Expressive Writing/Emotional Disclosure/Journaling
Expressive writing/journaling is the art of putting thoughts and feelings on paper. Writing about negative emotional experiences may improve physical and psychological health, and writing about deep feeling regarding personal stressors can enhance well-being and health.
Exercise
Exercise is physical activity that involves repetitive bodily movement done to improve or maintain one or more of the components of physical fitness: cardiorespiratory endurance (aerobic fitness), muscular strength, muscular endurance, flexibility, and body composition. Exercise interventions in patients with cancer have been provided as home-based, patient self-managed programs as well as supervised and unsupervised individual or group exercise sessions of varying duration and frequency.
Estrogen Replacement
Estrogens are a group of steroid compounds that are the primary female sex hormones. Estrogen replacement therapy is the provision of estrogens and has been used to treat postmenopausal symptoms. Estrogen replacement has been evaluated in patients with cancer for treatment of hot flashes. It should be noted that this is the opposite effect of hormonal treatment for cancer in which anti-estrogen agents are administered.
Erythropoiesis Stimulating Factors (ESA)
Erythropoiesis-stimulating factors (ESAs) such as erythropoetin and its synthetic alternatives (darbopoetin, erythropoetin alpha) are essential hormones that control red blood cell production, and are mainly used in the treatment of anemia. The U.S. Food and Drug Administration has issued several warnings related to the use of ESAs; related concerns included risk of increased tumor growth, decreased survival time and cardiovascular side effects. The effects of erythropoietin on fatigue and cognitive impairment have been examined in patients with cancer in the setting of anemia.
Epithelial Growth Factor
Epithelial growth factor (EGF) regulates epithelial cell proliferation, growth, and migration. In addition, it has an effect on angiogenesis for the nutritional support of tissues. Thus, EGF may have an effect on wound healing and tissue generation. EGF has been examined for effectiveness in prevention and treatment of radiodermatitis.
Epidural Analgesia
Epidural analgesia is administration of an analgesic into the epidural space of the spine. This may be done by bolus administration or infusion. This type of analgesia has been evaluated for management of acute and intractable pain in patients with cancer.
Environmental Interventions
Environmental interventions for control and prevention of infection include such things as methods for disinfection and sterilization of surfaces and equipment, use of high-efficiency particulate air filtration, positive air pressure rooms, frequency of room air exchanges, hand hygiene, and the use of standard barriers for body fluids. Guidelines for environmental precautions for patients with neutropenia have been identified by the Infectious Diseases Society of America and Centers for Disease Control and Prevention.
Energy Conservation and Activity Management
Energy conservation is the deliberate and planned management of one’s personal energy resources to prevent their depletion. Energy conservationstrategies include planning, delegating, setting priorities, pacing, resting, and scheduling activities that require high-energy use at times of peak energy. Balancing rest and activity during times of high fatigue allows for maintaining adequate energy to perform valued activities and reach important goals.
Emollients and Moisturizers
Emoliients and moisturizers are substances that may contain a variety of chemical agents designed to make the external skin layers more pliable and increase skin hydration by reducing water evaporation from the skin. Emollients and moisturizers have been studied in patients with cancer regarding their effects in the management of skin toxicities caused by cancer treatments.
Elemental Diet and Oral Rinse
An elemental diet contains easily absorbable proteins in the form of amino acids, very minimal fat content, and easily absorbable vitamins and mineral content. Elemental diets have been used to maintain nutrition and reduce diarrhea (because absorption in the upper intestine can reduce stool volume) in patients with inflammatory bowel diseases. Use of an elemental diet formula was studied in patients with cancer for its effect on radiation-induced diarrhea (Russell, 1975). Use of an elemental diet as an oral rinse prior to swallowing has been tested for its effect on mucositis.