Review 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 Annemarie Coolbrandt a,b, *, Hans Wildiers c,d , Bert Aertgeerts e , Elisa Van der Elst a , Annouschka Laenen f , Bernadette Dierckx de Casterle ´ a , Theo van Achterberg g , Koen Milisen a,h a Center for Health Services and Nursing Research, KU Leuven, Leuven, Belgium b Department of Oncology Nursing, University Hospitals Leuven, Belgium c Department of General Medical Oncology, University Hospitals Leuven, Belgium d Department of Oncology, KU Leuven, Belgium e Academic Centre for General Practice, KU Leuven, Belgium f Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven, Belgium g Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands h Division of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium International Journal of Nursing Studies 51 (2014) 495–510 A R T I C L E I N F O Article history: Received 16 January 2013 Received in revised form 16 August 2013 Accepted 22 August 2013 Keywords: Cancer Chemotherapy Intervention Complex interventions Nursing Symptom burden Side effects Systematic review A B S T R A C T Objectives: 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. Design: 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. Results: 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%. Conclusion: 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. ß 2013 Elsevier Ltd. All rights reserved. * Corresponding author at: Centre for Health Services and Nursing Science, KU Leuven, Kapucijnenvoer 35 (3th floor), 3000 Leuven, Belgium. Tel.: +32 16341314. E-mail address: annemarie.coolbrandt@uzleuven.be (A. Coolbrandt). Contents lists available at ScienceDirect International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns 0020-7489/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijnurstu.2013.08.008