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Evidence-Based Practice

Marlon Saria, MSN, RN, AOCNSAssociate Editor

An Intervention to Manage Patient-Reported

Symptoms During Cancer Treatment
Phoebe D. Williams, PhD, RN, FAAN, Kirstin Williams, MSN, RN, FNP-BC, Stephanie LaFaver-Roling, MSN, RN, FNP-BC, OCN,
Renee Johnson, MSN, RN, ANP-BC, and Arthur R. Williams, PhD, MA, MPA
Patients with cancer receiving therapy may face a variety of complicated and stressful symptoms. Oncology nurses can advocate for
patients by performing their roles as educators and comanagers of cancer-related side effects. In addition, symptom-focused education
provided by oncology nurses can enable patients to administer self-care more effectively.

Patients with cancer receiving therapy

experience a wide variety of symptoms
(Eaton & Tipton, 2009; Henry et al.,
2008; Oncology Nursing Society [ONS],
2010; Williams et al., 2001) that greatly
affect their quality of life (QOL). Severe,
unmanaged symptoms demand a large
amount of time from nurses and can
reduce treatment compliance. In this
pilot study, nurses provided education derived from evidence-based interventions
recommended by Yarbro, Frogge, and
Goodman (2004); ONS (Eaton & Tipton,
2009); and the National Comprehensive
Cancer Network (2005) to patients with
cancer receiving treatment.
The study sought to answer the question: What are the effects of a nursing intervention focused on teaching symptom
management to patients as they undergo
therapy for cancer? The primary outcome
measured was symptom occurrence and
severity; secondary measures were functional status and health-related QOL.

Literature Review
The authors used the Stetler Model of
Research Utilization as a guide to search
the oncology literature for well-designed
studies that showed positive outcomes
from interventions including components of symptom assessment and patient
education and support (Polit & Beck,
2010; Stetler, 2001; Titler et al., 1994).
The Stetler Model also includes a translation or application in a specific care

setting and an evaluation of outcomes.

Cognitive-behavioral approaches that
focus on problem solving, information
acquisition, self-care management for
symptoms, and emotional and social support have been found to greatly improve
patients QOL and overall functioning.
The literature in general showed that
patient symptom management is an important aspect of oncology care. In addition, nurses can help patients self-manage
their symptoms using established methods. To view summaries of the studies,
see Appendix A in the online version of
this article at http://ons.metapress.com/
content/1092-1095.

Methods
A two-group repeated-measures design
was used in this pilot study. Participants
in the control group (n = 10) received the
usual standard of care, whereas those in
the intervention group (n = 10) received

the educational intervention based on

their self-reported symptoms. The study
was approved by the institutional review
boards at a university cancer center in
a medium-sized city in the midwestern
United States and a regional cancer center
in a smaller city about 80 miles away.
Trained oncology RN researchers identified potential participants using the inclusion criteria and the daily list of clinic
visitors. The researchers used nonprobability (purposive) sampling and randomized eligible participants into control and
intervention groups. Newly diagnosed
adult patients with cancer who agreed
to join the study and signed the consent
form were included. Initial participant accrual was slow at the first site; therefore,
another site and researcher were added
using similar procedures. After signing
the consent form, all participants were
instructed to self-report symptoms on
the Therapy-Related Symptom Checklist
(TRSC) (baseline).

Phoebe D. Williams, PhD, RN, FAAN, is a professor in the School of Nursing at the University
of Kansas, Kirstin Williams, MSN, RN, FNP-BC, is an advanced nurse practitioner at Childrens
Mercy Hospital, and Stephanie LaFaver-Roling, MSN, RN, FNP-BC, OCN, is an advanced
practice nurse at the University of Kansas Cancer Center, all in Kansas City; Renee Johnson,
MSN, RN, ANP-BC, is an advanced nurse practitioner at the Cotton ONeil Diabetes and Endocrinology Center in Topeka, KS; and Arthur R. Williams, PhD, MA, MPA, is a professor and chair
of Health Policy and Management in the College of Public Health at the University of South
Florida in Tampa. The authors take full responsibility for the content of the article. The authors
did not receive honoraria for this work. No financial relationships relevant to the content of
this article have been disclosed by the authors or editorial staff.
Digital Object Identifier: 10.1188/11.CJON.253-258

Clinical Journal of Oncology Nursing Volume 15, Number 3 Evidence-Based Practice

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253

Study Instruments
The TRSC is a patient self-report tool
that can serve as a guide (checklist) for
clinicians and a subjective measure of
therapy-related symptom severity (Barry
& Dancey, 2005; Williams, Ducey, Williams, Sears, & Tobin, 1997; Williams et al.,
2001; Williams, Williams, Ducey, Sears, &
Tobin-Rommelhart, 2000). The TRSC asks
patients to rate 25 symptoms on severity
using a five-point scale; other symptoms
may be added and rated as well. A higher
total score indicates greater severity and
frequency of symptoms.
The Health-Related Quality-of-Life Linear Analogue Self-Assessment (HRQOLLASA) (Bretscher et al., 1999) measures
six items on a 10-point scale from 0 (as
bad as can be) to 10 (as good as can be).
The items have been validated as general
measures of global QOL dimensional constructs in numerous settings (Bretscher et
al., 1999; Degner & Sloan, 1995; Grunberg,
Groshen, Steingass, Zaretsky, & Meyerowitz, 1996; Hyland & Sodergren, 1996; Sloan
et al., 2002; Sriwatanakul et al., 1983). A
high score on the HRQOL-LASA indicates
a high QOL (Sloan et al., 2002).
The Karnofsky Performance Status Scale
and Health Form (KPS) (Karnofsky &
Burchenal, 1991) is completed by the
nurse. The KPS rates the condition and
activity or functional status of patients
receiving cancer treatment from 0 (dead)
to 100 (fully functional). Higher scores
indicate better functional status. The KPS
has good psychometric properties and has
been used in clinical oncology research
(Firat, Bousamra, Gore, & Byhardt, 2002;
Hassan & Weymuller, 1993; Piamjariyakul
et al., 2010; Williams, Balabagno, et al.,
2010; Williams et al., 1997, 2001; Williams,
Lopez, et al., 2010). However, the scale
seems to be less sensitive to changes in
medical conditions than the TRSC or the
HRQOL-LASA.
The sociodemographic form collected
data including age, gender, and marital status. The form was completed once (at baseline) by participants or a family member.

Data Collection
Participants in the control group received usual care, including the standard
packet given to all patients with cancer.
The packet provides information about
parking, office procedures, schedule of
clinic visits, and when to call the nurse
254

or doctor (i.e., for a fever of 100.5F or

higher). Study instruments were completed at baseline, midpoint, and endpoint.
Treatment cycles were every 21 days (six
patients) or every 14 days (four patients);
therefore, the midpoint was defined as day
1 of cycle 2, and the endpoint was defined
as day 1 of cycle 3 before chemotherapy
was administered. The same time points
were used in the intervention group.
The 10 participants in the intervention
group received an educational intervention provided by the nurse that focused
on the reported symptoms from the
TRSC, as well as standard care. All members of the project team had research
education and training. The two nurses
who provided the educational interventions to the patient cohorts were trained
to ensure consistent delivery.

Intervention
The teaching interventions provided
during face-to-face interactions and telephone contact with participants were documented carefully. The nurse completed
a teaching and support intervention form
to document every contact (including telephone and face to face) with the patient
and the intervention provided.
For example, a nurse had face-to-face
contact with Patient A. The 60-minute
session covered standard care information. Handouts also were provided on the
potential side effects of cisplatin. During
the follow-up telephone call, information
on the need for adequate hydration and
strategies to prevent nausea and vomiting
were reinforced. The call lasted for about
10 minutes. At the midpoint session (lasting about 25 minutes), the face-to-face
discussion focused on alleviation of the
reported symptoms of appetite loss, dry
mouth, sore throat, and skin changes,
and handouts were provided again. At the
endpoint, Patient A was unable to come to
the clinic because of the side effects of radiation therapy. Therefore, the nurse communicated with Patient A via telephone;
the 15-minute intervention focused on
reported symptoms of nausea, vomiting,
and sore throat. Total intervention time
with Patient A was 110 minutes.

Data Analysis
The researchers conducted a betweengroup analysis of baseline, midpoint,
and endpoint data on symptom occur-

rence and severity, health-related QOL,

and functional status. Descriptive data
analyses included frequencies and percentages, mean scores for each symptom,
total scores on all instruments at all time
points, and paired t tests for changes
between the means of each group at baseline and the two follow-up points (mean
difference tests).

Findings
The sample included 20 newly diagnosed adult patients with cancer (17
women and 3 men). The majority had
breast cancer (n = 16). Age distributions
were similar between the intervention

group (X = 58.3 years; SD = 16.9) and the

control group (X = 4.1 years; SD = 12.2).

The time length of all sessions with the
intervention group ranged from 1.82.5
hours (see Table 1). Participants in the control group completed the data collection
forms and received the standard packet
of information from the nurse researcher
for an average contact of about one hour.
The intervention group reported lower
symptom occurrence and severity overall,
despite starting with higher baseline values (see Table 2). Baseline TRSC data in the
control group showed lower mean symp
tom occurrence and severity (X = 0.2)

compared to the intervention group (X =

3.6). However, midpoint scores showed
lower mean symptom occurrence and

severity in the intervention group (X = 7.5

versus 23) and again at the endpoint (X =

5.5 versus 16.5). At the endpoint, symptom
occurrence and severity improved from
the midpoint by 27% in the intervention
group versus 11% in the control group.
KPS scores were not significantly dif
ferent in the intervention group (X = 89)

and the control group (X = 93) at baseline. Scores for both groups decreased
at midpoint and endpoint, although the
control group reported slightly higher

mean scores at midpoint (X = 86 versus

X = 80), and at endpoint (X = 84 versus

X = 75). Likewise, only slight variations

in health-related QOL scores were found
at each time point. No participant from
either group was admitted to the hospital
or emergency room during the study.

Discussion
Overall, the current study showed that
patient education and nurse follow-up

June 2011 Volume 15, Number 3 Clinical Journal of Oncology Nursing

Table 1. Interventions Provided to Patient Cohorts at Specific Time Intervals

PATIENT

BASELINEa

2448 HOUR
FOLLOW-UPb

MIDPOINTa

BETWEEN MIDAND ENDPOINTSb

ENDPOINTa

UNIVERSITY CANCER CENTER

Standard care items

Teaching sheet on cisplatin
Handouts for nausea and vomiting, taste
changes, peripheral neuropathy, fatigue,
decreased white blood cell count, decreased
platelets, anorexia, and diarrhea

Reinforced adequate hydration

and prevention
of nausea and
vomiting

Discussed information and

gave handouts on anorexia,
mouth sores, sore throat,
and skin changes

Unable to reach
patient by telephone

Discussed interventions for nausea and vomiting

and sore throat

Standard care items

Teaching sheet on carboplatin
Handouts for nausea and vomiting, taste
changes, peripheral neuropathy, fatigue,
decreased white blood cell count, decreased
platelets, anorexia, diarrhea, and constipation

Discussed
treatment and
prevention of
constipation

Discussed information and

gave handouts on taste
changes, fatigue, anorexia,
weight loss, and constipation

Patient withdrew.

Standard care items

Teaching sheets on cisplatin and etoposide
Handouts for nausea and vomiting, taste
changes, peripheral neuropathy, fatigue,
decreased white blood cell count, decreased
platelets, anorexia, diarrhea, alopecia, and
constipation

Reinforced exercising to help

with fatigue

Discussed information and

gave handouts on nausea
and vomiting, fatigue,
diarrhea, weight loss, and
infection

Unable to reach
patient by telephone

Standard of care items

Teaching sheets on cisplatin and paclitaxel
Handouts for nausea and vomiting, taste
changes, peripheral neuropathy, fatigue,
decreased white blood cell count, decreased
platelets, anorexia, diarrhea, mouth sores,
myalgias, and alopecia

Patient reported
no new symptoms.

Discussed information and

gave handouts on fatigue,
anorexia, weight loss,
insomnia, pain, and constipation

Reviewed interventions for

fatigue, anorexia,
and constipation

Discussed interventions for fatigue, sore throat,

constipation, and
infection

Standard of care items

Teaching sheets on cisplatin, bleomycin, and
etoposide
Handouts for nausea and vomiting, taste
changes, peripheral neuropathy, fatigue,
decreased white blood cell count, decreased
platelets, anorexia, diarrhea, skin changes,
alopecia, and constipation

Unable to reach
patient by telephone

Discussed information and

gave handouts on nausea,
vomiting, and anorexia;
gave brochure on sexuality

Unable to reach
patient by telephone

REGIONAL CANCER CENTER

Standard care information

Chemotherapy teaching sheets
Handouts for nausea and vomiting, decreased
white blood cell count, anemia, decreased
platelets, anorexia, diarrhea, mouth sores,
skin changes, and alopecia

Discussed,
reviewed, and
mailed information for nausea
and vomiting
and constipation

Discussed information
and gave handouts on
nausea and vomiting,
taste changes, fatigue, decreased platelets, anorexia,
mouth sores, sore throat,
alopecia, insomnia, and
constipation

Discussed,
reviewed, and
mailed information for alopecia
and constipation

Discussed interventions for

fatigue, decreased
platelet count, anorexia, insomnia,
and constipation

Standard care information

Chemotherapy teaching sheets
Handouts for nausea and vomiting, taste
changes, fatigue, decreased white blood cell
count, anemia, decreased platelet count, anorexia, diarrhea, mouth sores, skin changes,
alopecia, and infection

Discussed,
reviewed, and
mailed information for insomnia

Discussed information and

gave handouts on nausea
and vomiting, taste changes, alopecia, insomnia, and
constipation

Discussed,
reviewed, and
mailed information for insomnia
and constipation

Discussed interventions for taste

changes, fatigue,
and sore throat

(Continued on next page)

Face to face
By telephone
Note. The midpoint was defined as day 1 of cycle 2; the endpoint was defined as day 1 of cycle 3 before chemotherapy was administered.
Note. Patients at the Regional Cancer Center received treatments either every 14 days with adriamycin and cyclophosphamide or every 21 days with
fluorouracil, epirubicin, and cyclophosphamide.
a

Clinical Journal of Oncology Nursing Volume 15, Number 3 Evidence-Based Practice

255

Table 1. Interventions Provided to Patient Cohorts at Specific Time Intervals (Continued)

PATIENT

2448 HOUR
FOLLOW-UPb

BASELINEa

BETWEEN MIDAND ENDPOINTSb

MIDPOINTa

ENDPOINTa

REGIONAL CANCER CENTER (continued)

Standard care information

Chemotherapy teaching sheets
Handouts for nausea and vomiting, decreased
white blood cell count, anemia, decreased
platelet count, anorexia, diarrhea, mouth
sores, skin changes, and alopecia

Unable to reach
patient by telephone

Discussed information
and gave handouts on
nausea and vomiting, taste
changes, fatigue, anorexia,
and alopecia

Unable to reach
patient by telephone

Discussed interventions for nausea and vomiting,

taste changes,
fatigue, anorexia,
and alopecia

Standard care information

Chemotherapy teaching sheets
Handouts for nausea and vomiting, decreased
white blood cell count, anemia, decreased
platelet count, anorexia, diarrhea, mouth
sores, skin changes, and alopecia

Discussed,
reviewed, and
mailed information for fatigue

Discussed information and

gave handouts on fatigue
and insomnia

Discussed,
reviewed, and
mailed information for insomnia

Discussed interventions for

alopecia

Standard care information

Chemotherapy teaching sheets
Handouts for nausea and vomiting, decreased
white blood cell count, anemia, decreased
platelet count, anorexia, diarrhea, mouth
sores, skin changes, and alopecia

Unable to reach
patient by telephone

Discussed information and

gave handouts on insomnia, pain, and constipation

Discussed,
reviewed, and
mailed information for insomnia

Discussed interventions for

peripheral neuropathy, alopecia,
and insomnia

Face to face
By telephone
Note. The midpoint was defined as day 1 of cycle 2; the endpoint was defined as day 1 of cycle 3 before chemotherapy was administered.
Note. Patients at the Regional Cancer Center received treatments either every 14 days with adriamycin and cyclophosphamide or every 21 days with
fluorouracil, epirubicin, and cyclophosphamide.
a

were associated with decreased patient

self-reported symptom severity and revealed a trend suggesting possible improvements in health-related QOL and
functional status. The findings are consistent with the literature (Given et al., 2002;
Molassiotis et al., 2009). In a randomized
trial of patients with breast cancer, Given
et al. (2002) found a significant decrease
in symptom severity at the 10-week interval, which remained through 20 weeks.
A randomized trial by Molassiotis et al.
(2009) also found that a symptom-focused
homecare program enabled patients with
cancer to more effectively manage adverse effects of their treatment compared
to usual care.
Participants in the intervention group
in the current study reported that the
nurse intervention significantly alleviated symptom occurrence and severity.
In this pilot study, many participants in
the intervention group verbalized their
appreciation of the closer follow-up as
well as the increased amount of time allowed for their education and questions.
Two participants commented on the
helpfulness of the teaching sheets and
the treatment binder. One participant
256

said, More information means better

ammunition to fight the disease.

Limitations
The small sample size made the current
pilot study underpowered for quantitative
analyses. Using the means and variances
found in the study sample, the post-hoc
power of the current study (Bonferroni
corrected) was only 0.64. Generally, a
power of 0.8 or higher is considered adequate for research purposes. The researchers performed multiple tests; therefore,
they used Bonferroni correction to ensure
than an alpha of 0.05 was maintained
across all t tests. The implication is that
a true treatment effect may exist that
was not detected; therefore, the findings
reported in this article are a conservative
presentation of true treatment effects.

Nursing Implications
Patients with cancer receiving therapy
experience a variety of symptoms, which
can be complicated and stressful to manage. The symptoms can severely affect
QOL and may even be life threatening in

some instances. In most cases, the nurse

functions as the patient educator and
comanager of symptoms and side effects.
Symptom-focused patient education
provided by oncology nurses can enable
patients to more effectively manage their
treatment and adverse effects. The current study demonstrated that a standardized patient-reported symptom checklist
such as the TRSC adds to the efficiency of
symptom assessment and management.
Although telephone interactions were
shown to augment face-to-face communications (Basch et al., 2005; Kearney et
al., 2006; Weaver et al. 2007; Williams &
Catapusan, 2010; Wongpiriyayothar, Piamjariyakul, & Williams, 2010), a symptom
checklist can be used to optimize care
in traditional clinics as well as in technologically inclined healthcare settings
(Gonzalez, Williams, Tirado, & Williams,
2011; Lantican, Williams, Bader, Lerma, &
Bistrow, 2011; Williams, Williams, & Doolittle, 1999, 2006; Williams et al., 2011).

Conclusion
The current study was a pilot demonstration of the Stetler (2001) model

June 2011 Volume 15, Number 3 Clinical Journal of Oncology Nursing

Table 2. Mean Scores on Data Collection Tools at Three Time Points

CONTROL GROUP
TRSCa
TIME POINT

Baseline
Midpoint
Endpoint

20
20
17

INTERVENTION GROUP

HRQOL-LASAb

SD

0.2
23
16.5

0.63
16.5
14.2

SD

7.6
7.7
7.6

2.4
2
2

KPSc

TRSCa

SD

93
86
84

4.8
5.2
8.4

HRQOL-LASAb

SD

3.6
7.5*
5.5*

3.6
5.5
5.3

SD

7.5
7.7
7.4

1.7
1.6
1

KPSc

SD

89
80
75

13.6
12.5
7.6

* p < 0.05 (corrected)

a
Scores range from 0100; higher scores indicate more reported symptoms and higher severity.
b
Scores range from 010; higher scores indicate better health-related quality of life.
c
Scores range from 0100; higher scores indicate better functional status.
HRQOL-LASAHealth-Related Quality-of-Life Linear Analogue Self-Assessment; KPSKarnofsky Performance Status Scale and Health Form; TRSC
Therapy-Related Symptom Checklist

of evidence-based practice and the use

of a calibrated checklist (the TRSC) as a
clinical tool for patients with cancer to
report symptom occurrence and severity and for clinicians to use the information as a basis for appropriate symptommanagement interventions. The Stetler
model guided the authors literature
search, and the evidence was applied
in the specific care sites. Future plans
include longer-term use of the evidence
at the study settings.
Author Contact: Phoebe D. Williams, PhD, RN,
FAAN, can be reached at pwilliam@kumc.edu,
with copy to editor at CJONEditor@ons.org.

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.E215-E222

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Appendix A. Selected Literature Review

STUDY

FOCUS

SAMPLE

METHODS

FINDINGS

Barsevick
et al.,
2004

Evaluation of energy conservation and activity management to

decrease fatigue and maintain
functional performance

American sample; experimental group (n = 200) received

energy conservation and
activity management intervention; control group (n = 196)
received intervention focused
on nutrition; patients were
informants.

Assessment with standardized

questionnaires and scales
Randomized clinical trial

The experimental group demonstrated significant benefit.

Scores showed the expected
increase in fatigue (associated with cancer therapy) was
minimized.

Chelf et
al., 2002

Learning and support preferences of patients with cancer

625 American patients with cancer; patients were informants.

Assessment with a structured

interview and questionnaire
Survey questions on preferred
ways to learn new information about the illness, treatments, etc.
No control group
Explanatory descriptive survey
design

Patients preferred interactive,

interpersonal communication
with physicians or nurses.
Printed material was preferred
to enhance and support knowledge gain.

Given et
al., 2002

Pain and fatigue management

for patients receiving chemotherapy

Two groups of American patients: conventional care group

(n = 60) and standard care plus
nursing intervention group
(n = 53); patients and caregivers
were informants.

Assessment with interviews

Quantitative, experimental
design
The intervention aimed to resolve adverse symptoms.

Patients receiving the intervention reported significant reduction in number and severity of
symptoms.

Given et
al., 2004

Cognitive behavioral intervention for symptom management

of patients undergoing chemotherapy

American patients received either conventional care alone

(n = 119) or with an experimental intervention (n = 118).
Patients and caregivers were
informants.

Assessment with Symptom Severity Index

Randomized, controlled trial
The intervention specified adaptive strategies that would help
patients reduce severity of
symptoms and their effect on
emotional distress and physical function.

Patients in the experimental

group reported significantly
lower symptom severity at 10
and 20 weeks.

Henry et
al., 2008

Prevalence of adverse effects

while receiving cancer treatment; time burden of treating
adverse effects

814 American patients with

cancer receiving chemotherapy
or radiotherapy; patients were
informants.

Assessment with interviews and

standardized scales
Patients were asked to complete
a survey (online or via telephone) regarding cancer treatment side effects and time
spent treating side effects,
including impact on work
productivity.
No control group
Cross-sectional survey design

The majority of patients receiving cancer therapy experience

at least one side effectfatigue
was the most common. Time
spent on treating side effects
increased, and work productivity
decreased.

Jacobsen
et al.,
2002

Efficacy and cost of two forms of

stress management of patients
with cancer undergoing chemotherapy

382 American patients preparing

to start chemotherapy; patients
were informants.

Assessment with standardized

tools
Study had a control group.
Randomized trial (standard care
versus self-care); longitudinal
design

Patients receiving self-administered interventions (self-care)

reported significantly better
psychosocial outcomes than
those receiving standard care.
Self-care was more cost effective
than professional intervention.

Jahraus et
al., 2002

Impact of education program

on perceived adequacy of
knowledge of patients with
breast cancer receiving radiation
treatment

79 Canadian patients were divided into three groups according to age: premenopausal
(n = 23), perimenopausal (n =
28) and postmenopausal (n =
28); patients were informants.

Assessment with questionnaires

and interviews
No control group
Descriptive design

Patients differed on their desire for knowledge regarding

their disease processes. The
most sought-after information
involved side effects of treatment. Education of patients
should be tailored to meet
individual needs.
(Continued on next page)

ABMTautologous bone marrow transplantation; QOLquality of life; TRSCTherapy-Related Symptom Checklist

Clinical Journal of Oncology Nursing Volume 15, Number 3 Evidence-Based Practice

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Appendix A. Selected Literature Review (Continued)

STUDY

FOCUS

SAMPLE

McLachlan et al.,
2001

Psychosocial functioning of
patients with cancer using
coordinated psychosocial interventions based on patient selfassessment

450 Australian patients with

cancer grouped into intervention and control (standard
care) groups; patients were
informants.

Mills &
Sullivan,
1999

Information needs of patients

diagnosed with cancer

Molassiotis et
al., 2009

Efficacy of a homecare nursing program in decreasing side

effects and toxicities of oral
chemotherapy as compared to
usual care

Oliver et
al., 2001

METHODS

FINDINGS

Assessment with standardized

tools
Randomized trial

No differences were observed at

baseline with respect to cancer
needs, QOL, or psychosocial
functioning of the intervention
when compared to the control
group. The intervention group
showed significant reduction in
depression when compared to
the control group.

Meta-analysis

Patients lack of appropriate information lessened coping abilities and contributed significantly
to anxiety and stress.

164 patients in the United Kingdom with colorectal or breast

cancer beginning oral chemotherapy (capecitabine), stratified
based on diagnosis; patients
were informants.

Assessment with standardized

toxicity grading tools and
scales
Randomized, controlled trial
Experimental group received
symptom-focused nursing
intervention; control group
received standard of care.

The experimental group had

significantly fewer toxicity symptoms compared to the control
group. The first two cycles of
capecitabine treatment may be
the most critical time for intervention and support.

Improvement in pain control

among patients with cancer using individualized patient education and coaching

67 American patients with

cancer (aged 1875 years) randomized to experimental and
control groups; patients were
informants.

Assessment with standardized

questionnaires
Randomized trial; quantitative
design

The experimental group showed

improved average pain severity
compared to the control group.

Piamjariyakul et
al., 2010

Use the TRSC to examine reported symptoms and self-care

strategies in Thai patients with
cancer.

202 Thai patients undergoing

radiotherapy, chemotherapy,
or combination; patients were
informants.

Identified symptoms experienced as well as self-care

strategies used to alleviate
symptoms
Assessment with interview and
standardized tools
No control group
Descriptive, cross-sectional
design

Patients receiving combined

radiotherapy and chemotherapy
reported more severe symptoms
on the TRSC. Use of self-care
(including complementary care)
was prevalent with common
methods such as diet, nutrition,
lifestyle, and mind-body control.
Cultural beliefs may influence
coping mechanisms.

Tarzian et
al., 1999

Patients perspectives of information needs related to ABMT

10 patients pre-ABMT and 10

patients post-ABMT; patients
were informants.

Assessment with an interview

No control group
Qualitative, phenomenologic
design

Pre-ABMT recipients reflected

the need to know versus the
fear of knowing too much. PostABMT recipients expressed that
they did not know enough about
procedures and symptoms.
Education improved adherence
to treatment regimens and
increased ability to cope with
symptoms.

Yesilbalkan et al.,
2009

Perception of fatigue in patients

with gastrointestinal cancers
after an intervention

35 Turkish patients with gastrointestinal cancer receiving

chemotherapy

Patients were asked to report

fatigue level and QOL.
Assessment with standardized
tools
No control group
Quasiexperimental, repeated
measures design

Mean fatigue scores showed

significant decrease at sessions 2 and 3 (T1 and T2) of the
intervention. QOL scores also
showed improvement at specified time points compared to
baseline.

ABMTautologous bone marrow transplantation; QOLquality of life; TRSCTherapy-Related Symptom Checklist

A2

June 2011 Volume 15, Number 3 Clinical Journal of Oncology Nursing