John Sitzia

Volume measurement in lymphoedema treatment: examination of formulae

The purpose of this study was to examine a variety of mathematical volume formulae and their respective validity in establishing limb volume in monitoring and evaluation of treatment for lymphoedema. Using a random sample of treatment records from the Day Ward, Worthing Hospital, it is shown that the formula most commonly used at present, that for a cylinder, produces imprecise volume data. A simplified formula derived from the formula for a frustum is tested, and is found to produce more accurate data. The paper proposes that the frustum formula is more appropriate in establishing limb volume, and should be adopted by practitioners.

Patient satisfaction with cancer chemotherapy nursing: a review of the literature

Assessments of patient satisfaction have become widely accepted as a legitimate and worthwhile approach to improvement of service quality. Satisfaction studies are common in areas such as general practice or midwifery, but the approach has hardly been applied to assessments of care for persons with cancer. This paper first provides an historical background to satisfaction research in Western countries, then goes on to introduce conceptual issues in this field. Literature relevant to patient satisfaction with cancer chemotherapy services is then examined, with the review structured by four aspects of care: treatment accessibility and environment, technical aspects of care, interpersonal aspects of care, and patient information and education. The literature clearly suggest two areas which need urgent attention: assessments and management of adverse effects, and provision of patient information.

A study of patients' experiences of side-effects associated with chemotherapy: pilot stage report

This paper reports findings from the pilot stage of a longitudinal descriptive study of problems experienced by day-patients undergoing chemotherapy treatment with the Day Ward, Worthing Hospital. Unlike the majority of studies in this field, this study allows documentation of all side-effects perceived by the patient as important, and is designed to follow the progress in incidence and severity of each problem through the treatment course. Preliminary findings show some 100 side-effects have been identified, with different problems being most troublesome for each treatment regime. Full data are provided. The study emphasises the importance of regime-specific data both in formulating clinical practice and in the provision of patient education.

Manual Lymphatic Drainage Compared with Simple Lymphatic Drainage in the Treatment of Post- mastectomy Lymphoedema

Summary Purpose To determine whether manual lymphatic drainage (MLD) is significantly more effective than simple lymphatic drainage (SLD) in reducing oedematous limb volume in women with breast cancer related arm oedema. Design Randomised trial. Methods The study measured change in affected limb volume over a two-week intensive treatment period. One group of patients (N = 13) was treated with SLD, the other group (N = 15) with MLD. All patients were treated daily by the same lymphoedema specialist nurse and wore multi-layered bandaging between treatments. The sole outcome measure was percentage change in excess limb volume (PCEV) following treatment. Results The mean percentage reduction in PCEV was 33.8% in the MLD group and 22.0% in the SLD group (mean difference 11.8%, 95%CI = –3.8% to +27.4%). Conclusions These data suggest that MLD is more effective than SLD in reducing limb swelling. However, the data are not statistically conclusive. These results firmly support the need for this study to be replicated with a larger, statistically viable sample.

Survey of the incidence and severity of side-effects reported by patients receiving six cycles of FEC chemotherapy

The purpose of this study was to investigate the side-effects experienced by patients receiving 5-fluorouracil + epirubicin + cyclophosphamide (FEC) chemotherapy in the treatment of cancer of the breast. A primary objective was to document the incidence and severity of side-effects at each cycle of chemotherapy treatment. Thirteen patients participated. Data collection was via a self-report questionnaire listing 61 possible side-effects. Participants completed a questionnaire following each cycle of chemotherapy. Participants graded the severity of each side-effect using an ordinal scale of 0–4. A score for each side-effect was calculated, based on the product of incidence and severity values (‘C score’). Patients also stated which had been the worst side-effect at each cycle. The response rate was 70%. Seventy-one side-effects were reported by the sample. Hair loss was the most common side-effect (mean incidence = 98%). However, patients ranked nausea as the worst side-effect overall. Fatigue, difficulty sleeping, vomiting and night sweats also appeared significant problems. Although limited by the small sample size, this study suggests the problems experienced by patients undergoing FEC chemotherapy are many and diverse.

Development and evaluation of a questionnaire to assess patient satisfaction with chemotherapy nursing care

This paper reports the development and psychometric testing of an instrument to assess patient satisfaction with out-patient chemotherapy treatment, the Worthing Chemotherapy Satisfaction Questionnaire WCSQ). Content validity was established in two stages.The first stage involved a preliminary identification of themes and the development of a patient self-report questionnaire using a 4-step approach.The second stage involved an analysis of quantitative and qualitative data from 173 completed questionnaires. Construct validity was evaluated using a 3-step approach, including confirmation of a homogenous factor using Cronbachs alpha (α), and discriminance procedures to examine differences in the satisfaction of compliant and non-compliant patients. Reliability of the questionnaire was assessed by determining the internal consistency of subscales using Cronbachs α.The results indicate that the WCSQ displays acceptable reliability and validity. Analyses of the findings from 173 patients suggest that there exist six distinct components of satisfaction with chemotherapy care: interpersonal aspects of care, technical aspects of care, patient education, multidisciplinary teamwork, treatment environment and hospital accessibility.