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

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. 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. 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%. 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.