Volume 6, Issue 3, March – 2021 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Prevention of Complications in Cancer Patients:

A Systematic Review
Gina María Padilla-Garcia1, Isabel Cristina Mesa-Cano1,2,
Andrés Alexis Ramírez-Coronel1,2,3
1
Master's Degree in Postgraduate Care Management of the Catholic University of Cuenca, Ecuador.
2
Nursing Career of the Catholic University of Cuenca, Ecuador.
3
Laboratory of Psychometry, Comparative Psychology and Ethology of the Center for Research, Innovation and Technology
Transfer (CIITT) of the Catholic University of Cuenca, Ecuador.

*Correspondence: Mesa Cano Isabel Cristina

Affiliation: Master in Postgraduate Care Management, Universidad Catholica de Cuenca, Ecuador

Abstract:-The oncologic patient faces a series of doubts long term, as part of the most important activities because it
and uncertainties characterized by the fear of the side allows the patient to actively participate in their care (2).
effects that these procedures bring with them, being
prevention one of the most effective strategies to be able In many cases of oncologic patients who receive a
to cope with this scenario, with direct repercussion in surgical treatment, temporary or permanent, they do not
their emotional/psychological state. The main objective cease to be a problem for the patients if they do not have
was to determine the measures to prevent complications knowledge of prevention in order to lead a more pleasant
in oncologic patients. A systemic literature review was life and thus avoid complications that aggravate their current
carried out, using the following databases: PubMed, situation (3).
Scielo, Redalyc, Scopus, Springer y Science direct. Using
the following keywords: "oncologic", "prevention" Therefore, the nurse who works in the area of
"complications". The results of the systematic review oncology patient care should carry out an educational
have made it evident that the management of prevention program aimed at informing, resolving doubts and questions
of complications is a fundamental component of the of the patient and family members about prevention before,
treatment of the cancer patient and should be based during and after the treatment received, in order to reduce
primarily on prevention rather than treatment. Effective and prevent in some cases the risk of complications derived
prevention management in oncology patients allows for a from the treatment and possible hospital readmissions, as
better quality of life for the patient, avoids potentially well as to improve their quality of life (4).
serious complications and facilitates adherence to
chemotherapy treatment. The probability of presenting The present study seeks to determine the effectiveness
complications depends primarily on the chemotherapy of prevention of complications in oncology patients, about
plan, and therefore the precise determination of the the treatment, side effects that may occur, special care and
same is fundamental for the individual management of how this treatment can modify their lives (5). This in order
each patient. Most of these complications can be to have evidence for health professionals to implement
prevented since they develop due to errors in the and/or improve educational programs based on the
education of oncology patients. knowledge needs of each patient and his family about these
aspects, not only inside the hospital but also outside it (6).
Keywords:- Complications, Cancer, Prevention.
Continuous follow-up of patients should also be
I. INTRODUCTION established, where a team of health professionals treat the
person holistically, teach them how to take care of
Cancer is one of the main public health problems, themselves, how to manage their symptoms, also take care
which in the last decade has increased notably within the of their mental health, and above all provide the emotional
framework of chronic degenerative diseases, affecting men support that is so necessary in these cases; this would reduce
and women without exception (1). the negative impact on the life of each person, minimize the
possibility of mistakes by the patient related to the
This disease is characterized by the uncontrolled management of their disease and help to reduce undesirable
proliferation of cells, it begins with the transformation of a situations or complications that hinder the outcome of the
single cell, which can have its origin in external agents and treatment established (7).
in inherited genetic factors, one of the treatments of choice
for this disease is chemotherapy/radiotherapy depending on The reason for this research is due to the fact that
the cases and the stage, nursing care in this treatment should oncology patients currently face a series of doubts and
include the prevention of complications that occur in the uncertainties characterized by the fear of the side effects that

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these procedures bring with them, a situation that directly
affects their recovery and quality of life (8). In view of this
reality, prevention is one of the most effective strategies to
cope with this scenario, which implies that the person knows Table 1: Detailed search strategies.
or is aware of the different preventive actions or precautions Database Records obtained Date of search
to consider in order to achieve a satisfactory state of health PubMed 15 12/12/2020
(9). Scielo 50 16/12/2020
Redalyc 10 05/01/2021
The prevention of complications in an oncological Scopus 8 08/01/2021
patient is an aspect that has a direct impact on his physical, Springer 6 30/12/2020
mental and emotional health, since the person takes the Science direct 5 22/12/2020
corresponding measures to take care of himself, ceasing to
feel "useless", adapting certain behaviors to the reality of his Inclusion criteria
treatment, with self-esteem, confidence and hope that The selection of articles was made as follows:
everything will go well, actions that although they may not - Languages: Spanish and English.
seem of great importance, for specialists such as Júlia - Year of publication: from 2010 to 2020.
Schneider, are related to his quality of life and emotional - Original research article.
well-being (10). - Quantitative or mixed studies.
- Quality of the articles.
Considering all the above, the present scientific article
of bibliographic review arises with the purpose of Exclusion criteria
determining the effectiveness in the prevention of We excluded from the study articles that are not from
complications in oncological patients, we will proceed to the year of publication sought, thesis type studies
duly substantiate the subject addressed by means of a (undergraduate, graduate and doctoral), monographs and
theoretical support duly referred, which will then be argumentative essays, the impossibility of retrieving the full
contrasted with the data obtained, being able then to text of the article and articles repeated from a previous
corroborate or refute the hypotheses that are part of the search.
study (11).
Procedure
The following research questions have been posed: In the first stage, the topic and formulation of the
What are the types of nursing interventions aimed at research question in the acronym format PICO (Population,
teaching for the prevention of complications in oncologic Intervention, Control and Outcome) were identified: "What
patients? and What effects does the application of nursing are the types of nursing interventions aimed at teaching for
interventions aimed at teaching produce in the prevention of the prevention of complications in oncology patients?" and
complications in oncologic patients? "What effects does the application of nursing interventions
aimed at teaching produce in the prevention of
II. METHODOLOGY complications in oncology patients?"
Type of research In the second stage, original articles related to the
A systematic review of the literature was carried out. prevention of complications in oncology patients, published
The recommendations of the PRISMA statement were used in Portuguese, English and Spanish, with full text and
to carry out this process. The document was written through online, were established as inclusion criteria, and thesis-type
the analysis and synthesis of relevant scientific information studies (undergraduate, graduate and doctoral), monographs
on prevention of complications in oncologic patients. and argumentative essays were established as exclusion
criteria. Then, in the third stage, the primary selection of
Search strategies publications was made by reading the title and abstract.
The following databases were reviewed: PubMed,
Scielo, Redalyc, Scopus, Springer and Science direct. The In the fourth and fifth stages, the studies were
following terms and keywords were used: "prevention", evaluated with more criteria (according to the objectives
"complications", "oncology" (in Spanish) and "prevention", set), and the results obtained were interpreted, which led to
"complications", "oncology" (in English). The intersection the sixth stage where the formation of the discussion and
between these descriptors, using Boolean AND and OR synthesis of knowledge was established. A systematic
connections. We also reviewed cross-sectional, retrospective review was carried out with rigorous and exhaustive
and prospective studies. scientific information with studies with more and better
pertinent information, without introducing information or
publication bias, in such a way as to contribute to the
scientific community.

Table 2. Summary of article selection process.

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Phase 1: Screening according to
No. of records obtained in each Phase 2: Screening according to full text and
article title and abstract (62
database (200 items) article quality (13 articles)
articles)
PubMed: 3 PubMed:3 PubMed: 3
Scielo: 5 Scielo: 5 Scielo: 5
Redalyc: 2 Redalyc: 2 Redalyc: 2
Scopus: 1 Scopus: 1 Scopus: 1
Springer: 0 Springer: 0 Springer: 0
Science direct: 1 Science direct: 1 Science direct: 1

III. RESULTS

Cancer is a serious disease, but when optimal care is provided, it can be reversed. In this sense, the quality of life of people
with cancer includes multiple dimensions: physical, social, psychological and spiritual, which the nursing professional will take
into account in his care plan; the measures of well-being will be functional activities of pain management, fatigue, tiredness, sleep,
nausea, vomiting and other symptoms as individual responses of the patient. Self-care and complication prevention skills are
moderately related to quality of life in adult cancer patients. Therefore, considering self-care and quality of life as fundamental
pieces for the prevention and recovery of the health of individuals, it points to the importance of a work aimed at an integral health
care with an expanded look at the psychosocial aspects of health. Some of the findings were that people who improved their
capacity for self-care perceive their quality of life better, effectively reducing later complications.

Table 2. Articles selected for review with their main results.

Authors/citation/ Participants Interventions Results Tipo de
Year/ Country/ estudio
Database/Number
Vázquez Llanos, 18 cases 23 surveys applied in two Deficiencies were shown in the Quantitative-
Díaz Campos and diagnosed with workshops carried out in prevention actions carried out in the qualitative
Pérez Rondón (23) cancer, with the the chair for the elderly community and in the comprehensive cross-
2019/Cuba addition of their belonging to the San Juan care of oncology patients and their sectional
Scopus/1 family members, de Dios Popular Council, families, from a psychosocial approach. descriptive
and 27 families which dealt with the study.
designated by the prevention of chronic
Basic Health non-communicable
Team as families diseases and aging.
at risk. Information collection
instruments were applied
to a total of 162 people.
Veintramuthu San A study was Drug-drug interactions Sixty-five interactions were identified Prospective -
kar conducted in a were analyzed using the out of 100 patients. Of all drug-drug observational
Parthasarathy Ra multispecialty Medscape drug interactions, 33.85% were major, 60% study.
ma Jerrin Mathew hospital over an interaction checker. were moderate and 6.15% were minor
(24) 8-month period interactions. Clinically significant
(2020) among 100 interactions were reported (55.38%) and
India hospitalized 69.44% of them were accepted and
Scielo/2 cancer patients in modified accordingly. In addition, we
the oncology observed 50.77% of interactions
department. between coadministered drugs. Older
people (48%) have more comorbidity,
such as diabetes (30%) and hypertension
(17.81%).
Cintia Capucho It was performed It was performed during a The type of catheter material presented Quantitative
Rodríguez with 30 women session of antineoplastic an association suggesting risk (RR = observational
Caroline with breast chemotherapy for the 2.76; CI = 1.199, 6.369); the infusion study.
Guilherme cancer. treatment of breast cancer, rate factor was RR = 2.22; whereas, CI =
Moacyr Lobo da in an oncology outpatient 0.7672, 6.436; The trajectory factors,
Costa Júnior clinic of a university number of punctures and vein movement
Emilia Campos hospital in the interior of present RR.
de Carvalho (25) the state of São Paulo,
(2012) Brazil. Data were

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Brasil. observed throughout the
Scielo/3 procedure, identifying
whether the result
occurred or not.

Luiza Zanette 18 cancer patients A sociodemographic The most prevalent age group was 65 to This is a
Reolon in hospital care questionnaire and the 74 years old, white, male, married, quasi-
Lilian Rigo who developed Quality-of-Life primary schooled, SUS users and experimental
Ferdinando de oral mucositis. questionnaire (UW-QOL) residents of different cities. The most trial.
conto were applied before the frequent cancer diagnosis was acute
Larissa Cunha low power laser sessions leukemia, with chemotherapy being the
(26) and after lesion treatment in 100% of cases and
(2017) regression. The statistical radiotherapy in 50%. The mean quality
Brasil. tests used were Student's of life score of the patients was 456.2
Scielo/4 t-test and Chi-square test, before the start of laser treatment and
assuming p<0.05 to be 678.3 after the intervention.
significant.

Frank Daniel 179 consecutive The incidence of Postoperative complications occurred in Prospective
Martos-Benítez patients who postoperative 54 subjects (30.2%); the most frequent cohort study
Anarelys underwent complications was were pulmonary (14.5%), pain (12.9%),
Gutiérrez-Noyola thoracic or evaluated using the cardiovascular (11.7%), infectious
Adisbel digestive tract Postoperative Morbidity (11.2%) and surgical wound (10.1%). In
Echevarría- surgery for cancer Survey and its influence the multivariate logistic regression
Víctores (27) and were admitted on mortality and hospital analysis, pulmonary (OR 18.68, 95%CI
(2015) to an oncologic stay. 5.59 - 62.39, p < 0.0001), cardiovascular
Cuba. intensive care (OR 5.06, 95%CI 1.49 - 17.13, p =
Scielo/5 unit. 0.009), gastrointestinal (OR 26.09,
95%CI 6.80 - 100, p = 0.009), and
gastrointestinal (OR 26.09, 95%CI 6.80
- 100, p = 0.002) complications were
associated with the most common
complications; CI95% 6.80 - 100.16; p <
0.0001), infectious (OR 20.55; CI95%
5.99 - 70.56; p < 0.0001) and renal (OR
18.27; CI95% 3.88 - 83.35; p < 0.0001)
complications were independently
related to hospital morbidity. The
occurrence of at least one complication
increased the probability of remaining
hospitalized (Log Rank test; p = 0.002).
García Almeida, 30 patients with Supplementation lasted Seventy percent were men, with a mean Single-center,
Lupiáñez Pérez, malnutrition or at six days. Compliance age of 60 years (range: 32 to 79) and observational,
Mercedes Blanco risk of (packaging used), with neoplasms of the lung (43.3%), prospective
Naveira, Ruiz malnutrition. acceptability (Madrid ENT (26.7%) and breast (13.3%), stage study.
Nava, Medina, Supplementation scale), anthropometric III-IV (56.7%), treated with radiotherapy
Cornejo Pareja, lasted six days. variables and (93.3%), chemotherapy (60%) and
Gómez Pérez, et Compliance gastrointestinal adverse surgery (16.7%). The product was
al. (28) (containers used), events (AEs) were accepted by all patients. Compliance
(2017) acceptability evaluated. was 100%. Gastrointestinal AEs (grade
España. (Madrid scale), II) related to the supplement were
Redalyc/6 anthropometric observed in two patients (6.7%); both
variables and subjects had previous gastrointestinal
gastrointestinal pathologies. Median weight, body mass
adverse events index (BMI) and protein intake
(AEs) were increased during supplementation (0.2

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evaluated. kg, 0.1 kg/m2 and 6.2 g). No differences
were observed with respect to calorie,
lipid and carbohydrate intake.

Araujo et al. (29) Clinically relevant fatigue (score ≥ 4) Cross-

(2015) Probabilistic Fatigue was assessed was present in 31.9% of the sample and sectional
Colombia. sample of 163 using the Piper fatigue the mean intensity was 6 (SD = 1.3). study
Redalyc/7 patients under scale. Pain and depression were factors
outpatient follow- independently associated with fatigue
up.
Marques da Silva Conducted with Data were collected from Cognitive function leads to lower overall
et al. (30) 144 patients (72 a sociodemographic and quality of life, with greater impact on Cross-
(2017) men and 72 clinical questionnaire and men compared to women. Body image sectional
Brazil women) under the European (p=0.023), abdominal pain (p=0.020) study.
Pubmed/8 chemotherapy Organization for Reseach and dry mouth (p=0.001) represent
treatment in a and Treatment of Cancer's lower quality of life in women, while in
hospital in Health-Related Quality of men are the symptoms: fecal
southeastern Life instrument. incontinence (p<0.001), sexual
Brazil. impotence (p=0.027) and sexual interest
(p<0.001).
Pachón Ibáñez et We compared 131 To know the incidence of Patients not taking glutamine had a 1.78- Prospective
al. (31) patients who odynophagia, treatment fold increased risk ratio for mucositis cohort study.
(2018) received interruptions and (95% CI [1.01-3.16], p = 0.047). For
Pubmed/9 glutamine orally analgesia and nasogastric odynophagia, patients not taking
at a dose of 10 g / tube requirements. glutamine had a 2.87-fold increased
8 hours with 131 hazard ratio (95% CI [1.62-5.18], p =
patients who did 0.0003). 19.8% of patients who did not
not. take glutamine discontinued treatment
versus 6.9% of patients who did (p =
0.002). Regarding support requirements,
87.8% of patients without glutamine
required analgesia versus 77.9% of
patients with glutamine (p = 0.03) and
nasogastric tube was indicated in 9.9%
and 3.1% respectively (p = 0.02).
Soolmaz Moosavi It was carried out Semi-structured Two themes of "systematic mindfulness" Descriptive
et al. (32) with 21 interviews were used to and "mindfulness with paradoxical qualitative
Brazil. participants, who collect data. The data outcomes" were extracted from our study.
(2020) were selected by were analyzed using the participants' experiences of spiritual
Pudmeb/10 purposive conventional content mindfulness.
sampling. analysis method.
In a multispecialty This study concluded that In this study, 65 IDD were identified out
Veintramuthu hospital. For a DDIs are very common in of 100 patients. Of all DDIs, 33.85% Prospective-
Sankar et al. (33) period of 8 cancer patients, were major, 60% were moderate and observational
India. months among particularly in people with 6.15% were minor DDIs. Clinically study
(2019) 100 oncology more comorbidities and significant DDIs were reported (55.38%)
Scielo/11 patients using multiple and 69.44% of them were accepted and
hospitalized in the medications. The clinical modified accordingly. In addition, we
oncology pharmacist and physicians observed 50.77% of DDIs among
department. should work together to coadministered medications. Older
extend the practice of people (48%) had more comorbidity
DDI prevention in the such as diabetes (30%) and hypertension
management of individual (17.81%).
patients to improve their
quality of life.

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Ruiz-Moria et al. Patients seen The DDIs were analyzed Fifty-nine patients were evaluated, 31 Non-
(34) during 2017 in a using males (52.5%) and 28 females (47.5%), experimental,
Perú. Cardiology Medscape drug-drug with a median age of 42 years. The descriptive,
(2018) Service due to interaction checker. median heart rate was 46 beats per retrospective
Science Direct/12 post- minute. Bradycardia was more frequent study.
chemotherapy in acute myelocytic leukemia (25.42%),
bradycardia. followed by acute lymphoblastic
leukemia (20.34%). It was asymptomatic
in 88.13% of cases. The chemotherapy
drugs associated with bradycardia in
acute myelocytic leukemia were
cytarabine in combination with
daunorubicin, while in acute
lymphoblastic leukemia they were
vincristine in combination with
daunorubicin. Long QTc interval was
present in 12 cases (20.34%). The time
between chemotherapy and onset of
bradycardia was 24 to 48 hours in 35.6%
and heart rate recovery was between 24
to 48 hours in 61.02%.

IV. DISCUSSION interventions have been adapted to the requirements of each

care center (15).
Due to the natural history of the disease, cancer
patients present extreme physical instability. Starting from The theories and models become nowadays the basis
this situation of instability, they will have multiple of patient care, they allow organizing nursing interventions
complications throughout the evolution of their disease. The that sustain the discipline as a working method since nurses
aim of this article was to determine the measures to prevent learn to think critically and to strengthen their actions in
complications in oncologic patients. A multidisciplinary scientific evidence (16). Critical thinking has been
management with a holistic vision of the patient is important incorporated at present as a new academic field in nursing,
in order to detect and treat as early as possible the physical which is almost nonexistent in clinical practice in our
problems that the patient will encounter during the course of country. Moreover, the models constitute a guideline for
his disease. professional practice, since they provide a common
language that channels the work in a single front of action
 Epistemological evolution of nursing care (17). The models of care in general are the basis from which
Given the importance of the contribution of the all the processes of patient care emerge. They provide a
discipline of nursing to the care of the oncological patient, it focus and organization that are based on the concepts
is necessary to start from a review for this, an analysis is proposed by the conceptual model and the nursing work
made in which the dimension of a conscious formation of a method or nursing care process (18).
philosophy in nurses is highlighted, as well as its
relationship with the development of science and its link  Strategies in the prevention of complications in oncology
with this discipline, taking into account that it is precisely patients.
philosophy, a fundamental element in the integral formation Oncological diseases have increased in recent decades,
that society currently demands (12). constituting one of the health problems worldwide, within
the chronic regenerative diseases affecting both men and
The need to begin to interpret and search for unifying women, increasing the mortality rate, among these we have
meanings in clinical practice is becoming more evident oncological diseases that require alternative treatment, with
every day. To act sensibly and with professional judgment, a the aim of recovering the patient's state of health, reducing
strong conceptual reasoning is required, to work on the mortality and the risk of complications (19).
epistemic object of nursing and to deepen the identity of
being, knowing and doing of the professional discipline Thus, the person who undergoes this treatment
(13). We proceed to conceptualize everything that care frequently experiences unpleasant situations due to
implies in order to strengthen in a better way the scientific physiological, dietary, hygienic, esthetic, psychological,
support, we take the characteristics that correspond to social and economic changes in his bio-psychological
Dorothea Orem's model, which is based on the vital self-care homeostasis (20). It is evident that the oncologic patient
in oncological patients (14). Nursing theories and models considers his disease as a great limiting burden in different
are not really new, they have transcended since Dorothea aspects of life and that he has to learn to carry it as a
Orem proposed her ideas about nursing as a profession and normality being the prevention for health an initial part in
not only as a charitable action towards the human being as it the rehabilitation of the oncologic patient and that the
was seen at that time, since then nursing practices and nursing staff knows the basic principles of the teaching-

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learning process, has competences to communicate with the [3]. Arribas-García S, Jaureguizar Alboniga-Mayor J,
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