Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy: A Randomized Control Trial.

BACKGROUND: Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer. OBJECTIVE: This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction. METHODS: This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0. RESULTS: The IED significantly reduced the occurrence of aspiration pneumonia (P = .012), delayed the onset of aspiration pneumonia (P = .005), and extended the survival time (P = .007) in the experimental group. CONCLUSION: For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia. IMPLICATION FOR PRACTICE: The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

Use of Transcutaneous Electrical Nerve Stimulation to Alleviate Thirst After Surgery: A Randomized Controlled Trial.

PURPOSE: This prospective study investigated the preventive effect of transcutaneous electrical nerve stimulation (TENS) for postoperative thirst. DESIGN: This experimental study was conducted with the CONSORT checklist. METHODS: A total of 105 surgical patients who received general anesthesia were recruited from a medical center. Each patient was randomly assigned to the experimental group (n = 53; 20 min of TENS) or the control group (n = 52; routine care). In each group, oral moisture wetness was measured at 1 min, 20 min, and 50 min post-surgery. Descriptive and inferential statistics (Chi-square test, t test, one-way ANOVA, and generalized estimating equation (GEE) regression analysis) were performed to assess the proposed relationships. FINDINGS: The two groups showed similar characteristics at baseline. The oral moisture wetness was significantly higher in the experimental group than the control group at each post-surgery assessment time (all P < .001). The GEE results showed that patients in the experimental group reported more oral moisture wetness than patients in the control group. CONCLUSIONS: This study demonstrated that TENS can reduce thirst reported by patients after general anesthesia. Thus, this method may have clinical applications for managing postoperative thirst.

Exercise effects on fatigue in breast cancer survivors after treatments: A systematic review and meta-analysis.

AIM: The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment. BACKGROUND: Most studies found that exercise has valuable outcomes for cancer survivors. This meta-analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments. METHODS: We conducted a meta-analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated. RESULTS: Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low-moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors. CONCLUSION: Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue.

[Exploration of Distress Symptoms and Medical Interventions in Patients With Terminal Cancer in Hospice Shared Care].

BACKGROUND: Hospice shared care is a model of care widely used in patients with terminal cancer. Appropriate interventions to improve related symptoms should be provided during disease progression through the end of life. PURPOSE: The purpose of this study was to explore the related symptoms and to compare symptom severity before and after the implementation of hospice shared care and medical care interventions. METHODS: Fifty patients with terminal cancer were enrolled in this longitudinal, quasi-experimental research. Inclusion criteria included having an expected life span of < 6 months and agreeing to enter hospice shared care. RESULTS: The three most-frequently noted physical symptoms were, in rank order: "pain", "weakness", and "dyspnea". In terms of severity, "pain" was the most severe, followed by "weakness" and "disturbance of sleep". The three most-frequently noted psychological symptoms were, in rank order: "depression", "worry about the disease", and "afraid of dragging others down". In terms of severity, "depression" was the most severe, followed by "anxiety" and "worry about the disease". The frequency and severity of the top-3 social and spiritual distress symptoms were, in rank order: "unfinished wish", "economic difficulties", and "painlessness". During the study period, the severity of physical symptoms improved gradually, while the severity of psychological symptoms improved significantly. The top-3 items in the original medical team`s hospice-care interventions were, in rank order: "tube care", "laboratory test", and "wound care" in the non-pharmacological category; "symptom control medication", "antibiotic injection", and "intravenous fluid infusion" in the pharmacological category; and "cognitive clarification of the prognosis condition", "do not conduct resuscitation discussions and signing", and "emotional stress consoling" in the problem-coordination and interview categories. The interventions implemented by the hospice specialist team included "emotional stress interview", "team communication", and "cognitive clarification of prognosis condition" in the problem coordination and interview categories, and "massage", "consultation", and "nursing advice" in the non-pharmacological category. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The symptoms identified in this study provide clinical staff with a reference for the rapid assessment of patients with terminal-stage cancer. Manpower from various professional fields are committed to providing diversified services in the care teams, which positively affect the control of related symptoms. The experience presented in this article may be used as a reference to promote the hospice shared care model.

Optimal timing for hospice-shared care initiation in terminal cancer patients.

PURPOSE: The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of "early" initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer. METHODS: This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups ("hospice-shared care" (HSC) group and "usual care" (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups. RESULTS: After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. CONCLUSIONS: Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.

Definitive intensity-modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity-score-matched, nationwide, population-based cohort study.

BACKGROUND: No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC). METHODS: We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality. RESULTS: In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with <40 years were 2.984 (1.43, 4.225), 3.353 (2.578, 4.112), and 4.277 (4.104, 5.679), respectively. CONCLUSIONS: For patients with E-OCSCC, surgery may be considered the first option rather than definitive IMRT.

[A Preliminary Study to Investigate Frailty in Advanced Lung Cancer Patients Before Receiving Immunotherapy].

BACKGROUND: Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty. PURPOSE: This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy. METHODS: A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured. RESULTS: The ratio of frailty was 17.3%, with comorbidities (p = .023), body mass index (p = .004), Eastern Cooperative Oncology Group Status (p < .001), activities of daily living status (p < .001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.

Definitive radiotherapy or surgery for early oral squamous cell carcinoma in old and very old patients: A propensity-score-matched, nationwide, population-based cohort study.

PURPOSE: Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population. METHODS: We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments. RESULTS: The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P < 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively. CONCLUSIONS: Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.

Maintenance of pegylated liposomal doxorubicin/carboplatin in patients with advanced ovarian cancer: randomized study of an Asian Gynecologic Oncology Group.

OBJECTIVES: An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. METHODS: Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m², n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. RESULTS: Enrollment was slow, accrual was closed when 7+ years had passed. With a median follow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19-0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p<0.001). Quality of life was generally not significantly different. Distribution of BRCA1/2m or BRCA/HRDm was not significantly biased between the two arms. Wild-type BRCA/non-HRD subgroup seemed to fare better with maintenance therapy (HR=0.35; 95% CI=0.11-1.18; p=0.091). CONCLUSIONS: Despite limitations in small sample size, it suggests that maintenance carboplatin-PLD chemotherapy could improve PFS in advanced ovarian cancer.

Factors associated with professional healthcare advice seeking in breast cancer-related lymphedema.

OBJECTIVES: This study aimed to identify the cognitive factors associated with the professional healthcare advice (PHCA) seeking behavior in breast cancer-related lymphedema (BCRL). METHODS: From January 2018 to December 2018, patients with BCRL were prospectively enrolled for a cross-sectional survey of lymphedema-related perceived risks, lymphedema quality of life (LYMQoL), knowledge scale of lymphedema, and PHCA behavior at first clinical visit, 3 and 6 months postbaseline. RESULTS: A total of 180 patients including 100 (55.6%) patients underwent a vascularized lymph node transfer (VLNT) and 80 (44.4%) patients received compressive decongestive therapy (CDT) were enrolled. At 6 months of follow-up, mean episodes of cellulitis (from 2.2 to 0.2 times/year), mean circumferential difference (7.8 ± 3.9%), wearing compression garments (from 29% to 0 %) in the VLNT group were statistically reduced than those in the CDT group (p = .01, <.01, and <.01, respectively). The overall LYMQoL had statistical improvement in VLNT group (p < .01). The short symptom duration, greater education level, less episodes of cellulitis, and higher knowledge of lymphedema were associated with increased adherence to PHCA (p = .03, .03, .02, and .01, respectively). CONCLUSION: BCRL patients who sought PHCA had great control of lymphedema and improve their quality of life.

Individual and mutual predictors of marital satisfaction among prostate cancer patients and their spouses.

AIMS AND OBJECTIVES: To determine the individual and mutual predictors of the marital satisfaction of couples in which the husband experienced prostate cancer. BACKGROUND: Marital satisfaction of patients with prostate cancer has been insufficiently studied in Asian countries as compared with Western countries. DESIGN: This study used a prospective and repeated-measures design. METHODS: Seventy Taiwanese couples in which the husband had prostate cancer completed measures at 6 and 12 months post-treatment. Assessments of physical symptoms, marital satisfaction, coping behaviour and psychological distress were made. Multiple linear regression was used to analyse the data. RESULTS: The marital satisfaction of patients with prostate cancer and that of their spouses were significantly correlated. At 6 months, spouses' marital satisfaction, patients' appraisal of prostate cancer as a threat and patients' serum prostate-specific antigen levels were found to be the predictors of patients' marital satisfaction. Furthermore, patients' marital satisfaction and their spouses' psychological distress were predictors of spouses' marital satisfaction. At 12 months, spouses' marital satisfaction and patients' appraisal of prostate cancer as harm were predictors of patients' marital satisfaction. Finally, spouses' marital satisfaction (at 6 months) and appraisal of prostate cancer as a threat were predictors of spouses' marital satisfaction. CONCLUSIONS: At 6 months post-treatment, patients' and spouses' marital satisfaction will influence each other. However, at 12 months, patients' marital satisfaction exerts an insignificant effect on spouses' marital satisfaction. Moreover, patients' serum prostate-specific antigen level or the negative appraisal of prostate cancer affects their marital satisfaction. Spouses' marital satisfaction is affected by psychological distress and their negative appraisal of prostate cancer. RELEVANCE TO CLINICAL PRACTICE: The results can be used to develop interventions for prostate cancer couples. Such an intervention can be used to modify couples' appraisal of prostate cancer by changing incorrect thinking or to ease the psychological distress to improve marital satisfaction.

Psychosocial adjustments in patients with prostate cancer from pre-diagnosis to 6 months post-treatment.

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre-diagnosis, 1 month and 6 months post-treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post-treatment. However, the adjustment to health-care orientation was worst at the time of pre-diagnosis and improved during post-treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health-care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre-diagnosis.

Monitoring patient-centered outcomes through the progression of breast reconstruction: a multicentered prospective longitudinal evaluation.

Studies have shown that having breast reconstruction has a positive influence on patient satisfaction and health-related quality of life (HRQoL) at the conclusion of treatment. However, no study has critically evaluated changes to these patient-reported outcomes during the process of undergoing breast reconstruction. This study was to prospectively evaluate changes to patient-centered metrics through the progression of breast reconstruction. An IRB-approved prospective, multi-institutional study was performed for all patients undergoing breast reconstruction between 2009 and 2011. The Breast-Q reconstruction questionnaire was used for evaluation of HRQoL and was administered at five intervals in the perioperative period. Longitudinal evaluation was performed to assess changes to HRQoL metrics during this perioperative interval. One hundred and ten patients were enrolled, and 100 patients (91.9 %) completed appropriate follow-up. Preoperative HRQoL scores were higher in patients electing to forgo reconstruction (P < 0.004), while postoperative HRQoL scores consistently deteriorated at multiple time points following mastectomy as compared to reconstructed patients. On subgroup analysis, results indicated lower initial HRQoL scores in delayed reconstruction (P < 0.05) as compared to immediate reconstruction. These scores did, however, merge at approximately 9 months postoperatively. Changes to HRQoL outcomes occur through progression of breast reconstruction. Within the first year of surgery, early decreases are mirrored by significant increases at later time points above baseline levels when evaluating most forms of reconstruction. Choosing against reconstruction will likely result in continued deterioration of HRQoL for patients undergoing cancer surgery, but steady improvements can be expected if delayed reconstruction is chosen.

Changes in decisional conflict and decisional regret in patients with localised prostate cancer.

AIMS AND OBJECTIVES: To identify the changes and associated factors in decisional conflict and regret in patients with localised prostate cancer up to six months postprimary treatment. BACKGROUND: Various treatments of differing qualities can be used for patients with localised prostate cancer; these treatments may cause conflicts in treatment decision-making and post-treatment regret. DESIGN: A quantitative longitudinal study. METHODS: A total of 48 patients were recruited from a 3700-bed medical centre in northern Taiwan and assessed at pretreatment and one and six months post-treatment. Demographic characteristics, clinical information and results from the psychosocial adjustment to illness scale, decisional conflict scale and decision regret scale were collected. Data were analysed based on the generalised estimating equations models. RESULTS: The overall decisional conflict substantially improved over time. However, the feeling of being less informed was high and did not improve considerably during the study period. Education level, decision preferences and psychosocial adjustment were associated with decisional conflict and influenced decision-making. The feeling of ineffective decision-making and decisional regret was low, post-treatment. Psychosocial adjustment was associated with effective decision-making and decisional regret. CONCLUSION: In patients with localised prostate cancer, decisional conflict reduced considerably up to six months post-treatment. Moreover, the patients were satisfied with their treatment decision-making and believed that they had made the correct choice up to six months post-treatment. However, patients may have experienced feelings of being less informed pre- and post-treatment, particularly those with lower education levels, a preference for passive roles, or inferior psychosocial adjustment. Consequently, health professionals must provide adequate medical information and psychosocial intervention to help patients in the decision-making process. RELEVANCE TO CLINICAL PRACTICE: Nurses and healthcare providers must provide localised prostate cancer patients with adequate information and psychosocial intervention to reduce decisional conflict.

The effects of psychosocial strategies on anxiety and depression of patients diagnosed with prostate cancer: a systematic review.

BACKGROUND: Psychosocial strategies are commonly used to alleviate anxiety and depression in patients with prostate cancer. However, previous studies have shown inconsistent results. OBJECTIVES: This study examined the effects of psychosocial strategies on anxiety and depression in prostate cancer patients. DATA SOURCES AND REVIEW METHODS: A systematic literature review was conducted using 4 English databases (Pubmed, Cochrane Central Register of Controlled Trials, Cinahl, and PsycInfo) and 2 Chinese databases (Wanfang data and Chinese Electronic Periodical Service) with predetermined keyword searches. We first evaluated 8144 titles and/or abstracts. Fourteen studies that met the inclusion criteria were selected. The criteria for study inclusion were as follows: (1) randomized controlled trial design; (2) control group received usual or standard care; (3) focus on testing psychosocial strategies to improve anxiety and depression symptoms; and (4) studies conducted with prostate cancer patients at any stage of the disease. RESULTS: The quality of the studies was assessed using the Jadad scoring system. Only 35.7% of studies were regarded as high quality. The majority of studies (85.7%) delivered informational and educational or cognitive-behavioral interventions. The results show that psychosocial strategies have a substantial effect on reducing anxiety 3 months after intervention (standard mean difference -1.13, p<0.0001) and have a short-term effect on depression symptoms (immediately after intervention: standard mean difference -0.43, p<0.001; 3 months after intervention: standard mean difference -0.78, p=0.04). CONCLUSION: The results indicate that psychosocial strategies were more effective in reducing anxiety and depression compared with routine care, although the effect was not sustainable. However, high-quality methodologies, longer follow-up designs, and innovative psychosocial strategies are suggested for further study.

Prospective changes of the quality of life for patients newly diagnosed with oral cancer during the acute stage.

PURPOSE OF THE RESEARCH: Oral cancer is a common malignant disease in Taiwan. The purpose of this prospective follow-up study was to identify the changes in quality of life for newly diagnosed oral cancer patients during the acute stage. METHODS AND SAMPLE: Subjects were recruited from the outpatient department (OPD) in a medical center located in the northern part of Taiwan. 22 subjects completed both the EORTC QLQ-C30 and the EORTC QLQ-H&N35 at diagnosis, postoperative discharge, and the first postoperative follow-up. In addition, 91% of the subjects received surgery only as their main treatment. KEY RESULTS: During the three assessments, as measured by the EORTC QLQ-C30, subjects reported that their physical function was much better at diagnosis than at both postoperative discharge and first postoperative follow-up. Their role functioning was much better at diagnosis than at postoperative discharge. Nevertheless, subjects reported better emotional functioning at the first postoperative follow-up than at the other two points of assessment. Only less financial difficulty was reported in the first postoperative follow-up than at diagnosis and postoperative discharge. For QLQ-H&N35, subjects reported that several symptoms (i.e., swallowing) were more severe at postoperative discharge than at diagnosis. Usage of nutritional supplements at first postoperative follow-up was higher than that at diagnosis. CONCLUSION: Newly diagnosed oral cancer patients reported significant changes in certain domains of both the EORTC QLQ-C30 and QLQ-H&N35. Health professionals need to identify the pattern of changes and to provide supportive care to these new oral cancer patients throughout the treatment process, especially during the planning of discharge.

The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review.

The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms.

Comparison of effectiveness between moist and dry cryotherapy in reducing discomfort after orthognathic surgery.

AIMS: The purpose of this study was to compare the effectiveness between ice towel (moist cryotherapy) and ice-pack (dry cryotherapy) in postoperative care. BACKGROUND: Orthognathic surgery is often performed to modify the facial appearance of individuals. Cryotherapy was used to reduce the postoperative discomfort, such as local heat, pain and swelling. However, studies to compare the difference in effectiveness between moist and dry cryotherapy are lacking. DESIGN: A quasi-experimental design with follow-ups at regular intervals was conducted. The study involved data collection at the preoperative, postoperative 60, 90, 120, 180 minutes, 24 hours and 48 hours. METHODS: Subjects were recruited and assigned to group I (n = 27) and group II (n = 21) by locations. Group I received ice towels whereas group II used ice-packs as a strategy to reduce postoperative discomfort. Subjective indicators of local heat, pain and swelling were measured on postoperative days 1 and 2. When subjects went to postoperative recovery room, local temperatures on both sides of four facial areas and forehead were measured and repeated at scheduled intervals. RESULTS: Both subjective and objective indicators changed during the research period in these two groups. Group I subjects reported less postoperative discomfort, such as heat, swelling and pain. Group II subjects had higher reduction of local temperature in certain areas within 180 minutes. CONCLUSIONS: Both moist- and dry cryotherapy reduced postoperative discomfort effectively. The moist cryotherapy was more effective in reducing subjective discomfort caused by the operation. The dry cryotherapy reduced local temperature more effectively in certain areas after surgery. RELEVANCE TO CLINICAL PRACTICE: Cryotherapy could reduce postoperative discomfort, such as local heat, pain and swelling. When patient comfort is the major outcome of nursing intervention, moist cryotherapy is strongly suggested.

Changes of satisfaction with appearance and working status for head and neck tumour patients.

AIMS AND OBJECTIVES: The aim of this survey was to examine changes of satisfaction with appearance and working status of head and neck tumour patients after tumour excision and micro-reconstructive surgery. BACKGROUND: Most research related to head and neck tumour reconstruction deals with surgical techniques and complications. No reports discussed impact on personal appearance and working status. DESIGN: This is a retrospective cross-sectional study design with systematical sampling. METHODS: One questionnaire which included three instruments was mailed to patients selected systematically from a patient list; 525 questionnaires were mailed to the potential participants and 125 returned. However, only 97 effective questionnaires were analysed. Non-parametric statistics such as Spearman correlation, Wilcoxon signed rank test, Kolmogorov-Smirnov Z test and Kruskal-Wallis test were performed as the data were not normally distributed. RESULTS: Participants reported that they were least satisfied with their face (mean = 2.88 SD 1.34). Compared with presurgery condition, the satisfaction with current appearance was significantly lower (Wilcoxon signed rank test, Z = -6.39, p < 0.001). A total of 35.8% employed participants changed their jobs after cancer treatments. Their major reason for job change was discomfort caused by cancer treatment. Gender, employment status, type of job, type of treatment, age, duration from last radiotherapy and number of treatment modalities had an impact on satisfaction with appearance. CONCLUSIONS: Compared with presurgery, satisfaction with personal appearance did change negatively even after micro-reconstructive surgery had been conducted. In addition, certain participants changed their jobs because of cancer treatments. RELEVANCE TO CLINICAL PRACTICE: We should include job rehabilitation and body image into the daily care of head and neck cancer patients. For example, participants could learn how to use cosmetic strategies to improve their facial appearance during OPD follow-up. Thus, the negative impact might be reduced.

Effectiveness of cosmetic rehabilitation on the body image of oral cancer patients in Taiwan.

GOALS OF THE WORK: Oral tumors and their treatment cause obvious changes in disfigurement and functions of cancer patients. Therefore, some kind of strategy to improve personal appearance is important in nursing care. This prospective study intended to verify the effects of a cosmetic rehabilitation program on the body image of oral cancer patients. MATERIALS AND METHODS: A single-blind quasi-experimental design with repeated-measures design was used in this study. The experimental group received instruction on cosmetic rehabilitation, whereas the control group received regular nursing care. The experimental group and control group each had 22 subjects who were requested to complete the questionnaires throughout the regular follow-up (during admission, after 6 weeks, and after 12 weeks). The Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) was selected for data collection. MAIN RESULTS: The results showed that subjects in both experimental and control groups reported similar levels of body image in each subscale of MBSRQ-AS before conducting cosmetic rehabilitation. The appearance evaluation subscale was the only one that changed significantly in both the experimental and control groups during the research period. Nevertheless, results of item comparison showed that cosmetic rehabilitation had improved the scores of "I like the way I am," "most people think that I am good looking," "body weight," and "face" in the experimental group. CONCLUSION: Present study confirmed that cosmetic rehabilitation had similar effects on the body image of oral cancer patients. Integration of cosmetic program into the routine nursing care for oral cancer patients is highly recommended.