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.

Salient Features and Outline of the Joint Japanese Guidelines for Safe Handling of Cancer Chemotherapy Drugs.

The purpose of this paper is to introduce the outline and describe the salient features of the "Joint Guidelines for Safe Handling of Cancer Chemotherapy Drugs" (hereinafter, "Guideline"), which were published in July 2015. The purpose of this Guideline is to provide guidance to protect against occupational exposure to hazardous drugs (HDs) to all medical personnel involved in cancer chemotherapy, including physicians, pharmacists, and nurses and home health-care providers. The Guideline was developed according to the Medical Information Network Distribution Service guidance for developing clinical practice guidelines, with reference to five authoritative guidelines used worldwide. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ichushi-Web, and Cochrane Central Register of Controlled Trials were used for a systematic search of the literature. Eight clinical questions (CQs) were eventually established, and the strength of recommendation for each CQ is presented based on 867 references. The salient features of the Guideline are that it was jointly developed by three societies (Japanese Society of Cancer Nursing, Japanese Society of Medical Oncology, and Japanese Society of Pharmaceutical Oncology), contains descriptions including the definition of HDs and the concept of hierarchy of controls, and addresses exposure control measures during handling of chemotherapy drugs. Our future task is to collect additional evidence for the recommended exposure control measures and to assess whether publication of the Guideline has led to adherence of measures to prevent occupational exposure.

[Safe Handling of Hazardous Drugs in Nursing Practice].

Handling of hazardous drugs in nursing practice, there are risks of a wide variety of occupational exposures such as drug administration, management of spills, care of patients after administration, etc. Using a general infusion set for intravenous administration, there are risk of exposure such as scattering when the bottle needle is spiked into the infusion bag, leakage when priming the infusion line with antineoplastic drug, spillage when removing the side tube. For intravenous administration, use of CSTD for administration is most effective, but in many facilities, a general infusion set is used due to cost considerations. Drug preparation for local infusion is often done on the patients' bedside and is one of the most dangerous tasks for nurses who assist. There are also risks of exposure when handling patient excreta, body fluids and linen contaminated with them. Exposure measures are necessary for a minimum of 48 hours after administration. In the prevention of occupational exposure in these tasks, understanding and cooperation of doctors and pharmacists is particularly indispensable. Also, patients and families need to be provided appropriate guidance on exposure control. Under the organizational recognition and efforts against exposure control, it is necessary to create an environment in which all medical staff can devote themselves to work with confidence.

Development of the Hirai Cancer Fatigue Scale: Testing its reliability and validity.

PURPOSE: The purpose of this study was to develop the Hirai Cancer Fatigue Scale (HCFS) to assess the fatigue experienced by cancer patients, and to verify its reliability and validity. METHODS: Based on qualitative research about the perception of fatigue by Japanese cancer patients, we developed a questionnaire. The content validity was confirmed by 5 expert oncology nurses and 5 oncologists. 281 Japanese cancer patients participated in this study. Construct validity was analyzed using factor analysis, and internal consistency was analyzed using Cronbach's α coefficient. RESULTS: A 15-item scale with 3 dimensions, "physical/mental sensation", "activity-related sensation" and "cognitive sensation," was developed by factor analysis. This scale had an overall Cronbach's α coefficient of .943 and a test-retest reliability coefficient of r = .820 (p < 0.01), confirming the high reliability of the scale. The correlation coefficient was r = .759 (p < 0.01) between HCFS and abridged Profile of Mood States-Fatigue (POMS-F), and r = .763 (p < 0.01) between HCFS and Cancer Fatigue Scale (CFS), both showing high correlations and confirming criterion-related validity. CONCLUSION: HCFS enables reliable and valid evaluation of Japanese cancer patients' fatigue. Use of the HCFS would assist in convenient self-evaluation of fatigue, and would allow information to be effectively provided to healthcare professionals. It could also be used for outcome evaluation in an intervention study.

Oncology nurses' recognition of long-term cancer survivorship care in Japan.

OBJECTIVE: This study aims to assess the knowledge of definition of cancer survivors among Japanese oncology nurses and their roles in long-term cancer survivorship care. METHODS: A structured self-administered and self-report questionnaire created by the study investigators was given to members of the Japanese Society of Cancer Nursing. The subjects were 81 female oncology nurses. RESULTS: Forty-nine nurses had 11 or more years of nursing experience, while 27 nurses had cancer-related nursing certifications such as, certification in oncology nursing specialist. This study population had rather rich experience in oncology nursing. Sixty-two nurses defined a cancer survivor from the time of diagnosis, while the nurses' recognition of long-term survivorship care was poor, compared with nursing care at the time of diagnosis, during treatment, and end of life. CONCLUSIONS: The nurses were aware of the needs to recognize and address issues faced by long-term cancer survivors and for nursing study, but very few put the effective patient education and interventions into practice. It is because oncology nurses have few chances to see cancer survivors who go out of the hands of healthcare professionals. In increasing the number of long-term survivors, long-term survivorship care is needed in addition to incorporating such education into undergraduate and graduate programs. Further study on the knowledge of long-term cancer survivorship care and nursing practices are required.