Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.

BACKGROUND: There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT(3) inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms. OBJECTIVES: The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients. SEARCH STRATEGY: We searched MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, and conference abstracts. SELECTION CRITERIA: Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both. DATA COLLECTION AND ANALYSIS: Data were provided by investigators of the original trials and pooled using a fixed effect model. Relative risks were calculated on dichotomous data. Standardized mean differences were calculated for nausea severity. Weighted mean differences were calculated for number of emetic episodes. MAIN RESULTS: Eleven trials (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% confidence interval 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% confidence interval 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD = -0.19; 95% confidence interval -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics. AUTHORS' CONCLUSIONS: This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.

Differences in patients' and family caregivers' perceptions of the pain experience influence patient and caregiver outcomes.

The purposes of this study were to determine if there were differences in pain intensity scores, pain duration scores, mood states, and quality of life of oncology outpatients whose pain intensity scores were congruent with their family caregivers compared to patients whose pain intensity scores were non-congruent and to determine if there were differences in mood states, health status, and caregiver strain between family caregivers whose pain intensity scores were congruent with their family members and those family caregivers whose pain intensity scores were non-congruent. A total of 78 patient-caregiver dyads participated in the study. Patients completed a Demographic Questionnaire, a Cancer Pain Questionnaire, the Profile of Mood States, and the Multidimensional Quality of Life Scale-Cancer 2. Family caregivers completed a demographic questionnaire, the Profile of Mood States, the Caregiver Strain Index, and the Medical Outcome Study Short-Form Health Survey. Both patients and family caregivers rated the patient's pain intensity using a visual analogue scale (VAS). Patients in the non-congruent dyads (i.e. difference of >10 on the VAS score) had significantly more mood disturbance and a poorer quality of life than patients in the congruent dyads. Family caregivers in the non-congruent dyads had significantly higher caregiver strain score than caregivers in the congruent dyads. These findings suggest that differences in the perception of the pain experience between patients and their family caregivers is associated with deleterious outcomes for the patient and their family caregivers.

Health-related fitness and quality of life in organ transplant recipients.

BACKGROUND: The purpose of this study was to describe the levels of health-related fitness and quality of life in a group of organ transplant recipients who participated in the 1996 U.S. Transplant Games. METHODS: A total of 128 transplant recipients were selected on a first reply basis for testing. Subjects with the following organ types were tested: kidney (n=76), liver (n=16), heart (n=19), lung (n=6), pancreas/kidney (n=7), and bone marrow (n=4). Cardiorespiratory fitness (peak oxygen uptake) was measured using symptom-limited treadmill exercise tests with expired gas analysis. The percentage of body fat was measured using skinfold measurements, and the Medical Outcomes Short Form questionnaire (SF-36) was used to evaluate health-related quality of life. RESULTS: Participants achieved near age-predicted cardiorespiratory fitness (94.7+/-32.5% of age-predicted levels). Scores on the SF-36 were near normal. The active subjects (76% of total sample) had significantly higher levels of peak VO2 and quality of life and a lower percentage of body fat compared with inactive subjects (P<0.01). CONCLUSIONS: Although this is a highly select group which is not representative of the general transplant population, the data suggest that near-normal levels of physical functioning and quality of life are possible after transplantation and that those who participate in regular physical activity may achieve even higher levels.

Mood states of oncology outpatients: does pain make a difference?

The purposes of this study were to determine if there were significant differences in the mood states of oncology outpatients who had cancer-related pain and those who were pain free, and to evaluate the relationships between pain intensity and duration and mood states in those patients with pain. Two hundred (54.2%) patients experienced cancer-related pain during the previous month and 169 (45.8%) patients were pain free. Those patients who experienced cancer-related pain scored significantly higher on all of the subscale scores of the Profile of Mood States, except vigor, and had a significantly higher total mood disturbance (TMD) score than did pain-free patients. In addition, the subscale scores of tension, depression, anger, fatigue, confusion, and TMD scores were moderately correlated with increases in pain intensity. Also, depression, fatigue, confusion, and TMD scores were moderately correlated with increasing duration of pain. These data suggest that there is a relationship between pain and mood in oncology outpatients and that health-care professionals need to assess for mood disturbances in this population and develop appropriate treatment strategies.

Differences in nausea, vomiting, and retching between younger and older outpatients receiving cancer chemotherapy.

The purpose of this study was to determine whether there were differences in the side effects of nausea, vomiting, and retching (N, V, and R) between younger ( < 65 years, n = 102) and older ( > or = 65 years, n = 25) persons receiving outpatient chemotherapy. A longitudinal 4-month study was used for the 127 participants recruited from 18 settings. Participants completed two questionnaires (Inventory of N, V, and R and Behavior Checklist) over the course of the study. The pattern between the younger and older patients' N, V, and R subscale scores was consistent in that the younger patients' scores were consistently (except on one occasion) higher than the older patients' scores, but this difference was statistically insignificant. This study furthers our understanding of N, V, and R and has several clinical implications.

Perceptions of the mammography experience.

The 1993 projections for breast cancer indicate a morbidity of 183,000 women with a mortality rate of 18%. Mammography is one of three approaches available for the early detection of breast cancer. However, underutilization has been reported and attributed to pain associated with the procedure, the expense to the consumer, and lack of referral by physicians. Other reasons for the low utilization rates include fears on the part of the woman of a positive diagnosis, radiation, and a possible mastectomy. This study provides an analysis of the responses of a convenience sample of 272 women, aged 30-90 years, to two open-ended questions about the mammography experience. The words and phrases women used to describe the mammography experience and the sensations experienced in their breasts during mammography were subjected to content analysis. The results of this study suggest that the word descriptors women use to describe their experience during mammography are highly individualistic and may not be totally captured by numeric or descriptive rating scales of pain intensity.

The PRO-SELF Mouth Aware program: an effective approach for reducing chemotherapy-induced mucositis.

Many oncology patients receive chemotherapy drugs that have the potential to induce oral mucositis. If mucositis is not prevented, patients will have to manage the problems associated with mucositis: pain, local infection, and decreased ability to take fluids or food. At the time of this writing, clinical approaches for mucositis management are variable and generally ineffective. The mouth care program, PRO-SELF: Mouth Aware (PSMA), presented in this article, was found to be a significant component of a self-care program that may have reduced the incidence of chemotherapy-induced mucositis. The PSMA program has three dimensions: (a) didactic information, (b) development of self-care exercises (skills), and (c) supportive interactions with a nurse in the setting where the patients are receiving their treatment. This program focuses on decreasing the direct (i.e., incidence and severity of mucositis) and indirect morbidities of oral mucositis (i.e., number of local infections, level of discomfort/pain, and disruption in fluid and/or food intake). It provides the critical dimensions (i.e., specific information, self-care exercises, and nurse support) to promote the prevention of mucositis. The PSMA program is designed to provide patients with a definitive self-care repertoire to manage chemotherapy-induced mucositis in the home without the direct supervision of a health care provider.

Predictors of self-care: a test of Orem's model.

Despite advancements in self-care for people with cancer, a profile of individuals who perform self-care behaviors has not been determined. Without these data, interventions cannot be targeted to specific patient groups that demonstrate the most need. This study's investigators used Orem's model of self-care to determine predictors of self-care behavior. The sample consisted of 127 adults with cancer who were to receive their first dose of chemotherapy (e.g., doxorubicin, methotrexate, 5-fluorouracil, cyclophosphamide, or cisplatin, given alone or in combination). Data were collected from the subjects prior to the first cycle and at drug nadir for each of the four chemotherapy cycles. Potential predictors of self-care included demographic variables, performance status, affective state, social support, ability to manage a situation, self-care ability, and prior health-promoting activities. Self-care was measured using a 40-item behavior checklist. Multiple regression techniques were used to obtain four significant predictors of self-care, which accounted for 47% of the variance. Subjects with lower performance status, higher anxiety, less social support, and more education performed more self-care. These findings clarify Orem's model with this clinical population and provide a patient profile of self-care for practice.

The problem of pain in outpatients with breast cancer.

PURPOSE/OBJECTIVES: To determine the prevalence and causes of pain in a group of outpatients with breast cancer and to evaluate the effects of pain on the patient's activities of daily living (ADL), mood, and quality of life (QOL). DESIGN: Descriptive and correlational. SETTING: Sixteen outpatient facilities that are part of the Oncology Nursing Research Network. SAMPLE: A convenience sample of 97 outpatients who were actively being treated for breast cancer. METHODS: Patients completed a demographic questionnaire, a cancer pain questionnaire, the Profile of Mood States, and the Multidimensional Quality of Life Scale--Cancer. Patients' medical records were reviewed. MAIN RESEARCH VARIABLES: Pain intensity, pain duration, changes in ADL, changes in mood, and changes in QOL. FINDINGS: Forty-seven percent of the patients with breast cancer reported experiencing cancer-related pain. Patients with cancer-related pain had significantly higher mood disturbance scores and significantly lower QOL scores. CONCLUSIONS: Pain is a significant problem for outpatients with breast cancer that negatively affects mood, QOL, and functional status. IMPLICATIONS FOR NURSING PRACTICE: Future research is needed to determine the most effective strategies for treating pain associated with breast cancer. In addition, oncology nurses should perform ongoing assessments of patients' pain and the impact of the pain on various aspects of patients' lives.

Pain with mammography: fact or fiction?

This article presents an overview of current knowledge about mammography-related pain and discomfort. Possible causes of pain and discomfort are discussed along with the results of two pilot studies that investigated the prevalence and severity of pain and discomfort associated with film-screen mammograms in a mobile screening program. Based on these studies, the authors conclude that pain is a problem for a significant number of women from diverse ethnic and socioeconomic backgrounds. A nursing care plan is provided to assist nurses in reducing mammography-related pain and discomfort.

Differences in outcomes among patients experiencing different types of cancer-related pain.

PURPOSE/OBJECTIVES: To determine differences in pain characteristics, mood states, and quality of life (QOL) in outpatients with different types of cancer-related pain (i.e., somatic, visceral, or neuropathic) compared to outpatients who were pain-free. DESIGN: Descriptive, comparative. SETTING: Sixteen outpatient facilities that are part of the Oncology Nursing Research Network. SAMPLE: A convenience sample of 129 outpatients who experienced cancer-related pain and 169 pain-free patients, all of whom were actively being treated for cancer. METHODS: All patients completed a demographic questionnaire, the Multidimensional Quality of Life Scale-Cancer, and the Profile of Mood States, Patients with pain completed a Cancer Pain Questionnaire and the McGill Pain Questionnaire. Patients' medical records were reviewed. MAIN RESEARCH VARIABLES: Types of cancer-related pain (i.e., somatic visceral, or neuropathic), pain intensity, pain duration, quality of pain, QOL, and mood states. FINDINGS: No differences were found in any pain characteristics or any pain indices from the word descriptors of the McGill Pain Questionnaire. Patients with somatic and visceral pain had significantly higher fatigue scores than pain-free patients. In addition, patients with somatic and visceral pain had significantly lower physical well-being, nutrition, and total QOL scores and more symptom distress than pain-free patients. CONCLUSIONS: The type of cancer-related pain appears to influence the mood states and QOL of outpatients with cancer. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses need fo determine the type of pain the patient is experiencing and the impact of the pain on the patient's mood and QOL.

Differences in pain knowledge and perception of the pain experience between outpatients with cancer and their family caregivers.

PURPOSE/OBJECTIVES: To determine if knowledge about pain and the perception of the pain experience differ when comparing outpatients experiencing cancer-related pain with their family caregivers. DESIGN: Quantitative, descriptive. SETTING: Sixteen oncology outpatient settings that are part of the Oncology Nursing Research Network. SAMPLE: Eighty-six outpatients with cancer-related pain and their family caregivers. METHODS: Patients and their family caregivers were recruited in the outpatient setting and asked to complete a demographic questionnaire and the Pain Experience Scale. The patients also were asked to complete the Karnofsky Performance Scale. MAIN RESEARCH VARIABLES: Patients' and their family caregivers' knowledge about pain and their perception of the pain experience. FINDINGS: No significant differences in knowledge scores were found between the patients and their family caregivers. A significant difference in the perception of the pain experience was found, with the family caregivers viewing the experience more negatively than the patients did. Family caregivers reported that (a) patients had significantly higher levels of pain compared to patient reports, (b) patients experienced significantly greater distress from their pain than the patients reported for themselves, and (c) family caregivers experienced significantly greater distress from the patients' pain than the patients reported for their caregiver. CONCLUSIONS: Outpatients with cancer and their family caregivers possess limited knowledge about pain and pain management and perceive the pain experience differently. IMPLICATIONS FOR NURSING PRACTICE: Outpatients and their family caregivers need to be better educated about how to manage cancer-related pain. In addition, to reduce patient and caregiver distress, oncology nurses need to facilitate communication between patients and family caregivers about the pain experience.

Gender differences in the dimensions of quality of life.

PURPOSE/OBJECTIVES: To explore gender differences and similarities in the dimensions of quality of life (QOL). DESIGN: Secondary analysis of the Multidimensional Quality of Life Scale--Cancer Version (MQOLS--CA) data from two different research studies. SETTINGS: Multiple outpatient oncology sites. SAMPLE: The typical female participant (n = 254) was 58 years old (SD +/- 11.3) with 14 years of education, married/partnered (64%), Caucasian (88%), and diagnosed with breast (47%) or colorectal (16%) cancer. The typical male participant (n = 222) was 60 years old (SD +/- 14) with 14.3 years of education, married/partnered (69%), Caucasian (85%), and diagnosed with colorectal (31%) or prostate (13%) cancer. METHODS: Factor analytic procedures and reliability testing. MAIN RESEARCH VARIABLES: QOL as measured by the MQOLS-CA, gender. FINDINGS: For women, two factors emerged from the analysis procedures-psychosocial well-being (7 items) and physical competence (6 items). For the men, two different factors emerged--vitality (8 items) and personal resources (4 items). None of the cancer-specific items from the MQOLS-CA loaded on any of the factors for either gender. CONCLUSIONS: Measurement of QOL requires gender-specific questions to accurately address the dimensions of the concept of QOL in females and males. IMPLICATIONS FOR NURSING PRACTICE: Additional research is warranted to replicate these findings. Gender-specific interventions could then be developed and tested to maximize the QOL of all patients.

Acupressure for nausea: results of a pilot study.

PURPOSE/OBJECTIVES: To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care. DESIGN: Single-cycle, randomized clinical trial. SETTING: Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice. SAMPLE: Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%). METHODS: The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data. MAIN RESEARCH VARIABLES: Nausea experience measured by the Rhodes inventory of Nausea, Vomiting, and Retching and nausea intensity. FINDINGS: Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea. CONCLUSIONS: Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer. IMPLICATIONS FOR NURSING PRACTICE: This study must be replicated prior to advising patients about the efficacy of acupressure for the treatment of nausea.

Comparison of perceived symptoms of patients undergoing bone marrow transplant and the nurses caring for them.

This study describes the symptomatology of patients hospitalized for bone marrow transplant (BMT) (n = 30) and compares their perceptions of these symptoms to those of nurses (n = 28). Patients and nurses responded to the Symptom Distress Scale (SDS) four times: within 48 hours of BMT day one (T1); day 7-10 post-BMT (T2); day 20-23 post-BMT (T3); and day 30-34 post-BMT (T4). Patients also completed the Profile of Mood States at T1. Each time, the investigators completed a Karnofsky Performance Status evaluation of each patient. Patients perceived significantly more distress from their symptoms at T1 than their nurses perceived that they were experiencing. Over time, patients' SDS scores did not change significantly. However, nurses' SDS scores indicated significant differences, with their SDS scores at T1 less than those at T2 and T3. The results indicate the importance of nurses exploring the perceived symptom experiences of patients undergoing BMT. Any incongruence between nurses' and patients' perceptions potentially could prevent patients' symptoms from being managed effectively.

Patients' perspectives of fatigue while undergoing chemotherapy.

PURPOSE/OBJECTIVES: To explore the experience of fatigue from the perspective of patients undergoing chemotherapy. DESIGN: Qualitative research and secondary analysis of data from a larger study. SETTING: Participants were recruited from 18 sites, including large outpatient chemotherapy clinics and private medical oncologists' offices. SAMPLE: 127 adult patients who were beginning their first protocol of chemotherapy. METHODS: Data were collected through individual and open-ended interviews and a qualitative, thematic analysis of the participants' responses using grounded theory techniques. MAIN RESEARCH VARIABLE: The experience of fatigue as perceived by patients undergoing chemotherapy. FINDINGS: The analysis resulted in eight major thematic categories: (a) experiencing fatigue, (b) effects on well-being, (c) attribution of origin, (d) awareness and expectations, (e) emotional reactions, (f) activity, (g) the "biggest" concern, and (h) strategies and plans. CONCLUSIONS: This study demonstrates the variation, extent, duration, and temporality of fatigue among patients receiving chemotherapy and the dynamic, changing aspects of the experience. IMPLICATIONS FOR NURSING PRACTICE: Fatigue must be considered within the context of patients' daily lives and environments, disease processes, and treatment modalities. Nurses must listen carefully to patients' own descriptions of being tired. Further research examining patients' perspectives of and experiences related to fatigue is necessary to increase the theoretical understanding of fatigue and to improve therapeutic nursing interventions.

Differences in fatigue by treatment methods in women with breast cancer.

PURPOSE/OBJECTIVES: To investigate the differences between various cancer therapies (radiation, hormonal, chemotherapy, and their combinations) and the specific dimensions of fatigue (affective meaning, behavioral/severity, cognitive/mood, and sensory). DESIGN: Descriptive, cross-sectional, mailed survey design. SAMPLE AND SETTING: Data were collected from women who were breast cancer survivors and members of a nonprofit educational organization in the North-east. Criteria for this study included no self-reported disease recurrence, and treatment was within 18 months prior to the mailed survey (N = 322). The typical participant was middle-aged (mean = 52.2; SD = 10.3), Caucasian (93%), postmenopausal (55%), and diagnosed with cancer 2.42 (SD = 2.6) years prior to the study. METHODS: Secondary data analysis from a study using the Piper Fatigue Scale. VARIABLES: Level of fatigue. FINDINGS: Significant differences were found by treatment in total fatigue scores (p < 0.03) and cognitive/mood scores (p < 0.05). Women who received combination therapy had the highest fatigue scores (mean = 4.8; SD = 2.0); those who received only radiation therapy had the lowest fatigue scores (mean = 2.7; SD = 2.0). CONCLUSIONS: Fatigue in breast cancer survivors varies by type of cancer therapy. Future studies are needed to investigate the relationships between fatigue and hormonal therapy, and they need to be designed to examine changes over time. IMPLICATIONS FOR NURSING PRACTICE: Study findings advance knowledge about fatigue in women with breast cancer and aid nurses in providing anticipatory guidance for women undergoing different treatment regimens.

Randomized clinical trial of chlorhexidine versus placebo for prevention of oral mucositis in patients receiving chemotherapy.

PURPOSE/OBJECTIVES: To test the effectiveness of a nurse-initiated systematic oral hygiene teaching program-PRO-SELF: Mouth Aware (PSMA)-in conjunction with two mouthwashes (0.12% chlorhexidine or sterile water) in preventing chemotherapy-induced oral mucositis. DESIGN: Randomized, double-blind, placebo-controlled, clinical trial. SETTINGS: 23 outpatient clinics and office practices in California. SAMPLE: 222 patients who were starting a cycle of mucositis-inducing chemotherapy. METHOD: Participants were followed over three chemotherapy cycles. All patients were provided the PSMA program. Random assignment to a mouthwash occurred prior to the development of oral mucositis. Researchers used the Oral Assessment Guide to assess the patients oral cavities monthly (with the patients cycles of chemotherapy) and when patients reported any oral changes between cycles. MAIN RESEARCH VARIABLES: Type of mouthwash, incidence, days to onset, and severity of chemotherapy-induced oral mucositis. FINDINGS: No significant differences existed between the two mouthwashes in regard to incidence, days to onset, and severity of mucositis. CONCLUSIONS: Because chlorhexidine (S20 per pint) was no more effective than water, a substantial cost savings can be realized by rinsing with water. Interestingly, the PSMA program appeared to reduce the incidence of mucositis from on a prior estimate of 44% to less than 26%. IMPLICATIONS FOR NURSING PRACTICE: A nursing prescription of a systematic oral hygiene program using water as a mouth rinse is cost efficient and may be effective in preventing oral mucositis.

The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer.

PURPOSE/OBJECTIVES: To confirm the multidimensionality of the Piper Fatigue Scale (PFS) and to reduce the total number of PFS items without compromising reliability and validity estimates. DESIGN: Methodologic, part of a larger, cross-sectional, mailed survey design study. SETTING: Urban and suburban area in the northeast United States. SAMPLE: As part of the larger study, 2,250 surveys were distributed to women survivors of breast cancer who were on a mailing list for the educational organization Living Beyond Breast Cancer, 715 surveys (32%) were returned. Of these, 382 women met this methodologic study's criteria for having completed each of the 40 items on the PFS. The average respondent was 50 years old, postmenopausal, and treated with combination cancer therapy. METHODS: Principal axes factor analysis with oblique rotation. MAIN RESEARCH VARIABLES: Fatigue factors/subscales. FINDINGS: Five factors/subscales were identified initially. Because the fifth factor contained only two items (ability to bathe/wash and ability to dress), these items and the associated factor/subscale were dropped from the final solution. An additional nine items, not loading on any factor (> 0.40), also were dropped. The remaining items and factors/subscales were reviewed to ensure that the criteria were met: a pattern of inter-item correlations between 0.30-0.70; a minimum number of five or more items/subscale; standardized alpha for the subscales and total scale of at least 0.89; and absence of gender-specific items. CONCLUSIONS: The revised version of the PFS consists of 22 items and four subscales: behavioral/severity (6 items), affective meaning (5 items), sensory (5 items) and cognitive/mood (6 items). Standardized alpha for the entire scale (n = 22 items) is 0.97, indicating that some redundancy still may exist among the items. Additional revisions await further testing. IMPLICATIONS FOR NURSING PRACTICE: As fatigue is acknowledged to be the most frequent symptom experienced by patients with cancer, accurate measurement and assessment is essential to advance not only the science of fatigue but, most importantly, to evaluate the efficacy of intervention strategies on patient and family outcomes.

Randomized clinical trial of the effectiveness of 3 commonly used mouthwashes to treat chemotherapy-induced mucositis.

OBJECTIVE: To test the effectiveness of 3 mouthwashes used to treat chemotherapy-induced mucositis. The mouthwashes were as follows: salt and soda, chlorhexidine, and "magic" mouthwash (lidocaine, Benadryl, and Maalox). STUDY DESIGN: A randomized, double-blind clinical trial was implemented in 23 outpatient and office settings. Participants were monitored from the time they developed mucositis until cessation of the signs and symptoms of mucositis, or until they finished their 12-day supply of mouthwash. All participants followed a prescribed oral hygiene program and were randomly assigned a mouthwash. Nurses used the Oral Assessment Guide for initial assessment and taught patients how to assess their own mouths, then phoned the patients every other day to gather status reports. RESULTS: In 142 of 200 patients, there was a cessation of the signs and symptoms of mucositis within 12 days. No significant differences in time for the cessation of the signs and symptoms were observed among the 3 groups. CONCLUSIONS: Given the comparable effectiveness of the mouthwashes, the least costly was salt and soda mouthwash.