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.

Adherence to moderate-intensity exercise during breast cancer therapy.

PURPOSE: The aims of this pilot study were the following: 1) to examine patterns of adherence to a brisk walking program in women receiving adjuvant chemotherapy or radiation therapy for newly diagnosed breast cancer using a prospective, randomized, controlled experimental design; 2) to examine the influence of disease symptoms and treatment side effects on exercise levels; and 3) to suggest methods that may improve future clinical trials of moderate-intensity exercise in similar populations. DESCRIPTION OF STUDY: Fifty-two patients with newly diagnosed breast cancer were randomly assigned to one of two treatment arms: usual care or usual care plus exercise. Those assigned to the exercise group received a standardized, self-administered, home-based brisk walking intervention in addition to usual care. Each day subjects completed self-report diary forms that elicited information about activity levels, and the occurrence of symptoms and side effects during cancer treatment. RESULTS: Analyses of self-reported daily activity levels revealed a diffusion of treatment effect. Fifty percent of the usual-care group reported maintaining or increasing their physical activity to a moderate-intensity level, while 33% of the exercise group did not exercise at the prescribed levels. Analyses of self-reported disease symptoms and treatment side effects did not reveal clinically meaningful differences between the two groups. CLINICAL IMPLICATIONS: The results of this study suggest that women who exercised regularly before receiving a breast cancer diagnosis attempted to maintain their exercise programs. Women who lead sedentary lifestyles may benefit from a structured exercise program that includes information and support related to exercise adherence strategies.