Management of Opioid-Induced and Non-Opioid-Related Constipation in Patients With Cancer: Systematic Review and Meta-Analysis.

PROBLEM IDENTIFICATION: A systematic review and meta-analysis was conducted to inform the development of national clinical practice guidelines on the management of cancer constipation. LITERATURE SEARCH: PubMed®, Wiley Cochrane Library, and CINAHL® were searched for studies published from May 2009 to May 2019. DATA EVALUATION: Two investigators independently reviewed and extracted data from eligible studies. The Cochrane Collaboration risk-of-bias tool was used, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. SYNTHESIS: For patients with cancer and opioid-induced constipation, moderate benefit was found for osmotic or stimulant laxatives; small benefit was found for methylnaltrexone, naldemedine, and electroacupuncture. For patients with cancer and non-opioid-related constipation, moderate benefit was found for naloxegol, prucalopride, lubiprostone, and linaclotide; trivial benefit was found for acupuncture. IMPLICATIONS FOR PRACTICE: Effective strategies for managing opioid-induced and non-opioid-related constipation in patients with cancer include lifestyle, pharmacologic, and complementary approaches. SUPPLEMENTAL MATERIAL CAN BE FOUND AT HTTPS: //bit.ly/3c4yewT.

Radiodermatitis in Patients With Cancer: Systematic Review and Meta-Analysis.

PROBLEM IDENTIFICATION: A systematic review and meta-analysis was conducted to inform the development of guidelines on the management of radiodermatitis among patients with cancer. LITERATURE SEARCH: The authors updated a systematic review to include available literature published through September 30, 2019. DATA EVALUATION: Two investigators assessed risk of bias using the Cochrane Collaboration risk-of-bias tool and certainty of the evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. SYNTHESIS: The use of deodorant/antiperspirant had no effect on development of radiodermatitis. Aloe vera and emu oil were equivalent or less effective than standard care. Oral curcumin had a minimal beneficial effect. Nonsteroidal topical interventions had a minimal beneficial effect on the development of moist desquamation and relief of itching while causing a small increase for grade 2 radiodermatitis. Topical calendula increased risk for the development of radiodermatitis. Topical steroids and dressings each showed benefits to minimize the development of radiodermatitis and moist desquamation while lowering rates of patient-reported symptoms, such as pain and pruritus. IMPLICATIONS FOR RESEARCH: Symptom management strategies for radiodermatitis among patients with cancer that are likely to be effective include topical nonsteroidals, topical steroids, and dressings. SUPPLEMENTAL MATERIAL CAN BE FOUND AT HTTPS: //bit.ly/2FWj3Kp.

ONS Guidelines™ for Cancer Treatment-Related Radiodermatitis.

PURPOSE: Radiodermatitis is a side effect of radiation therapy. Evidence-based interventions to minimize severity or delay progression are important for clinical care. This guideline intends to support individuals with cancer, clinicians, and others in decisions regarding radiodermatitis treatment. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation was convened to develop a national clinical practice guideline for the management of radiodermatitis. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines were followed. The Cochrane Collaboration risk-of-bias tool was used, and certainty of the evidence was assessed using the GRADE approach. A quantitative and narrative synthesis of the evidence was completed. FINDINGS: The panel agreed on eight recommendations and made a conditional recommendation for deodorant/antiperspirant. Aloe vera and oral curcumin had knowledge gaps and were recommended only in the context of a clinical trial. The panel suggested against emu oil, calendula, and nonsteroidal interventions. IMPLICATIONS FOR NURSING: This guideline summarizes evidence-based interventions for the management of radiodermatitis to guide clinical care. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //bit.ly/2GEwJtT.

ONS Guidelines™ for Opioid-Induced and Non-Opioid-Related Cancer Constipation.

PURPOSE: This evidence-based guideline intends to support clinicians, patients, and others in decisions regarding the treatment of constipation in patients with cancer. METHODOLOGIC APPROACH: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of cancer-related constipation. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the evidence and make recommendations. FINDINGS: The panel agreed on 13 recommendations for the management of opioid-induced and non-opioid-related constipation in patients with cancer. IMPLICATIONS FOR NURSING: The panel conditionally recommended a bowel regimen in addition to lifestyle education as first-line treatment for constipation. For patients starting opioids, the panel suggests a bowel regimen as prophylaxis. Pharmaceutical interventions are available and recommended if a bowel regimen has failed. Acupuncture and electroacupuncture for non-opioid-related constipation are recommended in the context of a clinical trial. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //bit.ly/30y29sI.

ONS Guidelines™ for Cancer Treatment-Related Lymphedema.

PURPOSE: Lymphedema is a chronic condition that may result from cancer-related surgery. The incidence of lymphedema varies greatly; however, patients remain at risk for life and may experience decreased quality of life and functional capacity. Providing recommendations for an evidence-based guideline for care of cancer treatment-related lymphedema will help to improve outcomes for patients with this chronic condition. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation convened to develop a national clinical practice guideline on prospective surveillance, risk reduction, and conservative treatment of lymphedema. Systematic reviews of the literature were conducted and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology approach was used to assess the evidence. FINDINGS: The panel made multiple recommendations for patients who are at risk for or experiencing lymphedema. IMPLICATIONS FOR NURSING: Early diagnosis and treatment of lymphedema may mitigate symptoms. This evidence-based guideline supports patients, clinicians, and other healthcare professionals in clinical decision making. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-lymphedema.

ONS Guidelines™ for Cancer Treatment-Related Skin Toxicity.

BACKGROUND: Management of cancer treatment-related skin toxicities can minimize treatment disruptions and improve patient well-being. OBJECTIVES: This guideline aims to support patients and clinicians in decisions regarding management of cancer treatment-related skin toxicities. METHODS: A panel developed a guideline for management of cancer treatment-related skin toxicities using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) for certainty of evidence and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines. The Cochrane risk-of-bias tool assessed risk of bias. A quantitative or narrative synthesis of the evidence was completed. RESULTS: The panel issued seven conditional recommendations for epidermal growth factor receptor inhibitor rash, hand-foot skin reaction, hand-foot syndrome, and chemotherapy-induced alopecia. The panel suggested strategies for prevention and treatment for all toxicities except hand-foot syndrome, which only has a prevention recommendation. IMPLICATIONS FOR NURSING: Cancer treatment-related skin toxicities can significantly affect quality of life. Incorporation of these interventions into clinical care can improve patient outcomes. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/supplementary-material-ons-guidelines-cancer-treatment-related-skin-toxicity.

ONS Guidelines™ for Cancer Treatment-Related Hot Flashes in Women With Breast Cancer and Men With Prostate Cancer.

PURPOSE: Hot flashes are a common and troublesome side effect of surgery or endocrine therapy. They may lead to physical and psychological distress and negatively affect quality of life. This clinical practice guideline presents evidence-based recommendations for pharmacologic, behavioral, and natural health product interventions for treatment-related hot flashes in patients with breast or prostate cancer. METHODOLOGIC APPROACH: An interprofessional panel of healthcare professionals with patient representation prioritized clinical questions and patient outcomes for the management of hot flashes. Systematic reviews of the literature were conducted. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the evidence and make recommendations. FINDINGS: The panel agreed on 14 pharmacologic, behavioral, and natural health recommendations. IMPLICATIONS FOR NURSING: Conditional recommendations include the use of antidepressants rather than no treatment, physical activity rather than no treatment, and the avoidance of gabapentin and dietary supplements in the treatment of hot flashes. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //onf.ons.org/ons-guidelines-hot-flashes-supplementary-material.

Family Caregiver Strain and Burden: A Systematic Review of Evidence-Based Interventions When Caring for Patients With Cancer.

BACKGROUND: Caregivers of patients with cancer experience high levels of caregiver-related strain and burden (CGSB). Cancer caregiving is complex and can change dramatically depending on the cancer trajectory. Often, this experience leads to poor health outcomes for the caregiver. OBJECTIVES: This review appraises the evidence on CGSB published from 2007 to October 2017. METHODS: 128 interventional studies found in PubMed® and CINAHL® were appraised and categorized based on the Oncology Nursing Society's Putting Evidence Into Practice schema. FINDINGS: Psychoeducation, supportive care/support interventions, and cognitive behavioral interventions are recommended to decrease CGSB. Caregiver skill training, couples therapy, decision support, mindfulness-based stress reduction, multicomponent interventions, and palliative care are likely to be effective. The evidence is not established for 13 interventions. Despite the proliferation of studies focusing on CGSB, studies with stronger designs and larger samples are needed.

Beyond the Impact Factor.

The impact factor can undervalue the importance of smaller, specialized journals, and no single metric can serve as a perfect assessment of a journal's value or worth. This article provides a brief overview of various publication metrics, including the Scopus CiteScore, Eigenfactor®, and Altmetric attention score, using examples from the Oncology Nursing Forum. It also addresses the use of the Oncology Nursing Forum as a resource for research and answering clinical questions.

Searching for Oncology-Related Information.

OBJECTIVES: To provide an overview of the literature review process and current information resources relevant to oncology nursing topics. DATA SOURCES: Books, databases, journals, LibGuides, point-of-care tools, practice guidelines, statistical Websites, personal experience. CONCLUSION: Searching for information requires knowledge and familiarity with pivotal resources and best practices for accessing and using these resources. Colleagues and medical librarians can provide searching assistance and guidance for novice nurse authors. IMPLICATIONS FOR NURSING PRACTICE: Developing fluency and awareness of information resources in the field of oncology eases the way for nurses to participate in publishing.

Online Registries for Researchers: Using ORCID and SciENcv.

The Open Researcher and Contributor ID (ORCID) registry helps resolve name ambiguity by assigning persistent unique identifiers that automatically link to a researcher's publications, grants, and other activities. This article provides an overview of ORCID and its benefits, citing several examples of its use in cancer and nursing journals. The article also briefly describes My NCBI and the Science Experts Network Curriculum Vitae (SciENcv) and its connection to ORCID.

A Clinical Librarian-Nursing Partnership to Bridge Clinical Practice and Research in an Oncology Setting.

Nurses in clinical settings in which evidence-based, individualized care is expected are often the best resource to identify important clinical questions and gaps in practice. These nurses are frequently challenged by a lack of resources to fully develop their questions and identify the most appropriate methods to answer them. A strategic and ongoing partnership between medical library services and nursing can support nurses as they embark on the process of answering these questions and, ultimately, improving patient care and clinical outcomes

Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

This article describes the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines that are intended to help authors improve the reporting of systematic reviews and meta-analyses, illustrating with examples from the Oncology Nursing Society journals and Putting Evidence Into Practice resources.

What does it mean to be an oncology nurse? Reexamining the life cycle concepts.

PURPOSE/OBJECTIVES: To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994. DATA SOURCES: Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995-2009 was obtained from PubMed, CINAHL(R), PsycINFO, ISI Science, and EBSCO Health Source(R): Nursing/Academic Edition databases. DATA SYNTHESIS: Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring. CONCLUSIONS: The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries. IMPLICATIONS FOR NURSING: This review indicates that although the healthcare system has changed significantly in 15 years, nurses' experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

Is ondansetron more effective than granisetron for chemotherapy-induced nausea and vomiting? A review of comparative trials.

Nausea and vomiting are two of the most distressing side effects of chemotherapy. Guidelines recommend the use of 5-HT3 receptor antagonists as a pharmacologic intervention for acute and delayed nausea and vomiting for moderately and highly emetogenic chemotherapy. Although newer antiemetics and 5-HT3 receptor antagonists are available, ondansetron and granisetron still are used widely. A review of the literature was conducted to identify trials that compared the antiemetic efficacy of ondansetron and granisetron. Studies were identified by searching the PubMed, EMBASE, Ovid MEDLINE, CINAHL, and Evidence-Based Medicine Reviews databases. The six studies reviewed in this article were either a meta-analysis; a randomized, controlled trial; or another type of research study published from 2000 to date. The results reported in the studies reveal that ondansetron and granisetron have equal antiemetic efficacy in reducing or eliminating chemotherapy-induced nausea and vomiting (CINV), with the evidence classified as good based on U.S. Preventive Services Task Force criteria for judging the strength of the overall evidence. Although side effects of ondansetron and granisetron have been reported, they normally are mild and of brief duration, not severe or lasting enough to warrant discontinuation.

Computerized versus paper-and-pencil testing methods for a nursing certification examination: a review of the literature.

In conjunction with the decision of the Oncology Nursing Certification Corporation (ONCC) to computerize its examinations, the literature was reviewed to identify comparative studies of computerized versus paper-and-pencil testing methods and to determine the relative advantages of each. Data sources included journal articles and newsletter features identified via the ERIC, CINAHL, and PubMed databases or through frequent citation in the literature. The majority of studies found test scores to be independent of delivery mode. Several advantages of computerized testing were identified, including scheduling convenience, instant scoring capability, and enhanced security. One disadvantage may be an increase in testing anxiety for those without previous experience, although results in this area were mixed. Finally, studies and surveys often indicate an acceptance and preference for linear computer-based testing (CBT) by examinees.

Searching for information for presentations and publications.

Numerous information sources are available to the clinical nurse specialist preparing a presentation or writing a manuscript for publication. However, searching through this information to identify reputable sources and reliable data can be time consuming. Using a search plan that incorporates a timeline increases efficiency and helps visualize progress. A targeted search of biomedical databases, such as MEDLINE and PubMed, retrieves pertinent journal articles and avoids the "hit-and-miss" approach often used by novice speakers and authors. Information should be reviewed and organized soon after it is obtained so that more time can be spent writing and less time spent locating a specific reference or piece of information. The information can then be arranged in the order of the presentation or manuscript to facilitate the preparation process.