The perception of life and death in patients with end-of-life stage cancer: A systematic review of qualitative research.

PURPOSE: This study aims to clarify the perceptions on life and death among patients with the end-of-life stage cancer through a systematic review. METHODS: The search strategy combined MeSH terminology with free text searches, and was applied to the PubMed, CINAHL, Embase, and ICHUSHI (Japan Medical Abstracts Society) databases covering from 2010 to 5/2022. To ensure the quality of the research included, the Critical Appraisal Skills Program Qualitative Studies Checklist was used. Data relating to the perceptions of life and death of patients with the end-of-life stage cancer was extracted and analyzed with reference to qualitative meta-synthesis methods. RESULTS: Ultimately, 50 studies were included. Five themes were derived based on the perceptions of life and death of patients with the end-of-life stage cancer: despair, making sense of death, how to live the rest of life, special feelings for loved ones, and fluctuation. By making sense of death in their own way, and reconciling it with their current situation, patients with the end-of-life stage cancer, even in despair over their impending death, look ahead into the future and their surroundings and consider how they would live the remaining time they have. During this time, the special feelings they have for their loved ones make an impact. CONCLUSIONS: An important new finding from this study lies in the fact that the patients' desire to live as ordinary people who were not patients were expressed as a face that they hid from their families. Further research is needed in low-income countries/regions.

Randomized clinical trial quantifying the effectiveness of a self-monitoring intervention in cancer patients with peripheral neuropathy: A quantitative study.

Objective: The aim of this study was to quantitatively evaluate the efficacy of a self-monitoring intervention for the management of persistent chemotherapy-induced peripheral neuropathy (CIPN). Methods: A randomized controlled clinical trial was conducted on 65 outpatients receiving taxane or platinum-based anticancer drugs. Participants were assigned to the control group (CG; n â€‹= â€‹32) or the self-monitoring group (SMG; n â€‹= â€‹33) and followed for 6 weeks. Non-interveners were blinded. Participants in the intervention group self-monitored and recorded. The researchers provided feedback on the recorded symptoms and coping strategies once every 3 weeks. The efficacy of the 6-week self-monitoring intervention was assessed, using various measures, at baseline (T0), 3 weeks (T1), and 6 weeks (T2). Scores of CIPN, Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity, Distress and Impact Thermometer, Self-Efficacy Scale for Advanced Cancer, and Functional Assessment of Cancer Therapy-General of both groups were compared. Safety behavior in daily life was also compared. The study was conducted from August 9, 2017 to March 30, 2020 in outpatient clinics at three hospitals. Analysis was conducted using the t-test, Mann-Whitney U test, χ2 test, and two-way repeated-measures analysis of variance (two-way RMANOVA). Results: No significant differences were noted between the two groups in the CIPN score, the Distress and Impact Thermometer score, and in safety behavior in daily life. The mean Self-Efficacy Scale for Advanced Cancer score at T1 differed between the two groups (CG mean â€‹± â€‹SD: 358.44 â€‹± â€‹109.90; SMG mean â€‹± â€‹SD: 421.21 â€‹± â€‹85.54), which was significantly higher in the SMG (P â€‹= â€‹0.012). Two-way RMANOVA revealed an interaction between the CG and SMG (F â€‹= â€‹5.689, P â€‹= â€‹0.004). Quality of life scores were higher in the SMG than in the CG at T0, T1, and T2. Two-way RMANOVA analysis showed an effect of the intervention (F â€‹= â€‹7.914, P â€‹= â€‹0.007). Conclusions: The self-monitoring intervention maintained the participants' quality of life. This finding suggests its effectiveness in patients with peripheral neuropathy.

Efficacy of an Algorithm-Based Nursing Intervention to Promote a Balance Between Cancer Patients' Social Roles and Outpatient Treatment: A Quasi-Experimental Study.

BACKGROUND: Cancer patients undergoing treatment are often unable to balance treatment and work because of the time required for care at the hospital and a desire to avoid problems at work. OBJECTIVE: The aim of this study was to elucidate the efficacy of an algorithm-based nursing intervention (ANI) to promote balance between social roles and outpatient treatment in cancer patients. METHODS: Participants were outpatients receiving cancer therapy and randomly assigned to a control or an intervention group, the latter to receive ANI for 2 months. The outcomes were assessed using the Distress and Impact Thermometer and changes in employment status. Data from 54 evaluable participants in each group were analyzed. RESULTS: Distress and Impact Thermometer scores in the intervention group were significantly lower than those in the control group ( P < .001). In addition, 2 months later, 20 participants had resigned from their employment or were on leave in the control group (37.0%); this was twice the number in the intervention group, a significant difference ( χ2 = 4.573, P < .05). Logistic regression analysis showed that the odds ratio in the control group was 3.6 times that of the intervention group of having resigned. CONCLUSION: The ANI appears to have reduced distress and impact scores associated with the course of treatment and to have reduced the likelihood of resignations at 2 months after implementation. IMPLICATIONS FOR PRACTICE: The intervention appears to be effective and may be a new tool for use by outpatient oncology nurses.

Non-pharmacological interventions for cancer-related fatigue in terminal cancer patients: a systematic review and meta-analysis.

BACKGROUND: Cancer-related fatigue (CRF) is a highly distressing symptom in patients with cancer. Although various interventions have been reported to reduce fatigue, few are available for use in terminally ill cancer patients, and it is unknown which interventions are effective. They are also often difficult to implement in terminally ill patients with cancer. We, therefore, assessed the recommended interventions to reduce CRF in terminally ill cancer patients. METHODS: Four electronic databases were searched to identify studies published between January 2015 and March 2021. The inclusion criteria were terminally ill cancer patients; non-pharmacological interventions; studies in which usual care or control groups were compared, or comparisons were made prior to the post-intervention period; studies in which the primary outcome was fatigue scale or symptom scale (including those measuring fatigue on a subscale); and experimental study designs including randomised controlled trials (RCTs) and quasi-experimental studies. A summary of the data extracted from each study was created. We also conducted a meta-analysis of the RCTs. RESULTS: A total of 1,954 publications were identified from the initial database, eight of which were included in this study. Three RCTs and five non-RCTs were included in the final evaluation. Most of the studies had a small number of participants. We conducted a meta-analysis of two of the three RCTs included in this study. There was insufficient evidence to determine the effects of the interventions compared to the controls [standard mean difference, -0.05; 95% confidence interval (CI): -0.48 to 0.37; two studies; 290 participants; I2=65%]. CONCLUSIONS: Few reports exist on non-pharmacological interventions for patients with terminal cancer and there was insufficient evidence to determine the effect of the interventions on fatigue. This highlights the lack of RCTs on non-pharmacological procedures and therapies for reducing fatigue.

The Lived Experience of Persons with Terminal Cancer: A Qualitative Study.

This study aims to elucidate the life and death experiences of patients with terminal cancer. The researchers interviewed 18 terminal cancer patients, for a total 3,118 min. A psychophenomenological approach was used for analysis. Three themes were derived: a new appreciation for the gleam of an ordinary life after experiencing extreme suffering, a desire to at least pass away peacefully when sensing impending death, and a desire to remain useful to loved ones and other suffering patients like them. The novelty of this research derives from its finding that life and death are not in conflict and can lead to hope.

How to come to terms with facing death: a qualitative study examining the experiences of patients with terminal Cancer.

BACKGROUND: Cancer patients who have reached the terminal stage despite attempts at treatment are likely to experience various problems, particularly as they encounter increasing difficulty in doing what they were able to do easily, and their physical symptoms increase as the disease advances. The purpose of this study is to explore how terminal cancer patients who have not clearly expressed a depressed mood or intense grief manage their feelings associated with anxiety and depression. METHODS: Eleven terminally ill patients with cancer who were receiving symptom-relieving treatment at home or in palliative care units were interviewed. Interviews were generally conducted weekly, two to five times for each participant. In total, 33 interviews were conducted, and the overall interview time was 2027 min. Data were analyzed via qualitative methods. RESULTS: The following five themes were extracted regarding the experience of managing feelings associated with anxiety and depression when facing death: "I have to accept that I have developed cancer," "I have to accept the undeniable approach of my own death," "I have to accept my need for assistance," "I have to accept this unsatisfactory circumstance" and "I have to accept this as my destiny and an outcome of my life." CONCLUSION: The present study revealed key themes related to how patients come to terms with their impending death. Nurses are required to comprehend the patients' complicated mental patterns that are expressed in their daily languages. Furthermore, the findings clarify the necessity for nurses to help patients understand the acceptance of a terminal disease state during a patient's final days.

Emotional Responses to Persistent Chemotherapy-induced Peripheral Neuropathy Experienced by Patients with Colorectal Cancer in Japan.

OBJECTIVE: For patients who wish to continue treatment for persistent chemotherapy-induced peripheral neuropathy (PCIPN) while maintaining the quality of life (QOL), the only effective way appears to be the stop-and-go strategy. The objective of the present study was to analyze emotional responses of Japanese patients with colorectal cancer (CRC) experiencing PCIPN for the first time and to consider effective ways of providing supportive nursing care. METHODS: In all, 25 patients with metastatic CRC who had completed more than six courses receiving first-line therapy with modified FOLFOX6 were included. Data were collected through semi-structured interviews. RESULTS: Emotional responses to PCIPN experienced by patients with CRC fell into the following categories: (1) suffering from an inability to cope with the previously unknown sensation of numbness, (2) inability to perform daily living activities activities of daily living [ADL]/instrumental activities of daily living [IADL] independently and feeling fear for physical safety, (3) feeling a sense of relief at being able to live the same life as before, and (4) facing the threat of cancer and tolerating the numbness caused by the life-supporting treatment. Fear, helplessness, dismay and other uncomfortable feelings represented 72.5% of all emotional responses, probably reflecting the lack of effective intervention for PCIPN. CONCLUSIONS: These results suggest that both subjective and objective assessments of PCIPN and proper use of a stop-and-go strategy are essential for treatment continuation and maintenance of patient's QOL; therefore, an integrated approach is desirable.