Kwekkeboom, K. L., Abbott-Anderson, K., & Wanta, B. (2010). Feasibility of a patient-controlled cognitive-behavioral intervention for pain, fatigue, and sleep disturbance in cancer. Oncology Nursing Forum, 37, E151–E159.
To evaluate the feasibility of a patient-controlled, cognitive-behavioral intervention for pain, fatigue, and sleep disturbance during treatment for advanced cancer and to assess the initial efficacy of the intervention.
Patients provided baseline measures, such as measures relating to demographics and a symptom inventory, received education, and underwent training to use an mp3 player loaded with 12 cognitive-behavioral strategies (relaxation exercises, guided imagery, nature sounds). Patients used the strategies as needed for symptom management for two weeks and kept a log of symptom ratings with each use. Following the two-week intervention, patients completed a second symptom inventory and an evaluation of the intervention. Clinic staff identified patients who met the eligibility criteria based on diagnosis and treatment and then were briefly introduced to the study and asked if a research nurse could visit to provide additional information. The research nurse met with interested patients, assessed symptoms, and completed eligibility screening. Study purpose and procedures were explained, and written informed consent was obtained.
The study used a one-group, pre- and postintervention design.
The patient-controlled, cognitive-behavioral intervention is feasible and may reduce the day-to-day severity of co-occurring pain, fatigue, and sleep disturbance.
The findings support nurse education and the recommendation of the specified patient-controlled, cognitive-behavioral interventions for the management of pain, fatigue, and sleep disturbance. In regard to patient care and symptom management at all stages of cancer, nurses are the front-line educators of patients. This intervention supports the principle of autonomy for patients able to participate actively in care. Further study—a randomized, controlled trial to test the efficacy of the intervention for co-occurring pain, fatigue, and sleep disturbance—was under way at the time this study was published.
Kwekkeboom, K. L., Abbott-Anderson, K., Cherwin, C., Roiland, R., Serlin, R. C., & Ward, S. E. (2012). Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. Journal of Pain and Symptom Management, 44, 810–822.
To test the effects of a psychoeducational intervention on pain, fatigue, and sleep disturbance.
Patients were randomly assigned to the intervention group or the wait-list control group. The intervention consisted of a single one-on-one training session with a research nurse, which was followed by recorded guidance that provided imagery, relaxation exercises, and nature sounds. Most exercises lasted 20 minutes and were delivered via an mp3 player. The study lasted two weeks.
Patients were undergoing the active antitumor treatment phase of care.
The study used a randomized, controlled trial, pre- and postintervention design.
The intervention demonstrated a small statistically significant effect on the symptoms of pain and fatigue and the overall symptom cluster of pain, fatigue, and sleep disturbance.
The intervention was a relaxation or imagery therapy rather than a true CBT. The intervention was associated with short-term statistically significant benefits, but the actual size of the effect was small. Findings suggested that approaches using relaxation and imagery may result in some small benefit for patients, but the effect was weak.
Kwekkeboom, K.L., Abbott-Anderson, K., Cherwin, C., Roiland, R., Serlin, R.C., & Ward, S.E. (2012). Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. Journal of Pain and Symptom Management, 44, 810–822.
To assess the efficacy of a cognitive-behavioral (CB) intervention for the pain, fatigue, and sleep disturbance symptom cluster
Patients were randomized to the CB group or a waitlist control group. The intervention was a single one-on-one training session with a research nurse providing information about causes of pain, fatigue, and sleep disturbance; rational about how CB strategies could affect symptoms; overview of 12 strategies; and recommendations for patients to practice. CB strategies were relaxation and imagery approaches. Patients were provided scripted recordings to use on an MP3 player and written instructions. Patients were followed for two weeks and completed study assessments at baseline and at two weeks. The control group had usual care. Patients in the intervention group were to keep a log recording each use of CB strategies, and all patients in both groups were taught to complete a daily symptom diary. Follow-up phone calls were made to both groups on the second study day, the seventh study day, and at the end of the two-week study period. Post-intervention measures of symptom severity were mailed to participants to complete and provide to clinic staff.
CB strategies were used an average of 13.65 times (SD = 6.98) during the two weeks. Patients in the control group were significantly more depressed at baseline (p = .003). Total cluster scores post-intervention were lower in the intervention group (eta2 0.052, p = .032). Examination of individual symptoms showed differences between groups in pain (P = .006) and fatigue, but not in sleep.
Use of various patient self-controlled relaxation and imagery recordings appeared to have a beneficial effect in reducing pain and fatigue compared to controls. No clear effect was seen on sleep disruption.
Findings suggest that patient use of relaxation and imagery instructions and recordings may improve management of pain and fatigue during cancer treatment.
Kwekkeboom, K.L., Abbott-Anderson, K., Cherwin, C., Roiland, R., Serlin, R.C., & Ward, S.E. (2012). Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. Journal of Pain and Symptom Management, 44, 810–22.
To assess the efficacy of a cognitive-behavioral (CB) therapy intervention for the symptom cluster of pain, fatigue, and sleep disturbance
Patients were randomized to the CB group or a waitlist control group. The intervention was a single, one-on-one training session with a research nurse providing information about causes of pain, fatigue, and sleep disturbance. Patients learned how CB strategies could affect symptoms and received an overview of 12 strategies and recommendations to practice. CB strategies included relaxation and imagery approaches. Patients were provided scripted recordings to use on an MP3 player and written instructions. Participants were followed for two weeks, and study assessments were completed at baseline and at two weeks. The control group received usual care. Intervention patients kept a log recording each use of CB strategies, and all patients in both groups were taught to complete a daily symptom diary. Follow-up phone calls were made to both groups on study days 2 and 7 and at the end of the two-week study period. Postintervention measures of symptom severity were mailed to participants to complete and provide to clinic staff members.
Randomized, controlled trial
CB strategies were used an average of 13.65 times (SD = 6.98) during the two weeks. Patients in the control group were significantly more depressed at baseline (p = 0.003). Total cluster scores postintervention were lower in the intervention group (eta2 = 0.052, p = 0.032). An examination of individual symptoms showed differences between the groups in pain and fatigue but not in sleep.
The use of various patient-controlled relaxation and imagery recordings appeared to have a beneficial effect in reducing pain and fatigue compared to a control group. There was no clear effect on sleep disruption.
The findings of this study suggest that patient use of relaxation and imagery instructions and recordings may improve the management of pain and fatigue during cancer treatment.
Kwekkeboom, K.L. (2003). Music versus distraction for procedural pain and anxiety in patients with cancer. Oncology Nursing Forum, 30, 433–440.
This intervention was music versus simple distraction and control (treatment as usual).
The study reported on a sample of 58 patients with cancer having painful, cancer-related medical procedures.
A randomized controlled trial design was used.
There were no significant differences in post-procedure anxiety (no p values reported), pain, or perceived control across conditions.
Kwan, M.L., Cohn, J.C., Armer, J.M., Stewart, B.R., & Cormier, J.N. (2011). Exercise in patients with lymphedema: A systematic review of the contemporary literature. Journal of Cancer Survivorship: Research and Practice, 5(4), 320–336.
To examine the evidence and produce recommendations for exercise and lymphedema management in female breast cancer survivors
A total of 659 references were retrieved. Two authors used the Oncology Nursing Society Putting Evidence Into Practice (PEP) categories of evidence to evaluate the references.
Patients were undergoing multiple phases of care.
Resistance exercises were determined to be \"Likely to be effective.\" Aerobic and resistance exercise were rated as \"Benefits balanced with harms,\" though no clear harms were obvious in the review of the studies. Other exercise approaches studied were deemed \"Effectiveness not established.\"
Benefits of exercise have been reported, and this review suggests that current evidence supports the use of resistance exercising.
Findings support the use of resistance exercise in women with breast cancer for the management of arm lymphedema.
Kvillemo, P., & Branstrom, R. (2011). Experiences of a mindfulness-based stress-reduction intervention among patients with cancer. Cancer Nursing, 34, 24–31.
To examine the perceived effects and experiences of mindfulness-based stress-reduction (MBSR) training as described by patients with cancer
Eight group sessions of a modified MBSR program using relaxation, meditation, and yoga exercises. The instructors were two clinical psychologists. At the end of the intervention, quantitative psychological measures were assessed and participants were invited to participate in a semistructured telephone interview regarding their experiences. This study reports on the data from the qualitative analysis of interviews.
A qualitative study design was used.
Thematic analysis of audiotaped interview transcripts
Meditation and yoga exercises were experienced as most positive. The group itself offered a positive effect through shared experience, nonjudgmental approach, and acceptance.
The thematic analysis was insufficient to offer support for the researchers’ conclusions.
This intervention requires significant training, time, and effort for implementation.
Kutner, J.S., Smith, M.C., Corbin, L., Hemphill, L., Benton, K., Mellis, B.K., . . . Fairclough, D.L. (2008). Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal Medicine, 149, 369–379.
To test the hypothesis that massage would decrease pain and analgesic medicine use
To explore effects on quality of life and physical and emotional symptom distress
Patients were randomly assigned to a massage treatment group or to a control group in which patients received simple touch controlled for time and attention. Individual baseline data for disease characteristics, pain, symptom distress, quality of life, functional status, expectations from massage, and concurrent interventions were collected within 72 hours of study inclusion and at three weekly visits over the three to four weeks of study participation, for measurement of sustained effects. Data collectors were blinded to study group assignment. Participants received up to three 30-minute treatments over two weeks with at least 24 hours between treatment sessions, according to a schedule jointly determined by the patient and the treatment provider. Treatment providers obtained immediate outcome data prior to and following each treatment. All participants received routine care in addition to study interventions. Massage intervention included gentle effleurage, petrissage, and myofascial trigger point release. The most frequently massaged areas were neck and upper back and arms, hands, lower legs, and feet. Massages were performed by licensed massage therapists who had at least six months’ experience working with patients with advanced cancer. Control touch included placement of both hands on the participant bilaterally on the neck, shoulder blades, lower back, calves, heels, clavicles, lower arms, hands, patellae, and feet with light and consistent pressure. All treatment providers had standardized hands-on training and were evaluated for competency.
The study was a randomized, single-blind, controlled trial.
Both massage and touch were associated with significant improvements in immediate and sustained pain outcomes. Massage was superior to touch, but the difference was not statistically significant. Both groups demonstrated statistical, but not clinically significant, improvement in BPI scores. Both massage and simple touch were reported to be associated with statistically significant immediate improvement in mood, with massage showing statistically superior effect compared to touch. Confidence intervals were provided, but significance levels were not reported. Both groups demonstrated improvement in physical and emotional symptom distress and quality of life across weekly evaluations, but there were no differences between groups. There were no adverse effects associated with the interventions, and no differences in general adverse events or mortality between groups. Differences in pain medication use were not reported.
Both massage and simple touch appeared to have immediate beneficial effects on pain and mood in these patients. Both groups experienced slight improvement in pain, quality of life, and symptom distress over time. These changes were minimal, showing statistical significance but not clinical relevance.
Simple touch appeared to have a short-term positive effect on patient mood and pain experience. This is an intervention that should be easy to provide for patients and could be something that caregivers could also be educated to provide. This intervention could be useful for intermittent use as an adjunct to other interventions for pain management. Formal massage did not provide significantly greater effects. Given findings of simple touch in the population studied here, evaluation of this approach in other patient groups can be useful.
Kutner, J.S., Smith, M.C., Corbin, L. Hemphill, L., Benton, K., Mellis, B.K., . . . Fairclough, D.L. (2008). Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal Medicine, 149, 369–379.
To test the hypothesis that massage would decrease pain and analgesic medicine use
Patients were randomly assigned to a massage treatment group or to a control group in which patients received simple touch controlled for time and attention. Individual baseline data for disease characteristics, pain, symptom distress, quality of life, functional status, expectations from massage, and concurrent interventions were collected within 72 hours of study inclusion and at three weekly visits over the three to four weeks of study participation for measurement of sustained effects. Data collectors were blinded to study group assignment. Participants received up to three 30-minute treatments over two weeks, with at least 24 hours between treatment sessions, according to a schedule jointly determined by the patient and the treatment provider. Treatment providers obtained immediate outcome data prior to and following each treatment. All participants received routine care in addition to study interventions. Massage intervention included gentle effleurage, petrissage, and myofascial trigger point release. Most frequently massaged areas were neck and upper back, arms, hands, lower legs, and feet. Massages were performed by licensed massage therapists who had at least six months’ experience working with patients with advanced cancer. Control touch included placement of both hands on the participant bilaterally on the neck, shoulder blades, lower back, calves, heels, clavicles, lower arms, hands, patellae, and feet with light and consistent pressure. All treatment providers had standardized hands-on training and were evaluated for competency.
A randomized, single-blind, controlled trial design was used.
Both massage and touch were associated with significant improvements in immediate and sustained pain outcomes. Massage was superior to touch, but the difference was not statistically significant. Both groups demonstrated statistical, but not clinically significant, improvement in BPI scores. Both massage and simple touch were reported to be associated with statistically significant immediate improvement in mood, with massage showing statistically superior effect compared to touch. Confidence intervals were provided but significance levels were not reported. Both groups demonstrated improvement in physical and emotional symptom distress and quality of life across weekly evaluations, but there were no differences between groups. There were no adverse effects associated with the interventions, and no differences in general adverse events or mortality between groups. Differences in pain medication use were not reported.
Both massage and simple touch appeared to have immediate beneficial effects on pain and mood in these patients. Both groups experienced slight improvement in pain, quality of life, and symptom distress over time. These changes were minimal, showing statistical significance but not clinical relevance.
Simple touch appeared to have a short-term positive effect on patient mood and pain experience. This is an intervention that should be easy to provide for patients, and could be something that caregivers could also be educated to provide. This intervention could be useful for intermittent use as an adjunct to other interventions for pain management. Formal massage did not provide significantly greater effects. Given findings of simple touch in the population studied here, evaluation of this approach in other patient groups can be useful.
Kus, T., Aktas, G., Alpak, G., Kalender, M.E., Sevinc, A., Kul, S., . . . Camci, C. (2016). Efficacy of venlafaxine for the relief of taxane and oxaliplatin-induced acute neurotoxicity: A single-center retrospective case-control study. Supportive Care in Cancer, 24, 2085–2091.
To evaluate the effect of venlafaxine 75 mg daily oral administration on peripheral neuropathy (PN) pain severity reduction rates in patients on taxane- or oxaliplatin-based chemotherapy with moderate to severe painful chemotherapy-induced PN (CIPN) compared to participants who refused treatment
Retrospective, case-control, nonblinded design with a venlafaxine-treated group and a case-matched control group that had rejected CIPN treatment
Every three weeks, PN was measured using the 10-item NPSI mean composite score, which ranged from 0 (“no pain”) to 10 (“worst pain imaginable”). Each NPSI item used the same 0–10 NRS to measure patient-reported severity for the past 24 hours of various neuropathic pain symptoms (e.g., burning pain, pain provoked by cold, abnormal pin-and-needle sensations). The severity of venlafaxine-associated adverse effects was also measured using the CTCAE, version 4.03, ranging from 0 (normal) to 4 (life-threatening).
This study provided weak evidence supporting the superiority of venlafaxine compared to no venlafaxine in decreasing PN symptoms among participants with moderate to severe painful CIPN and mild depression while receiving taxane- and/or platinum-based chemotherapy. Participants who received venlafaxine 75 mg once daily experienced a reduction in painful and nonpainful PN symptoms after three weeks that continued through nine weeks, compared to no change in participants who did not receive venlafaxine. Participants with milder PN before treatment experienced the most benefit. However, these results may not be reliable or valid because of the retrospective design and potentially biased study procedures/methods/analysis.
Additional testing of venlafaxine in large prospective, randomized, controlled trials is needed before it can be used in clinical practice to treat CIPN. However, the positive results of this trial emphasize the importance of continual nursing assessment of PN signs and symptoms throughout chemotherapy because pain treatments may be most beneficial to patients with acute mild CIPN.