional status deteriorated.

The Effect of Dignity Therapy on the Quality of Life of Patients with Cancer Receiving Palliative Care

Background:

Patients with cancer deal with physical, psychosocial, spiritual, and existential problems that impact on their quality of life. This study aimed to assess the effect of dignity therapy on the quality of life of mentioned patients.

Materials and Methods:

In this quasi-experimental study, 50 patients with cancer hospitalized in a palliative care center in Tehran, Iran, in 2017-18 who fulfilled inclusion criteria were selected through convenience sampling. The European Organization for Research and Treatment of Cancer Quality of Life-C15-Palliative (EORTC-QLQ-C15-PAl) questionnaire was filled by patients before and 2 weeks after dignity therapy. Data were analyzed using descriptive statistics such as frequency, mean, and standard deviation, as well as inferential statistics, including independent t-test and Chi-square test.

Results:

Results showed that dignity-therapy led to more improvement in the quality of life of the intervention group (t_35,18= 4.82, p = 0.001). There was also a significant difference between the two groups in terms of the physical functioning scale (t_32,96= -2.60,p = 0.01) and emotional functioning (t _45,69= 6.54, p < 0.001). We also found that dignity-therapy led to more improvement in nausea and vomiting (χ² = 5.71, p = 0.02), insomnia (χ² = 15.78, p < 0.001), appetite (χ² = 5.09, p = 0.02), and constipation (χ² = 12.50, p < 0.001).

Conclusions:

The application of new approaches like-dignity therapy could benefit patients with cancer in terms of reducing their distress, improving symptom severity, physical and emotional functioning, and total quality of life.

Nontraditional and Home-Based Self-management Interventions in Cancer Patients With Pain: A Mixed-Method Systematic Review

One or 2 decades ago, oncologists focused on only cancer treatments or acute care related to cancer. Since cancer care is considered as long-term cares, cancer patients require self-management (SM) ability or skill to manage their symptoms and daily cares. This mixed-method review is to evaluate quantitative and qualitative studies, which were conducted using non-traditional SM interventions for cancer pain based. This review also explores the process of SM in the chronic care model (CCM). PubMed, CINAHL, Scopus, and Wiley were used from 2011 to 2018. A total of 16 quantitative and 2 qualitative studies were included for this review. All interventions are divided into 3 types, which are educational and/or counseling programs, complementary and alternative medicine (CAM) therapy, and exercise. Ten of the included 16 studies were statistically significant on pain management: 3 CAM studies (100%), 1 exercise study (100%), and 6 of the 12 educational and/or counseling studies (50%). The CAM and exercise were statistically effective in improving cancer pain in the review. However, uncertainty remains regarding the strength of the evidence, due to the small number of studies included and lack of consistent methodologies. The application (5A) of SM support may help cancer patients to manage their pain.

The effect of sleep quality, sleep components, and environmental sleep factors on core curriculum exam scores among pharmacy students

INTRODUCTION

Sleep deprivation is associated with poor academic performance, although the impact on pharmacy students has been minimally reported. This study examined sleep quality in pharmacy students in the first (P1), second (P2), and third (P3) professional years during perceived low and high stress periods in a course. Individual sleep and environmental factors were also explored.

METHODS

This prospective cohort study used an 18-item survey adapted from the Pittsburgh Sleep Quality Index (PSQI) that included demographics, individual sleep components, and factors affecting sleep. Surveys were administered at the beginning of the quarter (low stress) and the week before final exams (high stress). Chi-square tests compared categorical variables; ANOVA/ANCOVA tests compared continuous variables.

RESULTS

During high stress, PSQI scores worsened among all classes and was significant for the P3s. Average sleep duration was 6.64 (SD 1.18) and 6.8 (SD 1.18) hours per night for P1s and P3s, respectively, at the beginning of the quarter; both groups had significant reduction in sleep duration at the end of the quarter. There were no significant correlations between PSQI and exam scores. Factors impacting sleep such as exercise, use of technology at bedtime, and work hours outside of school decreased during high times of stress, for P1s, P2s, and P3, respectively.

CONCLUSIONS

Students demonstrated worsening sleep quality during high stress periods and less sleep than recommended. Academic performance was not adversely affected. Future research should use sleep logs and other performance measures to determine the impact of sleep quality on academic success and wellbeing.

Psychosocial Interventions for Pain Management in Advanced Cancer Patients: a Systematic Review and Meta-analysis

Purpose of Review

This systematic review and meta-analysis aimed to synthesize the evidence on the effects of psychosocial interventions on pain in advanced cancer patients.

Recent Findings

The included studies investigated the effects of relaxation techniques, cognitive-behavioral therapy, music therapy, mindfulness- and acceptance-based interventions, and supportive-expressive group therapy. Overall, we found a small, but significant effect on pain intensity (d = − 0.29, CI = − 0.54 to − 0.05). Effect sizes were highly heterogeneous between studies. We did not find evidence for the superiority of any of the intervention types. However, psychosocial interventions may be more effective if they specifically targeted pain distress as the primary outcome.

Summary

Although findings were mixed, psychosocial interventions can be recommended to complement comprehensive care to alleviate pain in patients facing an advanced or terminal stage of the disease. Future research should develop innovative interventions tailored specifically for pain relief.

Are the MORECare guidelines on reporting of attrition in palliative care research populations appropriate? A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Palliative care trials have higher rates of attrition. The MORECare guidance recommends applying classifications of attrition to report attrition to help interpret trial results. The guidance separates attrition into three categories: attrition due to death, illness or at random. The aim of our study is to apply the MORECare classifications on reported attrition rates in trials.

METHODS

A systematic review was conducted and attrition classifications retrospectively applied. Four databases, EMBASE; Medline, CINHAL and PsychINFO, were searched for randomised controlled trials of palliative care populations from 01.01.2010 to 08.10.2016. This systematic review is part of a larger review looking at recruitment to randomised controlled trials in palliative care, from January 1990 to early October 2016. We ran random-effect models with and without moderators and descriptive statistics to calculate rates of missing data.

RESULTS

One hundred nineteen trials showed a total attrition of 29% (95% CI 28 to 30%). We applied the MORECare classifications of attrition to the 91 papers that contained sufficient information. The main reason for attrition was attrition due to death with a weighted mean of 31.6% (SD 27.4) of attrition cases. Attrition due to illness was cited as the reason for 17.6% (SD 24.5) of participants. In 50.8% (SD 26.5) of cases, the attrition was at random. We did not observe significant differences in missing data between total attrition in non-cancer patients (26%; 95% CI 18-34%) and cancer patients (24%; 95% CI 20-29%). There was significantly more missing data in outpatients (29%; 95% CI 22-36%) than inpatients (16%; 95% CI 10-23%). We noted increased attrition in trials with longer durations.

CONCLUSION

Reporting the cause of attrition is useful in helping to understand trial results. Prospective reporting using the MORECare classifications should improve our understanding of future trials.

A systematic review of self-reported pain in childhood cancer survivors

AIM

The aim of this systematic review was to examine the frequency and risk factors of pain among long-term childhood cancer survivors based on self-reported questionnaire studies. Participants aged 21 years or younger at the time of their cancer diagnosis were included.

METHODS

The Medline (OVID), PubMed and PsycINFO databases were searched for manuscripts published between January 1, 1990, and August 31, 2018, following the PRISMA statement for reporting systematic reviews.

RESULTS

In total, 25 studies, including five prospective cohort studies measuring pain up to 32 years post-diagnosis, were identified. Female sex, young age at diagnosis, older age at assessment, greater time since diagnosis, specific diagnoses (such as central nervous system [CNS] tumours, bone tumours and sarcoma), fatigue and persistent emotional distress were associated with cancer-related pain. The most common pain types were migraines, headaches and back pain.

CONCLUSION

A subset of childhood cancer survivors reported clinically significant self-reported pain. Identifying survivor subgroups at risk for pain could be essential for developing tailored intervention and prevention strategies. Prospective studies that use standardised and psychometrically sound tools to evaluate pain are needed.

Associations Among Sleep Latency, Subjective Pain, and Thermal Pain Sensitivity in Gynecologic Cancer

OBJECTIVE

Pain is common among women with gynecologic cancer and contributes to depressed mood, sleep disturbances, and likelihood of future chronic pain. Little is known about how psychosocial factors are associated with central sensitization of pain in gynecologic cancer. This study examined relations among depressive symptoms, sleep, subjective pain, and aftersensation pain (a proxy for central sensitization of pain) in gynecologic cancer.

METHODS

Participants were 42 women (mean age [SD] = 59.60 [10.11] years) enrolled in a randomized clinical trial examining psychological intervention effects on sleep, pain, mood, and stress hormones/cytokines in gynecologic cancer. Six to eight weeks after surgery, participants completed an assessment of depressive symptoms, sleep, and subjective pain and a temporal summation of pain protocol via quantitative sensory testing (QST).

RESULTS

Controlling for recent chemotherapy, history of chronic pain, and analgesic medication use, regression analyses revealed that longer sleep onset latency (SOL; B = 3.112, P = 0.039, bias-corrected and accelerated (BCa) 95% confidence interval [CI] = 0.371 to 6.014) and greater sensory pain (B = 0.695, P = 0.023, BCa 95% CI = 0.085 to 1.210) were associated with greater aftersensation pain at 15 seconds. Greater sensory pain scores were associated with greater aftersensation pain at 30 seconds (B = 0.286, P = 0.045, BCa 95% CI = 0.008 to 0.513). Depression was not associated with aftersensation pain. The overall models accounted for 44.5% and 40.4% of the variance in aftersensation pain at 15 and 30 seconds, respectively. Conclusions. Longer SOL and higher subjective sensory pain were related to greater aftersensation of experimentally induced pain in women postsurgery for gynecologic cancers. Interventions that improve sleep and subjective sensory pain during the perisurgical period may reduce risk for central sensitization of pain.

Effectiveness of integrated nursing interventions for fatigue in patients with advanced cancer: a systematic review of randomized controlled trials

Objective

To evaluate the effectiveness of integrated nursing interventions for fatigue in patients with advanced cancer.

Methods

Medline, Pubmed, Embase, CINAHL, Web of Science, and the Cochrane Library were searched systematically till June 2017. A systematic review was conducted to collect randomized controlled trials (RCTs) reporting on the effect of nurse-driven interventions to improve fatigue in patients with advanced cancer. Quality assessment was conducted using the Cochrane Collaboration’s risk of bias tool.

Results

Six RCTs involving 736 adult participants were included. The fatigue intensity was improved significantly by nursing interventions. The analyzed results revealed significant improvements in the intervention group: less than 3 months (standard mean difference [SMD] = −0.33, 95% confidence interval [CI] [−0.48, −0.19], P < 0.01) and more than or equal to 3 months (SMD = −0.40, 95% CI [−0.57, −0.24], P < 0.01). Four studies with a moderate risk of bias were judged, and the remaining studies were at high risk of bias.

Conclusions

The results indicate that integrated nursing interventions may relieve fatigue in patients with advanced cancer. However, due to the high risk of bias in most of the included studies and the diversity of interventions, the results and implementation process should be carefully monitored.

Effects of a multidisciplinary quality of life intervention on sleep quality in patients with advanced cancer receiving radiation therapy

OBJECTIVES

Sleep disturbances are prevalent in cancer patients, especially those with advanced disease. There are few published intervention studies that address sleep issues in advanced cancer patients during the course of treatment. This study assesses the impact of a multidisciplinary quality of life (QOL) intervention on subjective sleep difficulties in patients with advanced cancer.

METHOD

This randomized trial investigated the comparative effects of a multidisciplinary QOL intervention (n = 54) vs. standard care (n = 63) on sleep quality in patients with advanced cancer receiving radiation therapy as a secondary endpoint. The intervention group attended six intervention sessions, while the standard care group received informational material only. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), administered at baseline and weeks 4 (post-intervention), 27, and 52.

RESULTS

The intervention group had a statistically significant improvement in the PSQI total score and two components of sleep quality and daytime dysfunction than the control group at week 4. At week 27, although both groups showed improvements in sleep measures from baseline, there were no statistically significant differences between groups in any of the PSQI total and component scores, or ESS. At week 52, the intervention group used less sleep medication than control patients compared to baseline (p = 0.04) and had a lower ESS score (7.6 vs. 9.3, p = 0.03).

SIGNIFICANCE OF RESULTS

A multidisciplinary intervention to improve QOL can also improve sleep quality of advanced cancer patients undergoing radiation therapy. Those patients who completed the intervention also reported the use of less sleep medication.

Psychosocial interventions for advanced cancer patients: A systematic review

OBJECTIVE

Psychosocial care for advanced cancer encompasses a wide range of interventions that help patients make life-changing decisions, manage debilitating symptoms, confront impending mortality, and improve other patient outcomes. Psychosocial care is becoming increasingly available to advanced cancer patients; however, an overview of the various types of interventions is lacking.

METHODS

The current review systematically examined randomised-controlled trials of psychosocial interventions for advanced cancer patients from January 2007 to June 2018. MEDLINE, CINAHL Plus, PsycINFO, and Scopus databases were searched, and a total of 68 studies were included in the review.

RESULTS

We found a range of psychosocial interventions studies and grouped them based on six theoretical/clinical approaches: cognitive behavioural therapy based; meaning enhancing; dignity, life review, and narrative; other counselling; education only; and music, writing, and others. The different psychosocial interventions had significantly varied characteristics (eg, format, duration, and resources used) to address issues faced by advanced cancer patients. There is compelling evidence for the use of meaning-centred psychotherapy to improve meaning and quality of life and use of question prompt lists and communication skills training to improve communication with health care providers.

CONCLUSIONS

Some psychosocial interventions are further along in establishing evidence for effectiveness. Our findings demonstrate a growing capacity within the field to meet the psychosocial needs of advanced cancer patients. Lessons and direction in clinical practice and future research endeavours are discussed.

Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial

Aims: To examine the effect of progressive resistance training (PRT) on health related quality of life and a predefined symptom cluster of pain-sleep-fatigue. Methods: This study was a planned secondary analysis of a randomized controlled trial examining the effect of PRT on prevention of arm lymphedema in a population of women between 18 and 75 years undergoing breast cancer surgery with axillary lymph node dissection. Participants were allocated by computer randomization to usual care control or a PRT intervention in a 1:1 ratio. The intervention, initiated in the third post-operative week, consisted of three times PRT per week, supervised in groups in the first 20 weeks, and self-administered in the following 30 weeks. Questionnaire assessments were made at baseline, 20 weeks and 12 months, with the European Organization for Research and Treatment in Cancer Core questionnaire (EORTC QLQ C30) and the Functional Assessment of Chronic Illness Therapy-(FACIT) fatigue questionnaire. The symptom cluster of pain-sleep-fatigue was measured with a constructed score adding EORTC C30 subscales of insomnia, pain, and fatigue. Data were treated as repeated measurements and analyzed with mixed models. Results: Among 158 recruited participants, we found a clinically relevant increased emotional functioning with nine points at both follow-ups (p = .02), and 16 and 11 points at 20 weeks and 12 months respectively (p = .04) in social functioning. Furthermore, in the subgroup of women with the symptom cluster pain-sleep-fatigue present at baseline, a significant effect was found for global health status (p = .01) and social functioning (p = .02). Conclusion: To our knowledge, this is the first study to report clinically relevant effects of PRT on social and emotional functioning in the first postoperative year after breast cancer surgery. Furthermore, a subgroup of women with the pain-sleep-fatigue symptom cluster had particular benefit from PRT on global health status and social functioning.