The Effect of Nonpharmacological Interventions on Managing Symptom Clusters Among Cancer Patients: A Systematic Review.

Abstract

Cancer patients often experience multiple concurrent and related symptoms, or symptom clusters. Research increasingly indicates that targeting a symptom cluster as an overall entity instead of individual symptoms could be more effective and efficient in improving patients' quality of life. Various nonpharmacological interventions are used to manage symptom clusters in cancer patients during and after treatment, but the effect of such interventions is uncertain. To provide a summary of such interventions and evaluate their effects in terms of symptom cluster severity, quality of life, and functional ability of patients with cancer. A comprehensive literature search of 5 English and 2 Chinese electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, CNKI, and Wanfang) was combined with hand searching, to identify eligible research studies from 2001 to January 2018. Two reviewers carried out data selection, data extraction, and quality appraisal independently. A narrative approach was used to summarize data. Thirteen randomized controlled trials, involving 1490 patients, were included in the review. The methodological quality of the studies was generally fair. Nonpharmacological interventions can reduce the severity of symptom clusters, especially the pain-fatigue-sleep disturbance, cognitive, and gastrointestinal clusters, and improve both quality of life and functional ability. While symptom cluster interventions are potentially useful in cancer care, further well-designed research is needed to test them rigorously on various types of cancer symptom clusters. Nonpharmacological interventions are shown to be effective in managing cancer-associated symptom clusters and could be considered as part of the existing healthcare services for cancer patients.