# Efficacy Analysis of Comprehensive Nursing in the Care of Ovarian Carcinoma Treated with Paclitaxel Combined with Nedaplatin

Authors: Yahui Li; Jing Wu; Gehong Zhu
Journal: Computational and Mathematical Methods in Medicine
 (2022)

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## Abstract

Objective. To determine the effectiveness of comprehensive nursing in the care of ovarian carcinoma (OC) patients treated with paclitaxel (PTX) plus nedaplatin (NDP). Methods. The research population comprised 180 advanced OC patients who received treatment in the Shaanxi Cancer Hospital between November 2018 and November 2021. The enrolled cases were assigned to two groups based on different nursing plans: an observation group (OG) with 100 cases treated with comprehensive nursing and a control group (CG) with 80 cases intervened by conventional nursing. Intergroup comparisons were performed to identify statistical significance in terms of the following parameters: serum NGF, TK1, and CA15-3 levels; VAS, SAS, and SDS scores; nursing compliance; incidence of adverse reactions; and nursing satisfaction. Results. Compared with CG, OG showed the following: (1) lower posttreatment NGF, TK1, and CA15-3 levels; (2) lower scores of SAS and SDS; (3) higher nursing compliance; and (4) lower incidence of adverse reactions and higher nursing satisfaction after nursing. Conclusions. Comprehensive nursing far outperformed conventional nursing in the care of advanced OC patients treated with PTX plus NDP, which is worth popularizing.


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## Body

## 1. Introduction

Ovarian carcinoma (OC) is one of the most deadly gynecological malignancies, ranking as the fifth leading cause of cancer deaths among women in many developed countries [1, 2]. It is a collection of heterogeneous tumors with different clinicopathological and molecular characteristics [3], with approximately 70-80% of cases being diagnosed at a late stage due to unconspicuous or nonspecific clinical presentations [4, 5]. Advances have been made in both traditional and new treatments for the disease over the past few decades [6]. Among various treatments, nedaplatin (NDP) plus paclitaxel (PTX) maintenance chemotherapy is a common approach, with evidence indicating that weekly dose-dense PTX combined with platinum can improve patient survival [7]. However, 60-70% of patients still face the risk of recurrence even after relevant treatment, which has a great impact on their 5-year survival [8]. This shows that after treatment, other means are needed to maintain the effect of treatment [9]. Nursing is a necessary means to maintain the therapeutic effect. Therefore, this research, which focuses on OC nursing, is of great significance to maintain a more effective therapeutic effect for patients with the disease, thereby reducing disease recurrence.After a variety of treatment means, a good nursing model is conducive to patient recovery and maintains therapeutic effects [10, 11]. Comprehensive nursing is such a good and flexible nursing method that can be tailored according to the changes of patients’ conditions. Its strong comprehensiveness can considerably ease surgery-induced negative psychological state of patients while helping them to develop a healthy lifestyle from the aspect eating habits, which is of great significance to patients’ rehabilitation [12, 13]. However, there is scanty research on the employment of comprehensive nursing care in OC patients after chemotherapy. Consequently, this study assesses the effectiveness of comprehensive nursing on OC patients from various blood test indexes after treatment, as well as anxiety, depression, and various complications.


## 2. Methods

### 2.1. Study Population

The study population comprised 180 advanced OC patients who received treatment in the Shaanxi Cancer Hospital between November 2018 and November 2021. Based on different nursing plans, 100 cases receiving comprehensive nursing after treatment were included in the observation group (OG), and the other 80 cases receiving conventional nursing were included in the control group (CG). Inclusion criteria are as follows: all cases were diagnosed as OC by cytology or histopathological biopsy and received treatment treated in our hospital;age≥18; active participation and cooperation of patients and their family members; and complete case data. Exclusion criteria are as follows: other malignant tumors; intolerance or contraindications to chemotherapy; primary diseases of blood system, or dysfunction of heart, liver, kidney and other organs; allergic constitution; and pregnant or lactating women. This study was conducted after obtaining approval from the Medical Ethics Committee of Shaanxi Cancer Hospital, and patients and their families signed informed consent.


### 2.2. Methods

The two cohorts of patients received the same treatment (PTX plus NDP) but different posttreatment nursing methods. The patients in CG were given conventional nursing, that is, monitoring the changes of vital signs, giving routine dietary guidance, helping patients with mobility difficulties to recover from exercise, daily cleaning of the ward to keep the environment clean, and instructing patients to review regularly upon their discharge from hospital, while the patients in OG received comprehensive care. All examinations were completed within 24 hours of admission. Upon patient admission, the medical staff carried out a detailed investigation and understanding of a series of personal-related conditions of the patient, as well as the patient’s awareness of the complications related to the combination therapy of OC. Based on the investigation, a nursing plan suitable for each patient was developed. During the health education for patients, the medical staff not only distributed the relevant health manuals to them but also explained the relevant knowledge of OC in detail, including the occurrence, treatment, drug use, treatment of posttreatment complications (if any), and home care methods. Family members were also involved in learning to play a part in the care. In addition, health education was conducted once a week (2 h/time), and the frequency was adjusted according to the degree of knowledge acquired by patients and their families. Furthermore, the patients were cared for psychologically and emotionally. They were informed that negative emotions can easily worsen their illness. Psychological nursing was carried out in an environment in which interpersonal atmosphere and treatment are more harmonious, and appropriate encouragement was given to patients in time, so as to establish their confidence to recover from surgical treatment. The medical staff also reminded the patients of some precautions during treatment. For example, during health education, the patients were instilled with the need to strictly abide to the instructions of the medical staff during the operation and strictly follow the doctor’s advice to use drugs and cannot stop taking drugs against the medical advice. After surgical treatment, medical staff deliberately set aside a period of time (about 10-15 min) every day to help patients with impaired mobility to do rehabilitation exercise. Moreover, during and after treatment, patients were given dietary guidance, highlighting light diet, balanced nutrition, and more intake of food with high nutritional value and avoiding alcohol, tobacco, and greasy and spicy food. On the day before discharge, patients and their families were given postdischarge nursing guidance, covering medication, diet, exercise, and reexamination. They were also instructed to master the basic essentials of home nursing, disinfection, and isolation. Follow-up was conducted periodically. After that, they were followed up regularly.


### 2.3. Endpoints

#### 2.3.1. Serum Nerve Growth Factor (NGF), Thymidine Kinase 1 (TK1), and Carbohydrate Antigen 15-3 (CA15-3)

At admission and 30 days after nursing, 5 mL of fasting cubital venous blood was collected into test tubes without anticoagulant and naturally agglutinated at indoor temperature for 20-30 min. After 10 min of centrifugation (1500×g at 4°C), the serum was separated and stored at -20°C for subsequent detection of NGF, TK1, and CA15-3 via ELISA [14].


#### 2.3.2. Mental Health (MH)

The MH level of both groups was evaluated and compared at admission and 30 days after receiving nursing care, with the self-rating anxiety/depression scale (SAS/SDS) [15, 16] as evaluation criteria. The worse the MH level of patients, the higher the score.


#### 2.3.3. Nursing Compliance

Patients’ compliance during nursing care was also observed and compared. Complete compliance: the patient actively cooperates with medical staff in the nursing process. Partial compliance: the patient occasionally has irregular behaviors in the nursing process but continues to cooperate after being reminded by medical staff. Noncompliance: the patient is completely uncooperative with the medical staff.


#### 2.3.4. Adverse Reactions (ARs)

ARs, including myelosuppression, alopecia, gastrointestinal discomfort, and anemia, were compared.


#### 2.3.5. Nursing Satisfaction

The nursing satisfaction assessed by the satisfaction questionnaire made by our hospital was also compared. The score ranged from 0 to 100, with a score of ≥85 and 84-60 indicating satisfied and basically satisfied, respectively. Higher scores suggest better nursing quality.


### 2.4. Statistical Methods

The software applied for statistical analysis and image rendering was SPSS 21.0 (Bizinsight Information Technology Co., Ltd.) and GraphPad Prism 6 (GraphPad Software, San Diego, USA), respectively. The statistical methods for the comparison of measurement data (mean age, body mass index (BMI), etc.) expressed as (χ¯±s) and counting data (drinking, smoking, etc.) were t-test and χ2 test, respectively, and statistical significance was present when P<0.05.


## 2.1. Study Population

The study population comprised 180 advanced OC patients who received treatment in the Shaanxi Cancer Hospital between November 2018 and November 2021. Based on different nursing plans, 100 cases receiving comprehensive nursing after treatment were included in the observation group (OG), and the other 80 cases receiving conventional nursing were included in the control group (CG). Inclusion criteria are as follows: all cases were diagnosed as OC by cytology or histopathological biopsy and received treatment treated in our hospital;age≥18; active participation and cooperation of patients and their family members; and complete case data. Exclusion criteria are as follows: other malignant tumors; intolerance or contraindications to chemotherapy; primary diseases of blood system, or dysfunction of heart, liver, kidney and other organs; allergic constitution; and pregnant or lactating women. This study was conducted after obtaining approval from the Medical Ethics Committee of Shaanxi Cancer Hospital, and patients and their families signed informed consent.


## 2.2. Methods

The two cohorts of patients received the same treatment (PTX plus NDP) but different posttreatment nursing methods. The patients in CG were given conventional nursing, that is, monitoring the changes of vital signs, giving routine dietary guidance, helping patients with mobility difficulties to recover from exercise, daily cleaning of the ward to keep the environment clean, and instructing patients to review regularly upon their discharge from hospital, while the patients in OG received comprehensive care. All examinations were completed within 24 hours of admission. Upon patient admission, the medical staff carried out a detailed investigation and understanding of a series of personal-related conditions of the patient, as well as the patient’s awareness of the complications related to the combination therapy of OC. Based on the investigation, a nursing plan suitable for each patient was developed. During the health education for patients, the medical staff not only distributed the relevant health manuals to them but also explained the relevant knowledge of OC in detail, including the occurrence, treatment, drug use, treatment of posttreatment complications (if any), and home care methods. Family members were also involved in learning to play a part in the care. In addition, health education was conducted once a week (2 h/time), and the frequency was adjusted according to the degree of knowledge acquired by patients and their families. Furthermore, the patients were cared for psychologically and emotionally. They were informed that negative emotions can easily worsen their illness. Psychological nursing was carried out in an environment in which interpersonal atmosphere and treatment are more harmonious, and appropriate encouragement was given to patients in time, so as to establish their confidence to recover from surgical treatment. The medical staff also reminded the patients of some precautions during treatment. For example, during health education, the patients were instilled with the need to strictly abide to the instructions of the medical staff during the operation and strictly follow the doctor’s advice to use drugs and cannot stop taking drugs against the medical advice. After surgical treatment, medical staff deliberately set aside a period of time (about 10-15 min) every day to help patients with impaired mobility to do rehabilitation exercise. Moreover, during and after treatment, patients were given dietary guidance, highlighting light diet, balanced nutrition, and more intake of food with high nutritional value and avoiding alcohol, tobacco, and greasy and spicy food. On the day before discharge, patients and their families were given postdischarge nursing guidance, covering medication, diet, exercise, and reexamination. They were also instructed to master the basic essentials of home nursing, disinfection, and isolation. Follow-up was conducted periodically. After that, they were followed up regularly.


## 2.3. Endpoints

### 2.3.1. Serum Nerve Growth Factor (NGF), Thymidine Kinase 1 (TK1), and Carbohydrate Antigen 15-3 (CA15-3)

At admission and 30 days after nursing, 5 mL of fasting cubital venous blood was collected into test tubes without anticoagulant and naturally agglutinated at indoor temperature for 20-30 min. After 10 min of centrifugation (1500×g at 4°C), the serum was separated and stored at -20°C for subsequent detection of NGF, TK1, and CA15-3 via ELISA [14].


### 2.3.2. Mental Health (MH)

The MH level of both groups was evaluated and compared at admission and 30 days after receiving nursing care, with the self-rating anxiety/depression scale (SAS/SDS) [15, 16] as evaluation criteria. The worse the MH level of patients, the higher the score.


### 2.3.3. Nursing Compliance

Patients’ compliance during nursing care was also observed and compared. Complete compliance: the patient actively cooperates with medical staff in the nursing process. Partial compliance: the patient occasionally has irregular behaviors in the nursing process but continues to cooperate after being reminded by medical staff. Noncompliance: the patient is completely uncooperative with the medical staff.


### 2.3.4. Adverse Reactions (ARs)

ARs, including myelosuppression, alopecia, gastrointestinal discomfort, and anemia, were compared.


### 2.3.5. Nursing Satisfaction

The nursing satisfaction assessed by the satisfaction questionnaire made by our hospital was also compared. The score ranged from 0 to 100, with a score of ≥85 and 84-60 indicating satisfied and basically satisfied, respectively. Higher scores suggest better nursing quality.


## 2.3.1. Serum Nerve Growth Factor (NGF), Thymidine Kinase 1 (TK1), and Carbohydrate Antigen 15-3 (CA15-3)

At admission and 30 days after nursing, 5 mL of fasting cubital venous blood was collected into test tubes without anticoagulant and naturally agglutinated at indoor temperature for 20-30 min. After 10 min of centrifugation (1500×g at 4°C), the serum was separated and stored at -20°C for subsequent detection of NGF, TK1, and CA15-3 via ELISA [14].


## 2.3.2. Mental Health (MH)

The MH level of both groups was evaluated and compared at admission and 30 days after receiving nursing care, with the self-rating anxiety/depression scale (SAS/SDS) [15, 16] as evaluation criteria. The worse the MH level of patients, the higher the score.


## 2.3.3. Nursing Compliance

Patients’ compliance during nursing care was also observed and compared. Complete compliance: the patient actively cooperates with medical staff in the nursing process. Partial compliance: the patient occasionally has irregular behaviors in the nursing process but continues to cooperate after being reminded by medical staff. Noncompliance: the patient is completely uncooperative with the medical staff.


## 2.3.4. Adverse Reactions (ARs)

ARs, including myelosuppression, alopecia, gastrointestinal discomfort, and anemia, were compared.


## 2.3.5. Nursing Satisfaction

The nursing satisfaction assessed by the satisfaction questionnaire made by our hospital was also compared. The score ranged from 0 to 100, with a score of ≥85 and 84-60 indicating satisfied and basically satisfied, respectively. Higher scores suggest better nursing quality.


## 2.4. Statistical Methods

The software applied for statistical analysis and image rendering was SPSS 21.0 (Bizinsight Information Technology Co., Ltd.) and GraphPad Prism 6 (GraphPad Software, San Diego, USA), respectively. The statistical methods for the comparison of measurement data (mean age, body mass index (BMI), etc.) expressed as (χ¯±s) and counting data (drinking, smoking, etc.) were t-test and χ2 test, respectively, and statistical significance was present when P<0.05.


## 3. Results

### 3.1. General Data

The two groups exhibited no statistical differences in general information such as mean age, BMI, drinking/smoking (yes/no), working status, family type, and residence (P>0.05) (see Table 1 for details).Table 1
Patient’s general information.
ClassificationObservation group (n=100)Control group (n=80)t/χ2PMean age (years)48.11±6.9248.84±6.460.720.470BMI27.34±1.6227.29±1.390.220.827Drinking0.090.769Yes72 (72.00)56 (70.00)No28 (28.00)24 (30.00)Smoking0.010.919Yes88 (88.00)70 (87.50)No12 (12.00)10 (12.50)Working state1.420.233Employed78 (78.00)68 (85.00)Unemployed22 (22.00)12 (15.00)Family type2.510.113Nuclear family64 (64.00)60 (75.00)Others36 (36.00)20 (25.00)Place of residence0.010.945Rural37 (37.00)30 (37.50)Urban63 (63.00)50 (62.50)


### 3.2. Serum NGF, TK1, and CA15-3 Contents

Intergroup comparisons of serum NGF, TK1, and CA15-3 contents revealed statistically lower levels of these parameters in OG (P<0.05). Figure 1.Figure 1
Serum levels of NGF, TK1, and CA15-3 in the two groups: (a) serum NGF levels before and after nursing in the two groups. (b) Serum TK1 levels in the two groups before and after nursing. (c) Serum CA15-3 levels before and after nursing in the two groups. Note:#P<0.05 vs. before treatment; ∗P<0.05 vs. control group.
(a)(b)(c)


### 3.3. Psychological Status

The intergroup comparison of MH revealed statistically lower SAS and SDS scores in OG versus CG after nursing intervention (P<0.05). Figure 2.Figure 2
Mental health of patients in the two groups: (a) SAS scores before and after nursing in the two groups. (b) SDS scores of the two groups before and after nursing. Note:#P<0.05 vs. before treatment; ∗P<0.05 vs. control group.
(a)(b)


### 3.4. Nursing Compliance

After statistical comparison, it was found that the total compliance was higher in OG than in CG (P<0.05) Table 2.Table 2
Compliance of patients in the two groups.
ClassificationObservation group (n=100)Control group (n=80)χ2PComplete compliance73 (73.00)36 (45.00)——Partial compliance24 (24.00)24 (30.00)——Noncompliance3 (3.00)20 (25.00)——Total compliance (%)97 (97.00)60 (75.00)19.30<0.001


### 3.5. Adverse Reactions

Comparing ARs between the two groups, we found an obviously lower incidence of ARs in OG compared with CG (P<0.05) Table 3.Table 3
Incidence of adverse reactions in the two groups.
ClassificationObservation group (n=100)Control group (n=80)χ2PMyelosuppression0 (0.00)2 (2.50)——Hair loss2 (2.00)4 (5.00)——Gastrointestinal discomfort2 (2.00)4 (5.00)Anemia0 (0.00)2 (2.50)——Total incidence (%)4 (4.00)12 (15.00)6.640.01


### 3.6. Nursing Satisfaction

The statistical comparison of patient satisfaction towards nursing revealed a statistically higher satisfaction degree in OG compared with CG (P<0.05) Table 4.Table 4
Nursing satisfaction of patients in the two groups.
ClassificationObservation group (n=100)Control group (n=80)χ2PSatisfied70 (70.00)34 (42.50)——Basically satisfied28 (28.00)30 (37.50)——Dissatisfied2 (2.00)16 (20.00)——Satisfaction (%)98 (98.00)64 (80.00)16.00<0.001


## 3.1. General Data

The two groups exhibited no statistical differences in general information such as mean age, BMI, drinking/smoking (yes/no), working status, family type, and residence (P>0.05) (see Table 1 for details).Table 1
Patient’s general information.
ClassificationObservation group (n=100)Control group (n=80)t/χ2PMean age (years)48.11±6.9248.84±6.460.720.470BMI27.34±1.6227.29±1.390.220.827Drinking0.090.769Yes72 (72.00)56 (70.00)No28 (28.00)24 (30.00)Smoking0.010.919Yes88 (88.00)70 (87.50)No12 (12.00)10 (12.50)Working state1.420.233Employed78 (78.00)68 (85.00)Unemployed22 (22.00)12 (15.00)Family type2.510.113Nuclear family64 (64.00)60 (75.00)Others36 (36.00)20 (25.00)Place of residence0.010.945Rural37 (37.00)30 (37.50)Urban63 (63.00)50 (62.50)


## 3.2. Serum NGF, TK1, and CA15-3 Contents

Intergroup comparisons of serum NGF, TK1, and CA15-3 contents revealed statistically lower levels of these parameters in OG (P<0.05). Figure 1.Figure 1
Serum levels of NGF, TK1, and CA15-3 in the two groups: (a) serum NGF levels before and after nursing in the two groups. (b) Serum TK1 levels in the two groups before and after nursing. (c) Serum CA15-3 levels before and after nursing in the two groups. Note:#P<0.05 vs. before treatment; ∗P<0.05 vs. control group.
(a)(b)(c)


## 3.3. Psychological Status

The intergroup comparison of MH revealed statistically lower SAS and SDS scores in OG versus CG after nursing intervention (P<0.05). Figure 2.Figure 2
Mental health of patients in the two groups: (a) SAS scores before and after nursing in the two groups. (b) SDS scores of the two groups before and after nursing. Note:#P<0.05 vs. before treatment; ∗P<0.05 vs. control group.
(a)(b)


## 3.4. Nursing Compliance

After statistical comparison, it was found that the total compliance was higher in OG than in CG (P<0.05) Table 2.Table 2
Compliance of patients in the two groups.
ClassificationObservation group (n=100)Control group (n=80)χ2PComplete compliance73 (73.00)36 (45.00)——Partial compliance24 (24.00)24 (30.00)——Noncompliance3 (3.00)20 (25.00)——Total compliance (%)97 (97.00)60 (75.00)19.30<0.001


## 3.5. Adverse Reactions

Comparing ARs between the two groups, we found an obviously lower incidence of ARs in OG compared with CG (P<0.05) Table 3.Table 3
Incidence of adverse reactions in the two groups.
ClassificationObservation group (n=100)Control group (n=80)χ2PMyelosuppression0 (0.00)2 (2.50)——Hair loss2 (2.00)4 (5.00)——Gastrointestinal discomfort2 (2.00)4 (5.00)Anemia0 (0.00)2 (2.50)——Total incidence (%)4 (4.00)12 (15.00)6.640.01


## 3.6. Nursing Satisfaction

The statistical comparison of patient satisfaction towards nursing revealed a statistically higher satisfaction degree in OG compared with CG (P<0.05) Table 4.Table 4
Nursing satisfaction of patients in the two groups.
ClassificationObservation group (n=100)Control group (n=80)χ2PSatisfied70 (70.00)34 (42.50)——Basically satisfied28 (28.00)30 (37.50)——Dissatisfied2 (2.00)16 (20.00)——Satisfaction (%)98 (98.00)64 (80.00)16.00<0.001


## 4. Discussion

As one of the gynecological malignancies, OC is highly migratory and easily metastasized to abdominal organs, and in many cases, it has already metastasized once detected [17–19]. PTX plus NDP is a common method to treat OC; however, it is easy for cancer cells to develop drug resistance, leading to disease relapse [20]. Therefore, after treatment, a series of nursing measures are required to maintain the therapeutic effect and enable patients to recover effectively.First, we found more significant deductions in cancer-related serum factors (NGF, TK1, and CA15-3) in OG compared with CG after nursing. TK1 plays a vital part in DNA synthesis and cell proliferation, with elevated expression in various cancers, which is a common prognostic factor of cancer [21]. NGF generally affects the nervous system; NGF and its precursor, proNGF, stimulate the survival or growth of cancer cells, respectively, which can enhance the invasiveness of cells [22]. CA15-3 is a common serological marker in various cancers, with elevated expression indicating further progression of cancer, but its sensitivity is poor [23]. The results of this study showed that comprehensive nursing had a better effect on reducing cancer-related factors than conventional nursing, which is consistent with the suggestion of Lu et al. [24] in the study on the care for OC. This is because compared with conventional nursing, comprehensive nursing is more integrated and targeted, and its clinical nursing methods, application of nursing management system, and nursing procedures are more standardized, with stricter management requirements for medical teams [25–27]. This study also found that after nursing, the scores of anxiety (SAS) and depression (SDS) were reduced in both cohorts, especially in OG. As we all know, negative emotions tend to aggravate patient’s conditions and form a vicious circle. In order to get a good recovery, patients need to maintain psychologically healthy [22]. Therefore, great efforts should be made during the care to avoid such emotions in patients. In terms of nursing methods, comprehensive nursing has better and more detailed health education than conventional nursing, which enables patients and their families to fully understand the treatment process of chemotherapy and medication and to better deal with adverse reactions and complications caused by the drugs. Therefore, patients in OG with health education carried out from multiple dimensions were more confident. In addition, medical staff provided special psychological counseling to help patients build confidence during the comprehensive nursing process, so that the depression and anxiety patients in OG were validly eliminated. It is precisely because of that the therapeutic effect of OG is better, with more significant improvements in various factors.This study also has shortcomings. Due to the influence of equipment and some other objective conditions, we were unable to detect more indicators. Besides, we have not yet developed a valid indicator to determine whether patients relapsed after treatment to help verify the maintenance of efficacy during care. In future research, we will continue to address these defects.


## 5. Conclusion

Collectively, comprehensive nursing has advantages over conventional nursing in the care of advanced OC patients treated with PTX plus NDP, which is worth popularizing.



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