ORLANDO, FL—Effective nursing interventions for the cluster of sleep disturbance, pain, anxiety, depression, and low energy/fatigue (SPADE) symptoms women with ovarian cancer report secondary to ongoing chemotherapy treatment are limited, concludes a literature review presented at the ONS 40th Annual Congress.

This is due, in part, to the few studies published that address treatment-related symptoms in women with ovarian cancer. In fact, only 3 of 8 studies identified in this systematic review contained detail sufficient to replicate the intervention,” reported Lorie L. Davis, MSN, RN, OCN®, of Indiana University in Indianapolis, Indiana.

The review was conducted to describe experimental and quasi-experimental research addressing interventions for the SPADE symptoms and to critique intervention quality.


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The investigators searched the PubMed database for studies meeting prespecified inclusion criteria and found 136 studies. But after further refining their results, only eight studies met the inclusion criteria and were evaluated and critiqued for the quality of the intervention in six important content areas, reported Davis.

Seven studies (87.5%) had statistically or clinically significant findings. Interventions had an average of 4.4 components, with a range of 3 to 6 components. Intervention delivery, setting, and exposure varied widely across studies. “Interventions are obviously becoming more complex,” Davis concluded.

Limitations to this study were the patients were only women with ovarian cancer, and PubMed was the only database searched. In addition, the studies focused only on treatment-related SPADE symptoms; therefore, the investigators do not know if the patients experienced the symptoms prior to treatment.

Despite the limitations, the investigations conclude that improved reporting of treatment-related  symptoms  would facilitate better translation of interventions into practice.

Attention to intervention reporting is necessary for future research, and complex cancer symptom clusters is a current research priority.

This study was supported in part by a Doctoral Degree Scholarship in Cancer Nursing from the American Cancer Society (DSCN-14-080-01-SCN); a Predoctoral Fellowship from the Behavioral Cooperative Oncology Group, Walther Program for Cancer Care Research.