Wang, T., Wang, H., Yang, T., Jane, S., Huang, T., Wang, C., & Lin, Y. (2015). The effect of abdominal massage in reducing malignant ascites symptoms. Research in Nursing and Health, 38, 51–59.
To evaluate the effect of abdominal massage on reducing ascites, pain, and other ascites-related symptoms
Gentle abdominal massage consisting of straight rubbing, point rubbing, and kneading was provided by a trained nurse practitioner (NP) for 15 minutes, twice a day (7–8 am and 4–5 pm) for three consecutive days. Control participants received social attention by the same NP who delivered the massage. The NP followed a script during the interaction exploring the patient’s feelings and thoughts and providing information about treatment. Symptoms and body weight were measured in the morning for four successive days (pre- to post-test).
Randomized, controlled trial using repeated measures
There was no significant change in pain, tiredness, nausea, drowsiness, poor appetite, shortness of breath, mobility limitation, or body weight among patients who received massage. The intervention group did experience a significant improvement in depression (p = 0.003), anxiety (p = 0.002), poor well-being (p = 0.001), and perceived abdominal bloating (p < 0.001). These symptoms improved gradually over time for the intervention group, but slightly increased over time for the control group. No massage-related adverse events occurred.
Abdominal massage did not improve pain in this study; however, this may be related to the low level of pain among patients at baseline. Massage improved depression, anxiety, well-being, and perceived abdominal bloating. Additional study is needed with larger groups of patients with malignant abdominal ascites.
This non-invasive, inexpensive intervention was not effective in reducing pain for patients with abdominal ascites, but it may provide relief for other symptoms such as abdominal bloating, depression, anxiety, and poor well-being. After additional study, if this intervention is proved to be appropriate for pain management, nurses will need training on proper massage techniques.
Wang, L., Gu, Z., Zhai, R., Zhao, S., Luo, L., Li, D., . . . Gao, C. (2015). Efficacy of oral cryotherapy on oral mucositis prevention in patients with hematological malignancies undergoing hematopoietic stem cell transplantation: A meta-analysis of randomized controlled trials. PloS One, 10, e0128763.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care
Oral cryotherapy for patients with hematologic malignancies receiving HSCTs with high-dose melphalan decreased the incidence of severe OM. Cryotherapy also may be helpful for patients receiving other preparative regimens. Cryotherapy may decrease the duration of TPN usage and shorten hospital stay. Oral cryotherapy did not appear to affect on the length of analgesic use.
Limitations of this study included the small number of RTCs and the small sample sizes of those RCTs. The methodologic quality of the studies might have resulted in bias.
Oral cryotherapy is a low-cost, easy modality that demonstrated efficacy in decreasing the severity of OM in patients with hematologic malignancies receiving HSCTs. Additional studies on the efficacy of cryotherapy with other conditioning regimens are needed.
Wang, L., Baser, O., Kutikova, L., Page, J.H., & Barron, R. (2015). The impact of primary prophylaxis with granulocyte colony-stimulating factors on febrile neutropenia during chemotherapy: A systematic review and meta-analysis of randomized controlled trials. Supportive Care in Cancer, 23, 3131–3140.
PHASE OF CARE: Active antitumor treatment
Prophylaxis with G-CSF reduces the risk for NF during myelosuppressive chemotherapy.
Patients with cancer undergoing myelosuppressive chemotherapy are at risk for FN. Prophylaxis with G-CSF can reduce this risk for improved patient outcomes.
Wang, Y. J., Boehmke, M., Wu, Y. W., Dickerson, S. S., & Fisher, N. (2011). Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nursing, 34, E1–E13.
To examine the effectiveness of an exercise program on quality of life (QOL), fatigue, sleep disturbances, exercise self-efficacy, exercise behavior, and exercise capacity in women with breast cancer.
Patients were randomly assigned to an exercise or usual care group. The exercise intervention was a six-week walking program based on modified exercise guidelines of the American Cancer Society and American College of Sports Medicine. This program included use of a heart rate ring monitor, pedometer, weekly telephone call, weekly meetings, and an exercise diary. Exercise was of low to moderate intensity (40%–60% maximum heart rate). In this program, patients did weekly goal setting and were given advice and information, and several specific strategies were described that were intended to boost self-efficacy. Patients were oriented to the exercise program prior to surgery, and exercise was begun within a few days after surgery. Data were collected 24 hours prior to surgery and at 24 hours prior to the first cycle of chemotherapy, 7 to 10 days after chemotherapy, and at the end of six weeks.
Patients were undergoing the active treatment phase of care.
The study was a randomized, controlled trial.
The pattern of change in QOL over time showed significant consistent improvement among those in the exercise group compared to usual care controls (p < 0.001). Patterns of change in sleep and sleep disturbance also showed significant improvement over time compared to controls (p < 0.006). The pattern of fatigue showed higher fatigue levels in the exercise group at all study time points. Average fatigue scores changed from 40.5 to 45.8 at week 6 in the exercise group and from 40.1 to 40 with usual care. Patients in the exercise group had significantly better exercise self-efficacy (p ≤ 0.001) and higher levels of exercise behavior (p < 0.001) than those receiving usual care. Patients in the exercise group walked farther on the 6MWT than controls after the intervention (p ≤ 0.001).
Findings showed that a self-managed home exercise program, along with intervention strategies aimed at boosting self-efficacy, had a positive effect on QOL and exercise behavior among women newly diagnosed with breast cancer.
The findings did not show a positive impact of a home-based exercise self-efficacy intervention on fatigue in the first six weeks after surgery in newly diagnosed patients. However, over a longer period of time, patients in the exercise group did better. Nurses may need to educate patients that adherence to an exercise program may not show results in the short term and that effects may take some time to be felt. Nurses can educate and encourage patients to exercise at home, and support activities to boost patient sense of efficacy may improve patient adherence to an exercise prescription.
Wang, X.F., Feng, Y., Chen, Y., Gao, B.L., & Han, B.H. (2014). A meta-analysis of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Scientific Reports, 4, 4813.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care, palliative care
Five out of six studies demonstrated an increase in complete response in patients receiving standard antiemetic regimens plus olanzapine on day 1 of chemotherapy (odds ratio [OR] = 1.95, 95%; confidence interval [CI] = 1.17–3.23; p = 0.01). Five out of six studies showed a cumulative delay in vomiting (OR = 2.65, 95%; CI = 1.36–5.15; p = 0.004). Overall complete response relative risk was improved (4.07, 95%; CI = 1.59–10.43). Also note the following: delayed-phase antinausea effects in olanzapine-containing antiemetic regimens (OR = 2.79, 95%; CI = 1.76–4.43; p = 0.0001); antinausea effects in the overall phase (OR = 3.40, 95% CI = 2.32–5.00; p = 0.00001); and no superiority in the acute phase (RR = 1.34, 95%; CI = 0.77–2.34; p = 0.30).
Complete response is more likely in patients who received antiemetic regimens containing olanzapine compared to patients who did not receive olanzapine. Olanzapine is more effective in delayed CINV than acute.
Olanzapine may add CINV control when added to a standard antiemetic regimen during the delayed phase.
Wang, X., Wang, L., Wang, H., & Zhang, H. (2015). Effectiveness of olanzapine combined with ondansetron in prevention of chemotherapy-induced nausea and vomiting of non-small cell lung cancer. Cell Biochemistry and Biophysics, 72, 471–473.
To compare the effects of ondansetron and olanzapine to ondansetron alone for management of chemotherapy-induced nausea and vomiting (CINV)
All patients received 8 mg IV ondansetron 30 minutes before chemotherapy. Patients in the experimental group also received 10 mg olanzapine for eight days. CINV was evaluated after one chemotherapy cycle.
PHASE OF CARE: Active antitumor treatment
Randomized, two-group trial
World Health Organization toxicity grading criteria
The incidence of vomiting in the acute phase was 33.33% in the olanzapine group and 54.76% in the control group (p < 0.05). The incidence of delayed CINV was 16.67% with olanzapine and 47.62% in the control group (p < 0.01).
The use of olanzapine as part of an antiemetic regimen was associated with a lower incidence of vomiting in the acute and delayed phases.
This study adds to the body of evidence demonstrating the potential role of olanzapine for control of CINV. Olanzapine may have particular benefit for control in the delayed phase. Nurses need to evaluate the patterns of CINV in patients receiving chemotherapy and can identify patients who may benefit from the use of olanzapine along with other antiemetic agents.
Wang, Y.H., Yao, N., Wei, K.K., Jiang, L., Hanif, S., Wang, Z.X., & Pei, C.X. (2016). The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: A systematic review and meta-analysis. European Journal of Clinical Nutrition, 70, 1246–1253.
STUDY PURPOSE: To evaluate the effects of probiotics for the prevention of diarrhea in patients receiving chemoradiotherapy for cancer
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
Probiotics may have a role in the prevention or management of chemotherapy- and radiotherapy-induced diarrhea. The risk of probiotic-associated infections is unclear.
Probiotics may have a role in the prevention and management of chemotherapy- and radiotherapy-induced diarrhea; however, studies have used different probiotic combinations, and the best combination is unclear. Infection-related risks are unclear, but some associated infections have been reported. Caution should be used in patients who are severely immunocompromised.
Wang, Y. J., Boehmke, M., Wu, Y. W., Dickerson, S. S., Fisher, N. (2011). Effects of a 6-week walking program on Taiwanese women newly diagnosed with early-stage breast cancer. Cancer Nursing, 34, E1–E13.
To examine the effectiveness of an exercise program on quality of life (QOL), fatigue, sleep disturbances, exercise self-efficacy, exercise behavior, and exercise capacity in women with breast cancer.
Patients were randomly assigned to an exercise or usual care group. The exercise intervention was a six-week walking program based on modified exercise guidelines of the American Cancer Society and American College of Sports Medicine. This program included use of a heart rate ring monitor, pedometer, weekly telephone call, weekly meetings, and use of an exercise diary. Exercise was of low to moderate intensity (40%–60% maximum heart rate). In this program, patients performed weekly goal setting and were provided advice and information, and several specific strategies were described that were intended to boost self-efficacy. Patients were oriented to the exercise program prior to surgery, and exercise was begun within a few days after surgery. Data were collected at 24 hours prior to surgery and at 24 hours prior to the first cycle of chemotherapy, seven to 10 days after chemotherapy, and at the end of six weeks.
Patients were undergoing the active treatment phase of care.
The study used an experimental, longitudinal repeated measures design.
The pattern of change in QOL over time showed significant consistent improvement among those in the exercise group compared to usual care controls (p < 0.001). Patterns of change in and overall sleep disturbance also showed significant improvement over time compared to controls (p < 0.006). The pattern of fatigue showed higher fatigue levels in the exercise group at all study time points. Average fatigue scores went from 40.5 to 45.8 at week 6 in the exercise group and from 40.1 to 40 with usual care. Patients in the exercise group had significantly better exercise self-efficacy (p ≤ 0.001) and higher levels of exercise behavior (p < 0.001) than those receiving usual care. Patients in the exercise group walked farther in the six-minute walk test than controls after the intervention (p ≤ 0.001).
Findings showed that a self-managed home exercise program, along with intervention strategies aimed at boosting self-efficacy, had a positive effect on QOL and exercise behavior among women newly diagnosed with breast cancer.
Findings of this study did not show a positive impact of a home-based exercise and self-efficacy interventions on fatigue in the first six weeks after surgery in newly diagnosed patients. However, over a longer period of time, patients in the exercise group did better. These findings suggest that nurses may need to educate patients that adherence to an exercise program may not show results in the short term and that effects may take some time to be felt. Nurses can educate and encourage patients to exercise at home and support activities to boost a patient's sense of efficacy may improve patient adherence to an exercise prescription.
Wandt, H., Schaefer-Eckart, K., Wendelin, K., Pilz, B., Wilhelm, M., Thalheimer, M., . . . Study Alliance Leukemia. (2012). Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: An open-label, multicentre, randomised study. Lancet, 380, 1309–1316.
To determine the effectiveness of the therapeutic transfusion strategy (bleeding occurred) versus the prophylactic strategy of platelet count of 10 x109 at the morning blood draw in two defined groups
The primary end point of the study was to evaluate two groups of patients: patients with acute myeloid leukemia (AML) (group A, n = 190) versus patients who had received an autologous transplantation (group B, n = 201), comparing prophylactic platelet transfusion to therapeutic platelet transfusion. Group A consisted of a prophylactic group (n = 96) and a therapeutic group (n = 94). Group B also consisted of a prophylactic group (n = 98) and a therapeutic group (n = 94). Those in group A assigned to the prophylactic transfusion protocol were given one unit of platelets when the morning count was 10x109 or lower one day after the end of induction therapy or consolidation. The protocol started on the day of stem cell transplantation in group B. The therapeutic groups received a transfusion only when a grade 2 or higher bleeding episode occurred. If bleeding continued, next steps, including further transfusions, were decided by the treating provider.
PHASE OF CARE: Active antitumor treatment
Multicenter, open-label randomized trial of patients with hematologic malignancies
In the prophylactic group, the morning platelet level was the determining factor to transfuse or not. In the therapeutic group, platelets were administered if a patient's bleeding was defined as a grade 2 or higher according to the World Health Organization criteria.
A significant result of p < 0.0001 in the reduction of platelets transfused in the therapeutic group was noted. The therapeutic group had a higher risk of grade 2 bleeding, which consisted mainly of petechial bleeding or purpura of the skin. The group with AML showed a significant result of p < 0.0001 in a grade 4 bleeding risk of 37% compared to the transplantation group of 18%.
This study revealed that the therapeutic strategy for patients receiving autologous stem cell transplantation would be safe and could become the standard of care with platelet transfusion limitation. The standard of care for patients with AML should remain the standard with prophylactic platelet transfusion because of the risk for increased bleeding.
There was only a 78% protocol compliance rate on the therapeutic group. The study was not powered to prove a significant difference in grade 4 bleeding events or lethal events.
Therapeutic platelet transfusions for patients receiving transplanations could become standard practice, given the hardship to maintain a continued platelet inventory, and decrease the risk of alloimmunization. Nurses need to remain vigilant in assessing and monitoring for increased bleeding. Education would be a necessity to ensure that early identification of potential bleeding is assessed.
Wanchai, A., Armer, J. M., & Stewart, B. R. (2011). Nonpharmacologic supportive strategies to promote quality of life in patients experiencing cancer-related fatigue: a systematic review. Clinical Journal of Oncology Nursing, 15, 203–214.
To review the literature on nonpharmacologic supportive strategies to enhance quality of life (QOL) among patients with breast cancer experiencing cancer-related fatigue.
Databases searched were MEDLINE and CINAHL (2000–2010).
Search keywords were breast cancer patient, oncology patient, fatigue, cancer-related fatigue, quality of life, health-related quality of life, physical activity, and exercise.
Studies were included in the review if they
Eighty-nine articles were identified, of which 28 met the inclusion criteria. No method of quality rating of the studies was described.
Supervised exercise was used in eight studies. Four of these showed that exercise significantly improved QOL and reduced fatigue. Two studies showed that supervised exercise improved QOL but not fatigue; they had noted study limitations and intervention contamination. One large multi-site study showed that supervised aerobic exercise improved self-esteem, fitness, etc., but had no significant effect on QOL, depression, anxiety, or fatigue
Home-based exercise was used in six studies. All of these confirmed a positive effect of participation in exercise on fatigue. Fatigue levels either decreased, or those who exercised had significantly less increase in fatigue over time.
Telephone-based encouragement in activity was used in one study (25 patients). At 12 weeks, there were significant increases in activity, QOL, and fatigue.
One study used print materials and step pedometers along with physical activity recommendations. Those who received all three of these strategies had improved QOL and fatigue.
Education and counseling was used in five studies. Mixed results were seen across studies, with a positive effect on fatigue that was significant in three of these studies.
Sleep therapy was examined in three studies. Two of these demonstrated a significant positive effect on fatigue with cognitive behavioral therapy and insomnia treatment. One large study using cognitive behavioral therapy showed improvement in sleep quality but no effect on fatigue.
Other interventions were yoga in one study, tai chi in one study, and physical therapy in one study. Yoga was associated with an improvement in fatigue, and physical therapy was also associated with improvement, although this was only studied in 11 patients.
This review generally showed that supervised exercise and supervised exercise and other strategies to promote exercise can reduce cancer-related fatigue and improve QOL in women with breast cancer. Findings were limited by several studies with small sample sizes and variations in the phases of care in which the interventions were provided. There was insufficient evidence to draw conclusions about the complementary therapies included.
Based on current evidence, exercise, educational counseling, and sleep therapy appear to be helpful methods to improve QOL and reduce fatigue. Because of methodological limitations of many of these previous studies, further well-designed research is needed to confirm these conclusions.