Nursing Intervention Program for Patients with Cancer Symptoms


Assistant Professor Autchareeya Patoomwan, RN, PhD (Nursing)

Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


Sleep is a complex physiologic process which is vital for life.   Although the basic function of sleep remains unknown, most of the biologic controlling system of sleep involve central nervous system components which are nuclei in the hypothalamus, brainstem, and basal forebrain.1 Thus, the injury to these areas either directly from the cancer in the brain or indirectly from the cancer therapy including chemotherapy or cranial radiation and neurosurgery might affect the normal sleep/wake rhythms, causing a variety of sleep problems.  Cancer and its therapy often disrupts the circadian, homeostatic, neurologic, and psychiatric-behavioral processes that regulate normal sleep. Sleep Disturbances in Pediatric Cancer Model proposes that many factors may contribute to changes in sleep observed in children with cancer including cancer-related factors (diagnosis, medication, treatment), mechanisms of altered sleep (psychosocial, environment and biological processes), and child/family factors (child temperament, family sleep habits, child age, parenting skills, etc.).

           Sleep problems are common in children with cancer during and after treatment, and in long-term survivors.  The exact prevalence of sleep problems in children with cancer is unknown.   Moreover, prevalence rates vary across studies because of the variability and validity of measurement. It can be estimated ranging from 25% to 87%.2   However, what we know is that children with brain tumors are at increased risk for poor sleep quality, excessive daytime sleepiness, and fatigue compared to children with non-central nervous system malignancies and healthy children.3 

          Disrupted sleep can negatively affect the overall quality of life of children with cancer and the healing process as well since sleep is essential for immune function.  Thus, it is vital for nurses who work with children with cancer to have an awareness on sleep problems and provide anticipatory guidance to parents on the factors that can cause the child with cancer at risk for sleep problems.  An important role for pediatric oncology nurses is to manage sleep problems by identifying risk factors and causes of sleep problems in order to design and provide individualized intervention to promote sleep in this population.


  1. Saper CB, Scammell TE & Lu J.  Hypothalamic regulation of sleep and circadian rhythms.  Nature 2005; 27: 1257-63.
  2. Daniel LC, Schwarts, LA, Mindell, JA, Tucker, CA & Barakat, LP.  Initial validation of the sleep disturbances in pediatric cancer model.  J Pediatr Psych 2016; 41:588-99.
  3. Graef DM, Crabtree VM, Srivastava DK, Li C, Pritchard M, Hinds PS, & Mandrell B.  Sleep and mood during hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma.  Psycho-Oncol 2018; 27:1847-53.


Penprapa Piriyajittrakornkij, RN, BNS

Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

Kingtip Tamthong, RN BNS, MA (Anthropology)

Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand


The purpose of Surgical Oncology Day Care Unit, Vongvanij 8th floor, is to take care for patients and ensure a high standard of treatment, safety and satisfaction. In our unit we provide service for out-patients receiving chemotherapy. Breast cancer is the most common type of the top three diseases of cancers among women.  Regarding chemotherapy side effects, hair loss is viewed as the most common adverse effect concerning body image among cancer patients.

The Queen Sirikit centre for breast cancer serves as medical services in particular new optional treatments and high medical technology for breast cancer patients.  As we know, chemotherapy-induced alopecia has been viewed as a cause of distress to cancer patients undergoing chemotherapy treatment. Thus far, the breast center also provides scalp cooling for patients, which is considered as one of new optional methods of preventing hair loss during chemotherapy administration. 

Additionally, when the oncologist suggests the scalp cooling to reduce hair loss for patients receiving chemotherapy regimen, these patients will gain the counseling from the nurse counselor having a great deal of experience at the breast cancer clinic on 2nd floor at Vongvanij building.  Also, during chemotherapy administration these patients will obtain chemotherapy regimen with scalp cooling at the oncology day care unit, Vongvanij 8th floor as well as standard care. Therefore, to raise awareness the essence of fostering psychological supportive care concerning body image in cancer patients during chemotherapy treatment and administering holistic care are needed.

Treatment steps using scalp cooling 

1. To assess the patient’s condition by taking the history of illness, treatment, allergies, general appearance, and chemotherapy regimen.
2. To implement the scalp cooling process as following steps:
– To identify the patient by doing identification and assess the patient‘s physical and
psychological status, a history of treatment and allergies.
– To assess the ECOG Score ( Eastern Cooperative Oncology Group performance status)
– To record vital signs, laboratory and chemotherapy protocols
3. To show the scalp cooling process to patient through the photos and explanation.
4. To evaluate the hair and scalp using the Sinclair’s midline hair density scale and take the picture for evaluation in order to compare the hair loss during the treatment
5. To choose a gel and cover cap that fits for individual patient’s head
6. To make the hair wet all over the head. Then the middle hair combing is equally divided.
7. To put the gel and cover cap on the head with softness and apply a head band to reduce the compression of the gel cap on the forehead
8. To attach the scalp with the machine and then start pre cooling time with pre medication 30 minutes before chemotherapy administration. Also, the infusion time of scalp cooling depends on the chemotherapy regimen, and the machine will control the temperature at 17˚C
9. To provide a specialized warming blanket and adjust the patient’s position for the greatest comfort during the process.10. To monitor vital signs and observe at all times whether the patient has discomfort. Also, to evaluate for any negative symptoms during the process such as chills, dizziness, and headache and monitor hypersensitivity, adverse reactions for early detection and effective nursing care.
11.When the chemotherapy is completed, the scalp cooling needs to be continued until the completion of the time recommended, which is called the post infusion cooling time roughly 60 minutes.12. After finishing the cooling time process, the nurse will provide a cool dryer for the patient and advise the patient about hair care as follows:
– using baby shampoo and employing gentle combing
– avoiding the drying hair on a hot setting.
13. During treatment, the nurse will administer health education to the patients. Additionally, nurses will empower patients and offer options to enhance the image including hats, hair cover scarf and wigs. Importantly, our goal is to provide the best quality of care for our patients.
14. To record data correctly as a nursing documentation.

Results summary of scalp cooling’s indicators on 1st Oct 2017 – 30th Sep 2018.

The chemotherapy regimen. Percent of patients used scalp cooling, level hair loss 1-3.

Goal > 50% 

(no need use a wig)

Percent of patients used complete cycle scalp cooling during chemotherapy treatment.

Goal > 60%

AC: adriamycin cyclophosfamide 56.1 68.29
AC-T 85.19 81.48
T: Taxane 77.78 88.89
TC: Taxane carboplatin 50 92.86
CMF:cyclophosfamide methotrexate 5 FU 100 100
Other 50 100
Average 69.85 88.56


Adverse events from chemotherapy with scalp cooling

Regimen Adverse events Headache Cold Dizziness
AC: adriamycin cyclophosfamide 9.76% 14.63% 4.88%
AC-T 3.70% 7.41% 0
T: Taxane 0 11.11% 0
TC: Taxane carboplatin 0 7.14% 0
CMF: cyclophosfamide methotrexate 5 FU 0 0 0
Other 0 0 0
Average 2.24% 6.72% 0.81%



Ploenpit Thamnipa, RN MNS

Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Associate Professor Nanthana Thananowan, RN PhD

Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Rapepan Uppagan, RN MNS

Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Boonlert Viriyapak, MD

Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand


Purpose: To examine the effects of exercise program on peripheral neuropathy and the quality of life in patients with ovarian cancer receiving chemotherapy.

Design: A quasi-experimental design.

Methods: Participants were 86 patients with ovarian cancer receiving chemotherapy at a

university hospital. They were divided into a control group and a treatment group, with 43 samples for each group. Both groups received standardized care while the treatment group also received the exercise program, including personal reviewing about hands and legs exercise with VDO for practicing at home, knowledge about peripheral neuropathy and self-care manual, and the toolkit for stimulating hands and legs sensation. The data were collected by using a demographic questionnaire, FACT/GOG-NTX and FACT-G before the program implementation (T0) and after receiving the program (T1 and T2). Data analyses included descriptive statistics, independent t-tests, chi-square tests, and repeated measures ANOVA.

Main findings: There was no statistically significant difference of the mean scores on peripheral neuropathy (F = 0.52, p = 0.473) and the quality of life (F = 0.93, p = 0.477) between the study groups. However, for the intervention group, the time effects on peripheral neuropathy at T0 and T1 (mean difference = 4.64, p = 0.002) and at T0 and T2 (mean difference = 6.28, p < 0.001) were statistically significant.

Conclusion and recommendations: These findings imply that those patients in the intervention group had a stable degree of peripheral neuropathy at each two time points. Further research is needed to measure peripheral neuropathy at different times, i.e. every 3 weeks to help clarify the impairment pattern. Results enhanced nurses to understand and develop interventions

to prevent peripheral neuropathy among patients receiving chemotherapy.


Newton MJ. An exercise intervention for women undergoing chemotherapy for ovarian cancer: feasibility and preliminary outcomes [master’s thesis]. Queensland: Queensland University of Technology; 2010. 168 p.

Maryam A, Fazlollah A, Eesa M, Ebrahim H, Abbas VF. The effect of designed exercise programme on quality of life in women with breast cancer receiving chemotherapy. Scand J Caring Sci. 2010;24(2):251-8.

Thamnipa P, Konsue P, Therasakvichya S. Perception of symptoms and symptom management of side effects in ovarian cancer patients receiving chemotherapy. J Nursing Sci. 2014;32(1):28-38. 


Rasarudee Sriwisai, RN

Chemotherapy Unit, Outpatient Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand


Gemcitabine is a cytotoxic agent of antimetabolite, which can be given alone or combined with other anti-cancer drugs, such as Cisplatin, Carboplatin, Paclitaxel, and Docetaxel, depending on the type of cancer. However, it is likely to cause venous pain during drug administration. 

At Chemotherapy Unit, Chulabhorn Hospital, the incidence of venous pain between August and October 2015 was 43 out of 117 times of drug administration (37%). Thus, this study aimed to determine the contributing factors that influenced venous discomforts in cancer patients who received Gemcitabine administration.  

A retrospective study was conducted during January to October 2016 after the approval by Human Research Ethics Committee of Chulabhorn Research Institute No.007/2559. Three hundred and seventy-two sessions of 72 patients receiving Gemcitabine alone or in combination with other cytotoxic drugs were extracted from Chulabhorn Hospital’s data system. Gender, age, type of cancer, type of drug, regimen, dosage, solution, cycle, infusion time, puncture site, period of pain, location of pain, and pain score were analysed. The ordinal logistic regression with cluster variation analysis was performed by using STATA/SE version 12 (STATA Corp LP, College Station, TX, USA) statistical software.

Results showed that patients with Gemcitabine administration experienced venous pain (37.4%), including mild pain (32.3%) and moderate to severe pain (5.1%). The contributing factors that influenced venous pain were gender, age, cycle of Gemcitabine and puncture site.  There was a statistical significance in female, aged 65 years and younger, with the 4th to the 9th cycle (p<0.05). Whilst, the puncture site at Basillic vein significantly yielded less pain (p<0.05).

This study may benefit oncology nurses for the prediction of venous pain in patients receiving Gemcitabine. Moreover, the management planning of puncture site to lessen venous complications in those receiving chemotherapy should be administered as sensitive priority.

Event Hours(1)

  • Lotus 5-6.

    01:00 pm – 02:30 pm

    1. Asst. Prof. Dr. Autchareeya Patoomwan (Rama)
    2. Mrs. Penprapa Piriyajittrakornkij (CU)
    3. Mrs. Ploenpit Thamnipa (SI)
    4. Miss Rasarudee Sriwisai (CRA)

    Miss Kingtip Tamthong (CU)

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