Originally published as JCO Early Release 10.1200/JCO.2007.15.9053 on November 3 2008

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Nonpharmacologic Strategies for Managing Common Chemotherapy Adverse Effects: A Systematic Review

Kerryann Lotfi-Jam, Mariko Carey, Michael Jefford, Penelope Schofield, Catherine Charleson, Sanchia Aranda

From the Department of Nursing and Supportive Care Research, Peter MacCallum Cancer Centre; Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne; and The Cancer Council Victoria, Carlton, Victoria, Australia

Corresponding author: Sanchia Aranda, PhD, RN, Cancer Nursing Research, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Melbourne, Victoria 8006, Australia; e-mail: sanchia.aranda{at}petermac.org

Purpose Adverse effects of chemotherapy can be severe and can have a significant impact on a person's quality of life. With chemotherapy treatment increasingly administered in the ambulatory setting, there is a need for patients to be informed about effective self-care strategies to manage treatment adverse effects. Advice for patients needs to be based on evidence. This systematic review provides an overview of the intervention research in this area as well as an effectiveness review of nonpharmacologic (self-care) strategies evaluated in high-quality randomized controlled trials (RCTs).

Methods An extensive literature search was conducted to identify RCTs relating to self-care strategies for reducing nausea/vomiting, constipation, diarrhea, fatigue, hair loss, or mucositis. Relevant studies published in peer-reviewed journals between 1980 and August 2007 were included. Study characteristics, results and methodologic quality were examined. High-quality RCTs were further analyzed to establish the effectiveness of specific self-care strategies.

Results The search identified 77 RCTs. Findings from RCTs of reasonable quality provide limited support for cognitive distraction, exercise, hypnosis, relaxation, and systematic desensitization to reduce nausea and vomiting, psycho-education for fatigue, and scalp cooling to reduce hair loss.

Conclusion Although some strategies seem promising, the quality of the RCTs was generally quite low, making it difficult to draw conclusions about the effectiveness of self-care strategies. Future studies require better design and reporting of methodologic issues to establish evidence-based self-care recommendations for people receiving chemotherapy.

published online ahead of print at www.jco.org on November 3, 2008.

Supported by a grant from the Peter MacCallum Cancer Foundation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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