| 1. |
- Enblom, Anna, 1978-, et al.
(författare)
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Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea - a randomized controlled study.
- 2012
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Ingår i: Annals of oncology. - : Elsevier BV. - 1569-8041 .- 0923-7534. ; 23:5, s. 1353-1361
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It is not known if verum (real) acupuncture is effective for nausea and vomiting (emesis) during radiotherapy. PATIENTS AND METHODS: We randomly treated 215 blinded cancer patients with verum: penetrating 'deqi' creating acupuncture (n = 109) or non-penetrating sham needles (n = 106) two to three times per week. The patients documented emesis daily during the radiotherapy period. Primary end point was the number of patients with at least one episode of nausea. RESULTS: In the verum and the sham acupuncture group, 70% and 62% experienced nausea at least once during the radiotherapy period (relative risk 1.1, 95% CI 0.9-1.4) for a mean number of 10.1 and 8.7 days. Twenty five percent and 28% vomited, and 42% and 37% used antiemetic drugs at least once, respectively. Ninety-five percent in the verum acupuncture group and 96% in the sham acupuncture group believed that the treatment had been effective against nausea. In both groups, 67% experienced positive effects on relaxation, mood, sleep or pain reduction and 89% wished to receive the treatment again. CONCLUSION: Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea, but in this study, nearly all patients in both groups experienced that the treatment was effective for nausea.
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| 2. |
- Lindgren, Anna, 1981-
(författare)
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Incontinence, physical activity, and pelvic floor muscle training in female pelvic cancer survivors after radiotherapy
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cancer treatment continues to improve, contributing to an ever-growing population of cancer survivors. Pelvic cancer survivors (PCS) constitute the second largest group of female cancer survivors after breast cancer. Many female PCS have been treated with radiotherapy as a part of their cancer treatment. Unfortunately, like all effective cancer treatments, pelvic radiotherapy is associated with a risk of subsequent, unwanted side effects. Some side effects remain or persist long after the end of treatment and some are even lifelong. A common and burdensome side effect after pelvic radiotherapy is urinary and/or fecal incontinence. Incontinence is known to negatively affect quality of life (QoL) and physical activity levels. Physical activity contributes to several positive health effects. In cancer survivors, it may reduce the risk of recurrence and even the mortality risk. Cancer survivors in general, and female PCS in particular, tend to be less physically active after cancer treatment than before treatment. When suffering from urinary and even fecal incontinence, pelvic floor muscle training (PFMT) is recommended as a first-line treatment for the general population. In addition to decreased incontinence levels, PFMT may contribute to increased physical activity and better QoL. However, little attention is given to PFMT as a potential treatment for incontinence in the Swedish national care program for pelvic cancer rehabilitation. Furthermore, there is as yet no evidence that PFMT is as effective in female PCS as in female non-cancer survivors. The effectiveness of PFMT cannot be taken for granted because female PCS survivors often have treatmentinduced damage to structures in the pelvic floor that might affect its applicability. However, the problem of incontinence among female PCS remains, along with the fact that they tend to be less physically active than other cancer survivors. Indeed, this is an important research area and a necessary problem for health-care providers to resolve, not least for physiotherapists.Aim: The overall aim of this thesis is to improve the understanding of female PCS’ experiences of incontinence in relation to physical activity, QoL, and rehabilitative efforts, including PFMT. This includes gaining increased knowledge about the relation between incontinence and physical activity in the form of exercise and QoL, and whether PCS experience that physiotherapy contributes in a valuable way to reducing their incontinence. This could enable the development of meaningful physiotherapeutic interventions, that PCS can and are willing to engage in, to achieve a potential reduction in incontinence, as well as increased QoL and activity levels.Methods: The thesis includes four different studies, using three different methods, all conducted with female PCS. Studies I (n=13) and IV (n=11) are qualitative individual interview studies, using semi-structured interview guides. Study II is a cohort-based cross-sectional observational study (n=578) and Study III is a prospective cohort-based observational study (n=260).Results: Female PCS reported an absence of information regarding incontinence as a potential side effect of radiotherapy treatment. They experienced that incontinence prevented them from being as physically active as before treatment, and that incontinence of urine and feces impaired several aspects of QoL, including sexual health. They lacked potential rehabilitative options beyond conventional pelvic cancer rehabilitation. After practicing PFMT for three months, they found it a valuable rehabilitative measure for incontinence. They also experienced the physiotherapeutic support and guidance as valuable in teaching them how to contract the pelvic floor muscles correctly and providing individual guidance regarding dose, frequency, and progression of the training. In Study II, 67% of female PCS exercised at least once a week, while 33% exercised less than once a week. Women who reported leakage of large or all volume of feces (multivariable analysis) were statistically significantly more likely to exercise less than once a week. A similar co-variation was seen among women who reported leakage of moderate to large volumes of urine (univariate analysis). This, however, was not statistically significant in a multivariable analysis. When exercising on a weekly basis, they reported less frequently depressed mood and better QoL, compared to those who exercised less than once a week. Three months after an individually designed intervention program, in line with the conventional pelvic cancer rehabilitation offered within Swedish healthcare today, female PCS reported statistically significantly lower levels of urinary and fecal incontinence. However, no statistically significant changes in frequency of exercise were seen.Conclusion: Incontinence was a barrier to physical activity and exercise, and it reduced QoL and impaired sexual health in female PCS. When experiencing incontinence, and in particular fecal incontinence, female PCS were less likely to exercise on a weekly basis. Female PCS who exercise at least once a week experienced better QoL and less frequently depressed mood than PCS who were not exercising every week. Female PCS did not exercise more often after conventional pelvic cancer rehabilitation, not even after incontinence levels were reduced. Female PCS had a positive attitude towards PFMT. After at least three months’ experience of practicing PFMT, they found it a valuable rehabilitative effort for incontinence. They also found physiotherapeutic support and guidance to be of great importance. Female PCS expressed a need for better information routines regarding side effects, such as incontinence, after cancer treatment. They also expressed a need for better information routines, including accessibility of additional rehabilitative efforts, beyond the conventional pelvic cancer rehabilitation offered today, when suffering from incontinence of urine and/or feces.
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| 3. |
- Enblom, Anna, 1978-, et al.
(författare)
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Can individuals identify if needling was performed with an acupuncture needle or a non-penetrating sham needle?
- 2008
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Ingår i: Complementary Therapies in Medicine. - : Elsevier BV. - 0965-2299 .- 1873-6963. ; 16:5, s. 288-94
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Tidskriftsartikel (refereegranskat)abstract
- A control treatment in acupuncture research must be credible, regardless if the needling is performed by one or by several therapists.Objective: To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability.Design: Eighty individuals were randomized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle.Results: An equal proportion of individuals, 27 (68%), in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80% (ns). Bang's blinding index was 0.20 (95% CI 0.03-0.36) in the acupuncture group and 0.10 (95% CI 0.09-0.29) in the sham group (interpretation: 20 and 10% identified needling type beyond statistical chance). Acupuncture was on a four-grade scale rated as median "mildly painful" and sham as "not painful" (ns). Pain ratings varied from median "not" to "mildly painful" in the therapists (p = 0.01).Conclusions: Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10-20% of the individuals were unblinded beyond chance. The therapists, not the needling type, influenced how painful the needling was perceived. IMPLICATIONS: To achieve blinding success in acupuncture efficacy studies using the sham needle, the needling procedure must be strictly standardized in order to minimize differences between the therapists.
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| 4. |
- Enblom, Anna, 1978-, et al.
(författare)
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Frequent Stools Were Related to Reduced Quality of Life and Capacity in Daily Activities Weekly Observations During and After Pelvic or Abdominal Radiotherapy
- 2020
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Ingår i: Cancer Nursing. - : LIPPINCOTT WILLIAMS & WILKINS. - 0162-220X .- 1538-9804. ; 43:6, s. 478-488
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Tidskriftsartikel (refereegranskat)abstract
- Background Greater knowledge regarding stool frequency and infrequency during pelvic and abdominal irradiation is needed to accurately identify patients at risk of either. Objective To describe occurrence of frequent and infrequent stools during pelvic-abdominal radiotherapy, and to compare quality of life (QoL) and activities of daily living (ADLs) of those patients experiencing frequent stools with those of patients experiencing infrequent stools. Methods Longitudinally during radiotherapy, 193 patients (64% had gynecological tumors) documented stool frequency, medications, and QoL using the Functional Assessment of Cancer Therapy-General. Results Fifty (26%) experienced frequent stools (>= 28 stools a week), and 17 (9%) experienced infrequent stools (<3 stools a week). The frequency of stools and the consumption of medication for diarrhea were highest the last week of the radiotherapy period (50% had >= 49 stools a week, and 50% could not even define the number of stools). Thirty-seven of the patients experiencing frequent stools used antidiarrhea medications. Patients with frequent stools experienced lower QoL (P = .035) and capacity in ADLs (P = .023) compared with patients not experiencing frequent stools. Conclusions A fourth of patients irradiated over pelvic or abdominal fields experienced frequent stools, defined as moderate to severe diarrhea, and those patients experienced lower QoL and capacity in ADLs compared with patients who did not experience frequent stools. Infrequent stools were rarely experienced. Implications for Practice Cancer nursing professionals should deliver evidence-based strategies to prevent frequent stools and treat frequent stools as an approach to lower the risk of impaired capacity in daily living and worsened QoL.
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| 5. |
- Enblom, Anna, 1978-, et al.
(författare)
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Methodology Aspects of Nausea Measuring During Pelvic Radiotherapy: Daily Nausea Measuring Is Successful to Identify Patients Experiencing Nausea
- 2020
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Ingår i: Cancer Nursing. - : LIPPINCOTT WILLIAMS & WILKINS. - 0162-220X .- 1538-9804. ; 43:2, s. 93-104
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Tidskriftsartikel (refereegranskat)abstract
- Background Nausea seems underreported during pelvic radiotherapy. Objective The aims of this study were to investigate if a 5-week recall measure of nausea covering the entire radiotherapy period was comparable with accumulated daily nausea measurements and to investigate if the measuring method affected potential difference in quality of life (QoL) between nauseated patients and patients free from nausea. Methods This longitudinal methodology study covered 200 patients (mean age, 64 years; 84% women; 69% had gynecological cancer). The patients graded QoL (Functional Assessment of Cancer Therapy-General). They registered nausea daily and at a 5-week recall at the end of radiotherapy. Results The nausea-intensity category scale and visual analog scale correlated well (Spearman correlation coefficient = 0.622). According to the 5-week recall, 57 of 157 answering patients (36%) experienced nausea during the radiotherapy period. Using the daily nausea measurements, 94 of 157 patients (60%) experienced nausea (relative risk, 1.65; 95% confidence interval, 1.29-2.10). Of these 94 nauseated patients, 39 (42%) did not report nausea using the 5-week recall. The nauseated patients experienced worse QoL (physical/functional subscores) than patients free from nausea whether nausea was registered daily or at the 5-week recall. Conclusions Almost half, 42%, of the patients who experienced nausea according to daily nausea measurements did not report having had nausea according to the 5-week recall. Nauseated patients graded worse QoL than patients who were free from nausea. Implications for Practice Nursing professionals should measure nausea repeatedly to identify patients at risk of nausea and worsened QoL, to be able to deliver evidence-based antiemetic treatment strategies.
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| 6. |
- Enblom, Anna, 1978-
(författare)
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Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Many patients with cancer experience emesis (nausea and vomiting) during radiotherapy. The overall aim of this thesis was to improve the situation for patients with risk for emesis during radiotherapy, by evaluating emesis in patients receiving verum (genuine) acupuncture, sham (simulated) acupuncture or standard care during radiotherapy.Methods: In study I, a cross-sectional sample (n=368) treated with radiotherapy over various fields answered a study-specific questionnaire. In study II, 80 healthy volunteers were randomized to receive needling with verum acupuncture or non-penetrating telescopic sham needles by one of four physiotherapists. In study III, 215 patients were randomly allocated to verum (n=109) or non-penetrating telescopic sham (n=106) acupuncture during their entire radiotherapy period over abdominal or pelvic fields. The same 215 patients were also included in study IV. They were compared to 62 patients irradiated over abdominal or pelvic fields, selected from study I.Results: In study I, the weekly prevalence of nausea was 39 % in all radiotherapy-treated patients and 63 % in abdominal or pelvic irradiated patients. Age younger than 40 years and previous experience of nausea in other situations were characteristics associated with an increased risk for nausea. Of the 145 nauseous patients, 34 % considered their antiemetic treatment as insufficient. Patients with nausea reported lower level of quality of life compared to patients free from nausea. In study II, most individuals needled with verum (68 %) or sham (68 %) acupuncture could not identify needling type, and that blinding result varied from 55 to 80 % between the four therapists. In study III, nausea was experienced by 70 % (mean number of days=10.1) and 25 % vomited during the radiotherapy period. In the sham group 62 % experienced nausea (mean number of days=8.7) and 28 % vomited. Ninety five percent in the verum and 96 % in the sham group believed that the treatment had been effective for nausea. In both groups, 67 % experienced other positive effects, on relaxation, mood, sleep or pain-reduction, and 89 % were interested in receiving the treatment again. In study IV, the weekly prevalence of nausea and vomiting was 38 and 8 % in the verum group, 37 and 7 % in the sham group and 63 and 15 % in the standard care group. The nausea difference between the acupuncture and the standard care cohort was statistically significant, also after overall adjustments for potential confounding factors. The nausea intensity in the acupuncture cohort was lower compared to the standard care cohort (p=0.002). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (Relative risk 1.6).Conclusions and implications: Nausea was common during abdominal or pelvic field irradiation in patients receiving standard care. Verum acupuncture did not reduce emesis compared to sham acupuncture, while reduced emesis was seen in both patients treated with verum or sham acupuncture. Health-care professionals may consider identifying and treating patients with increased risk for nausea in advance. The telescopic sham needle was credible. Researchers may thus use and standardize the sham procedure in acupuncture control groups. The choice of performing acupuncture during radiotherapy cannot be based on arguments that the specific characters of verum acupuncture have effects on nausea. It is important to further study what components in the acupuncture procedures that produce the dramatic positive but yet not fully understood antiemetic effect, making it possible to use those components to further increase quality of care during radiotherapy.
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| 7. |
- Neher, Margit, et al.
(författare)
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Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation : Focus Group Interviews Exploring Rehabilitation Professionals' Perceptions
- 2021
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Ingår i: Journal of Cancer Education. - : Springer. - 0885-8195 .- 1543-0154. ; 36:4, s. 779-786
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Tidskriftsartikel (refereegranskat)abstract
- To explore primary care professionals' perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals' knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.
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