Cancer Treatment Care Research Articles

Aromatherapy as an Adjuvant Treatment in Cancer Care – A Descriptive Systematic Review

Claims of benefits of aromatherapy for cancer patients include reduced anxiety levels and relief of emotional stress, pain, muscular tension and fatigue. The objective of this paper is to provide an updated descriptive, systematic review of evidence from pre-clinical and clinical trials assessing the benefits and safety of aromatherapy for cancer patients. Literature databases such as Medline (via Ovid), the Cochrane database of systematic reviews, Cochrane Central were searched from their inception until October 2010. Only studies on cancer cells or cancer patients were included. There is no long lasting effect of aromatherapy massage, while short term improvements were reported for general well being, anxiety and depression up to 8 weeks after treatment. The reviewed studies indicate short-term effects of aromatherapy on depression, anxiety and overall wellbeing. Specifically, some clinical trials found an increase in patient-identified symptom relief, psychological wellbeing and improved sleep. Furthermore, some found a short-term improvement (up to 2 weeks after treatment) in anxiety and depression scores and better pain control. Although essential oils have generally shown minimal adverse effects, potential risks include ingesting large amounts (intentional misuse); local skin irritation, especially with prolonged skin contact; allergic contact dermatitis; and phototoxicity from reaction to sunlight (some oils). Repeated topical administration of lavender and tea tree oil was associated with reversible prepubertal gynecomastia.

Aromatherapy as an adjuvant treatment in cancer care – a descriptive systematic review

Aromatherapy as an adjuvant treatment in cancer care – a descriptive systematic review

A literature review to investigate the link between psychosocial characteristics and treatment adherence in cancer patients.

Adherence to medication has been recognized as a key issue in health outcomes and efforts to improve patients' adherence are being made by the pharmaceutical industry, experts, and government bodies alike. This paper presents a review of these issues according to previous descriptive findings. Relevant studies written in English, published in 1976 or later, were identified through Medline, Embase and PsycInfo databases and reviewed. Review articles and clinical trials were excluded; all observational studies and surveys were considered. Articles were reviewed for any discussion of patients' characteristics and psychosocial characteristics affecting adherence to cancer treatment. The search strategy included a combination of key words adherence and cancer in titles. The major findings are summarized and presented under two main headings: i) patients' characteristics; and ii) psychosocial characteristics. In general, factors associated with increased likelihood of adherence to cancer treatment included younger age, higher education, higher income and Caucasian ethnicity. With regards to the psychosocial factors, lower levels of depression and anxiety, optimism as well as social support seemed to have a positive effect on treatment adherence. Studies of patterns of care in cancer treatment can help identify challenges in health care provided to particular subgroups of cancer patients and can aid researchers in designing studies that account for such factors in clinical and outcomes' research.

A literature review to investigate the link between psychosocial characteristics and treatment adherence in cancer patients

Adherence to medication has been recognized as a key issue in health outcomes and efforts to improve patients’ adherence are being made by the pharmaceutical industry, experts, and government bodies alike. This paper presents a review of these issues according to previous descriptive findings. Relevant studies written in English, published in 1976 or later, were identified through Medline, Embase and PsycInfo databases and reviewed. Review articles and clinical trials were excluded; all observational studies and surveys were considered. Articles were reviewed for any discussion of patients’ characteristics and psychosocial characteristics affecting adherence to cancer treatment. The search strategy included a combination of key words adherence and cancer in titles. The major findings are summarized and presented under two main headings: i) patients’ characteristics; and ii) psychosocial characteristics. In general, factors associated with increased likelihood of adherence to cancer treatment included younger age, higher education, higher income and Caucasian ethnicity. With regards to the psychosocial factors, lower levels of depression and anxiety, optimism as well as social support seemed to have a positive effect on treatment adherence. Studies of patterns of care in cancer treatment can help identify challenges in health care provided to particular subgroups of cancer patients and can aid researchers in designing studies that account for such factors in clinical and outcomes’ research.

Crucial Controversies in Surgery

Crucial Controversies in Surgery

Health reforms as examples of multilevel interventions in cancer care.

To increase access and improve system quality and efficiency, President Obama signed the Patient Protection and Affordable Care Act with sweeping changes to the nation's health-care system. Although not intended to be specific to cancer, the act's implementation will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer. The success of complex health reforms requires understanding the scientific basis and evidence for carrying out such multilevel interventions. Conversely and equally important, successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.

Multilevel Interventions: Measurement and Measures

Multilevel intervention research holds the promise of more accurately representing real-life situations and, thus, with proper research design and measurement approaches, facilitating effective and efficient resolution of health-care system challenges. However, taking a multilevel approach to cancer care interventions creates both measurement challenges and opportunities. One-thousand seventy two cancer care articles from 2005 to 2010 were reviewed to examine the state of measurement in the multilevel intervention cancer care literature. Ultimately, 234 multilevel articles, 40 involving cancer care interventions, were identified. Additionally, literature from health services, social psychology, and organizational behavior was reviewed to identify measures that might be useful in multilevel intervention research. The vast majority of measures used in multilevel cancer intervention studies were individual level measures. Group-, organization-, and community-level measures were rarely used. Discussion of the independence, validity, and reliability of measures was scant. Measurement issues may be especially complex when conducting multilevel intervention research. Measurement considerations that are associated with multilevel intervention research include those related to independence, reliability, validity, sample size, and power. Furthermore, multilevel intervention research requires identification of key constructs and measures by level and consideration of interactions within and across levels. Thus, multilevel intervention research benefits from thoughtful theory-driven planning and design, an interdisciplinary approach, and mixed methods measurement and analysis.

Medical Family Therapy in Cancer Care: Patient and Family Experiences

This study used a phenomenological approach to explore the experience of patients and family members who received Medical Family Therapy (MedFT) services as a part of their cancer care treatment. Narratives were collected from fourteen participants, resulting in the formation of 3 main categories and 13 thematic clusters. Participants described in detail what made the services unique to their treatment, methods of engagement that were meaningful, and interventions and strategies they found beneficial. Recommendations for future research and clinical implications are provided.

Effectiveness of a Multidimensional Physical Therapy Program on Pain, Pressure Hypersensitivity, and Trigger Points in Breast Cancer Survivors

To evaluate the effects of an 8-week multidimensional physical therapy program, including strengthening exercises and recovery massage, on neck and shoulder pain, pressure hypersensitivity, and the presence of active trigger points (TrPs) in breast cancer survivors. In this randomized controlled clinical trial, 44 breast cancer survivors were randomly assigned into 2 groups: CUIDATE group who received a multidimensional physical therapy program; or CONTROL group who received usual care treatment for breast cancer. CUIDATE program consisted of 24 hours of individual physical training (aerobic, mobility, stretching, and strengthening exercises) and 12 hours of physical therapy recovery (stretching, massage) interventions (3 times/wk, 90 min). Outcomes included neck and shoulder pain (visual analog scale, 0 to 100), pressure pain thresholds over the C5-C6 zygapophyseal joints, deltoid muscles, second metacarpal and tibialis anterior muscles, and the presence of active TrPs in shoulder muscles. Outcomes were assessed at baseline and after the 8-week program by a blinded assessor. The CUIDATE group showed an estimated improvement for neck pain of -56 mm [95% confidence interval (CI), -71--40, P<0.001; effect size 2.72, 1.94 to 3.44] and for shoulder/axillary of -56 mm (95% CI, -74--38, P<0.001; effect size 2.45, 1.66 to 3.23). Improvements were also noted for pressure pain thresholds levels: C5-C6 zygapophyseal joints (between-group differences 101 kPa, 95% CI, 60-143; effect size 1.68, 1.00 to 2.35; 92 kPa 55 to 129; d: 1.98, 1.18 to 2.77), deltoid muscles (98 kPa, 45 to 149; d: 1.34, 0.62 to 2.04; 75 kPa 18 to 132; d: 1.12, 0.27 to 1.96), second metacarpal (93 kPa, 45 to 134; d: 1.30, 0.63 to 1.86; 99 kPa 59 to 139; d: 1.60, 0.96 to 2.24), and tibialis anterior muscles (71 kPa, 40 to 144; d: 1.16, 0.65 to 2.34; 118 kPa 57 to 178; d: 1.17, 0.56 to 1.77). Finally, patients within the CUIDATE program showed a greater reduction of active muscle TrPs compared with the CONTROL group (P<0.01). An 8-week multidimensional program including strengthening exercises, and massage as major components was effective for improving neck and shoulder pain and reducing widespread pressure hyperalgesia in breast cancer survivors compared with usual care treatment.

がん治療と緩和ケア（3） がん患者の食欲不振におけるオランザピンの効果

がん治療と緩和ケア（3） がん患者の食欲不振におけるオランザピンの効果

Treatment of Cancer and Palliative Care (2) Expected Role of Probiotics in Clinical Practice, Especially in Children Undergoing Chemotherapy

Leukemias and sarcomas account for many of the pediatric cases of malignancy; indeed leukemia accounts for approximately 40% of cases. The basic treatment for pediatric malignancy is chemotherapy; however, the use of anticancer drugs may also damage normal cells in the body. This creates a problem of increased susceptibility to infection because of a weakened immune system. The use of antibiotics is therefore essential to prevent and treat infections. However, antibiotics can kill both pathogenic bacteria and useful bacteria. By disturbing the balance of intestinal bacteria, antibiotics may disrupt intestinal barrier function, thus, perversely increasing the risk of infection. In the present paper, we focus on the use of probiotics to improve the balance of intestinal bacteria. In particular, we examine the effectiveness of probiotics in children undergoing chemotherapy.

Treatment of Cancer and Palliative Care (4) Cost-effectiveness Analysis of Molecularly Targeted Drugs

Treatment of Cancer and Palliative Care (4) Cost-effectiveness Analysis of Molecularly Targeted Drugs

Nutritional and psychosocial status of colorectal cancer patients referred to an outpatient oncology clinic

Malnutrition and psychological distress are associated with poorer outcomes following treatment for colorectal cancer. Screening for issues such as malnutrition, depression, and anxiety is being adopted in some oncology settings, but its effectiveness or the relationship between these risk factors in this population are not well understood. A retrospective chart review was conducted of 836 health assessment forms provided to colorectal cancer patients referred to an outpatient oncology clinic. Nutritional (Patient-Generated Subjective Global Assessment) and psychological (Psychosocial Screen for Cancer) screening tools were included in the form. Demographic and screening tool information was obtained from completed forms. The prevalence of nutritional risk, depression, and anxiety were determined based on screening tool scores and clinical cutoffs. An ordinal regression model was fitted to determine which demographic and psychosocial factors best predicted nutritional risk. Only 252 (30%) of the forms were completed enough for inclusion in analysis. The prevalence of nutritional risk, anxiety, and depression were determined to be 29%, 10%, and 7%, respectively. A regression model containing the variables depression, anxiety, gender, health coverage, and marital status was found to best explain the nutritional score. Depression was the most significant predictor, with odds of increased nutritional risk being 5.6 times greater for depressed individuals (P = 0.0005). The use of nutritional and psychosocial screening tools is warranted and needs to be emphasized more in oncology settings. There appears to be a relationship between psychosocial issues and increased nutritional risk which should be taken into account when considering cancer care interventions.

A Conceptual and Empirical Basis for Including Medical Family Therapy Services in Cancer Care Settings

Psychosocial interventions in oncology settings have largely been individually and group-based despite evidence that a family-based approach fills a treatment gap in the cancer care experience. Medical Family Therapists are trained to address the family as the unit of treatment and provide services that consider family dynamics, reorganization of couple and family roles, and broader systemic issues. This article describes the conceptual bases for Medical Family Therapy services provided in cancer care settings, and reviews research on their implementation and effectiveness. Following a review of the literature, recommendations for studying the effectiveness and efficacy of MedFT in cancer care treatment are detailed.

What is the evidence for the use of mindfulness‐based interventions in cancer care? A review

The aim of this paper is to present and critically appraise the evidence for the use of mindfulness-based interventions in cancer care. Systematic review methods were used. A thorough search of relevant major and specialised electronic databases was made and unpublished and ongoing work was also identified. Both qualitative and quantitative studies were eligible for inclusion. Information about aims, design, participant sample, measures, findings and intervention details were extracted from each study. Thirteen research papers and four conference abstracts published since 2007 were identified which met the criteria, reporting five different types of mindfulness intervention. The 13 papers composed of three randomised control trials, two non-randomised control trials, five pre and post-test designs and two qualitative studies. Studies report significant improvements in anxiety, depression, stress, sexual difficulties, physiological arousal and immune function or subjective benefits across all interventions. Methodological limitations were identified. Diversity in study designs and interventions makes comparisons between studies difficult. Some mindfulness interventions may have a place in acute treatment and palliative care. Mindfulness approaches are a promising intervention in cancer care, potentially across the cancer trajectory. Further qualitative research and research into different styles of mindfulness delivery are recommended.

Cognitive behavioral symptom management intervention in patients with cancer: survival analysis

Associations between psychological factors and cancer survival have been under debate. We retrospectively explored the effect of the Cancer Care Intervention (CCI), an individually delivered cognitive behavioral symptom management intervention on survival in individuals with cancer. Data were obtained from a randomized controlled trial (R01 CA79280; 1997-2003) that were originally designed to evaluate the CCI to reduce symptom severity in 237 individuals with solid tumors during their first course of chemotherapy. Participants were randomized into: (1) ten-contact, 20-week CCI plus usual care (n = 118) and (2) usual care only (n = 119). Survival data as of June 2009 were censored based upon Social Security Death Index. Participants were mostly female (73.4%), Caucasian (92.8%), and 59.6 ± 10.5 years old. Breast (38.8%) and lung (35%) cancer were the most common cancer types. At enrollment, 66.7% of the participants had cancers at stage III or greater. Overall mortality was 53.2% (126 of 237). The CCI did not significantly affect survival (median survival, CCI = 88 months; usual care = 53.3 months; log rank = 0.30, p = 0.58). Age, stage of cancer, and surgical removal of the tumor were the only factors significantly associated with survival. Post hoc analysis stratified by cancer site and gender (women with breast cancer, women with lung cancer, men with lung cancer, and others) showed no survival effect from the CCI. In this analysis, the CCI was not associated with better survival. For future research, studies exploring survival outcomes need to consider specific characteristics of each intervention and cancer type.

Multidisciplinary care in pediatric oncology.

This paper describes the significant advances in the treatment of childhood cancer and supportive care that have occurred over the last several decades and details how these advances have led to improved survival and quality of life (QOL) for children with cancer through a multidisciplinary approach to care. Advances in the basic sciences, general medicine, cooperative research protocols, and policy guidelines have influenced and guided the multidisciplinary approach in pediatric oncology care across the spectrum from diagnosis through long-term survival. Two case studies are provided to highlight the nature and scope of multidisciplinary care in pediatric oncology care.

Treatment of Cancer and Palliative Care What Are the Barriers to a home-based Palliative Care System? The Pharmacist's Viewpoint

Developing an effective home-based palliative care system in Japan has become more urgent following the addition of Home-Care Support Medical Clinics to the National Health Insurance scheme in 2006 and implementation of the Cancer Control Act in 2007. Additionally, shortening the number of days spent in acute-care hospitals and switching the provision of most anticancer therapies from a hospital setting to the home have increased this urgency. However, the number of cancer patients who choose to die at home remains low (5% to 6%) and indicates that a home-based palliative care system has not been adequately promoted. We discuss these issues from the pharmacist's viewpoint in this article.

Telomere-Based Cancer Treatment

Chemotherapy and radiation therapy are standard care in cancer treatment; however, both have numerous adverse side effects because they affect healthy as well as cancerous cells. The side effects, including decreased white blood cell count, nausea, hair loss, and fatigue, can be severe enough that patients may decide to forgo treatment. Targeted therapies are treatments that focus on specific molecules in cancerous cells and avoid disruption of healthy cells. Telomeres, the ends of chromosomes, are possible targets. In healthy cells, telomeres become shorter with each cell division, limiting the number of divisions that a normal cell can undergo. Many cancer cells have telomerase activity, which rebuilds telomeres after each cell division and confers immortality to cancer cells. Telomerase is an enzyme normally present to a significant degree only in the cells of developing fetuses. Treatments that target the telomerase enzyme itself or the chromosomal telomeres are being developed and tested in early clinical trials. This article focuses on several approaches to telomere-targeted therapy.

An international multicentre validation study of a pain classification system for cancer patients

Pain is a key symptom at all stages of cancer. It may be the first sign experienced by the patients, it may be a sign of relapse after curative treatment and many patients with metastatic disease may suffer for years due to suboptimal pain treatment. Cancer patients are reporting that pain is the symptom they mostly fear and that they hypothetically may consider to ask for euthanasia in a state of unbearable pain. During the last decade much attention has been given to improve pain treatment in cancer care; however, despite these efforts epidemiological studies are indicating that as many as 50% suffer from untreated pain. These data are in contrast to ‘older’ validation studies which have documented that as many as 90% may achieve acceptable pain control. Several explanations of the gap between best clinical practice and what happens in ‘real life’ have been put forward such as inferior diagnosis (pain classification), inferior follow up (evaluation of the pain treatment), lack of use of multi model treatment strategies and patient’s compliance to strong opioids. One fundament of medical science is to apply the existing knowledge about the use of diagnostic instruments such as biopsy, imaging, clinical examination and patient’s physical performance status in an appropriate and systematic manner. For cancer pain, international consensus does not exist