Literature review
Kaasa, S. (2015). Is Cancer Pain Control Improved by a Simple WHO Pain Analgesic Ladder Approach Combined With Tumor-Directed Treatment?.Journal of Clinical Oncology, JCO647537.
Article summary
This article takes into consideration the role that the WHO analgesic ladder plays in addressing cancer pain in palliative care patients. The authors identify that cancer pain occurs in 90% of cancer patients but only half them are under proper pain management. To this effect, therefore, there is the need for applying opioids under the WHO ladder guidelines as a way of addressing cancer pain in oncology care patients.
This is a narrative qualitative research article which focuses mainly on a study conducted by Bandieri et al regarding the application of the WHO analgesic ladder. The methodology employed in this study was a meta-analysis of studies conducted by the authors. The study does not, however, spell out the study population, therefore, contributing to its limitation.
Outcomes
The study proposes the inclusion of the WHO two-step approaches to palliative care patient has been effective in achieving desirable outcomes in patients.
Significance to Nursing and Patient Care
The results of the study posit that the use of analgesics can be incorporated into oncology practice in addition to other methods that will oversee the control of cancer pain.
Goodwin, P. J., Bruera, E., & Stockler, M. (2014). Pain in patients with cancer.Journal of Clinical Oncology, 32(16), 1637-1639.
Article summary
This qualitative study employs meta-analysis of different articles in regards to the subject in question. There are a total of nine articles employed in addressing the components of pain that different oncology patients undergo. The strength of the study is that it employs multiples studies from different authors thus boosting the validity level. There study population is not defined however thus presenting a weakness of the study.
Outcomes
The study results show indicate different factors that contribute to cancer pain including old age, minority status and the need for pain assessment.
Significance to Nursing and Patient Care
It is important for care providers to understand the specific needs of the patients to assist in providing with the best forms of analgesia. Such an objective can be achieved after a careful assessment of pain multipliers.
Rana, S. P., Ahmed, A., Kumar, V., Chaudhary, P. K., Khurana, D., & Mishra, S. (2011). Successful management of a difficult cancer pain patient by appropriate adjuvant and morphine titration. Indian journal of palliative care,17(2), 162.
Article summary
The study design employed in this article is a case study which addresses a 71-year-old female as the area of study. The aim of this method is to have a deep understanding of the pain she experiences and the medication dosages she should take. The study focuses on one individual only thus present a limitation of generalizability.
Outcomes
The research outcomes are that it is important for providing patients with the correct dosages of the analgesia at the rate of 10mg after every four hours.
Significance in nursing and Patient Care
The use of analgesics on cancer patients at the rate of 10mg in a four hourly program has been established to play a crucial role in addressing cancer pain in oncology care patients.
Ripamonti, C. I., Santini, D., Maranzano, E., Berti, M., Roila, F., & ESMO Guidelines Working Group. (2012). Management of cancer pain: ESMO clinical practice guidelines. Annals of oncology, 23(Suppl 7), vii139-vii154.
Article summary
This study focuses on the demographics which are currently being affected by cancer in the globally. There is the realization that no effective pain management techniques currently exist with about 64% of the cancer patients having the advanced condition of the pain. The measures that need to be employed in addressing this condition is using opioids even though there are side effects which have been linked to its usage.
The study design employed in this study is the use of meta-analysis that has incorporated the use of different types of studies regarding the management of cancer pain. One such study has used 15 Randomized Controlled Tests that involved observing 36 patients under analgesic medication.
Outcomes
This study established that the use of opioids in the pain management process is essential in boosting the quality of life of the patient even though there are side effects associated with their usage.
Significance in nursing and Patient Care
It is imperative that care providers be at the forefront in managing the pain that patients go through. Additionally, the side effects that come about with the usage of pain relieving medication in cancer patients need also to be addressed.
Situ, D., Wang, J., Shao, W., & Zhu, Z. H. (2011). Assessment and treatment of cancer pain: from Western to Eastern. Annals of palliative medicine, 1(1), 32-44.
Article summary
This study employed different statistical studies which present a case of the prevalence rates of cancer pain in these patients. The rates in patients who are not under any active treatment range from 24% to 560% while in those who have got advanced cancer it ranges from 62% to 86%. The study also classifies pain in accordance with different bodies and systems that deal with pain. Their results concerning the outcomes on different management techniques have also been charted. The strength of this study is that it gives an evaluation of different pain management practices making it all inclusive.
Outcomes
The study established that the use of different kinds of medication is useful in seeing to it that the levels of pain in cancer patients have been adequately addressed. The use of non–pharmacological methods has also been proven to assist in controlling these outcomes on patients.
Significance in nursing and Patient Care
It is imperative for care providers to expand the techniques which they use in addressing the levels of cancer pain in patients. The study shows that using analgesics like morphine and fentanyl in addition to nontraditional analgesic methodologies like massages cuts across the board in addressing cancer pain.
Thapa, D., Rastogi, V., & Ahuja, V. (2011). Cancer pain management-current status. Journal of Anaesthesiology Clinical Pharmacology, 27(2), 162.
Article summary
This is a qualitative study in which the authors propose the application of opioids in the treatment process of cancer pain. Cancer pain has been established to majorly affect the quality of life of most cancer patients. Such pain is however not fully addressed since there are challenges associated with poor assessments and anxiety. The authors propose the use of the WHO analgesic ladder in addressing the condition even though there are undesirable side effects associated with their usage.
Research elements
This study involved a literature search from MEDLINE database in regards to cancer pain management. Guidelines published by the WHO were also incorporated in the study. The study population has not been specified therefore presenting a problem of compromised validity which is the main limitation.
Outcomes
The study established that there are several reasons which lead to issues of under treatment in regards to the management of cancer pain including unavailability of morphine, limited resources in developing countries, barriers like lack of enough information concerning the medication and poor communication between the patient and the physician.
Significance in nursing and Patient Care
The research results present a case which the nurses can use when providing care to cancer patients. These methods include. The use of opioids, gene therapy, and celiac plexus block are essential in addressing the problem.
Singh, P., & Chaturvedi, A. (2015). Complementary and alternative medicine in cancer pain management: A systematic review. Indian journal of palliative care,21(1), 105.
Article summary
The article recognizes that cancer pain compromises the psychosocial, spiritual and social wellbeing of a cancer patient. This realization, therefore, has made this group of patients to fear the pain more than death. Therefore, the use of alternative and complimentary techniques like acupuncture and massage are the most appropriate, methods which can be used to control the pain.
Research elements
Thus study utilizes different studies extracted from the MEDLINE and Cochrane database in getting the required information regarding the use complimentary and alternative medicine (CAM) pain relief techniques. The incorporation of different RCT studies has been helpful in ensuring study validity and reliability. The limitation of the study is that since it is a systematic review the results may be compromised.
Research outcomes
The study established that the different CAM techniques have been effective in managing the problem of cancer pain in oncology patients.
Significance in nursing and Patient Care
The different CAM techniques discussed by the article can be used by nurses in seeing to it that cancer patients under intense pain can effectively manage their conditions so that the quality of life is improved.
Sagar, S., Dryden, T., & Wong, R. K. (2007). Massage therapy for cancer patients: a reciprocal relationship between body and mind. Current oncology,14(2).
Article summary
The article posits that there it is important to have in place strategies which will be useful in addressing cancer pain to boost coping levels. Additionally, using nuclear magnetic responses is critical in evaluating the effectiveness of the massage techniques.
Research elements
This study employed a review of studies from the Cochrane database in determining the effectiveness of the different therapeutic massage techniques in addressing patients’ pain level. The strength of the article is that it identifies major massage techniques which are the main area of interest in this case. The main limitation of the study was in regards to determining the validity of the different massage techniques
Outcomes
Results from the study posit that it is only through the use of nuclear responses which will determine the effectiveness of different massage techniques.
Significance to nursing and Patient Care
Nurses have got the obligation of making sure that cancer patients are reprieved from the pain that they usually go through. Applying mechanistic research and clinical trials play an important role in addressing this problem.
Warpenburg, M. J. (2014). Deep Friction Massage in Treatment of Radiation-induced Fibrosis: Rehabilitative Care for Breast Cancer Survivors. Integrative Medicine: A Clinician's Journal, 13(5), 32.
Article summary
Most patients with breast cancer usually undergo radiotherapy as a way of managing the condition. The pain that comes about as a result of this treatment technique calls for a technique which will effectively address the condition in plus managing the vascular and lymphatic system. Massages are the most effective in controlling the pain.
Research elements
This is a qualitative case study which takes into account the treatment journey of a 57–year-old breast cancer patient who experienced pain during chemotherapy sessions. The study from the PubMed database shows that the patient started her massage session using different friction techniques from the year 2013. The limitation of the study is that there is only one person used as the sample thus compromising the concept of generalizability.
Study outcomes
The patient underwent 7 different treatment sessions which improved her outcomes as the treatment progressed. The first three sessions had challenges in regards to the alleviation of pain. The fourth to the seventh sessions saw very minimal pain on the side of the patient.
Significance to nursing and Patient Care
The use of different massage techniques specifically circular friction, myofascial spreading and mobilization are important techniques in controlling the pain of breast cancer patients. Care providers are supposed to incorporate them in their caregiving process.
Miladinia, M., Baraz, S., Mousavi Nouri, E., & Gholamzadeh Baeis, M. (2015). Effects of Slow-stroke Back Massage on Chemotherapy-induced Nausea and Vomiting in the Pediatrics with Acute Leukemia: a Challenge of Controlling Symptoms. International Journal of Pediatrics, 3(6.2), 1145-1152.
Article summary
The primary objective of this study was determining the role that deep back massage plays in addressing the side effects of individuals who have gone through chemotherapy sessions. Vomiting and nausea and pain brought about by the treatment process needs to be addressed. The massage technique used was instrumental in reducing the incidence of vomiting and nausea after treatment and consequently low pain levels.
Research elements
This was a quantitative study which employed a Randomized Controlled Trial design. The sample size was comprised of 45 children with acute leukemia who were placed under control and experiment groups. Their vomiting patterns during the study period in regards to the therapy session were recorded. Levels of nausea were measured at intervals of half an hour and three hours. Data analysis was done by the use of Chi Square and ANOVA. The strength of the study is that data analysis was done using the ANOVA statistical software leading to boosted outcomes. The sample size of 45 is not large enough to address the issue of generalizability.
Research outcomes
The results from the study indicated that the patients using Super Smash Bros. Melee during the treatment process in addition to slow backstroke massage had reduced incidences of nausea and vomiting over the treatment period. By extension also, the levels of pain experienced considerably reduced.
Significance to nursing and Patient Care
It is crucial for nurses to ensure that the techniques they use ion managing their cancer patients incorporate slow backstroke massage in controlling the cases of vomiting and nausea and by extension pain in them. Such a realization ensures the patients emerge with desirable outcomes.
Sheikhi, M. A., Ebadi, A., Talaeizadeh, A., & Rahmani, H. (2005). Alternative methods to treat nausea and vomiting from cancer chemotherapy. Cancer, 450.
Article summary
The study identifies nausea and vomiting brought about by the process of chemotherapy as the most undesirable in the cancer treatment process. Additionally, pain also contributes to these patients from continuing with the treatment. The study, therefore, proposes the use of alternative medical techniques like the use of massage therapy in addition to ginger in controlling the painful effects of the cancer treatment.
Research elements
This is a qualitative study which was extracted from the PubMed online database regarding the control of nausea and vomiting incidences amongst cancer patients under chemotherapy. The study is a meta-analysis of multiple articles from different authors regarding the reduction of pain amongst patients with nausea and vomiting as side effects emanating from the cancer treatment process. Another study included in the meta-analysis involved the use of medicinal therapy in an experiment and control group which resulted in reduced cases of pain in 23% of the study population. The strength of the study is that it employs multiple studies in showing the effect that massage therapy and medicinal therapy has on the wellbeing of cancer patients. The study limitation is that it does not specify the population size.
Outcomes
The study outcomes indicate that using relaxation techniques is an important strategy towards alleviating cancer side effects of nausea and vomiting. Massaging is essential as it does not have any side effects on the patient.
Significance to nursing and Patient Care
The study is crucial for care providers in regards to the techniques that they should employ in alleviating cancer pain amongst patients. Massage therapy is important is vital since it does not have any side effects.
Simone, C. B., II, N. V., Hampshire, M. K., & Metz, J. M. (2012). Cancer patient attitudes towards analgesic utilization and pain intervention. The Clinical journal of pain, 28(2), 157.
Article summary
This study was done to address the perception which patients have in regards to their cancer pain management. Most cancer patients usually receive very minimal pain management. The study thus addresses the reasons for inadequate pain management amongst oncology patients.
Research elements
This study employed IRB-approved questionnaires which sought to establish reasons why patients did not use analgesics in addressing their pain. The study population comprised of 1,107 patients under oncology care. 73% of the patients were Caucasian while 69% had undergone surgery to address breast cancer. The strength of the study is that the study population was large enough to address the issue of generalizability.
Study outcomes
The study showed that 48% of the study participant reported direct pain from the cancer treatment process. Almost a quarter of the participants did not use analgesic however due to reasons like addiction fears, costs or no endorsements.
Significance to nursing and Patient Care
Nurses are under the obligation of discussing with their patients on how they are supposed to manage their symptoms and cancer pain. This aimed at making them utilize analgesics in managing their pain.
Bedard, G., Hawley, P., Zhang, L., Slaven, M., Gagnon, P., Bisland, S., & Chow, E. (2013). A survey of Canadian cancer patients’ perspectives on the characteristics and treatment of breakthrough pain. Supportive Care in Cancer,21(9), 2557-2563.
Article summary
Breakthrough pain continues to affect many patients under cancer treatment. The pain that patients feel in a major way affects their quality of life. Most of these patients are however not ready to use analgesics in addressing this pain due to reasons like costs, efficacy and the need to use other methods.
Research elements
The study population comprised of 94 Canadian patients in four oncology centers. They were recruited through a survey which aimed at assessing the extent of their breakthrough back pain. The focus was on the effect the pain had on their daily lives and functioning. The study population of 94 presents a case of thorough validity and reliability of the results achieved.
Research outcomes
96% of the participant reported that the pain compromised their daily lives for instance in regards to working and shopping. The nonusers of the analgesics cited that they did not use the analgesics due to the costs involved, fear of addiction, and little severity.
Significance in nursing and Patient Care
It is crucial for nurses to be at the forefront in addressing the fears that patients have regarding the use of analgesics in addressing cancer pain. Additionally, there is the need for nurses to use alternative treatment methodologies like massages for cancer pain.
Shinde, S., Gordon, P., Sharma, P., Gross, J., & Davis, M. P. (2015). Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?. Supportive Care in Cancer, 23(3), 695-703.
Article summary
The objective of this study was establishing the efficacy of adjuvant analgesics regarding cancer pain. The use of adjuvant analgesics is being applied on more than 80% of cancer patients with pain even though 50% of all cancer patients do not use the medication. The study reported that the use of this medication did not necessarily address the problems of pain in cancer patients.
Research elements
The design applied in this study was a retrospective observational study in a Cleveland clinic and was conducted in accordance with the IRB requirements. Demographic data applied involved gender, age, and cancer diagnosis. Additionally, data on adjuvant use, pain scores and time of discharge were also recorded in a period of three months. The fact that different elements of the population were considered during the study means that the results gotten were inclusive. This is the main strength of the study. The limitation of the study is that it does not show the population size thus low levels of generalizability.
Research outcomes
The study results showed that there were differences in regards to pain incidences both in the experiment and control group after using morphine and adjuvant analgesics. As such, adjuvant analgesics do not reduce cancer pain per se.
Significance to nursing and Patient Care
There is the need for nurses to take into account the pain which cancer patients go through during their treatment process. Using analgesics has been proven to have minimal effects on the outcomes of the patients and as such, it is crucial for them to apply massages in taking care of their patients.
Simone II, C. B., & Jones, J. A. (2013). Palliative care for patients with locally advanced and metastatic non-small cell lung cancer. Annals of palliative medicine, 2(4), 178-188.
Article summary
The study acknowledges that cancer patients globally are battling with cancer with statistics indicating that 85% of them have got non-small cell lung cancer. This form of cancer is associated with weight loss, dyspnea and pain. Most of these issues are brought about by factors like therapy process used in treating cancer conditions. The use of analgesics is essential in addressing these pain incidences.
Research elements
This study was derived from the PubMed database and has incorporated different studies which address the problem of cancer and the corrective mechanisms. One study with a sample size of 151 palliative care patients indicated that the use of analgesia improved the outcomes of this group of patients. Another study with 1,453 patients as the study population in a questionnaire based survey recorded pain incidences between 74% and 90% of the patients. The strength of the study is that it has incorporated an analysis of both qualitative and quantitative studies in the analysis part ensuring that the results are reliable.
Research outcomes
The study established that in order top effectively address cancer pain in these patients, there is the need for assessing the pain levels, coping levels in regards to psychosocial stress for the best corrective measures to be taken.
Significance in nursing and Patient Care
In order for nurses to ensure better outcomes in oncology patients, they are tasked with ensuring that such patients are well assessed in regards to their coping levels before the best corrective pain management technique is applied on them.
References
Bedard, G., Hawley, P., Zhang, L., Slaven, M., Gagnon, P., Bisland, S., & Chow, E. (2013). A survey of Canadian cancer patients’ perspectives on the characteristics and treatment of breakthrough pain. Supportive Care in Cancer,21(9), 2557-2563.
Goodwin, P. J., Bruera, E., & Stockler, M. (2014). Pain in patients with cancer.Journal of Clinical Oncology, 32(16), 1637-1639.
Kaasa, S. (2015). Is Cancer Pain Control Improved by a Simple WHO Pain Analgesic Ladder Approach Combined With Tumor-Directed Treatment?.Journal of Clinical Oncology, JCO647537.
Miladinia, M., Baraz, S., Mousavi Nouri, E., & Gholamzadeh Baeis, M. (2015). Effects of Slow-stroke Back Massage on Chemotherapy-induced Nausea and Vomiting in the Pediatrics with Acute Leukemia: a Challenge of Controlling Symptoms. International Journal of Pediatrics, 3(6.2), 1145-1152.
Rana, S. P., Ahmed, A., Kumar, V., Chaudhary, P. K., Khurana, D., & Mishra, S. (2011). Successful management of a difficult cancer pain patient by appropriate adjuvant and morphine titration. Indian journal of palliative care,17(2), 162.
Ripamonti, C. I., Santini, D., Maranzano, E., Berti, M., Roila, F., & ESMO Guidelines Working Group. (2012). Management of cancer pain: ESMO clinical practice guidelines. Annals of oncology, 23(suppl 7), vii139-vii154.
Sagar, S., Dryden, T., & Wong, R. K. (2007). Massage therapy for cancer patients: a reciprocal relationship between body and mind. Current oncology,14(2).
Sheikhi, M. A., Ebadi, A., Talaeizadeh, A., & Rahmani, H. (2005). Alternative methods to treat nausea and vomiting from cancer chemotherapy. Cancer, 450.
Shinde, S., Gordon, P., Sharma, P., Gross, J., & Davis, M. P. (2015). Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements?. Supportive Care in Cancer, 23(3), 695-703.
Simone II, C. B., & Jones, J. A. (2013). Palliative care for patients with locally advanced and metastatic non-small cell lung cancer. Annals of palliative medicine, 2(4), 178-188.
Simone, C. B., II, N. V., Hampshire, M. K., & Metz, J. M. (2012). Cancer patient attitudes towards analgesic utilization and pain intervention. The Clinical journal of pain, 28(2), 157.
Singh, P., & Chaturvedi, A. (2015). Complementary and alternative medicine in cancer pain management: A systematic review. Indian journal of palliative care,21(1), 105.
Situ, D., Wang, J., Shao, W., & Zhu, Z. H. (2011). Assessment and treatment of cancer pain: from Western to Eastern. Annals of palliative medicine, 1(1), 32-44.
Thapa, D., Rastogi, V., & Ahuja, V. (2011). Cancer pain management-current status. Journal of Anaesthesiology Clinical Pharmacology, 27(2), 162.
Warpenburg, M. J. (2014). Deep Friction Massage in Treatment of Radiation-induced Fibrosis: Rehabilitative Care for Breast Cancer Survivors. Integrative Medicine: A Clinician's Journal, 13(5), 32.
