Dodd, M.J., Dibble, S.L., Miaskowski, C., MacPhail, L., Greenspan, D., Paul, S.M., . . . Larson, P. (2000). Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodonology, 90, 39–47.
To determine the efficacy of three different mouthwashes in the treatment of chemotherapy-related mucositis
All patients received the PRO-SELF Mouth Aware (PSMA) educational program from a nurse who was blinded to the intervention treatment. The program included didactic information, the development of self-care strategies, and nurse support in the treatment setting. Good oral hygiene was an emphasis of the program, and patients were provided with specific oral hygiene practices to follow during chemotherapy. Nurses contacted the patients via telephone every other day. Patients were randomly assigned to receive one of three possible intervention treatments that were given to the patient in 1-pint opaque plastic bottles. The interventions were either salt and soda, chlorhexidine, or magic mouthwash. Nurses received training in the PSMA program every six months. Patients used the mouthwash four times per day until symptoms resolved or for 12 days. Patients swished 20 mL of their intervention mouthwash for 20 seconds and spit. Mouthwash bottles were collected when symptoms resolved or on day 12, whichever came first, and remaining medication was measured to gauge patient compliance. Oral assessments began upon enrollment, and the first assessment was conducted by a physician or nurse. Patient-directed oral assessments continued thereafter, four times per day, or until mucositis resolved or for 12 days, whichever came first.
Randomized, double-blinded clinical trial
There were no differences between any of the groups in the time to cessation of mucositis symptoms (F2,141 = .52, p = .59). The mean number of days to cessation of symptoms was 6.59 days in the chlorhexidine group, 7 days in the salt and soda group, and 7.17 days in the magic mouthwash group.
Although clinicians regularly use chlorhexidine mouthwash, this study demonstrates that there is no difference between treatments of salt and soda rinses and magic mouthwash as part of a treatment protocol for chemotherapy-induced oral mucositis. Participants in the magic mouthwash group reported the highest mean number of days to cessation of symptoms, indicating this is the least effective treatment of the three.
Educating patients about proper oral hygiene while receiving chemotherapy is important. Nurses should be aware, however, that there is no difference between chlorhexidine mouthwash, salt and soda rinses, and magic mouthwash, the three mouthwashes traditionally used in the clinical setting. As the least effective of the mouthwashes in terms of mean days to cessation of symptoms, magic mouthwash does not appear to be an effective intervention in the treatment of chemotherapy-induced oral mucositis.
Dodd, M. J., Cho, M. H., Miaskowski, C., Painter, P. L., Paul, S. M., Cooper, B. A., . . . Bank, K. A. (2010). A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nursing, 33, 245–257.
The primary aim was to evaluate the effectiveness of a home-based exercise training intervention called the Pro-self: Fatigue Control Program on the management of cancer-related fatigue (CRF). The secondary aim was to study the effects of the intervention on sleep disturbance, depression, and pain.
Patients were randomized to one of three groups. Two groups received a home-based prescription for exercise called the Pro-self: Fatigue Control Program (during and after cancer treatment). One of these groups had follow-up. The third group received usual care. All patients completed four valid and reliable tools at baseline, the week before the second chemotherapy treatment, at the end of cancer treatment, and at the end of the study (about one year after the start of the study). The tools measured fatigue, sleep disturbance, depression, and pain and were analyzed to compare how fatigue and other study variables had changed over time and by groups. It was a randomized, single-blind, three-arm, controlled trial design.
The study was a randomized, controlled trial (RCT).
Change in fatigue did not change over time. No significant change in fatigue occurred among groups.
The home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment. The optimal timing of exercise remains to be determined.
When the study was conducted, the benefits of exercise were being reported in the literature and patients could not be asked to stop their regular exercise. The PFS was administered only three times a year, which might not be frequent enough to capture the true effect of exercise on CRF. The self-report of exercise behaviors was obtained with no objective measures.
CRF is a common problem. Some physical activity is better than none, and there is no harm in exercise as tolerated during cancer treatment. More frequent assessments of fatigue, sleep disturbance, depression, and pain may capture the effect of exercise.
Dockham, B., Schafenacker, A., Yoon, H., Ronis, D.L., Kershaw, T., Titler, M., & Northouse, L. (2015). Implementation of a psychoeducational program for cancer survivors and family caregivers at a Cancer Support Community affiliate: A pilot effectiveness study. Cancer Nursing. Advance online publication.
To examine the effectiveness and feasibility of the Family involvement, Optimistic attitude, Coping effectiveness, Uncertainty reduction and Symptom management (FOCUS) program on the quality of life (QOL), benefits of illness and caregiving, communication, and support of cancer survivors and their caregivers in a cancer support community (CSC) site using a small group format
Researchers modified the FOCUS program (a nurse-delivered, home-based intervention for patient/caregiver dyads) for use and administration by social workers at a CSC site to cancer survivors and their caregivers. The program was administered in six sessions over six weeks to three to four dyads in a small-group format.
Pre- and postintervention study with no control group
The intervention effect was assessed by dyadic scores (survivors and caregivers were treated as a unit). Dyadic QOL (physical, emotional, and functional) was significantly improved from preintervention to postintervention, but there was no improvement in social QOL. Dyadic perception of illness and self-efficacy also were significantly improved, but dyadic communication and support were not. The dyadic main effect size ranged from small to moderate for different outcomes. Effect sizes were larger for survivors than for caregivers. For feasibility, the enrollment rate was 60%, retention was 92%, and the intervention fidelity was 94%. Caregivers and survivors were highly satisfied with the intervention.
The modified FOCUS program was feasible and effective when administered to small groups of survivor/caregiver dyads. However, the assessment of improvement in outcomes considering the dyad a unit may lead to confusion in interpreting the outcomes of specific participants (survivors versus caregivers).
Tailored interventions to assist caregivers are effective. Collaborations with community settings that allow for the administration of evidence-based programs assisting caregivers may make such interventions more feasible and available to larger numbers of patients and caregivers. Careful attention to intervention fidelity is essential when programs are translated on a larger scale.
Dobrila-Dintinjana, R., Trivanovic, D., Zelic, M., Radic, M., Dintinjana, M., Petranovic, D., . . . Matijasic, N. (2013). Nutritional support in patients with colorectal cancer during chemotherapy: Does it work? Hepato-Gastroenterology, 60, 475–480.
To determine if dietary counseling, oral nutrition, and megestrol acetate affect nutritional status and survival in patients with advanced cancer
Consecutive patients were given nutritional counseling, 400 mg per day megestrol, oral supplements of 600 kcal per day, and a product containing eicosapentaenoic acid with an additional 600 kcal. Prospective patients were then compared to historical controls when nutritional supplements were not available in the country. Patients were followed for up to 24 weeks.
Prospective and observational with a historical control comparison
This study reports a higher prevalence of diarrhea and water retention in patients receiving nutritional intervention. It reports a lower prevalence of loss of appetite at 12 weeks in those given the intervention compared to historical controls (p = .0046) and improvement of appetite by 12 weeks in the intervention group (p = .0046). Survival curve analysis showed improved survival among those who received the intervention (p = .022)
Oral dietary supplements and nutritional counseling may benefit patients with advanced colorectal cancer.
Dietary counseling and provision of oral nutritional supplements may be of benefit to patients.
Doan, T.N., Kirkpatrick, C.M., Walker, P., Slavin, M.A., Ananda-Rajah, M.R., Morrissey, C.O., . . . Kong, D.C. (2016). Primary antifungal prophylaxis in adult patients with acute lymphoblastic leukaemia: A multicentre audit. The Journal of Antimicrobial Chemotherapy, 71, 497–505.
To investigate practices for antifungal prophylaxis and incidence of invasive fungal disease (IFD)
A retrospective chart review was conducted to collect data on patients from beginning of induction to completion of consolidation regarding the use of antifungal prophylaxis and IFD outcomes. Cost analysis was included.
PHASE OF CARE: Active antitumor treatment
Retrospective
European Organization for Research and Treatment of Cancer (EORTC) criteria for proven, possible, or probable IFD
Ninety-eight percent had neutropenia ranging from 18–45 days in duration. Prophylactic antifungal agents were given to 85% of patients. The only significant difference between those who developed IFD and those who did not was the use of antifungal prophylaxis. Those receiving prophylaxis had a lower incidence of proven or probable IFD (2.6%) than others (21.4%) (p = 0.024). IFD incidence was highest in patients receiving BFM95 treatment (hyper-CVAD: hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone). Cost of care for those with IFD was significantly higher from hospitalization, diagnostic testing, and antifungal treatment costs (p < 0.001).
The use of antifungal prophylaxis was associated with a lower incidence of IFD and associated healthcare costs.
Antifungal prophylaxis in at-risk patients was shown to be effective in reducing the incidence of IFD and associated healthcare costs.
Do, J., Cho, Y., & Jeon, J. (2015). Effects of a 4-week multimodal rehabilitation program on quality of life, cardiopulmonary function, and fatigue in breast cancer patients. Journal of Breast Cancer, 18, 87–96.
To examine effects of a rehabilitation program
Patients were randomly assigned to an early exercise group or a delayed exercise group. Participants attended rehabilitation sessions five times per week for four weeks. Sessions involved the use of upper and lower extremity stretching, aerobic, and strengthening exercises. During weeks 1–4, the early exercise group participated, and during weeks 4–8, the delayed group participated. Patients were evaluated at baseline and at two, four, six, and eight weeks.
Randomized, parallel group trial with repeated measures
Patients in both groups showed significant improvements in all measures except body image (p < 0.001). The greatest improvements were shown during the period of time that individuals were participating in the exercise sessions in both groups. There was no significant difference between groups.
The exercise combinations used here were effective in reducing fatigue and improving quality of life among participants
The findings of this study add to the already extensive body of evidence that various forms of exercise are beneficial to reduce fatigue in patients with cancer. This study showed effects specifically during the time in which participants were exercising, suggesting the need for ongoing involvement in activity to maintain effectiveness
Do, J.H., Kim, W., Cho, Y.K., Lee, J., Song, E.J., Chun, Y.M., & Jeon, J.Y. (2015). Effects of resistance exercises and complex decongestive therapy on arm function and muscular strength in breast cancer related lymphedema. Lymphology, 48, 184–196. Retrieved from https://journals.uair.arizona.edu/index.php/lymph/article/view/18835
To examine the effects of adding resistance exercise to complete decongestive therapy (CDT) on arm volume, function, strength, and quality of life
Patients were randomized to intervention and control groups. The control group received CDT alone for one to two weeks, and those with severe lymphedema also had bandaging. The intervention received the same CDT, as well as exercise using resistance bands. Resistance exercises included isolated shoulder movements five times per week for eight weeks with three sets of 10 repetitions of exercises. Study assessments were conducted at baseline and after eight weeks. Arm volume measurement was taken at two weeks.
PHASE OF CARE: Late effects and survivorship
Randomized, two group trial
Both groups showed improvement in quality of life scores and arm volumes with no significant differences between groups. Arm disability scores were significantly lower in the intervention group post-treatment (p = 0.001).
The addition of resistance exercise to CDT improved arm function, reduced disability, and did not have any adverse effects on arm lymphedema volume.
The findings support the addition of moderate intensity resistance exercise to CDT for the management of lymphedema. Resistance exercise was associated with improved function, less arm disability, and no adverse effects on lymphedema volume. Nurses can recommend that patients use moderate exercise of this sort. Resistance exercise can be done with resistance bands—an inexpensive and practical way to achieve this intervention.
Dirksen, S. R., & Epstein, D. R. (2008). Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Journal of Advanced Nursing, 61, 664–675.
The intervention was delivered by a master’s prepared nurse and consisted of four weekly classes and two weeks of treatment conducted through individual weekly telephone sessions. Each class followed a standard format using a treatment manual. The cognitive-behavioral therapy (CBT) intervention consisted of stimulus control instructions, sleep restriction therapy, sleep education, and hygiene content, including cognitive strategies. The aim of the stimulus control interventions was to shape cognitions to reassociate the bed and bedroom with rapidly falling asleep or falling back to sleep. The aims of stimulus control were to acquire a consistent sleep pattern, strengthen the bed and bedroom as cues for sleep, and weaken them as cues for activities that interfere with sleep. Sleep restriction therapy was based on the observation that people with insomnia spend too much time in bed attempting to sleep. The treatment focused on developing a sleep-wake schedule that consolidates sleep and limits it to a specific time by restricting the amount of time spent in bed. Sleep education and hygiene consisted of giving basic information about sleep processes and functions, developmental sleep changes, circadian rhythms, individual sleep needs, sleep deprivation, and supportive information. Dysfunctional cognitions that may contribute to sleep difficulty were also challenged.
This was a randomized, controlled trial with assignment to either CBT for insomnia or a control group that received education about sleep and sleep hygiene.
Profile of Mood States Fatigue/Inertia Subscale (POMS-F/I)
Women in the intervention group demonstrated significantly lower fatigue compared to those in the control group. The authors concluded that because mediation analyses indicated that the intervention had no direct effect on any of the psychosocial outcomes, that the intervention had an indirect effect on the outcome of fatigue due in part to improvements in sleep quality (both groups demonstrated improvements in mean scores for insomnia severity across the course of the study, and in a study reported elsewhere, they also demonstrated significant improvements in other sleep outcome indicators and favorable changes in actigraphy).
A modest amount of continuing education, as well as access to some instructional materials for patients, are needed to prepare health care professionals to deliver CBT interventions for insomnia.
Dirican, A., Andacoglu, O., Johnson, R., McGuire, K., Mager, L., & Soran, A. (2010). The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 19(5), 685–690.
To evaluate the short-term benefits of low-level laser therapy (LLLT) when added to the conventional management of breast cancer-related lymphedema (BCRL)
All patients had experienced at least one conventional treatment modality, such as complex physical therapy, manual lymphatic drainage, or pneumatic pump therapy. LLLT was added to patients' ongoing therapeutic regimen. All patients completed two cycles of LLLT. Assessment took place before and after the first and second cycle of LLLT sequentially.
The study took place in an outpatient setting at the University of Pittsburgh Medical Center.
The study used a quasi-experimental design.
The difference between sums of the circumferences of the affected and unaffected arms decreased 54% and 73% after the first and second cycles of LLLT, respectively. Eighty-two percent of patients 14 out of 17 experienced decreased pain with motion by an average of 40% and 62.7% after the first and second cycle of LLLT, respectively. Scar mobility increased in 13 (76.4%) and shoulder range of motion improved in 14 (82.3%) patients after LLLT. One patient developed cellulitis during LLLT.
Patients with BCRL received additional benefits from LLLT when used in conjunction with standard lymphedema treatment, including reduction in limb circumference, pain, increase in range of motion and scar mobility.
Further studies with appropriate sample size and control groups are necessary to assess the long-term effects of LLLT in combination with conventional treatments as well as the effect of the repetitive application.
DiPalma, J.A., Cleveland, M.B., McGowan, J., & Herrera, J.L. (2007b). A randomized, multi-centered, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. American Journal of Gastroenterology, 102, 1436–1441.
To compare the safety and efficacy of polyethylene glycol (PEG) versus placebo over a six-month treatment period in patients with chronic constipation.
PEG 3350 (Miralax®) laxative 17 g or placebo was administered daily for six months. Patients were randomly assigned in a 2:1 ratio to PEG or placebo. This was a subjects mixed study. Medication was administered in 8 oz of juice or another beverage. Bisacodyl 10 mg (5 mg tablets) was used as rescue medication for severe discomfort related to constipation. Fiber was prohibited. Other nonconstipating medications were allowed.
50 centers in the United States
This was a double-blind, placebo-controlled, parallel, randomized controlled trial.
PEG is safe and effective in management of constipation in adults and older adults for up to six months.
The study focused on chronic constipation and lacked focus on cancer or opioid-induced constipation.