Lee, K.C., Yiin, J.J., & Chao, Y.F. (2016). Effect of integrated caregiver support on caregiver burden for people taking care of people with cancer at the end of life: A cohort and quasi-experimental clinical trial. International Journal of Nursing Studies, 56, 17–26.
To test the effects of an integrative, supportive intervention program for caregivers on caregiver strain and burden
Face to face sessions were done with caregivers to assess categories of caregiver burden, and then individually tailored interventions were provided in 30–40 minute individual sessions every two weeks until the patient expired. Telephone calls were done every other week to provide support and redirection to address areas of strain and burden. The intervention involved education, counseling regarding coping strategies, assistance in findings needed resources, and the provision of respite patient care. Patients in a different ward were allocated to a control group and received usual care. Usual care did not include proactive assessment to determine interventions. Ward assignment to control and intervention groups was done randomly. Participants were recruited when hospitalized and followed longitudinally. Data were collected every two weeks. All participants had access to a 24-hour help line.
Randomized, controlled, cohort, longitudinal trial
The analysis showed a significant group by time effect for caregiver burden scores (eta square 0.49, p < 0.001) and self-efficacy scores (eta square 0.46, p < 0.001). Those in the intervention group had higher self-efficacy and lower burden. There were no significant differences in patient symptom severity between groups.
The proactive assessment of caregiver stressors and individualized supportive and psychoeducational interventions reduced caregiver strain and burden and increased caregiver self-efficacy.
This study demonstrated that purposeful caregiver assessment and individualized planned interventions to support caregivers and work with them regarding their stressors was effective in reducing subjective caregiver strain and burden and improving self-efficacy during the last three months of the patient’s life. This study provided frequent caregiver contact with reassessment, enabling the identification of and response to changing needs.
Lee, J.Y., Park, H.Y., Jung, D., Moon, M., Keam, B., & Hahm, B.J. (2014). Effect of brief psychoeducation using a tablet PC on distress and quality of life in cancer patients undergoing chemotherapy: A pilot study. Psycho‐Oncology, 23, 928–935.
To examine the benefits of a single-session psychoeducational intervention using a tablet PC during chemotherapy
Patients were assigned to intervention or control groups according to their dates of informed consent rather than strict randomization. Study measures were obtained at baseline and two to four weeks later. The study group was given a single-session psychoeducational intervention using a tablet PC to administer the education.
Two-group trial
Compared to the control group, the intervention group showed a positive score change on the HADS scale. The mental component summary score of the SF-8, the IES-R avoidance subscale, the ISI, and the total score of the HADS scale were the following. HADS (p = .0002), SF-8 (p = .011), ISI (p = .021), and IES-R (p = .036) declined from baseline more in the intervention group. Scores did decline in both groups.
A tablet-based, 20-minute psychoeducational intervention could be an effective intervention for managing depression, sleep disturbance, and quality of life.
Lee, J., Dibble, S., Dodd, M., Abrams, D., & Burns, B. (2010). The relationship of chemotherapy-induced nausea to the frequency of pericardium 6 digital acupressure. Oncology Nursing Forum, 37, E419–E425.
To explain the relationship between the intensity of chemotherapy-induced nausea and vomiting (CINV) and the frequency of P6 digital acupressure in a group of patients with breast cancer who received moderately to highly emetogenic chemotherapy and applied P6 digital acupressure as an additional intervention for CINV control.
This was a secondary analysis of a multicenter, longitudinal, randomized, clinical trial that compared differences in CINV among three groups (P6 acupressure, placebo digital acupressure, and usual care). The original study was published in 2007.
Patients in the group receiving P6 acupressure in the parent study were instructed to perform digital acupressure for three minutes or point release at the P6 points on both arms in the morning plus an additional three minutes of acupressure to one arm whenever nausea occurred. Secondary analysis was conducted of this group’s data from the patient information questionnaire and daily log.
This was a multisite study conducted at 15 different sites in the United States.
All patients were in active treatment.
The study was design was a descriptive secondary analysis.
Nausea intensity was not found to be consistently related to frequency of acupressure use.
Types and dosages of antiemetics used were not described.
Based on the results of the parent study and the indepth secondary analysis of the acupressure group, patients with CINV may benefit from P6 acupressure throughout the first 11 days after chemotherapy. Because each patient is different, individualized patient teaching and resources for managing CINV are important.
Lederle, F.A., Busch, D.L., Mattox, K.M., West, M.J., & Aske, D.M. (1990). Cost-effective treatment of constipation in the elderly: A randomized double-blind comparison of sorbitol and lactulose. American Journal of Medicine, 89, 597–601.
To evaluate the use of sorbitol as an inexpensive alternative to lactulose for treating constipation in older adults.
Lactulose and 70% sorbitol (0–60 ml daily) were given for four weeks. During the treatment period, patients were instructed to begin taking 30 ml of the study laxative at bedtime, thereafter adjusting the dose as needed from 0–60 ml. Patients were instructed to maintain high dietary fiber and avoid sources of free fructose such as apples and pears.
The length of the wash-in and washout periods was based on previous studies, which showed up to three to four days are required for lactulose to take effect and the carryover effect after cessation of lactulose is about six to seven days. The study began with a two-week lead-in period, during which patients received lactulose in a single-blind fashion. This was followed sequentially by washout period A (two weeks), treatment period A (four weeks), washout period B (two weeks), and treatment period B (four weeks). The purpose of the lead-in period was to ensure (a) the patient tolerated lactulose, (b) the patient understood how to fill out the diary, and (c) the conditions preceding the two treatment periods were similar. At the end of washout period A, patients were randomly assigned to receive one of the two study laxatives in treatment period A, with the other laxative being used in treatment period B.
The primary endpoints of the study were average number of bowel movements per week and the average number of days per week on which bowel movements occurred.
This was a randomized, double-blind, crossover study.
The results supported the hypothesis that sorbitol and lactulose have no clinically or statistically significant difference in laxative effect. Sorbitol can be recommended as a cost-effective alternative to lactulose for the treatment of constipation in older men.
LeBlanc, J.K., Al-Haddad, M., McHenry, L., Sherman, S., Juan, M., McGreevy, K., . . . DeWitt, J. (2011). A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: One injection or two? Gastrointestinal Endoscopy, 74(6), 1300–1307.
To compare the pain relief achieved by one injection of alcohol versus two injections of alcohol during endoscopic ultrasound–guided (EUS) celiac plexus neurolysis (CPN); to compare the safety associated with the one- and two-injection techniques; to determine the extent to which the number of injections affects the onset and duration of pain associated with pancreatic cancer
Each CPN procedure involved injecting 20 ml 0.75% bupivacaine and 10 ml 98% alcohol into either one or two sites at the celiac trunk. The total sample was composed of 50 patients. Investigators conducted follow-up interviews by telephone to evaluate onset and duration of pain relief and complications. Interviews occurred at 24 hours after the procedure and then weekly.
Prospective single-blinded randomized parallel-group study
Fifty patients were enrolled and randomized. Pain relief was observed in 37 patients (74%): 20 (69%) in the one-injection group and 17 (81%) in the two-injection group. Median onset of pain relief in both groups was one day. Median duration of pain relief in the one-injection and two-injection groups was 11 weeks and 14 weeks, respectively. Complete pain relief was achieved in four patients (8%), two in each group. No long-term complications occurred.
The two techniques were not associated with any significant difference in patients' experience of pain.
Authors observed no difference in the safety associated with the two techniques or the survival rate. Nurses would be justified in advocating for the single-injection technique, to minimize patients' discomfort.
Leal, A.D., Qin, R., Atherton, P.J., Haluska, P., Behrens, R.J., Tiber, C.H., . . . Loprinzi, C.L. (2014). North Central Cancer Treatment Group/Alliance trial N08CA-the use of glutathione for prevention of paclitaxel/carboplatin-induced peripheral neuropathy: A phase 3 randomized, double-blind, placebo-controlled study. Cancer, 120, 1890–1897.
To determine the effectiveness of glutathione for the prevention of taxol/carboplatin-induced peripheral neuropathy
One hundred eighty-five patients were randomized to receive either placebo or glutathione 1.5 mgm/m2 while receiving paclitaxel and carboplatin therapy over 15 minutes immediately before chemotherapy.
PHASE OF CARE: Active antitumor treatment
Placebo-controlled, randomized, controlled trial
No differences were reported in neurotoxic symptoms between the groups the week following taxol infusion. In addition, no differences were reported between the groups receiving taxol every three to four weeks. Time to development of at least grade 2 neurotoxicity was higher in the placebo group (p = 0.039).
The results indicated that this was a negative trial and do not support the use of glutathione for neurotoxic symptoms from taxol/carboplatin therapy.
The results of this negative trial showed that glutathione was not effective in patients receiving taxol/carboplatin. Very limited evidence supports effective interventions for preventing or minimizing chemotherapy-induced peripheral neuropathy. Ongoing research is needed in this area.
Leach, H.J., Danyluk, J.M., Nishimura, K.C., & Culos-Reed, S.N. (2016). Benefits of 24 versus 12 weeks of exercise and wellness programming for women undergoing treatment for breast cancer. Supportive Care in Cancer, 24, 4597–4606.
Pre-post design
Lazzari, M., Greco, M.T., Marcassa, C., Finocchi, S., Caldarulo, C., & Corli, O. (2015). Efficacy and tolerability of oral oxycodone and oxycodone/naloxone combination in opioid-naive cancer patients: A propensity analysis. Drug Design, Development and Therapy, 9, 5863–5872.
To compare the analgesic efficacy and safety, and quality of life of oxycodone (OXY) compared with oxycodone/naloxone (OXN) combination in treating opioid-naïve patients
Patients were seen at three or four different times when starting long-acting oxycodone products.
PHASE OF CARE: Multiple phases of care
Retrospective, observational, three data collection time periods—T0, T30, and T60. T15 available for patients who needed closer monitoring.
The patients who received OXN had better early improvement in bowel function than the patients who received OXY (p < 0.001).
OXN and OXY have similar analgesic effects, but OXN seems to have better bowel outcomes.
OXN may have better bowel function outcomes compared with OXY in patients starting analgesics.
Lawson, L.M., Williams, P., Glennon, C., Carithers, K., Schnabel, E., Andrejack, A., & Wright, N. (2012). Effect of art making on cancer-related symptoms of blood and marrow transplantation recipients. Oncology Nursing Forum, 39, E353–E360.
To examine the effects of a one-hour art-making session during bone marrow transplantation (BMT) treatment
Interested patients were randomly assigned to the sequence to receive either the art-making session or the control condition first and were then crossed over to the other condition. Art-making sessions were 40–60 minutes. Patients were provided with a ceramic tile, brushes, and paint to create a tile at no cost. Measurements were obtained pre- and postintervention. Patients waited an average of 6.8 days between the treatment and control conditions.
Patients were undergoing active antitumor treatment.
A crossover pre/post-test design was used.
Symptoms declined in post-test measures in both conditions, with significant decline post art making (p = 0.01). There was no significant change in anxiety scores. Salivary cortisol levels declined significantly in both conditions. Time between conditions ranged from 1 to 28 days.
Art making appeared to reduce treatment-related symptoms but had no apparent effect on anxiety.
This pilot study showed that the art-making session appeared to have an effect in reducing treatment-related symptoms; it is not clear if the art making specifically was effective, or if any diversional activity would have the same result. Findings do not support an effect of art making on anxiety.
Lawrence, J.A., Balcueva, E.P., Groteluschen, D.L., Samuel, T.A., Lesser, G.J., Naughton, M.J., . . . Rapp, S.R. (2016). A study of donepezil in female breast cancer survivors with self-reported cognitive dysfunction 1 to 5 years following adjuvant chemotherapy. Journal of Cancer Survivorship, 10, 176–184.
To evaluate the feasibility of taking daily donepezil, an acetylcholinesterase inhibitor, to improve cognitive function in women who report cognitive impairment one to five years after completing adjuvant chemotherapy for breast cancer
This study evaluated the feasibility of a randomized, controlled trial of 24 weeks of donepezil (5 mg/day for 6 weeks, then 10 mg/day for 18 weeks) versus placebo. Potential participants were prescreened for moderate-to-severe self-reported cognitive impairment, and those enrolled were stratified by menopausal status and time since chemotherapy. Self-reported cognitive function, co-occurring symptoms, and quality of life were measured before the trial, halfway through the trial (i.e., 12 weeks), and at the completion of the trial (i.e., 24 weeks). Neuropsychological testing was conducted at baseline and 24 weeks.
Double-blind, randomized, controlled trial of donepezil versus placebo with repeated measures
Donepezil may have some benefit for patients related to changes in cognitive function. Further research is needed to provide strong evidence.
This study primarily showed that future large studies of donepezil in women with breast cancer are feasible. The findings suggest that donepezil may improve memory in breast cancer survivors who report moderate-to-severe cognitive problems. Executive function may improve for some women. Anxiety and insomnia are potential side effects.