The management of dyspnea in cancer patients: a systematic review

Goals of work The goal of the study is to evaluate the effectiveness of four drug classes (opioids, phenothiazines, benzodiazepines, and systemic corticosteroids) for relieving dyspnea experienced by advanced cancer patients. Materials and methods A systematic literature review was conducted to July 2006. Search sources included MEDLINE, EMBASE, HealthSTAR, CINAHL, and the Cochrane Library. Four reviewers selected evidence using predefined criteria: controlled trials not limited to cancer and involving the specified drug classes for dyspnea treatment. Main results Three systematic reviews, one with meta-analysis, two practice guidelines, and 28 controlled trials were identified. Most examined the effect of opioids, generally morphine, on dyspnea. Although the results of individual trials were mixed, the systematic review with meta-analysis detected a significant benefit for dyspnea with systemic opioids; two small placebo-controlled trials in cancer patients found systemic morphine reduced dyspnea, and dihydrocodeine also significantly reduced dyspnea in four placebo-controlled trials. Nebulized morphine was not effective in controlling dyspnea in any study or the meta-analysis. No controlled trials examined systemic corticosteroids in the treatment of cancer patients, and of the other non-opioid drugs examined, only oral promethazine, a phenothiazine, showed some benefit in the relief of dyspnea. Studies varied in methodological quality. Conclusions Systemic opioids, administered orally or parenterally, can be used to manage dyspnea in cancer patients. Oral promethazine may also be used, as a second-line agent if systemic opioids cannot be used or in addition to systemic opioids. Nebulized morphine, prochlorperazine, and benzodiazepines are not recommended for the treatment of dyspnea, and promethazine must not be used parenterally. A complete list of Supportive Care Guidelines Group members is available at: .     

The effects of psychosocial strategies on anxiety and depression of patients diagnosed with prostate cancer: A systematic review

Background

Psychosocial strategies are commonly used to alleviate anxiety and depression in patients with prostate cancer. However, previous studies have shown inconsistent results.

Objectives

This study examined the effects of psychosocial strategies on anxiety and depression in prostate cancer patients.

Data sources and review methods

A systematic literature review was conducted using 4 English databases (Pubmed, Cochrane Central Register of Controlled Trials, Cinahl, and PsycInfo) and 2 Chinese databases (Wanfang data and Chinese Electronic Periodical Service) with predetermined keyword searches. We first evaluated 8144 titles and/or abstracts. Fourteen studies that met the inclusion criteria were selected. The criteria for study inclusion were as follows: (1) randomized controlled trial design; (2) control group received usual or standard care; (3) focus on testing psychosocial strategies to improve anxiety and depression symptoms; and (4) studies conducted with prostate cancer patients at any stage of the disease.

Results

The quality of the studies was assessed using the Jadad scoring system. Only 35.7% of studies were regarded as high quality. The majority of studies (85.7%) delivered informational and educational or cognitive-behavioral interventions. The results show that psychosocial strategies have a substantial effect on reducing anxiety 3 months after intervention (standard mean difference −1.13, p < 0.0001) and have a short-term effect on depression symptoms (immediately after intervention: standard mean difference −0.43, p < 0.001; 3 months after intervention: standard mean difference −0.78, p = 0.04).

Conclusion

The results indicate that psychosocial strategies were more effective in reducing anxiety and depression compared with routine care, although the effect was not sustainable. However, high-quality methodologies, longer follow-up designs, and innovative psychosocial strategies are suggested for further study.     

Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review

Pain in cancer patients remains common and is often associated with insufficient prescribing of targeted analgesia. An explanation for undertreatment could be the failure to identify neuropathic pain mechanisms, which require additional prescribing strategies. We wanted to identify the prevalence of neuropathic mechanisms in patients with cancer pain to highlight the need for detailed assessment and to support the development of an international classification system for cancer pain. We searched for studies that included adult and teenage patients (age above 12 years), with active cancer and who reported pain, and in which a clinical assessment of their pain had been made. We found 22 eligible studies that reported on 13,683 patients. Clinical assessment methods varied, and only 14 studies reported confirmatory testing for either sensory abnormality or diagnostic lesion to corroborate a diagnosis of neuropathic pain. We calculated that the prevalence of patients with neuropathic pain (95% confidence interval) varied from a conservative estimate of 19% (9.4% to 28.4%) to a liberal estimate of 39.1% (28.9% to 49.5%) when patients with mixed pain were included. The prevalence of pain with a neuropathic mechanism (95% confidence interval) ranged from a conservative estimate of 18.7% (15.3% to 22.1%) to a liberal estimate of 21.4% (15.2% to 27.6%) of all recorded cancer pains. The proportion of pain caused by cancer treatment was higher in neuropathic pain compared with all types of cancer pain. A standardised approach or taxonomy used for assessing neuropathic pain in patients with cancer is needed to improve treatment outcomes.     

Effect of reminiscence therapy on depression in older adults: a systematic review

The objective of this systematic review is to provide healthcare professionals with information to assist in their decision to utilize reminiscence therapy for depression reduction in older adults outside of the primary care setting. Nine reviewed studies that were randomized controlled trials not only varied in person, outcome measurement, control, and exposure/intervention, the results of these studies were also diverse. About half of these studies showed that reminiscence therapy resulted in statistical significantly decrease in depression. Despite that reminiscence therapy requires further testing, it should be considered as a valuable intervention. Future directions of studies on reminiscence therapy are suggested.     

Laetrile for cancer: a systematic review of the clinical evidence

Background Many cancer patients treated with conventional therapies also try ‘alternative’ cancer treatments. Laetrile is one such ‘alternative’ that is claimed to be effective by many alternative therapists. Laetrile is also sometimes referred to as amygdalin, although the two are not the same. Objective The aim of this review is to summarize all types of clinical data related to the effectiveness or safety of laetrile interventions as a treatment of any type of cancer. Materials and methods All types of clinical studies containing original clinical data of laetrile interventions were included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1951), EMBASE (from 1980), Allied and Complementary Medicine (AMED), Scirus, CancerLit, Cumulative Index to Nursing and Allied Health (CINAHL; all from 1982), CAMbase (from 1998), the MetaRegister, the National Research Register, and our own files. For reports on the safety of laetrile, we also searched the Uppsala database. No language restrictions were imposed. Results Thirty six reports met our inclusion criteria. No controlled clinical trials were found. Three articles were nonconsecutive case series, 2 were consecutive case series, 6 were best case series, and 25 were case reports. None of these publications proved the effectiveness of laetrile. Conclusion Therefore, the claim that laetrile has beneficial effects for cancer patients is not supported by sound clinical data.     

Clinician-patient communication: a systematic review

Goal of Work  The goal of this work was to identify methods of clinician–patient cancer-related communication that may impact patient outcomes associated with distress at critical points in the course of cancer care. Materials and methods  A systematic review of practice guidelines, systematic reviews, or randomized trials on this topic was conducted. Guidelines for quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Instrument, and the contributive value for recommendations was assessed. Systematic reviews and randomized trials were also evaluated for methodological rigor. Results  Four existing guidelines, eight systematic reviews and nine randomized trials were identified. Two of the guidelines were of high quality, and all systematic reviews reported clear search criteria and support for their conclusions; the randomized trials were of modest or low quality. For all situations and disease stages, guidelines consistently identified open, honest, and timely communication as important; specifically, there was evidence for a reduction in anxiety when discussions of life expectancy and prognosis were included in consultations. Techniques to increase patient participation in decision-making were associated with greater satisfaction but did not necessarily decrease distress. Few studies took cultural and religious diversity into account. Conclusions  There is little definitive evidence supporting the superiority of one specific method for communicating information compared to another. Evidence regarding the benefit of decision aids or other strategies to facilitate better communication is inconsistent. Since patients vary in their communication preferences and desire for active participation in decision making, there is a need to individualize communication style.     

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness

Background Effective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills.Purpose To assess the effectiveness of different communication skills training courses for health professionals in cancer care.Methods We searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and results were extracted and compared in tabular format.Results A total of 47 studies potentially assessing communication training in the area of cancer care were identified. Sixteen papers were included describing 13 interventions. Four were randomised controlled trials (RCTs) (grade I), with samples ranging from 72 to 233 subjects. The others were all grade III. Eleven interventions trained health professionals, two trained medical students. The outcomes measured included communication skills as assessed on audio or video, professionals self-report and patient assessment. All the interventions demonstrated modest improvements (effect sizes ranged 0.15–2) and one found deterioration in the outcomes measured.Conclusion Communication training improves basic communication skills. Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations.     

Vital signs in hospital patients: a systematic review

Objectives: This review was initiated to identify the best available evidence on vital sign measurements in hospital patients. Method: Inclusion Criteria – Studies that evaluated some aspect of vital signs. Search – Covered all major databases and the references of identified studies. Data Analysis. because of the nature of identified studies, data were summarised using narrative rather than statistical methods. Results: A total of 737 papers of which 69 met the inclusion criteria. Conclusion: This review has highlighted a need for further investigation of issues related to the role, nature and optimal practice of monitoring patient vital signs.     

Communication training for health professionals who care for patients with cancer: a systematic review of training methods

Background Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer.Aim The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals.Method We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format.Results A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals self-report.Conclusions The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.     

早期气管切开对长期机械通气患者影响的系统评价

目的:评价早期气管切开对长期机械通气患者临床结局的影响。方法:计算机检索PubMed、Cochrane library、中国生物医学文献光盘数据库(CBM)和中国知识基础设施数据库(CNKI),均从最初检索至2010年6月。手工检索纳入文献的参考文献。收集国内外关于早期气管切开对长期机械通气患者影响的随机对照试验,并进行系统评价。结果:共6篇文献入选,合并结果显示早期气管切开不能降低长期机械通气患者的病死率[RR0.87,95%CI(0.59,1.30)]、医院获得性肺炎发病率[RR0.89,95%CI(0.68,1.17)]和机械通气时间[WMD-4.49,95%CI(-11.64,1.77)]。结论:现有证据表明,早期气管切开并不能给长期机械通气患者带来益处,但尚需更多设计完好的大样本随机对照试验进一步验证。     

Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials

Introduction  Massage is a popular adjunct to cancer palliation. This systematic review is aimed at critically evaluating all available randomised clinical trials of massage in cancer palliation. Materials and methods  Six databases were searched to identify all trials of classical massage for cancer patients. Studies of other types of massage, e.g. reflexology, aromatherapy, were excluded. Fourteen trials met all inclusion criteria. Discussion  Collectively, they suggest that massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions. Conclusion  The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.     

The treatment of lymphedema related to breast cancer: a systematic review and evidence summary

Goals of work

To provide an evidence summary report on the question: What are the treatment options for women with lymphedema following treatment for breast cancer?

Methods

Cancer Care Ontario’s Supportive Care Guidelines Group (SCGG) employed systematic review methodology to produce an evidence summary on this topic. Evidence-based opinions were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners.

Results

The systematic review search strategy identified ten randomized controlled trials which form the basis of this evidence summary report. Four key opinions offered by the SCGG are outlined below. Responses from the practitioner feedback process supported the validity of these opinions in Ontario. (1) There is some evidence to suggest that compression therapy and manual lymphatic drainage may improve established lymphedema, but further studies are needed. Compression garments should be worn from morning to night and be removed at bedtime. Patients should be advised that lymphedema is a lifelong condition and that compression garments must be worn on a daily basis. Patients can expect stabilization and/or modest improvement of edema with the use of the garment in the prescribed fashion. (2) There is no current evidence to support the use of medical therapies, including diuretics. (3) Additional efforts to define relevant clinical outcomes for the assessment of patients with lymphedema would be valuable. (4) These opinions are appropriate for patients with more than mild lymphedema, where the signs and symptoms are considered significant from the patients’ perspective.

     

Is tai chi an effective adjunct in cancer care? A systematic review of controlled clinical trials

Background Tai chi is a form of complementary and alternative medicine with similarities to aerobic exercises, which has been recommended for relieving cancer-related symptoms. The aim of this systematic review is to summarize and critically evaluate the evidence available from controlled clinical trials of tai chi as a supportive therapy for cancer patients. Methods We have searched the literature using 19 databases from their respective inceptions through October 2006, without language restrictions. Methodological quality was assessed using Jadad score. Results The searches identified 27 potentially relevant studies. Three randomised clinical trials (RCTs) and one non-randomised controlled trial (CCT) met our inclusion criteria. All of these trials assessed patients with breast cancer. Two RCTs reported significant differences in psychological and physiological symptoms compared to psychosocial support control. Most trials suffered from methodological flaws such as small sample size, inadequate study design and poor reporting. Conclusion The evidence is not convincing enough to suggest that tai chi is an effective supportive treatment for cancer. Further research should attempt to answer the many open questions related to the usefulness of tai chi for supportive cancer care.     

Effects of life review on mental health and well-being among cancer patients: A systematic review

BackgroundCancer patients often experience psychological distress. Life review has increasingly been used to enhance their mental health and well-being. However, no systematic review has synthesized the evidence, and its effects remain unclear.ObjectiveTo examine and synthesize the best available evidence on the effects of life review on mental health and well-being among cancer patients.DesignSystematic review of randomized controlled trials and clinical controlled trials.Data sourcesTwelve electronic databases were searched for published studies reported in English or Chinese, from inception to September 2016. Other supplementary sources, such as related websites, professional books, reference lists, and author contacts were also used for published or unpublished studies.Review methodsA comprehensive literature search was conducted to identify eligible randomized controlled trials or clinical controlled trials about the effects of life review on cancer patients. Study selection, quality assessment, and data extraction were independently performed by two reviewers. The results were synthesized without meta-analysis in this review.ResultsFifteen studies (899 participants) were identified; of that total, nine studies were rated as strong in quality, while six studies were of moderate quality. In addition to structured life review interviews, other elements such as memory prompts and a legacy product were integrated into life review programs. A majority of studies indicated that life review programs benefited cancer patients by reducing depression and anxiety, as well as improving their sense of hope, self-esteem and quality of life.ConclusionsLife review can improve mental health and well-being among cancer patients. This suggests that life review can be integrated into typical cancer treatment to enhance patients’ mental health and well-being. More research with rigorous design is necessary to further explore the effects of life review.     

The impact of gynaecological cancer treatment on physical activity levels: a systematic review of observational studies

Background

The natural history of physical activity levels during and following gynaecological cancer treatment is not well understood. This is required in order to establish the time at which physical activity levels are lowest in order to target cancer rehabilitation or exercise interventions in gynaecological cancer population accordingly.

Weight stigmatisation in physiotherapy: a systematic review

Background: Physiotherapists play an integral role in the provision of health care to individuals who are overweight or obese. An understanding of weight stigma is therefore important in ensuring best practice. Despite these considerations, no previous systematic reviews have investigated weight stigma in physiotherapy.

Objectives: To determine if (i) physiotherapists demonstrate weight stigma through explicit or implicit means and (ii) how weight stigma is perceived by physiotherapy patients.

Methods: Database searches were conducted to identify quantitative and qualitative studies published between January 1960 and September 2015. Two reviewers independently performed data extraction and assessments of methodological quality. Outcome measures included explicit attitudes, implicit attitudes and beliefs about obesity held by physiotherapists, as well as patient perceptions of obesity management.

Results: Seven high-quality studies were included in the review. Six studies demonstrated the existence of explicit weight stigma, with a majority of physiotherapists describing people with increased weight as ‘noncompliant’ and ‘unmotivated’. One study demonstrated the existence of implicit weight stigma, but this did not appear to influence treatment approaches. Four studies found stigmatising beliefs about weight among physiotherapists, and one study found that physiotherapy patients believed both physical environments and paternalistic communication styles propagated weight stigmatisation.

Conclusions: Explicit weight stigmatisation is common in physiotherapy and is often perceived by patients, who may feel unmotivated or ignored as a result. While implicit stigmatisation also occurs, it is unclear if this influences physiotherapy management. Future research is required to assist in the development of appropriate preventative strategies.     

Spinal manual therapy interventions for pediatric patients: a systematic review

Objective:

Although much has been written about the efficacy of manual therapy interventions for adults with headaches or spinal pain, little research has focused on the use of these interventions in pediatric patients. The purpose of this systematic review was to evaluate the evidence for spinal manual therapy (SMT) interventions in patients 4–17 years old with headaches and/or mechanical spinal pain.

Methods:

A search for relevant studies published in the past 15 years was conducted on MEDLINE, CINAHL, Cochrane Central Register of Randomized Control Trials, PEDro, PubMed, and Sports Discus. Only English language articles were reviewed. Studies had to include at least one outcome measure for pain, function, or quality of life. Studies evaluating post-operative interventions, or those in which the interventions were directed at influencing excessive spinal curvatures, were excluded. Case reports and studies that did not limit analysis of the results to the pediatric population were also excluded. Results: Two randomized control trials and two studies offering lower levels of evidence were identified in the literature search. The latter studies were prospective cohort studies. The four studies were evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.

Discussion:

There are very little data in the literature to support or refute the use of SMT interventions in pediatric patients. Further research is required to establish a strong evidence-based foundation for use of these interventions in children.     

系统性护理干预对乳腺癌化疗患者癌因性疲乏作用的系统评价

目的：分析系统性护理干预与常规护理干预两种护理方式在缓解乳腺癌化疗患者癌因性疲乏应用的差别。方法全面检索万方期刊数据库、中国期刊全文数据库、维普期刊全文数据库,收集关于系统性护理干预与常规护理干预在乳腺癌化疗患者癌因性疲乏作用对比的研究,采用Jadad量表对所有纳入的文献进行证据质量评价,运用统计学软件Stata和SAS,对癌因性疲乏和生活质量的观察指标进行Meta分析。结果共纳入13项研究,1322例患者,其中系统性护理组662例,常规护理组660例。系统性护理组缓解癌因性疲乏的作用优于常规护理组[OR（95％CI）＝3．497（2．838～4．310）,P ＜0．01];在提高生活质量方面也优于常规护理组（ SMD＞0,P＜0．05）。结论系统性护理干预在缓解乳腺癌化疗患者癌因性疲乏和提高患者生活质量方面明显优于常规护理干预,值得临床推广应用。     

Acupuncture for treating hot flushes in men with prostate cancer: a systematic review

Goals of work  The goal of the study was to assess the effects of acupuncture as a treatment for hot flushes in prostate cancer (PC) patients. Materials and methods  The literature was searched using 14 databases with dates ranging from their inceptions to December 2008 and without language restrictions. All clinical studies of any type of acupuncture in PC patients were included. Their main outcome measures had to be vasomotor symptoms. Their methodological quality was assessed using the modified Jadad score. Results  Six studies met all the inclusion criteria. One randomised clinical trial compared the effects of manual acupuncture with acupuncture plus electro-acupuncture. The other five studies were uncontrolled observational studies and therefore had limitations. Conclusion  The evidence is not convincing to suggest acupuncture is an effective treatment for hot flush in patients with PC. Further research is required to investigate whether acupuncture has hot-flush-specific effects.