Symptom monitoring, alleviation, and self-care among Mexican Americans during cancer treatment

Non-pharmacological interventions for chemotherapy-induced diarrhoea and constipation management: A scoping review

PURPOSE

Chemotherapy-induced diarrhoea (CID) and constipation (CIC) are among the most common and severe gastrointestinal symptoms related to chemotherapy. This review aimed to identify and describe the evidence for non-pharmacological interventions for the management of CID and CIC.

METHODS

The scoping review was based on the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Evidence from five databases were included: CINAHL, MEDLINE, Embase, PubMed, and APA PsycInfo. Data were systematically identified, screened, extracted and synthesised narratively to describe the evidence for non-pharmacological interventions and their effects on CID and CIC.

RESULTS

We included 33 studies, of which 18 investigated non-pharmacological interventions for CID management, six for CIC management, and nine for both CID and CIC management. Interventions were categorized into five groups, including (1) digital health interventions, (2) physical therapies, (3) diet and nutrition therapies, (4) education, and (5) multimodal. Diet and nutrition therapies were the most common to report potential effectiveness for CID and CIC outcomes. Most of the interventions were implemented in hospitals under the supervision of healthcare professionals and were investigated in randomised control trials.

CONCLUSIONS

The characteristics of non-pharmacological interventions were diverse, and the outcomes were inconsistent among the same type of interventions. Diet and nutritional interventions show promise but further research is needed to better understand their role and to contribute to the evidence base. Nurses are well placed to assess and monitor for CIC and CID, and also deliver effective non-pharmacological interventions.

Study protocol for Care cOORDInatioN And sympTom managEment (COORDINATE) programme: a feasibility study

INTRODUCTION

Sustainable approaches to support care coordination and symptom management needs of critically ill adults living with multimorbidity are needed to combat the challenges and complexity that multimorbidity presents. The study aims to test the feasibility of the Care cOORDInatioN And sympTom managEment (COORDINATE) intervention to improve health outcomes of adults living with multimorbidity.

METHODS AND ANALYSIS

A multicomponent nurse-driven intervention was developed using experience-based co-design and human-centred design. Inclusion criteria include (1) age 55 years and older, (2) admitted to an intermediate care unit, (3) presence of two or more chronic health conditions and (4) signed informed consent. Data collection will occur at baseline (time of recruitment predischarge) and 6 weeks and 3 months following hospital discharge. Outcome of interest from this feasibility study is to evaluate the financial, technical and logistic feasibility of a full-scale study including data collection and protocol adherence. Additionally, Cohen's d effect sizes for the change in outcomes over time will be computed to establish power calculations required for a full-scale study. The protocol was prepared in accordance with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Institutional Review Board of Johns Hopkins Medical Institutions. Given the success of this feasibility study, the potential for the COORDINATE intervention to decrease the symptom burden and improve participant quality of life among critically ill people with multimorbidity will be tested in a full-scale study, and findings will be actively disseminated.

TRIAL REGISTRATION NUMBER

NCT05985044.

Dietary strategies for chemotherapy-induced nausea and vomiting: A systematic review

BACKGROUND & AIMS

Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing cancer treatment side effects, affecting 20-70% of patients despite routine antiemetic prescription. Although dietary modifications are routinely recommended in clinical practice, there is lack of data synthesis to determine which dietary strategies for managing CINV are supported by quality evidence. This systematic review was conducted to examine the effect of dietary strategies on incidence and severity of CINV in adults compared with no intervention, usual care, or alternative strategies.

METHODS

Five electronic databases were searched from inception to 15th July 2021 for original research studies of interventional or observational design assessing dietary strategies for CINV. The quality of evidence was appraised, data were synthesized narratively, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment of the certainty of the evidence was applied.

RESULTS

Twenty-one studies were included, 10 (48%) interventional studies and 11 (52%) observational studies. Most interventional and observational studies had a high or neutral risk of bias (70% and 72%, respectively). Of the interventions studied, strongest evidence with highest certainty was found for the very large positive effect of CINV-specific education and support with a personalized meal plan from a dietician, implemented in person or in writing, for reducing the severity of nausea and overall CINV (effect size: very large; GRADE: high). A statistically significant very large positive effect of ginger tea consumption was also found on overall CINV severity; however, certainty in this effect was very low. Although confidence in the findings from observational studies was very low to low, a statistically significant positive association was also found between a moderate intake of alcohol and incidence of nausea, vomiting, or overall CINV as well as nausea severity; the Mediterranean diet and nausea incidence and severity; and adequate intake of energy, protein, fat, or carbohydrate and nausea or vomiting incidence.

CONCLUSION

Improved CINV was associated with CINV-specific nutrition education and support from health professionals. Non-restrictive dietary patterns that include adequate energy and macronutrient intakes, particularly protein, and include ginger, and Mediterranean diet concepts may benefit CINV; however, the confidence in the body of evidence to inform these conclusions is mostly very low to moderate. Future rigorous trials with adequate sample sizes, clearly defined dietary strategies, and valid outcome measures are warranted prior to dietary strategies being routinely prescribed alongside antiemetic regimens.

Symptom Occurrence, Severity, and Self-Care Methods by Ethnicity and Age Group Among Adults With Cancer

OBJECTIVES

To examine the relationships among cancer therapy-related symptom occurrence and severity, selected cancer-related variables, and demographic variables. Secondary purposes were to examine participants' reported symptom occurrence and severity by ethnicity and by age group and to identify self-care methods.

SAMPLE & SETTING

Convenience sampling was used and included 110 adults receiving cancer treatment from a major hospital in the northeast region of the United States.

METHODS & VARIABLES

A descriptive correlational design was used. Study variables were symptom occurrence and severity and selected demographic and cancer-related variables. The Therapy-Related Symptom Checklist was used to measure symptom occurrence and severity, and the Symptom Alleviation.

RESULTS

Significant relationships were found between symptom occurrence and severity and gender, economic status, and disease stage. Feeling sluggish was the most frequently reported symptom.

IMPLICATIONS FOR NURSING

Oncology nurses are in an influential position to educate and manage participants' cancer therapy-related symptoms.

Unplanned emergency department visits and hospital admissions of older adults under treatment for cancer in the ambulatory/community setting

PURPOSE

This study aims to identify the incidence and risk/protective factors for (1) unplanned emergency department (ED) visits and hospital admissions (HA) and (2) nausea/vomiting/dehydration (NVD) at time of treatment in older adults under treatment for cancer.

MATERIALS AND METHODS

This is a exploratory retrospective cohort study of adults (60 and older) with cancer. Adults were included if they had a new cancer diagnosis and were being treated with chemotherapy. Study outcomes included the number of ED visits and HA (cycles 1-4) and NVD at the time of receiving chemotherapy (cycles 2-4). Repeated measures, Poisson regression was used to obtain risk ratios with 95% confidence intervals for independent predictors of outcomes.

RESULTS

Of 402 study participants, 20% experienced an ED visit, and 18% experienced a HA. Common reasons for ED visits were pain (23.5%) and NVD (20.4%). Common reasons for HA were infection (34.4%) and NVD (22.2%). Multivariate analysis showed risk factors for ED visits included chemotherapy cycle 1, having esophageal cancer, being treated with ≥ 3 chemotherapy agents, and increasing levels of functional impairment. Risk factors for HA included chemotherapy cycle 1, increasing levels of functional impairment, intravenous fluids between treatment, and being prescribed antiemetics for home use. Predictors of NVD at time of chemotherapy treatment included Hispanic ethnicity, insurance status, cancer type, chemotherapy emetic potent, treatment frequency, intravenous fluids between cycles, and number of home antiemetics.

CONCLUSION

Unplanned ED visits and HA occur in older adults under treatment for cancer due to numerous treatment-related side effects. Helping older adults identify and manage side effects early may reduce the number of unplanned admissions.

Using Serious Games to Increase Prevention and Self-Management of Chemotherapy-Induced Nausea and Vomiting in Older Adults With Cancer

OBJECTIVES

To examine the frequency and types of preventive and self-management behaviors reported by participants, as well as report acceptability and usability data for the electronic Symptom Self-Management Training-Chemotherapy-Induced Nausea and Vomiting (CINV) serious game.

SAMPLE & SETTING

80 adults who were aged 60 years or older and newly diagnosed with cancer were recruited from a community cancer center.

METHODS & VARIABLES

Participants were randomized to an intervention or control group. A symptom management checklist was used to record preventive and self-management behaviors used after each chemotherapy treatment at home. Acceptability and usability were assessed using a brief survey.

RESULTS

The intervention group reported using more preventive behaviors, and the control group reported using more self-management behaviors. Antiemetics were the most common strategy used, followed by dietary strategies. Participants rated all aspects of the serious game highly for usability and acceptability.

IMPLICATIONS FOR NURSING

Oncology providers can help older adults plan for self-managing treatment-related side effects at home. Recording self-management behaviors may reinforce the importance of active prevention and management of CINV.

Factors Affecting the Severity of Fatigue during Radiotherapy for Prostate Cancer; an Exploratory Study

INTRODUCTION

Limited studies have examined potential risk factors associated with the fatigue experience of a sample of Puerto Rican men treated with radiotherapy for non-metastatic prostate cancer. Identifying these factors may provide initial information about targets for individualized interventions, leading to more effective management of fatigue in this population.

PURPOSE

To examine the relationship of age, body max index, depressive symptoms, physical activity, and sleep disturbance with fatigue during radiotherapy for prostate cancer.

METHODS

Twenty six participants completed five inventories: demographic intake, health form, the Functional Assessment of Cancer-Therapy-fatigue, Patient-Reported Outcome Measures Information System-Sleep disturbance, and the International Physical Activity Questionnaire-Short Form before, middle/days 19-21 and completion/days 38-42 of radiotherapy. The principal investigator rated the Hamilton depression scale. Descriptive statistics were performed. Interactions and influence of variables on fatigue were assessed using bivariate correlation and multiple linear regression, respectively.

RESULTS

At each study time point, sleep disturbance and depressive symptoms were strongly correlated with each other and fatigue. The linear combination of sleep disturbance and depressive symptoms was significantly related to fatigue.

CONCLUSION

Given the high association of sleep disturbance and depressive symptoms with fatigue, clinicians should assess and develop interventions to manage these symptoms altogether.

A critical review of self-care for sleep disturbances: prevalence, profile, motivation, perceived effectiveness and medical provider communication

Objective

This study aims to undertake the first critical review of self-care use among adults with sleep disturbances by focusing on the prevalence of self-care—the self-determined and self-administered use of products or practices—by adults with sleep disturbances.

Methods

A comprehensive search of 2006–2016 international literature in CINAHL, AMED, Medline and EMBASE databases was conducted. The search was confined to empirical research findings regarding sleep disturbances - as indicated by a validated sleep scale/index or clinician diagnosis.

Results

Of the 21 articles included in this review, only three reported on sleep disturbances other than insomnia disorder (ID) or insomnia symptoms (IS). Overall, a high prevalence of self-care use is reported among adults with sleep disturbances, particularly for ID and IS. Self-care products and practices are more likely to be used by adults with sleep disturbances, than those without sleep disturbances. Commonly used self-care products and practices include OTC hypnotics, antihistamines, diphenhydramine products, diet, exercise, painkillers, herbal medicines, vitamins, minerals and dietary supplements, yoga, tai chi, Qigong, meditation, exercise and relaxation.

Conclusions

Many adults with sleep disturbances–particularly ID or IS–frequently use self-care products and practices. Self-care products are also used concomitantly with conventional prescription medications without disclosure to medical professionals. The current literature is of varied methodological caliber, frequently relies on small sample sizes and low-quality data collection therefore further rigorous health services research is required. There is an especial paucity of data regarding self-care for sleep disturbances such as restless legs syndrome and obstructive sleep apnea. Healthcare providers may find it beneficial to actively ask patients about their use of self-care for sleep disturbances to help avoid harmful drug-drug or drug-herb interactions.

The Influence of Latino Symptom Experience on Participation in Usual Activities and Satisfaction With Participation in Social Roles

INTRODUCTION

Little is known about the Latino symptom experience and how symptoms influence participation in usual activities and satisfaction with participation in social roles.

METHOD

Secondary analysis of survey data collected in community and clinic settings was conducted. Data were collected using Health-Related Quality of Life 30-day items and Patient Reported Outcome Measurement System symptom status scales. Descriptive statistics and univariate linear and multiple linear regression models were computed.

RESULTS

Participants ( N = 2,974) were primarily female and Dominican. Most surveys were completed in Spanish and in the community setting; and the clinic sample had more symptoms. In the multiple linear regression for participation in usual activities, as the number of days with symptoms increased, the number of days that poor physical or mental health influenced participation in usual activities increased. In addition, for satisfaction with participation in social roles, as the number of days with pain and levels of depression and anxiety increased, the levels of satisfaction decreased. Spanish survey administration was associated with decreased levels of satisfaction; and recruitment setting was not a significant predictor.

CONCLUSION

The study addressed multiple knowledge gaps about the Latino symptom experience.

Disability and quality of life in community-dwelling elderly cancer survivors: Case-control study in the Korean population

PURPOSE

Advanced age is a significant risk factor for cancer and functional disabilities increase with age. The purpose of this case-control study of Korean individuals was to determine the effect of cancer and cancer treatment on functional disability and quality of life (QOL). Thus, we compared community-dwelling elderly cancer patients (ECPs) with individuals from the general elderly population (GEP) who never had diagnoses of cancer.

METHODS

We selected 1776 ECP who were at least 65 years-old from the 2008 Korean Community Health Survey data and used propensity score matching to randomly select 1766 individuals from the GEP who closely resembled the ECPs. Functional disability was measured using the Instrumental Activities of Daily Living (IADL) scale, and QOL was measured by the EuroQol Group EQ-5D.

RESULTS

ECPs were more dependent in preparation of food, doing laundry, and shopping (IADL scale), and in mobility and usual activities (EQ-5D). Although ECP had more problems with pain, discomfort, anxiety, and depression, they were more independent in self-care and handling of financial responsibilities.

CONCLUSIONS

ECPs had multiple physical and psychological symptoms that adversely affected functional disability and QOL, but higher functional ability, such as self-care and handling of financial responsibilities. Promotion of self-care by ECPs is pivotal for effective management in community practice.

Self-reported assessment of symptoms and self-care within a cohort of U.S. veterans during outpatient care for cancer

BACKGROUND

This study was undertaken as part of a feasibility study of the use of a symptom checklist and self-care assessment of veterans receiving oncology outpatient treatment within the U.S. Department of Veterans Affairs system.

OBJECTIVES

The study aimed to examine (a) symptom occurrence and severity as self-reported on the Therapy-Related Symptom Checklist (TRSC) by veterans at a cancer clinic, (b) symptom alleviation strategies and use of self-care, and (c) the relationship between symptom occurrence and severity and functional status and quality of life.

METHODS

Veterans (N = 100) undergoing chemotherapy and/or radiation therapy participated in a cross-sectional study. Tools used, including TRSC, Symptom Alleviation.

FINDINGS

Thirteen symptoms were reported by more than 35% of patients. Top-ranked symptoms by percentage occurrence and severity were feeling sluggish, taste changes, nausea, pain, constipation, loss of appetite, numbness of fingers and toes, difficulty sleeping, weight loss, hair loss, difficulty concentrating, shortness of breath, and decreased interest in sexual activity. Occurrence and severity of symptoms had significant negative correlations with functional status and with overall quality of life. Self-care (symptom alleviation) strategies that helped were medicines, diet and nutrition, and lifestyle change. Checklist use (TRSC) facilitated patient-report of symptoms during cancer treatments; self-care strategies helped relieve symptoms.

Monitoring and Alleviation of Symptom Occurrence and Severity Among Thai Children and Adolescents During Cancer Treatments

BACKGROUND

Symptom monitoring and alleviation are important during pediatric cancer treatments.

AIMS

To examine the use of the Therapy-Related Symptom Checklist for Children (TRSC-C; Thai version) for reported occurrence, severity, and management of treatment-related symptoms within a cohort of Thai pediatric oncology patients/parents

METHOD

Cross-sectional study; convenience sample: 100 parents of 71 male children/29 females, 63% with leukemia, 37%, other diagnoses; age-groups: <5 years, n = 33; 5 to 11 years, n = 44; 12 to 17 years, n = 25. Parents reported children's symptom occurrence/severity on the TRSC-C; and complementary care methods on the Symptom Alleviation: Self-Care Methods and their symptom alleviation methods. All tools had good psychometric properties.

RESULTS

18 symptoms on the 30-item TRSC-C occurred in 42% to 95% of children. Mean severity of symptoms was between 1.0 ("a bit") and 2.0 ("quite a bit"); 5-month to 11-year-old children had higher (worse) TRSC-C total scores. Complementary care was used and reported.

CONCLUSIONS

Monitoring of multiple symptoms with the TRSC-C and parental symptom alleviation helped children.

CLINICAL IMPLICATIONS

Thai parents/patients need and accept assistance in monitoring/managing side effects of pediatric cancer therapy.