Li, Q., & Loke, A.Y. (2014). A systematic review of spousal couple-based intervention studies for couples coping with cancer: Direction for the development of interventions. Psycho-Oncology, 23, 731–739.
STUDY PURPOSE: To explore the existing interventions for spousal couples coping with cancer in terms of type of intervention, contents, approach, and outcome measurements, and to identify directions for the development of interventions
DATABASES USED: Science Citation Index Expanded, PsycInfo, MEDLINE via OVIS SP, CINAHL
KEYWORDS: intervention; program; therapy; cope; coping; cancer; oncology; carcinoma; couple; partner; spouse
INCLUSION CRITERIA: Published in English or Chinese within the four databases searched; couple-based interventions; studies had to focus on couple-based interventions; outcome measures included the patients with cancer and their spousal caregivers
EXCLUSION CRITERIA: Commentaries, editorials, literature reviews, conference proceedings
Of the 17 articles reviewed, interventions were focused mainly on patient caregiving and caregiver self-care, usually lasted for six weeks using a face-to-face group mode., and had follow-up around three months. The outcomes measures were grouped into three main dimensions: dyadic appraisal, dyadic coping, and dyadic adjustments. Positive outcomes were reported for these interventions, including improvements in communications, dyadic coping, quality of life of the patients and their partners, psychosocial distress, sexual functioning, marital satisfaction, and caregiver self efficacy. The majority of interventions were delivered to individual couples face-to-face. Attrition rate ranged from 6%–34%, with an average of 20%. Interventions were grouped as skills training (n = 11), counseling (n = 6), and psychoeducation (n = 2). Skills training and psychoeducation were most often provided together.
The findings highlighted the positive outcomes of couple-based interventions that focus on couples coping with cancer. Although all studies focused on the couple's communication and relationship, only 40% focused on the subject of the caregiver's self-care. All of the intervention studies included in the review reported positive outcomes to some extent, including quality of life, psychosocial distress, sexual functioning, and marital satisfaction of the patients and their partners.
Future couple-based intervention research should focus on patients with cancer whose spouse is an active caregiver and provide intervention and assessment of both partners as a unit (dyad). Findings from this review show that couple-based interventions had multiple benefits for patients and caregivers. The high attrition rates seen suggest that the most acceptable timing, duration, and method of delivery is not clear. Although benefit was shown, what factors would indicate those couples who would be most likely to benefit from couples interventions is not clear, and findings do not clarify which approaches are most beneficial.
Li, X.M., Zhou, K.N., Yan, H., Wang, D.L., & Zhang, Y.P. (2012). Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: A randomized clinical trial. Journal of Advanced Nursing, 68, 1145–1155.
To evaluate the effects of music therapy on anxiety in women undergoing breast cancer surgery
Patients admitted to the hospital for mastectomy were randomly assigned to receive either music therapy or usual care. Patients in the intervention group listened to music they selected through a headphone connected to an MP3 player during their hospital stay. Music was provided twice daily for 30 minutes per session. The total time in the hospital receiving therapy was an average of 13.6 days following radical mastectomy and 18.9 days for chemotherapy. Assessments were done at baseline on the day before surgery, the day before hospital discharge, on second hospital admission for chemotherapy, and on a third hospital admission for chemotherapy.
Patients were undergoing active antitumor treatment.
A randomized controlled trial design was used.
State Anxiety Inventory
Pretest results showed that patients had moderate to severe anxiety levels prior to surgery. Mean post-test anxiety scores were lower in the experimental group, on the first post-test 4.57 points, and increasing across time to 9.69 points lower at the final post-test (p < 0.0001). Mean anxiety scores declined over time in all patients.
Findings suggest that listening to music can be beneficial in reducing anxiety during treatment for breast cancer.
Listening to music is a simple and low-cost intervention that may be helpful for some patients in reducing anxiety associated with cancer treatment.
Li, W.H., Chung, J.O., & Ho, E.K. (2011). The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing, 20, 2135–2143.
To examine the effectiveness of play, consisting of virtual reality computer games, in reducing anxiety and symptoms of depression in children hospitalized for cancer treatment
Children hospitalized for cancer treatment were invited to participate in the study. Patients received 30 minutes of a play intervention, consisting of virtual reality gaming, five days per week. Play was in a small-group setting that included no more than four patients. A historical comparison group was used in the study. Study measures were obtained at hospital admission and at day 7.
Prospective, single-blind trial with historical control comparison
ANOVA showed a main effect for time, suggesting significantly lower anxiety and depression symptoms in the group that participated in the play intervention. There were no significant differences in baseline scores between groups. In both groups, anxiety scores declined between baseline and day 7.
Play involving virtual reality may reduce symptoms of depression in children hospitalized for cancer treatment.
Findings suggest that use of virtual reality play may help pediatric inpatients being treated for cancer. Further well-designed research in this area is warranted. It is unclear if virtual reality is more effective than other means of distraction.
Li, Y., Klippel, Z., Shih, X., Wang, H., Reiner, M., & Page, J.H. (2016). Trajectory of absolute neutrophil counts in patients treated with pegfilgrastim on the day of chemotherapy versus the day after chemotherapy. Cancer Chemotherapy and Pharmacology, 77, 703–712.
To compare absolute neutrophil count (ANC) and febrile neutropenia (FN) in patients who receive pegfilgrastim on the same day of chemotherapy versus the next day
Data from a prior randomized, controlled trial was pooled for analysis. The trajectory of ANC and incidence of FN and related events were analyzed.
ANC at nadir was significantly lower in those who received same-day pegfilgrastim (p = 0.003). Time to nadir was slightly lower in those with same-day pegfilgrastim (p = 0.019). ANC at nadir was much lower among those who got same-day treatment (0.27 compared to 0.74 x 109/l, p < 0.001). Risk of grade 4 neutropenia was higher among those who got same-day treatment (odds ratio [OR] = 0.23, 95% CI [0.1, 0.49]). No significant difference existed between groups in incidence of FN as defined for this pooled analysis; however, the actual incidence was lower among those who received next-day treatment. ANC recovery was faster in those who received next-day pegfilgrastim.
Patients who received pegfilgrastim the day after chemotherapy had less severe ANC suppression and more rapid ANC recovery. No clear differences in incidence of FN were reported.
Initial trials were not designed to capture the incidence of FN and infections, so pooled analysis capability was limited.
This study adds to the body of evidence supporting the administration of pegfilgrastim as recommended, one to three days after chemotherapy.
Lhomme, C., Brault, P.H., Bourhis, J.H., Pautier, P., Dohollou, N., Dietrich, P.Y., . . . Hayat, M. (2001). Prevention of menstruation with leuprorelin (GnRH agonist) in women undergoing myelosuppressive chemotherapy or radiochemotherapy for hematological malignancies: A pilot study. Leukemia and Lymphoma, 42, 1033–1041.
Nineteen bleeding episodes occurred in 11 patients. Three patients required additional treatment, including additional nomegestrol acetate, methylergometrine, and/or platelet transfusions. Eleven episodes of spotting and six episodes of moderate bleeding not requiring treatment occurred in 10 patients. The majority of bleeding episodes were short with a median of three days (1–23). Seventeen patients had no clinically or therapeutically relevant bleeding. There was no premature termination because of toxicity. There was one subcutaneous nodule at injection site and eight superficial hematomas.
Le, Q.T., Kim, H.E., Schneider, C.J., Murakozy, G., Skladowski, K., Reinisch, S., … Henke, M. (2011). Palifermin reduces severe mucositis in definitive chemoradiotherapy of locally advanced head and neck cancer: A randomized, placebo-controlled study. Journal of Clinical Oncology, 29, 2808–2814.
To evaluate the efficacy and safety of palifermin in the reduction of oral mucositis (OM) associated with definitive chemoradiotherapy for locally advanced head and neck cancer (HNC)
The study was conducted in a multi-institutional setting.
Patients were undergoing the active treatment phase of care.
This was a randomized, placebo-controlled study.
The incidence of severe OM was significantly lower in patients receiving palifermin than those receiving placebo (54% versus 69%). In the palifermin arm, the median time to severe OM was delayed, median duration of severe OM was shortened, and the incidence of xerostomia at grade 2 or more was lower, favoring palifermin; however, the differences were not significant after multiplicity adjustment.
Opioid analgesic use, average mouth and throat soreness scores, and chemoradiotherapy compliance were not significantly different between treatment arms.
Adverse events were similar between arms. The most common study drug related adverse events were rash, flushing, and dysgeusia. After median follow-up of 25.8 months, overall survival and progression-free survival were similar between the treatment arms.
There was no mention as to whether the study was blinded to the researchers.
Oral mucositis is a severe complication of treatment for head and neck cancer, and effective treatment strategies are still needed. Although palifermin reduced severe functional OM, its role in the management of locally advanced HNC during chemotherapy remains unclear. Effective treatment strategies to manage OM associated with high-dose chemoradiotherapy still are needed.
Lew, M.W., Kravits, K., Garberoglio, C., & Williams, A.C. (2011). Use of preoperative hypnosis to reduce postoperative pain and anesthesia-related side effects. The International Journal of Clinical and Experimental Hypnosis, 59(4), 406–423.
To test the feasibility of hypnosis as a preoperative intervention; to explore the effects of preoperative hypnosis on anxiety and pain
Investigators gathered baseline assessments of pain, nausea, vomiting, distress, and anxiety. The hypnosis intervention was a 15-minute scripted hypnotic experience provided, within an hour before surgery, in the preoperative holding area of the operating suite. Investigators collected data and interviewed patients postsurgery. Data pertaining to historical controls were obtained from medical records matched for age, date, and type of procedure.
Active treatment
Prospective pre- and postdesign with historical control comparisons; mixed method
Postintervention measures showed a decrease in anxiety, worry, and nervousness; however, authors did not report significant pre- and poststudy differences. The hypnosis group had a higher prevalence of postoperative pain and nausea than did the historical group.
Providing a hypnosis intervention preoperatively appears to be feasible. Results reported do not provide substantial evidence of the efficacy of hypnosis in preventing postoperative pain and nausea.
This study suggests that providing a hypnosis intervention preoperatively can be feasible. The impact of such an intervention cannot be determined from this study.
Lewis, L., Carson, S., Bydder, S., Athifa, M., Williams, A.M., & Bremner, A. (2014). Evaluating the effects of aluminum-containing and non-aluminum containing deodorants on axillary skin toxicity during radiation therapy for breast cancer: A 3-armed randomized controlled trial. International Journal of Radiation Oncology, Biology, Physics, 90, 765–771.
To evaluate the effects of aluminum- and nonaluminum-containing deodorants
Patients were randomly assigned to use (a) just soap and water, (b) nonaluminum-containing deodorant and soap and water, or (c) aluminum-containing deodorant and soap and water. Low irritant soap was provided to study participants for use, as were both deodorants. The axilla of the breast or chest wall undergoing radiation was assessed weekly. One month after completion of treatment, patients were interviewed to assess their compliance with the treatment assignment.
PHASE OF CARE: Active antitumor treatment
Randomized, controlled, three-arm trial
There were no skin toxicities at two weeks, and at four weeks, less than 5% in all groups had at least grade 2 skin toxicity. At seven weeks, 66.7% of 12 remaining aluminum-containing users, 80% of the remaining 10 nonaluminum-containing deodorant users, and 58.8% of the 17 remaining controls had at least grade 2 toxicity. There was no statistically significant difference in axillary skin toxicity associated with study group, and there were no significant differences among groups in pain, itch, or burning sensation.
This study found no evidence that aluminum- or nonaluminum-containing deodorant use had an adverse effect on axillary skin toxicity during radiation therapy.
This study demonstrated that the use of deodorants, including aluminum-containing deodorant, did not adversely effect skin reactions during radiation therapy for breast cancer. Nurses can educate patients that they do not need to avoid using such deodorants during radiation therapy.
Lewis, F.M., Casey, S.M., Brandt, P.A., Shands, M.E., & Zahlis, E.H. (2006). The Enhancing Connections program: Pilot study of a cognitive-behavioral intervention for mothers and children affected by breast cancer. Psycho-Oncology, 15(6), 486–497.
The Enhancing Connections program is a five-session multicomponent cognitive behavioral educational counseling intervention delivered at two-week intervals. Each session is scripted and lasts one hour. Components include home-based interactive didactics for mothers, experiential exercises, skilled efficacy-enhancing rehearsals led by a patient educator, mother-child booklets about cancer, mother-child workbooks, and between-session telephone access to a patient educator.
13 mothers with stage 0, I, and II breast cancer and 13 school-age children
Pacific Northwest of the United States
Single-group pre- and post-test design
Maternal measures: Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory Form Y, and Cancer Self-Efficacy Scale.
Mother-child measures: Relatedness Scale and Family-Peer Relationship Scale.
Child measures: Illness-related Pressures Scale, Cancer-Worries Scale, Disenfranchised Grief Scale, Revised Child Manifest Anxiety Scale, Child’s Depression Inventory, and the Child Behavior Problem Checklist.
The program resulted in significant improvements between baseline and post-test in mother’s depressed mood, state anxiety, and self-efficacy in regard to caring for self and family and dealing with the impact of cancer. For children, the program resulted in significant improvements in behavior and emotional functioning, in anxiety or depressed mood, and in reduction of cancer worries.
Evidence suggests that the Enhancing Connections program helped mother and children improve functioning.
Lewis, F.M., Cochrane, B.B., Fletcher, K.A., Zahlis, E.H., Shands, M.E., Gralow, J.R., . . . Schmitz, K. (2008). Helping Her Heal: A pilot study of an educational counseling intervention for spouses of women with breast cancer. Psycho-Oncology, 17, 131–137.
To enhance spouses’ skills and confidence in communicating and interpersonally supporting their wives with breast cancer
To improve spouses’ self-care, depressed mood, anxiety, and marital adjustment
Baseline measures of the six study scales were obtained: depression, spouse skills, anxiety, self-efficacy of spouse, marital quality, and interpersonal sensitivity and mutuality. Five one-hour sessions were scheduled and delivered at two-week intervals. Details of the fully scripted educational counseling intervention session were described, and content was presented in a tabular format. Homework for each participant to complete with his wife was assigned to build skills and enhance efficacy. An exit interview with each participant and his wife was conducted. Post-test measures were taken.
A pre/post-test pilot study design was used.
Depressed mood and anxiety were significantly (p = 0.001 and p < 0.001, respectively) diminished; self-efficacy was significantly improved; spousal skills were significantly (p < 0.001) improved; and marital quality was significantly (p = 0.028) improved but only on one of the affectional expression subscales. There was no significant improvement on the other subscales of marital quality. There were no significant changes in the cancer-specific measure of marital quality. Spouses verbalized that the educational counseling intervention was helpful, specifically for listening skills.
A brief, structured, skill-focused, efficacy-enhancing educational counseling intervention has the potential to positively affect spouses’ adjustment (mood and anxiety), skills, self-efficacy, and self-care during the diagnosis and treatment phase of their wife’s breast cancer. The program focuses the intervention on the spouse to reduce tension and improve interpersonal communication regarding the wife’s diagnosis, treatment, feelings, and associated emotions.
The Helping Her Heal program offers promise to assist with building coping skills and support strategies for couples by educational counseling intervention among spouses of people with breast cancer and other chronic conditions.