The effect of navigation programme on the management of symptoms related to head and neck radiotherapy

Development of a nurse navigation program for cancer pain

Objective

Cancer pain significantly impacts the overall quality of life of cancer patients, necessitating proactive management. The manifestations of cancer pain vary individually and require tailored interventions to address each patient's unique characteristics. Therefore, this study aims to develop a nurse navigation program for cancer pain (NNP-CP) tailored to the needs of cancer patients requiring pain control, aiming to establish evidence-based clinical nursing practices and promote effective cancer pain management.

Methods

This study is a methodological research into developing a pain management program led by nurses for cancer patients requiring pain control, based on a professional navigation framework. The development of the program relied on three out of the five stages of the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model.

Results

A literature review was conducted to select the content and rationale to be included in the intervention program. Publications within the last 10 years in English or Korean were identified and screened based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 literature selection flow, 17 articles were included. Standardized information regarding cancer pain control was based on the 7th edition of 'Cancer Pain Management Guidelines'. The initial draft of the pain management intervention program was developed by organizing and structuring the derived content based on the professional navigation framework. Subsequently, the final intervention program was confirmed through the review by six clinical experts specializing in cancer pain.

Conclusions

Cancer pain is a significant factor that profoundly influences the quality of life and survival duration of cancer patients. While appropriate management methods offer the prospect of control, insufficient intervention is the current reality. Through the pain management intervention program based on the expert navigation framework that promotes continuity of care and empowers the recipients, this study anticipates not only pain reduction in cancer patients but also an enhancement in their quality of life.

Efficacy of nonpharmacological interventions for severe radiation-induced oral mucositis among head and neck cancer patients: A network meta-analysis of randomised controlled trials

AIMS AND OBJECTIVES

To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer.

BACKGROUND

Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear.

DESIGN

Systematic review and network meta-analysis based on the PRISMA-NMA guidelines.

METHODS

Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer.

RESULTS

Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective.

CONCLUSIONS

Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer.

RELEVANCE TO CLINICAL PRACTICE

Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice.

TRIAL REGISTRATION DETAILS

CRD42023400745.

Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature

Patient navigation is a strategy for overcoming barriers to reduce disparities and to improve access and outcomes. The aim of this umbrella review was to identify, critically appraise, synthesize, and present the best available evidence to inform policy and planning regarding patient navigation across the cancer continuum. Systematic reviews examining navigation in cancer care were identified in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cumulative Index of Nursing and Allied Health (CINAHL), Epistemonikos, and Prospective Register of Systematic Reviews (PROSPERO) databases and in the gray literature from January 1, 2012, to April 19, 2022. Data were screened, extracted, and appraised independently by two authors. The JBI Critical Appraisal Checklist for Systematic Review and Research Syntheses was used for quality appraisal. Emerging literature up to May 25, 2022, was also explored to capture primary research published beyond the coverage of included systematic reviews. Of the 2062 unique records identified, 61 systematic reviews were included. Fifty-four reviews were quantitative or mixed-methods reviews, reporting on the effectiveness of cancer patient navigation, including 12 reviews reporting costs or cost-effectiveness outcomes. Seven qualitative reviews explored navigation needs, barriers, and experiences. In addition, 53 primary studies published since 2021 were included. Patient navigation is effective in improving participation in cancer screening and reducing the time from screening to diagnosis and from diagnosis to treatment initiation. Emerging evidence suggests that patient navigation improves quality of life and patient satisfaction with care in the survivorship phase and reduces hospital readmission in the active treatment and survivorship care phases. Palliative care data were extremely limited. Economic evaluations from the United States suggest the potential cost-effectiveness of navigation in screening programs.