Characteristics and effectiveness of complex nursing interventions aimed at reducing symptom burden in adult patients treated with chemotherapy: a systematic review of randomized controlled trials.
OBJECTIVE
The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy.


METHODS
We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way.


RESULTS
We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in common. Although some interventions fail to show significant effects, others significantly reduce aspects of symptom burden by 10-88%.


CONCLUSIONS
Although some complex nursing interventions in this systematic review produce clinically meaningful and statistically relevant reductions in symptom burden, based on the available data it is not possible to make definitive conclusions about the vital parts, circumstances or preferred target population of the interventions. Quality of the studies and modeling and piloting of the interventions are important challenges for future research.
Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium; Department of Oncology Nursing, University Hospitals Leuven, Belgium. Electronic address: annemarie.coolbrandt@uzleuven.be.
Annemarie
A
Coolbrandt
Department of General Medical Oncology, University Hospitals Leuven, Belgium; Department of Oncology, KU Leuven, Belgium.
Hans
H
Wildiers
Academic Centre for General Practice, KU Leuven, Belgium.
Bert
B
Aertgeerts
Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.
Elisa
E
Van der Elst
Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Belgium.
Annouschka
A
Laenen
Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.
Bernadette
B
Dierckx de Casterlé
Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands.
Theo
T
van Achterberg
Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium; Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Koen
K
Milisen
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D009736:Nursing Process; D016032:Randomized Controlled Trials as Topic
D000970:Antineoplastic Agents
Cancer; Chemotherapy; Complex interventions; Intervention; Nursing; Side effects; Symptom burden; Systematic review