Background of the Problem
Cancer is considered to be the plague of the 21st century. It is one of the primary causes of mortality in the world. In the US alone, over 600,000 patients die of cancer per year (NIH, 2016). In addition, the number of new cases of cancer is growing, exceeding 1,700,000 diagnoses per year (NIH, 2016). Cancer is a dangerous disease that is very hard to cure. At later stages of the disease, when cancer has entered the metastasis stage, recovery is almost impossible.
The only way to treat the disease with a modicum of success is through chemotherapy, which is a dangerous method full of potential drawbacks and side effects. The common rumor states that undergoing chemotherapy decreases a person’s lifespan by an average of 5 to 10 years (NIH, 2016). This contributes to the exceeding rates of depression, anxiety, and stress undergone by the patients. They are caught in a situation where they are either going to die or suffer long-term effects from the treatment.
As it stands, the medical community does not provide a centralized EBP response to treating and preventing anxiety in patients, which is bound to lead to many long-term issues during and past the chemotherapy stage. Some of the suggested prospective ways of relieving anxiety involve medications, mindfulness-based techniques, physical activity, yoga, and acupuncture. Although each of these techniques shows promise, the results of randomized trials are often inconclusive, which prevents the adoption of either technique into wide medical practice.
PICOT Question
In patients diagnosed with cancer and undergoing chemotherapy (P), does acupuncture as a means of reducing anxiety in patients (I), compared to standard hospital protocol (C), provide better results (O) within a 1-month period (T)?
Purpose of the Study
The purpose of the study is to test out acupuncture as one of the potential non-intrusive methods of dealing with stress and anxiety associated with chemotherapy. The results of the experiment would add to the existing body of literature and provide insights on the viability of the technique in short-term and long-term prevention and recovery from psychological aspects of the treatment.
Methodology
The study is to be conducted utilizing a mixed-methods approach, combining quantitative and qualitative aspects of information-gathering and analysis. Qualitative information gathered from peer-reviewed literature will be utilized in order to understand the application of acupuncture in order to devise a comprehensive training program for nurses as well as to assess the potential results of the research. In addition, the qualitative material would be useful in analyzing and interpreting the findings as well as comparing them with other studies and techniques of anxiety and stress relief.
The information would be extracted from medical databases such as PubMed, CINAHL, Cochrane, and MEDLINE utilizing keywords such as cancer, anxiety, stress, depression, acupuncture, and chemotherapy. All articles reviewed in the scope of this research would need to be peer-reviewed and published within the last 10 years. Every source would be individually assessed in order to determine inclusion or exclusion from the study.
The quantitative part of the research would involve the application of the chosen method of anxiety and stress relief in a clinical setting. Quantitative data about the patients’ levels of anxiety would be collected before and after the intervention, using the GAD7 Anxiety Test Questionnaire. The data collected from the surveys will be analyzed using standard statistical methods, such as the t-tests, ANOVA, correlations, and regression analyses.
Synthesis of Evidence
It is scientifically proven that patients undergoing chemotherapy and other cancer treatments are more susceptible to increased levels of stress and anxiety. Hinz et al. (2010) state that the levels of anxiety in cancer patients are at least twice as high when compared to the general population. The researchers also indicated that levels of anxiety are correlated with patient age, with anxiety in elder patients not differing much from the general population.
Psychosocial interventions are being widely recognized as some of the less intrusive and more effective measures of managing anxiety. According to Jacobsen and Heather (2009), who conducted a systematic review of studies dedicated to various aspects of the implementation of psychosocial interventions. Out of 14 studies reviewed, eight offered conclusions about the efficacy of interventions for improving the patient’s mood and decreasing anxiety. Out of those eight studies, six came up with positive conclusions, which prove the potential of acupuncture in preventing and reducing anxiety.
Garcia et al. (2013) conducted a much wider systematic review of available evidence regarding the effectiveness of acupuncture in reducing some of the basic side-effects of chemotherapy, such as pain, nausea, fatigue, anxiety, sleep disturbance, and xerostomia. According to the findings, acupuncture had a decreased ROB when treating physical side-effects such as nausea and xerostomia. However, the results proved more positive when treating mental and emotional side-effects, such as fatigue, anxiety, and disrupted sleep patterns.
Errington-Evans (2011) conducted a comparative analysis of acupuncture in cancer researches in order to determine similarities and differences between the approaches as well as the differences in results. He discovered that while every study provided evidence of acupuncture offering results comparable to CBT, the discrepancies between researches as well as differences in western and eastern applications do not allow forming a coherent pattern of evidence to support the inclusion of acupuncture as a primary method of treating anxiety and stress.
Finally, Molassiotis et al. (2012), in their research of the use of acupuncture in patients with breast cancer, have discovered that acupuncture is useful for reducing the levels of anxiety, stress, and cancer-related fatigue in the majority of patients. This mirrors the results of other reviews provided in the scope of this paper, indicating the potential acupuncture has as a psychosocial method of therapy.
Proposed Changes
The proposed change to the existing medical practice involves the introduction of pre-and post-chemotherapy acupuncture treatment for cancer patients as a means of reducing anxiety and stress. Acupuncture should be treated as an alternative to conventional CBT due to similarities in results combined with the less stressful environment as well as the lack of psychological implications associated with CBT (Errington-Evans, 2011).
Implementation Strategies
Acupuncture should be implemented in patients with intervals matching their chemotherapy schedules. If the intervals exceed 2 weeks, acupuncture sessions should be held once or twice a week during these time periods in order to reduce long-term anxiety. The intervention is to be conducted utilizing trained personnel. Patients would be asked to fill out the GAR7 Anxiety Test Questionnaires, which would help detect any changes in overall anxiety and mood scores for each patient. The intervention for every individual patient is to continue for 1 month. The research is expected to last for 3 months.
Conclusions and Implications for Further Practice
Acupuncture is a prospective non-intrusive way of treating anxiety in cancer patients undergoing chemotherapy. Its effectiveness is supported by numerous sources of Asian and Western origin. It is a relatively simple and non-expensive way of reducing and preventing anxiety in stressful situations. This research is meant to test the usefulness of acupuncture in a clinical setting. The research design is simple and easy to replicate, meaning that it can be potentially used in other settings or on a grander scale.
References
Errington-Evans, N. (2011). Acupuncture for anxiety. CNS Neuroscience and Therapeutics, 18(4), 277-284.
Garcia, M. K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., … Cohen, L. Systematic review of acupuncture in cancer care: a synthesis of the evidence. Journal of Clinical Oncology, 31(7), 952-960.
Hinz, A., Krauss, O., Hauss, J. P., Hockel, M., Kortmann, R. D., Stolzenburg, J. U., & Schwarz, R. (2010). Anxiety and depression in cancer patients compared with the general population. European Journal of Cancer Care, 19(4), 522-529.
Jacobsen, P. B., & Heather, S. J. (2009). Psychosocial Interventions for anxiety and depression in adult cancer patients: Achievements and challenges. CA: A Cancer Journal for Clinicians, 58(4), 214-230.
Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, D. W., Filshie, J., … Richardson, A. (2012). Acupuncture for cancer-related fatigue in patients with breast cancer: A pragmatic randomized controlled trial. Journal of Clinical Oncology, 30(36), 4470-4476.
NIH. (2016). Cancer statistics. Web.