THE EFFECTS OF CARE COORDINATION ON SYMPTOMS AND QUALITY OF LIFE ON CANCER PATIENTS UNDERGOING TREATMENTS: A SYSTEMATIC REVIEW Tran Thuy Duong RN, BSN Supervisor: Dr Kimberly Alexander Submitted in fulfilment of the requirements of the degree of Masters of Nursing (Coursework) School of Nursing and Midwifery Faculty of Health Queensland University of Technology July 2015 Keywords Care coordination, cancer patients, treatments, symptoms, systematic review, and quality of life i Abstract Background: Patients living with cancer experience poor symptoms and quality of life during and after treatments As supplementary to usual care to improve symptoms and QoL, nursing interventions such as care coordination or nurse navigation are increasly used in cancer cares Objectives: The main objective of this systematic review was to evaluate the effectiveness of care coordination on symptoms and QoL of cancer patients receiving active treatments Methods: A systematic, computerized search in CINAHL, MEDLINE, PUBMED and PsycINFO was conducted Included studies in this review were measured symptoms or QoL in patients cared for by care coordination as a primary outcome measure In total, 3626 published articles were identified and 16 studies were reviewed that met the inclusion criteria and methological quality standards Results: The effect of care coordination in symptom improvement was documented in pain, fluid intake, sleep and rest, mobility, sociability, physical safety, body image and sexuality, while other symptoms were not improved Also, few studies provide evidence for better QoL scores and other subdomains However, this review cannot provide a qualified conclusion about the relationship between care coordination and symptoms and QoL The main reasons for this include: limited number of studies, inconsistencies across the included studies, and the poor quality of the included studies Conclusion: There was insufficient evidence to evaluate whether care coordination is effective in cancer patients’ QoL while undergoing treatments Future research ii needs to be conducted to understand the effect of care coordination on cancer patient symptoms and QoL iii Table of Contents Keywords i Abstract ii Table of Contents iv List of Figures vi List of Tables vii List of Abbreviations viii Statement of Original Authorship ix Acknowledgements x Chapter 1: Introduction 1.1 Background 1.2 Problems 1.3 Significance 1.4 The purposes of the project 1.5 Summary Chapter 2: Literature Review 2.1 Cancer symptoms on patients undergoing treatments 2.1.1 Chemotherapy 2.1.2 Radiotherapy 2.1.3 Stem cell transplant and Bone marrow transplant 2.1.4 Immunotherapy 10 2.2 Quality of life on patients undergoing cancer treatments 12 2.2.1 Quality of life 12 2.2.2 Quality of life on patients undergoing cancer treatments 13 2.3 Outcome measure instruments 15 2.3.1 Symptom measurement 15 2.3.2 Quality of life measurement 16 2.3.3 Factors associated with symptom burdens and QoL 18 2.4 Support interventions 20 2.4.1 The gaps of usual care nursing interventions 21 2.4.2 Care coordination 23 2.5 Summary 26 Chapter 3: Methodology 29 3.1 Literature search 29 3.2 Inclusion criteria 30 3.2.1 Types of studies 30 3.2.2 Types of participants 30 3.2.3 Types of interventions/Phenomena of Interest 31 3.3 Assessment of methodological quality 31 3.4 Data extraction 31 iv 3.5 Data synthesis 32 3.6 Methodological result 32 Chapter 4: Results 41 4.1 Demographic and sample group characteristics 41 4.1.1 Age… 41 4.1.2 Marital status 42 4.1.3 Employment status 43 4.1.4 Cancer stages 43 4.1.5 Treatments 44 4.2 Nursing Interventions 45 4.3 Outcome measure instruments 48 4.4 The effects of care coordination 49 4.4.1 The effects of care coordination on symptoms 49 4.4.2 The effects of care coordination on QoL 55 4.5 Summary 62 Chapter 5: Discussion 63 5.1 Overall symptom evaluation 63 5.1.1 Pain… 64 5.1.2 Depression 65 5.1.3 Distress 67 5.1.4 Anxiety 69 5.1.5 Other symptoms 70 5.2 Overall QoL evaluation 71 5.2.1 QoL evaluation on five studies favoured care coordination 73 5.2.2 QoL evaluation on nine studies which did not favour care coordination 81 5.3 Recommendations 83 5.3.1 Indications in research 83 5.3.2 Indications in clinical practice 85 5.4 Summary 86 Chapter 6: Conclusions 87 6.1 Summary of the systematic review findings 87 6.2 Limitations 88 References… 89 Appendices 99 Appendix A: Detailed search strategy according to databases 99 Appendix B: Critical appraisal checklists and data extraction forms from JBI MASTARI 103 v List of Figures Figure 1: The process of study selection 33 vi List of Tables Table 1: Summary table of the included studies 39 vii List of Abbreviations APN Advanced Nurse Practice BPI Brief Pain Inventory CES-D Centre for Epidemiologic Studies Depression Scale CPGS Chronic Pain Grade Scale EORTC QLQ-C30 European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire FACT-G Functional Assessment of Cancer Therapy-General HRQoL Health Related Quality of Life MPQ McGill Pain Questionnaire NRS Numeric Rating Scale PHQ-9 Patient Health Questionaire-9 score QLACS Quality of Life in Adult Cancer Survivors Scale QoL Quality of Life RCT Randomized Controlled Trial SF-36 Medical Outcomes Study 36-Item Short-Form Health Survey VAS Visual Analogue Scale WHO World Health Organization viii Krok, J L., & Baker, T A (2014) The influence of personality on reported pain and self-efficacy for pain management in older cancer patients Journal Of Health Psychology, 19(10), 1261-1270 doi:10.1177/1359105313488976 Kroenke, K., Outcalt, S., Krebs, E., Bair, M J., Wu, J., Chumbler, N., & Yu, Z (2013) Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain General hospital psychiatry, 35(4), 359-365 Laird, B J., Scott, A C., Colvin, L A., McKeon, A L., Murray, G D., Fearon, K C., & Fallon, M T (2011) Pain, depression, and fatigue as a 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290-297 98 References Appendices Appendix A: Detailed search strategy according to databases PubMed Search ID Search terms terms S1 S2 neoplasms OR cancer OR tumo?r OR maliginan* OR oncolog* nursing Chemotherapy OR radiotherapy OR Stem cell transplant OR Bone marrow transplant OR immunotherapy case management OR care coordinat* OR advanced practice nurs* OR S3 APN OR advanced nurs* care OR patient navigat* OR nurs* navigat* OR nursing intervention S4 Quality of life OR QoL OR Health related quality of life OR HRQoL OR patient outcomes S5 Symptom* OR pain OR nausea OR vomiting OR diarrhea OR fatigue S6 S1 OR S2 S7 S6 AND S3 AND S4 S8 S6 AND S3 AND S5 Appendices 99 CINAHL Search ID Search terms terms S1 S2 S3 Cancer OR tumo?r OR malignan* (MH "Neoplasms+") OR (MH "Oncologic Nursing+") OR (MH "Radiation Oncology Nursing+") Chemotherapy OR Radiotherapy OR Stem cell transplant OR Immunotherapy OR Bone marrow transplant Case management OR care coordinat* OR advanced practice nurs* OR S4 APN OR advanced nurs* care OR patient navigat* OR nurs* navigat* OR nursing intervention S5 Quality of life OR QoL OR Health related quality of life OR HRQoL OR patient outcomes S6 Symptom* OR pain OR nausea OR vomiting OR diarrhea OR fatigue S7 S1 OR S2 OR S3 S8 S7 AND S4 AND S5 S9 S7 AND S4 AND S6 Legend: MH – MeSH term/CINAHL Exact Subject Heading 100 Appendices MEDLINE Search ID Search terms terms S1 S2 Cancer OR neoplasms OR tumo?r OR maliginan* OR oncolog* nursing Chemotherapy OR Radiotherapy OR Stem cell transplant OR Bone marrow transplant OR Immunotherapy Case management OR care coordinat* OR advanced practice nurs* OR S3 APN OR advanced nurs* care OR patient navigat* OR nurs* navigat* OR nursing intervention S4 Quality of life OR QoL OR Health related quality of life OR HRQoL OR patient outcomes S5 Symptom* OR pain OR nausea OR vomiting OR diarrhea OR fatigue S6 S1 OR S2 S7 S6 AND S3 AND S4 S8 S6 AND S3 AND S5 Appendices 101 PsycINFO Search ID Search terms terms S1 S2 S3 Cancer OR tumo?r OR malignan* (MH "Neoplasms+") OR (MH "Oncology Nursing") OR (MH "Radiation Oncology") Chemotherapy OR Radiotherapy OR Stem cell transplant OR Immunotherapy OR Bone marrow transplant Case management OR care coordinat* OR advanced practice nurs* OR S4 APN OR advanced nurs* care OR patient navigat* OR nurs* navigat* OR nursing intervention S5 Quality of life OR QoL OR Health related quality of life OR HRQoL OR patient outcomes S6 Symptom* OR pain OR nausea OR vomiting OR diarrhea OR fatigue S7 S1 OR S2 OR S3 S8 S7 AND S4 AND S5 S9 S7 AND S4 AND S6 Legend: MH – MeSH term/CINAHL Exact Subject Heading 102 Appendices Appendix B: Critical appraisal checklists and data extraction forms from JBI MASTARI Appendices 103 104 Appendices Appendices 105 106 Appendices Appendices 107 ...Keywords Care coordination, cancer patients, treatments, symptoms, systematic review, and quality of life i Abstract Background: Patients living with cancer experience poor symptoms and quality of life. .. usual care to guarantee that the demands of patients and medical treatments are met 22 Chapter 2: Literature Review 2.4.2 Care coordination The delivery of care coordination originated in patient... were ? ?quality of life? ??, ? ?cancer? ?? and ? ?care coordination? ?? The term ? ?quality of life? ?? was expanded to “health-related quality of life? ??, “outcomes”, “HRQOL” and “qol” The term ? ?cancer? ?? was expanded