Xiao, Y., Liu, J., Liu, Y.C., Huang, X.E., Guo, J.X., & Wei, W. (2014). Phase II study on EANI combined with hydrochloride palonosetron for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. Asian Pacific Journal of Cancer Prevention, 15, 3951–3954.
To evaluate the effects of an electronic antinausea instrument (EANI) combined with hydrochloride palonosetron versus hydrochloride palonosetron alone on nausea and vomiting during the administration of highly emetogenic chemotherapy
The treatment group received 0.25 mg of hydrochloride palonosetron injected five minutes before chemotherapy while wearing an EANI (no report of how long the patients wore the instrument). The control group received 0.25 mg of hydrochloride palonosetron injected five minutes before chemotherapy alone.
Randomized, controlled trial
There was a significant difference in the response rate for nausea (90% response in treatment group and 76.7% response in control group, p < 0.05), and there was a significant difference in the response rate for vomiting (95% response in treatment group and 78.3% response in control group, p < 0.05). No significant differences in adverse reactions between the groups and no severe adverse reactions were reported.
The use of an electronic antinausea instrument along with hydrochloride palonosetron appeared to be more effective than hydrochloride palonosetron alone for the treatment of acute nausea and vomiting associated with highly emetogenic chemotherapy.
Electronic antinausea instruments may be effective for treating chemotherapy-induced nausea and vomiting, but additional studies are needed to confirm these findings.
Xiao, Y., Liu, J., Huang, X. E., Ca, L.H., Ma, Y.M., Wei, W., . . . Wu, Y.J. (2014). Clinical study on fluvoxamine combined with oxycodone prolonged-release tablets in treating patients with moderate to severe cancer pain. Asian Pacific Journal of Cancer Prevention, 15, 10445–10449.
To assess the safety and efficacy of fluvoxamine combined with prolonged-release oxycodone for the management of cancer-related chronic pain
Patients with moderate to severe cancer-related pain were randomized to either the control group, which was treated with only prolonged-release oxycodone, or the prolonged-release oxycodone combined with fluvoxamine group. A daily maintenance dose of oxycodone was determined per patient after two weeks. Fluvoxamine began at 50 mg per day and increased by 50–100 mg per day to a maximum of 150 mg twice daily. Patients were assessed three times daily for pain response and dosage adjustment.
Randomized, open-label trial
Pain severity declined in both groups. There were no reported significant differences between groups for pain severity or opioid consumption.
The findings of this study did not demonstrate the efficacy of fluvoxamine for chronic pain management.
This study did not show any benefit from the addition of fluvoxamine to prolonged-release opioids in the management of moderate to severe chronic cancer-related pain.
Xiangyong, Y., Zhongsheng, Y., Wenchao, L., Hui, D., Shuzhou, Q., Gang, C., . . . Lian, Z. (2016). External application of traditional Chinese medicine in the treatment of bone cancer pain: A meta-analysis. Supportive Care in Cancer, 24, 11–17.
Applications: Palliative care
Analysis showed improved partial pain response with Chinese medicine compared to sustained release morphine or bisphosphonates (RR = 1.18, p = 0.02)
External application of traditional Chinese herbal medicine was shown here to improve pain response rate in patients with metastatic bone pain; however, the quality of the evidence is insufficient to draw firm conclusions
All studies were deemed to be of low quality. The authors noted that included studies were mainly from Chinese publications, and that it is known that negative results are not published in China. This suggests important publication bias.
There is currently insufficient good quality evidence to demonstrate efficacy of traditional Chinese herbal medicine for pain management. Findings of this meta analysis suggest promise for this type of intervention as adjunctive treatment; however, well-designed research is needed for evaluation of the evidence.
Wysocki, W.M., Mitus, J., Komorowski, A.L., & Karolewski, K. (2012). Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: A randomized clinical trial. Acta Chirurgica Belgica, 112, 111–115.
To evaluate the impact of information, provided preoperatively, on the anxiety and knowledge of women undergoing mastectomy for breast cancer; to assess the specific impact of additional, structured preoperative information (delivered by means of educational/informational video) on perioperative anxiety and treatment- and disease-related knowledge in women undergoing mastectomy for breast cancer
Routine information was delivered to both arms of the study. Information was not standardized and included the typical conversation with the attending surgeon, surgical informed consent, and practical information from nurses. The treatment arm provided additional information delivered preoperatively via video; the information was recorded by a breast cancer survivor. Information in the video was obtained from the National Cancer Institute’s website. All patients were prospectively followed for one month (further follow-up was performed according to local treatment protocols) at 24–36 hours, 7 days, and 30 days postoperatively.
Open-labeled, randomized controlled trial
Patients who participated in the study showed no evident or significant improvement in perioperative anxiety or treatment- and disease-related knowledge, with the exception of knowledge concerning available primary treatment modalities.
Patient education, as well as emotional support, should always be important preoperatively and must continue postoperatively.
Wyse, J.M., Carone, M., Paquin, S.C., Usatii, M., & Sahai, A.V. (2011). Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 29(26), 3541–3546.
To determine if early ultrasound-guided celiac plexus neurolysis (EUS-CPN) prevents pain progression in and reduces narcotic use by patients with painful inoperable pancreatic cancer
Eligible for the study were patients referred for endoscopic ultrasound for the diagnosis and staging of suspected pancreatic cancer with new onset of suspected cancer-related pain. If onsite cytopathology results confirmed the diagnosis of adenocarcinoma and the lesion was deemed inoperable, consenting patients were randomly assigned to EUS-CPN or no EUS-CPN. Celiac plexus neurolysis (CPN) was performed during the endoscopic procedure. After the procedure patients returned to the referring physician for ongoing pain management. One month after randomization, a patient could undergo open-label CPN at the physician’s discretion. Investigators assessed outcomes at one and three months after randomization.
Double-blind randomized controlled trial
Results show that, compared to pain management with narcotics alone, early EUS-CPN provides greater pain relief. In the sudied patients, this approach was not better than chemotherapy or radiation therapy for pain control.
For patients with painful inoperable pancreatic cancer, early EUS-CPN may provide better pain control than do opioids alone. However, this study does not show any difference in overall morphine consumption associated with EUS-CPN. In this group of patients, palliative chemotherapy or radiation therapy appears to achieve pain control similar to the pain control that EUS-CPN achieves. EUS-CPN has not been associated with early or late complications; it may produce fewer side effects and symptoms than chemotherapy or radiation therapy. For this group of patients, nurses can advocate for consideration of EUS-CPN for adjuvant pain management. The advantage of early EUS-CPN is that the procedure can be done at the same time as a staging procedure, limiting the number of invasive procedures that the patient has to undergo.
Wyatt, G., Sikorskii, A., Rahbar, M. H., Victorson, D., & You, M. (2012). Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer. Oncology Nursing Forum, 39, 568–577.
To evaluate the safety and efficacy of reflexology.
Patients were randomly assigned to one of three groups: reflexology, lay foot manipulation, or the control. Certified reflexology providers administered the reflexology intervention in four weekly, 30-minute sessions. Foot manipulation providers were laywomen trained in the procedure. The laywomen delivered foot manipulation according to the relexology schedule. The control group received standard care. Study data were collected at baseline and at 5 and 11 weeks after randomization. Reflexologists and foot manipulation providers collected data after sessions at the planned time points.
The study has clinical applicability for late effects and survivorship.
The study was a three-group, single-blind, randomized, controlled trial.
At baseline, scores regarding anxiety and depression, according to the Center for Epidemiologic Studies Depression Scale (CESD), differed significantly (p < 0.01) across study groups. No differences were found regarding quality of life and symptoms of depression, anxiety, pain, or nausea. Those receiving reflexology reported lower levels of dyspnea than did the other two groups (p ≤ 0.02). Patients getting foot manipulation from laywomen had lower fatigue scores than did the controls (p < 0.01). Further analysis showed that the effect on fatigue was mediated by changes in dyspnea. Eleven percent of those in the foot manipulation group and 10% of those in the reflexology group did not complete all the sessions. The intervention had no adverse effects.
The findings suggested that reflexology may improve the symptoms of dyspnea and that foot manipulation may help reduce fatigue in women with advanced-stage breast cancer. The authors noted no effect of reflexology or foot manipulation on pain, anxiety, symptoms of depression, or nausea.
The findings did not indicate that reflexology and foot manipulation affected pain, anxiety, symptoms of depression, or nausea among women with advanced breast cancer. The study demonstrated that these interventions are safe for the type of patients who participated. Reflexology and foot manipulation are low-risk interventions that may be helpful to some patients. Laypeople and caregivers could be taught these techniques, which may provide a meaningful way for these people to be involved in symptom management.
Wu, H., Dodd, M. J., & Cho, M. H. (2008). Patterns of fatigue and effect of exercise in patients receiving chemotherapy for breast cancer. Oncology Nursing Forum, 35, E90-E99.
To examine daily fatigue patterns during the third cycle of chemotherapy in women with breast cancer and predict whether fatigue trajectories differ by exercise or chemotherapy regimens.
Patients completed a daily fatigue diary that included a fatigue rating and items to determine whether they were exercisers or nonexercisers. Patients were asked to complete the diary daily. Weekly telephone calls from an exercise physiologist were used to determine exercise adherence. Adherence was determined as either a yes or no based on whether the patient exercised at least three days per week for 20 minutes per session and at a “somewhat hard” intensity. Measures obtained during the third course of chemotherapy were used in this analysis.
Patients were undergoing the active treatment phase of care.
This was a prospective, longitudinal, repeated-measure design primary study; a secondary analysis of these data was performed.
Average levels of fatigue reported were moderate for the first eight days and mild for the rest of the cycle. Highest levels of fatigue were observed on days 1 to 3 for average and worst fatigue. Five distinct trajectory patterns of cancer-related fatigue (CRF) were identified: immediate and sharp increase followed by a gradual decline; early peak, a decline, and a sharp increase toward the end of the cycle; small variations among daily scores; chaotic pattern; and step-up evaluation followed by a gradual decline. Nonexercisers had higher average and worst fatigue (p < 0.01). In exercisers and nonexercisers, fatigue declined in severity over time, and the rate of decline was not significantly different between the two groups; however, fatigue levels were consistently higher among nonexercisers.
CRF peaked in the days immediately after intravenous chemotherapy and declined gradually over time. Fatigue tended to be lower in those who exercised as described.
Nurses should provide anticipatory guidance to patients so that they can plan for the days when they are at most risk for fatigue. Continued exercise during the course of chemotherapy may be helpful in mitigating the severity of fatigue.
Wu, T.H., Chiu, T.Y., Tsai, J.S., Chen, C.Y., Chen, L.C., & Yang, L.L. (2008). Effectiveness of Taiwanese traditional herbal diet for pain management in terminal cancer patients. Asia Pacific Journal of Clinical Nutrition, 17, 17–22.
To evaluate the effects of a Taiwanese traditional diet including paeony and licorice components on pain in patients with terminal cancer
Patients were randomly assigned to one of three groups: (a) Taiwanese traditional herbal diet (TTHD) group, consisting of analgesic herbs (paeony root and licorice root) and tonic vegetable soup (lilli bulbus, nelumbo seed, and jujube fruit), (b) reference group, receiving the regular hospital diet, (c) and control group, receiving the tonic soup without addition of analgesic herbs. All patients remained on the assigned diet for one week. Pain was assessed via patient self-report questionnaire on days 3 and 10.
The study was a randomized, parallel group trial.
All groups reported significant reduction in mean pain scores on days 3 and 10. Patients in the TTHD group reported a three-point improvement in pain (from 53 to 50), which was significantly greater than that in the reference and control groups (p < 0.01).
In this study, use of traditional Taiwanese analgesic herbs was effective for pain reduction, compared to control and reference groups, in palliative care patients who were not receiving other analgesic medications.
Patients on analgesics were excluded from this study, and authors stated that in 90% of cases, pain was not cancer-related. Application of findings to other groups with cancer-related pain who require substantial analgesic therapy is questionable. Though statistically significant, the clinical relevance of the change in average pain scores is questionable, with a change of 3 points on a 100-point scale. The pain scale is not clearly explained, and it appears its scoring is not a continuous variable, though the statistical analysis and summary data provided treats the data as continuous data.
Findings here suggest that traditional Taiwanese analgesic herbs may be helpful in managing pain in terminally ill patients. There are a number of study report issues that make these findings very limited, so applicability to other patients with cancer-related pain is questionable. Future research in this area should examine use of this approach as adjunctive therapy in concert with other analgesia in patients with pain that is truly cancer-related. Applicability in other cultures is needed.
Wu, W., Zhong, M., Zhu, D.M., Song, J.Q., Huang, J.F., Wang, Q., & Tan, L.J. (2016). Effect of early full-calorie nutrition support following esophagectomy: A randomized controlled trial. Journal of Parenteral and Enteral Nutrition. Advance online publication.
To evaluate the efficacy and safety of early supplementary parenteral nutrition (PN) following esophagectomy
Patients who had undergone scheduled esophagectomy (by laparoscopy or open surgery) for esophageal cancer were randomized 1:1 into two groups. The randomization sequence was generated by a computer, and the code was kept in sealed envelopes. Both groups were started on enteral nutrition (EN) within 24 hours after surgery; patients in the EN plus PN group also received supplementary parenteral nutrition (SPN), gradually increased over five days, to meet the full caloric target.
Randomized trial
The full-calorie target for each patient was based on measured resting energy expenditure, as determined by open-circuit indirect calorimetry (IC) (QUARK RMR). IC measurements were performed daily on each patient in both groups. The Chinese version of the Medical Outcome Study 36-Item Short-Form (MOS SF-36) as a surrogate of health-related quality of life assessment was used, and patients were required to fulfill the scale before surgery. Anthropometric parameters were taken. Standard laboratory blood biochemistry parameters were measured. Perioperatively, tumors were staged using the International Union Against Cancer's sixth edition of the tumor node metastasis (TNM) classification of malignant tumors (www.uicc.org) according to postoperative pathological results. The Clavien-Dindo classification was used to grade and record postoperative complications.
Patients in the EN plus PN group but not in the EN group preserved body weight (mean = 0.18, SD = 3.38 kg versus mean = −2.15, SD = 3.19 kg; p < 0.05) and FFM (mean = 1.46, SD = 2.97 kg versus mean = −2.08, SD = 4.16 kg) relative to preoperative measurements. Length of hospital stay, postoperative morbidity rates, and standard blood biochemistry profiles were similar. However, scores for physical functioning (mean = 71.5, SD = 24.3 versus mean = 60.4, SD = 27.4; p < 0.05) and energy/fatigue (mean = 62.9, SD = 19.5 versus mean = 54.2, SD = 23.5; p < 0.05) were significantly higher in the EN plus PN group 90 days following surgery.
Addition of early PN to supplement standard EN did not significantly change the perioperative outcomes of patients undergoing esophagectomy. However, for patients who received SPN, increased calorie and protein intakes were associated with preservation of body weight, FFM, and better health-related quality of life in short-term follow-up. Additional studies with larger sample sizes are needed to confirm these findings.
Wu, H. G., Song, S. Y., Kim, Y. S., Oh, Y. T., Lee, C. G., Keum, K. C., . . . Lee, S. W. (2009). Therapeutic effect of recombinant human epidermal growth factor (RhEGF) on mucositis in patients undergoing radiotherapy, with or without chemotherapy, for head and neck cancer: A double-blind placebo-controlled prospective phase 2 multi-institutional clinical trial. Cancer, 115(16), 3699-3708.