Jennifer Finnegan-John

A Systematic Review of Complementary and Alternative Medicine Interventions for the Management of Cancer-Related Fatigue

Fatigue, experienced by patients during and following cancer treatment, is a significant clinical problem. It is a prevalent and distressing symptom yet pharmacological interventions are used little and confer limited benefit for patients. However, many cancer patients use some form of complementary and alternative medicine (CAM), and some evidence suggests it may relieve fatigue. A systematic review was conducted to appraise the effectiveness of CAM interventions in ameliorating cancer-related fatigue. Systematic searches of biomedical, nursing, and specialist CAM databases were conducted, including Medline, Embase, and AMED. Included papers described interventions classified as CAM by the National Centre of Complementary and Alternative Medicine and evaluated through randomized controlled trial (RCT) or quasi-experimental design. Twenty studies were eligible for the review, of which 15 were RCTs. Forms of CAM interventions examined included acupuncture, massage, yoga, and relaxation training. The review identified some limited evidence suggesting hypnosis and ginseng may prevent rises in cancer-related fatigue in people undergoing treatment for cancer and acupuncture and that biofield healing may reduce cancer-related fatigue following cancer treatments. Evidence to date suggests that multivitamins are ineffective at reducing cancer-related fatigue. However, trials incorporated within the review varied greatly in quality; most were methodologically weak and at high risk of bias. Consequently, there is currently insufficient evidence to conclude with certainty the effectiveness or otherwise of CAM in reducing cancer-related fatigue. The design and methods employed in future trials of CAM should be more rigorous; increasing the strength of evidence should be a priority.

Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue

Background. Fatigue is a distressing and pervasive problem for people with cancer. In recent years, acupuncture has gained increasing attention among researchers as an alternative management strategy for cancer-related fatigue (CRF). This review aimed to evaluate the effectiveness of acupuncture for CRF. Methods. Five databases (Medline, CINAHL, Scopus, the Cochrane Library, and CAJ Full-text Database) were searched up to May 2013. Randomized controlled trials (RCTs) of acupuncture for the treatment of CRF were considered for inclusion. Results. Seven RCTs were included for meta-analysis, involving a total of 689 subjects. Three studies compared acupuncture with sham acupuncture for CRF with follow-up at 10 weeks; the standardized mean difference (SMD) for general CRF change values was −0.82 (95% confidence interval [CI] = −1.90 to 0.26). When acupuncture plus education intervention was compared with usual care, there was a statistically significant difference for the change score of general CRF (SMD = −2.12; 95% CI = −3.21 to −1.03). The SMD for general CRF change scores between acupuncture with no treatment or wait-list control was −1.46 (95% CI = −3.56 to 0.63). Finally, the SMD for general CRF change scores between acupuncture with acupressure or self-acupuncture was −1.12 (95% CI = −3.03 to 0.78). Three trials reported data for general quality of life and functioning status, reporting enough data for statistical pooling but showing no statistically significant difference (Z score = 1.15, P = .25, SMD = 0.99, 95% CI = −0.70 to 2.68 and Z score = 1.13, P = .26, SMD = 1.38, 95% CI = −1.02 to 3.79, respectively). The I2 statistics of all statistically pooled data were higher than 50%, indicating heterogeneity between the trials. Conclusions. There were 4 sets of comparison for the effectiveness of acupuncture for CRF; statistical pooling of the reduction in CRF from baseline to follow-up showed in favor of acupuncture. However, 3 sets of comparison for the pooled estimates of effect sizes had no statistical significance. Although one set of comparison (acupuncture plus education interventions vs usual care) had statistically significant differences, it is unclear whether this pooled positive outcome is attributable to the effects of acupuncture or to the education intervention. In addition, the duration of follow-up in these included trials was up to 10 weeks, and some RCTs had methodological flaws. Further rigorously designed RCTs adhering to acceptable standards of trial methodology are required to determine the effectiveness of acupuncture and its long-term effects on CRF.

Development and testing of the patient-reported chemotherapy indicators of symptoms and experience: patient-reported outcome and process indicators sensitive to the quality of nursing care in ambulatory chemotherapy settings.

Background: Outcome indicators are increasingly advocated to demonstrate the impact of high-quality care; however, generic measures do not encompass outcomes relevant to specialist areas. Objective: The aim of this study was to develop an outcome measure (Patient-Reported Chemotherapy Indicators of Symptoms and Experience [PR-CISE]) for use in ambulatory chemotherapy settings and assess its feasibility, acceptability, and preliminary efficacy in clinical practice. Methods: Three areas were covered by PR-CISE—symptom management, safe medication administration, and experience of supportive care. Outcome selection was guided by review of evidence and reference groups of users, clinicians, and experts. Over 12 weeks, PR-CISE was distributed to patients receiving ambulatory chemotherapy at 10 cancer centers. Data were analyzed descriptively and with case mix adjustment using regression-based models. Results: There were 2466 responses. There was variability across centers in terms of symptom experience and support provided. Across the whole sample, 25% reported moderate or severe nausea; however, rates varied between centers (25%–75%). Similar results emerged for other symptoms. When asked about support for symptom management, 80% reported that chemotherapy nurses asked about and were aware of symptom severity and provided useful information/advice. Once again, there was substantial variability between centers. Unexplained variation remained after case mix adjustment, suggesting that differences may be “real” rather than caused by population differences. Stakeholders planned to make changes to care delivery based on data on their performance. Conclusions: We successfully developed and tested indicators assessing the quality of care provided in ambulatory chemotherapy services. Implications: Results show that monitoring outcomes demonstrate potential differences in care quality and provide a stimulus to improve the experience and health of patients.

A longitudinal qualitative interview study tounderstand need for support in family members ofpeople having chemotherapy

BACKGROUND: The World Health Organisation reports that cancer mortality rates in developing African countries are rising because late diagnosis limits treatment options. In the UK there is evidence of inequalities in the delivery of cancer services to black and minority ethnic groups contributing to deaths from late diagnoses. UK studies of the African population are limited and focus on the African Caribbean community. Hence, UK cancer prevention strategies may not account for the African population’s cultural beliefs or attitudes towards cancer; this may affect awareness of the signs and symptoms. AIM: To identify evidence-based information about African immigrants’ views regarding cancer. METHODS: Six databases were searched: Academic Search Complete, AMED, CINAHL, MEDLINE, PsycInfo, and Soc Index. The literature search was extended to include grey literature and a search of reference lists of relevant studies. Publications not written in English were excluded. RESULTS: Six qualitative, nine quantitative, and one mixed method study were identified; all except two were conducted in the USA. The majority indicated that African people had low levels of knowledge about cancer risk factors, signs and symptoms. Misconceptions, cultural and religious belief and fear appear to influence African people’s views towards cancer; this may affects their behaviour in terms of seeking treatment. CONCLUSION: This review demonstrates a need for UK based studies to determine the relevance of review findings towards, and fill the gaps in knowledge about, the growing UK based African population.