The effect of relaxation exercises on symptom severity in patients with breast cancer undergoing adjuvant chemotherapy: An open label non-randomized controlled clinical trial

Identifying symptom cluster in cancer patients undergoing chemotherapy-in Vietnam: A cross-sectional study

BACKGROUND

Major cancer treatments can cause a wide range of unpleasant symptoms that burden oncology patients. Different symptom clusters (SC) among cancer patients have been reported in the literature. This study determined the prevalence of symptoms patients experience during chemotherapy treatment and identified symptom clusters among them.

METHODS

A cross-sectional study was conducted among 213 cancer patients undergoing chemotherapy in three large hospitals in Vietnam. Symptoms were measured by the Memorial Symptom Assessment Scale.

RESULTS

The most prevalent symptoms were lack of appetite (65.3%), difficulty sleeping (62.9%), dry mouth (57.7%), numbness (60.1%), hair loss (43.2%), change in the way food tastes (40.8%), and lack of energy (44.1%). Four symptom clusters were identified. Difficult concentration, pain, cough, and dizziness contributed to the first SC. The second one included lack of energy, numbness, change the food taste, and lack of appetite. Dry mouth, nausea, feeling bloated, problems with urination, hair loss, and constipation made up for the third SC. The final SC consisted of psychological symptoms, which were feeling nervous, feeling drowsy, feeling sad, worrying, problems with sexual interest or activity and difficulty sleeping.

CONCLUSION

The study demonstrated that respondents experienced various symptoms and symptom clusters during chemotherapy. These findings can be used to develop clinical guidelines for symptom assessment and management in oncology patients for healthcare professionals.

The effects of progressive muscle relaxation exercise applied to lung cancer patients receiving chemotherapy on dyspnea, pain and sleep quality: A randomized controlled trial

PURPOSE

The aim of the present study is the analysis of how progressive muscle relaxation exercise affects dyspnea, pain and sleep quality in patients with lung cancer receiving chemotherapy.

METHODS

Seventy-four patients diagnosed with lung cancer were included in this randomized controlled study. A total of 16 sessions of progressive muscle relaxation exercises were applied to the patients in the intervention group for a duration of 30 min, 2 days a week for 8 weeks. Patient Information Form, Medical Research Council Dyspnea Scale (MRC dyspnea scale), Pitssburg Sleep Quality Index (PSQI), Visual Analog Scale- Pain (VAS-P) were used to collect data.

RESULTS

Socio-demographic and disease characteristics were found to be similar in control and intervention groups. Final scores indicated significant differences between the experimental and control groups in all variables. The experimental group showed significantly more favorable results in dyspnea (p < 0.001), pain (p < 0.003) and sleep (p < 0.001) symptoms. When the effect size values (Cohen's d) of these findings were analyzed, PMR exercise was found to have a moderate effect on mean VAS-P scores (0.548) and a large effect on mean MRC dyspnea scale (1.073) and PSQI (0.970) scores. These results indicated significant differences in pre and post intervention mean scores.

CONCLUSION

Progressive muscle relaxation exercise applied to lung cancer patients receiving chemotherapy was found to be effective in reducing dyspnea and pain severity and improving sleep quality. Clinical trial registration at ClinicalTrials.gov. NCT04978805.

Progressive relaxation training in patients with breast cancer receiving aromatase inhibitor therapy-randomized controlled trial

BACKGROUND

Aromatase inhibitors have positive impacts on the disease-free life of patients with breast cancer. However, their side effects, especially arthralgia, may be experienced by many patients. This study sought to assess the efficacy of Progressive Relaxation Exercises on the prevalent side effects of Aromatase Inhibitors in patients with breast cancer.

MATERIALS AND METHODS

This clinical trial was conducted with single-blind randomization at a physiotherapy department in a local hospital. Patients who received Aromatase Inhibitor were assigned at random to either the study or control group. The study group (n = 22) performed a Progressive Relaxation Exercises program four days a week for six weeks, while the control group (n = 22) received advice on relaxation for daily life. Data was collected before the intervention and after six weeks. The study's primary endpoint was the Brief Pain Inventory, which was used to measure pain severity. Secondary endpoints included assessments of quality of life and emotional status, which were measured using the Functional Assessment of Chronic Illness Therapy and Hospital Anxiety and Depression scales, respectively.

RESULTS

The study group exhibited a significant reduction in Pain Severity (p = 0.001) and Pain Interference (p = 0.012) sub-scores. Reduction in Pain Severity (p<0.001) and Patient Pain Experience (p = 0.003) sub-scores was also noted between the groups. Quality of Life and Emotional Status showed no significant variation both within and between the groups (p>0.05).

CONCLUSION

The study demonstrated that Progressive Relaxation Exercises caused a significant reduction in pain scores among Breast Cancer patients receiving Aromatase Inhibitors. While a decrease in pain during the 6-week period is valuable data, it is necessary to monitor the long-term effects of relaxation techniques.

The Effect of Progressive Muscle Relaxation Exercises on Sleep Quality in Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Study

OBJECTIVES

This study aimed to evaluate the effect of progressive muscle relaxation exercises (PMRE) on sleep quality in patients undergoing chemotherapy treatment and experiencing disturbed sleep.

METHODS

The prospective randomized controlled study was conducted between March and September 2022 with 69 patients (intervention group: 34 patients, control group: 35 patients) in a hospital chemotherapy unit. During the data collection process, the "Personal Information Form" and "Pittsburgh Sleep Quality Index (PSQI)" were utilized. Patients in the intervention group performed PMRE twice a day for 8 weeks. Patients in the control group received routine care at the clinic without additional intervention. For data analysis, Student's t-test, Mann-Whitney U test, Fisher's exact test, and chi-square test were used.

RESULTS

The sociodemographic attributes of patients within both the intervention and control groups exhibited comparability. However, notable distinctions emerged in the PSQI Global sleep score and PSQI subdimension scores, encompassing sleep latency and duration, subjective sleep quality, habitual sleep efficiency, sleep disturbance, and daytime dysfunction between the two groups. The study found a notable difference in scores between the patients in the intervention group and those in the control group. The patients who received the intervention had significantly lower scores (P < .001).

CONCLUSION

The study revealed that PMRE was beneficial in improving sleep quality in cancer patients undergoing chemotherapy who had poor sleep quality.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses may consider using PMRE to improve the sleep quality of cancer patients receiving chemotherapy.

Effects of Oral Cryotherapy on Anticipatory, and Acute Nausea and Vomiting in Patients With Breast Cancer Undergoing Adjuvant Chemotherapy: A Randomized Controlled Clinical Trial

PURPOSE

To determine the effects of oral cryotherapy (OC) on the anticipatory, and acute nausea and vomiting of patients with breast cancer who are receiving adjuvant chemotherapy.

PATIENTS AND METHODS

Seventy eligible patients with breast cancer were assigned to 2 groups by stratified randomization. This parallel grouped, randomized, clinical trial used the ice application protocol. OC application for an intervention group (IG, n = 35) was performed in 3 stages: i) instructions on by the investigator at the hospital; ii) the implementation accompanied by the investigator at the hospital; iii) the individual application of at home by patients. The IG had been doing the application for 12 weeks. The patients in the control group (CG, n = 35) received standard care. Additionally, Rhodes Index of Nausea Vomiting, and Retching, and EORTC QLQ-C30 Life Quality Index were conducted on the first (T1 = cycle 1 day 0), second (T2 = cycle 2 day 21), third (T3 = cycle 3 day 42), and fourth (T4 = cycle 4 day 63) cycles of adjuvant chemotherapy.

RESULTS

The anticipatory nausea scores in the T2 and T4, IG were significantly lower than the CG (P < .05). In the T3, all symptom sub-dimensions except symptom occurrence (t = -0,48; P = .63) of the IG were significantly lower than those of the CG (P < .05). In the T1, T2, T3, and T4, acute nausea, acute vomiting, acute retching, and anticipatory retching scores, were significantly lower than the CG (P < .05).

CONCLUSION

OC alone was effective and safe for the treatment of nausea and vomiting. The results of this study showed the clinical applicability of OC in the management of nausea and vomiting.

Nonpharmacological Interventions for Management of the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Background

The pain-fatigue-sleep disturbance symptom cluster is commonly experienced by breast cancer patients, and a variety of nonpharmacological interventions are used to treat this symptom cluster.

Objective

To compare the efficacy of nonpharmacological interventions in improving the symptoms of the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients.

Methods

A comprehensive literature search was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, CNKI, and Wanfang databases to identify randomized controlled studies from database inception to May 2022. Two reviewers independently performed data retrieval and risk of bias assessments. The consistency model was used to conduct network meta-analyses (NMA) based on the frequentist framework to assess the interventions, which were ranked by the surface under the cumulative ranking curve (SUCRA). Finally, the CINeMA application was used to evaluate the results of the NMA and the evidence of quality. The results Twenty-three eligible studies assessing 14 interventions were included. According to SUCRA values, among the management effects of the three symptoms, the effect of progressive muscle relaxation (PMR) ranked first, followed by mindfulness-based stress reduction (MBSR). The overall evidence quality of our study ranges from very low to moderate.

Conclusion

PMR and MBSR were effective interventions for the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. Clinical recommendations prioritize PMR for symptom management, followed by MBSR. However, this should be interpreted cautiously, as the confidence in the evidence was not high.

Unmet needs and health-related quality of life of breast cancer survivors: survey from Gaza Strip, Palestine

BACKGROUND

Cancer, especially breast cancer, remains a public health problem because of its negative consequences, which require long-term programs to alleviate its devastating effects. This study aimed to examine unmet supportive care needs and health-related quality of life of females with breast cancer.

METHODS

A cross-sectional study with a mixed-method design was employed. A simple, randomly selected sample of 352 females attending Al-Rantisi and Al-Amal hospitals was included in this study. A validated Arabic version of the Supportive Care Needs Survey (34 items) and The European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C15-PAL) were used. Moreover, twenty-five semi-structured interviews were performed (13 females, eight husbands, and four healthcare workers). Quantitative data were analysed using descriptive and inferential analysis, whereas thematic analysis was used for qualitative data to highlight main themes.

RESULTS

The highest unmet need reported by females with breast cancer was psychological needs (63%), followed by health-related systems and information (62%) and physical and daily life (61%). Pain and fatigue were the most reported symptoms (65.8% and 62.5%, respectively), followed by emotional distress, physical function, and physical symptoms; 55.8%, 54.3%, and 51.5%, respectively. These unmet needs and health-related quality of life-related dimensions were highlighted and elicited by qualitative data analysis. Unmet needs are high among married females, on conservative treatments, young females (< 40 years old), and females in the first year of diagnosis. The presence of chronic diseases did not increase needs. However, health-related quality of life was affected. Six themes are subtracted: availability of anticancer therapy, affordability of healthcare, family and social support, psychological support, health education, and self-image & intimate relationship.

CONCLUSION

Many needs are unmet. Caring for females with breast cancer should be comprehensive to fill gaps, including psychological care, health information and education, physical care and support, and medical care.

The Effect of Progressive Relaxation Exercise on Physiological Parameters, Pain and Anxiety Levels of Patients Undergoing Colorectal Cancer Surgery: A Randomized Controlled Study

PURPOSE

This study aimed to determine the effect of progressive relaxation exercises on physiological parameters, pain, anxiety, and serum cortisol levels in patients undergoing colorectal cancer surgery.

DESIGN

This study is a randomized controlled study and has been registered at the Clinical Trial Registry Center (ID: NCT04731428).

METHODS

The study was conducted on 63 patients (experimental group = 31, control group = 32), who were scheduled for elective laparoscopic-colorectal surgery in the general surgery clinic of a university hospital in Istanbul between March 2018 and May 2019 and met the inclusion criteria. The patients in the experimental group were given progressive relaxation exercises for 15 minutes preoperatively and on postoperative days 1, 2, and 3 after breathing exercise training. The routine treatments and care process of the patients in the control group were maintained. The preoperative and postoperative pain and anxiety levels of both groups were evaluated. Blood pressure, heart rate and respiratory rate, oxygen saturation, and serum cortisol levels were measured at certain time intervals before and after the relaxation exercise.

FINDINGS

The patients in the experimental group had lower postoperative pain and anxiety levels and a lower rate of using opioid analgesic on postoperative day 0 compared to the control group. Progressive relaxation exercise had no statistically significant effect on serum cortisol or physiological parameters (P > .05).

CONCLUSIONS

Progressive relaxation exercise did not affect cortisol levels and vital signs but decreased pain and anxiety, and relatively increased tissue oxygenation, appearing an effective, safe, and practicable nursing intervention.

The effect of progressive relaxation exercises on treatment-related symptoms and self-efficacy in patients with lung cancer receiving chemotherapy

BACKGROUND

Patients with lung cancer receiving chemotherapy experience many symptoms, simultaneously or separately, that limit their daily living activities. This study aimed to determine the effect of progressive relaxation exercises on treatment-related symptoms and self-efficacy in patients with lung cancer receiving chemotherapy.

MATERIALS AND METHODS

This randomized controlled experimental study was conducted in a university hospital chemotherapy outpatient clinic in Turkey. The study sample consisted of 84 patients, randomly allocated to an experimental group (n = 42) and a control group (n = 42). The experimental group received applied training in progressive relaxation exercises using an MP3 player. The control group received only standard nursing interventions in the chemotherapy unit. Data were collected from patients using a personal information form, a telephone counseling follow-up form, the Memorial Symptom Assessment Scale and the Strategies Used by People to Promote Health Scale. Data collection tools were administered at four different times (at first interview and three times on the seventh day of the end of the chemotherapy cycle) and weekly telephone follow-ups were performed.

RESULTS

The symptom scores (frequency, severity and level of distress) significantly decreased in the experimental group, compared with the control group (p = 0.0001). Similarly, self-efficacy scores significantly improved in the experimental group (p = 0.001).

CONCLUSION

Progressive relaxation exercises were potentially effective in promoting symptom management and improving the level of self-efficacy.

Optimization assisted Kalman filter for cancer chemotherapy dosage estimation

Cancer is regarded to be the earth's most deadly disease, with one of the highest mortality rates among people. "Surgery, radiotherapy, chemotherapy, hormone therapy, and immunotherapy" were all options for treat cancer. Chemotherapy is a medication that is most often deployed for treating cancer, as cancer cells develop and proliferate faster than other cells in the body. Even though chemotherapy is an effective method to treatment various kinds of cancers, the treatment includes risk as it causes side effects due to improper drug usage. The application of a controller-based strategy for determining the optimal rate of drug injection during treatment has risen dramatically in recent years. Thereby, this work develops a robust controller for controlling the dosage of drugs that is carried out under parameter estimation. In addition, a Modified Regularized Error Function-based Extended Kalman filter (MREF-EKF) is introduced for estimating the tumor cells and it can be exploited for diverse conditions. Moreover, the overfitting issue that occurs during drug dosage estimation is also solved using this approach. Further, to improve the performance of the developed approach, the initial state of EKF is fine-tuned via Mean fitness-based Particle Swarm Update (MF-PSU), which is the enhanced version of Particle Swarm Optimization (PSO). At last, the supremacy of the presented approach is proved with respect to convergence analysis and error analysis. For instance, our method outperforms existing GWO + e_k + m, AGWO + e_k + m, and PSO + e_k + m approaches in convergence analysis at noise level 0.41 by 0.009%, 0.002%, and 4.9% respectively. In error analysis, the error values for tumor cells have reached a minimum error value of zero for all noise levels (0.41, 0.43, and 0.55). The findings of this study can help for a better understanding of our presented robust controller's effectiveness in controlling the dosage of drugs.

Regularized error function-based extended Kalman filter for estimating the cancer chemotherapy dosage: impact of improved grey wolf optimization

Objectives

The main aim of this work is to introduce a robust controller for controlling the drug dosage.

Methods

The presented work establishes a novel robust controller that controls the drug dosage and it also carried out parameters estimation. Along with this, a Regularized Error Function-based EKF (REF-EKF) is introduced for estimating the tumor cells that could be adapted for different conditions. It also assists in solving the overfitting problems, which occur during the drug dosage estimation. Moreover, the performance of the adopted controller is compared over other conventional schemes, and the attained outcomes reveal the appropriate impact of drug dosage injection on immune, normal, and tumor cells. It is also ensured that the presented controller does a robust performance on the parameter uncertainties. Moreover, to enhance the performance of the proposed system and for fast convergence, it is aimed to fine-tune the initial state of EKF optimally using a new Improved Gray Wolf Optimization (GWO) termed as Adaptive GWO (AGWO). Finally, analysis is held to validate the betterment of the presented model.

Results

The outcomes, the proposed method has accomplished a minimal value of error with an increase in time, when evaluated over the compared models.

Conclusions

Thus, the improvement of the proposed REF-EKF-AGWO model is proved from the attained results.

Effects of resistance exercise on complications, cancer-related fatigue and quality of life in nasopharyngeal carcinoma patients undergoing chemoradiotherapy: A randomised controlled trial

BACKGROUND

Chemotherapy of nasopharyngeal carcinoma (NPC) can lead to significant side effects and complications. Exercises during chemoradiotherapy have potential to reduce complications and fatigue and improve quality of life. The aim of the randomised clinical study was to investigate the benefits of resistance exercise during chemoradiotherapy in NPC patients.

METHODS

A total of 146 patients were randomised to perform resistance or relaxation exercises during chemoradiotherapy. Resistance exercise consisted of eight machine-based progressive resistance exercises, and relaxation control consisted of progressive muscle relaxation. Side effects and complications were analysed, and fatigue was assessed by Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) scores. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ30) scale was used to evaluate the effects of resistance exercise or relaxation control on quality of life. Per-protocol analysis was performed on the collected data.

RESULTS

Resistance exercise has stronger effects than relaxation in reducing complications, including oral mucositis, mouth-opening difficulties, xerostomia, hearing loss and nasal congestion, and alleviating both physical fatigue and mental fatigue. The improvement in quality of life was also more prominent among patients performing resistance exercise.

CONCLUSIONS

For NPC patients undergoing chemoradiotherapy, resistance exercise has a better efficacy in reducing complications, alleviating fatigue and improving quality of life.

Robust controller for cancer chemotherapy dosage using nonlinear kernel-based error function

It is well-known that chemotherapy is the most significant method on curing the most death-causing disease like cancer. These days, the use of controller-based approach for finding the optimal rate of drug injection throughout the treatment has increased a lot. Under these circumstances, this paper establishes a novel robust controller that influences the drug dosage along with parameter estimation. A new nonlinear error function-based extended Kalman filter (EKF) with improved scaling factor (NEF-EKF-ISF) is introduced in this research work. In fact, in the traditional schemes, the error is computed using the conventional difference function and it is deployed for the updating process of EKF. In our previous work, it has been converted to the nonlinear error function. Here, the updating process is based on the prior error function, though scaled to a nonlinear environment. In addition, a scaling factor is introduced here, which considers the historical error improvement, for the updating process. Finally, the performance of the proposed controller is evaluated over other traditional approaches, which implies the appropriate impact of drug dosage injection on normal, immune and tumor cells. Moreover, it is observed that the proposed NEF-EKF-ISF has the ability to evaluate the tumor cells with a better accuracy rate.