Sandherr, M., Hentrich, M., Von Lilienfeld-Toal, M., Massenkeil, G., Neumann, S., Penack, O., . . . Cornely, O.A. (2015). Antiviral prophylaxis in patients with solid tumours and haematological malignancies—Update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Annals of Hematology, 94, 1441–1450.
RESOURCE TYPE: Consensus-based guideline
PHASE OF CARE: Multiple phases of care
Not provided
The influenza vaccine is recommended in patients with active malignancy undergoing chemotherapy, patients with acute leukemia after chemotherapy, and all patients during maintenance treatment. Insufficient evidence exists for acyclovir prophylaxis for preventing herpes simplex virus (HSV), Epstein-Barr virus (EBV), and varicella-zoster virus (VZV) reactivation. The guidelines provide an algorithm for hepatitis B virus (HBV) reactivation prophylaxis, including screening, monitoring, and intervention based on positive HSs antigen and units of HBc DNA identified. Primary antiviral prophylaxis with nucleoside analogues for hepatitis B are effective in reducing risk. The guidelines identify risk factors for HBV reactivation:
These guideline add to the body of evidence recommending influenza vaccination in patients undergoing cancer treatment. This guideline does not recommend other routine prophylaxis and does provide suggestions regarding specific agents for prophylaxis according to individual patient risk factors based on disease, history, and treatment type.
Sanderson, C., Quinn, S.J., Agar, M., Chye, R., Clark, K., Doogue, M., . . . Spruyt, O. (2015). Pharmacovigilance in hospice/palliative care: Net effect of gabapentin for neuropathic pain. BMJ Supportive and Palliative Care, 5, 273–280.
To quantify immediate and short-term benefits and harms of gabapentin in hospice and palliative care patients
Data recorded at baseline, day 7, and day 21 were obtained from participating sites for patients receiving gabapentin for neuropathic pain. Benefits and harms factors were predefined by an expert committee. Overall benefit was defined as a one-point reduction in the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), and harms were attributed to gabapentin if the day 7 data showed higher CTCAE scores. The Naranjo Scale was used to determine attribution to the drug itself in scores above three.
Data were available at day 21 in 69 patients. Of these, 78% had improvement in their pain and 32% had associated harms. The most frequent harms were somnolence, cognitive disturbance, and fatigue. Twenty-nine patients had medication stopped or dosages reduced. The total number of patients who had benefit without harms was 9.4%. Regression analysis showed higher odds ratio of harm associated with comorbidities (p = 0.013).
Only 9% of palliative care/hospice patients receiving gabapentin had benefit for pain control without any associated harms.
Gabapentin is a common adjuvant pain medication. Findings from this study suggest that relatively few patients achieve benefits without harms. This study has multiple design and reporting limitations; however, it does raise the question of relative benefits of this medication in the hospice/palliative care population. Further well designed research to further evaluation risk/benefits of gabapentin are warranted. Nurses need to be aware of potential harms from various medications and monitor patient responses for appropriate care to identify and reduce harms. Potential for harm from gabapentin may be of greater concern among patients with multiple comorbid conditions.
Sanchez-Lara, K., Turcott, J.G., Juarez-Hernandez, E., Nunez-Valencia, C., Villanueva, G., Guevara, P., . . . Arrieta, O. (2014). Effects of an oral nutritional supplement containing eicosapentaenoic acid on nutritional and clinical outcomes in patients with advanced non-small cell lung cancer: Randomised trial. Clinical Nutrition, 33, 1017–1023.
To determine if a nutritional supplement taken by patients with advanced non-small cell lung cancer receiving paclitaxel with cisplantin/carboplatin chemotherapy can improve body composition, fatigue, health-related quality of life (HRQOL), and overall survival.
The patients were randomized to isocaloric diet or isocaloric diet plus eicosapentaenoic-acid (EPA) supplement ProSure®. Evaluations were conducted at baseline, after the first chemotherapy cycle, and after the second chemotherapy cycle.
PHASE OF CARE: Active antitumor treatment
The ONS-EPA group exhibited significant differences in weight (p = 0.01) and lean body mass (p = 0.01). Significant improvement was also seen in calorie and protein intake (p < 0.001) when the nutritional supplement was included. The ONS-EPA group also exhibited significant improvement in inflammatory markers between time points (p = 0.02 to p = 0.05). In HRQOL, there was significant improvement in global health status between time points for the ONS-EPA group (p = 0.021). Differences were seen between groups in fatigue (p = 0.04), appetite loss (p = 0.05), and neuropathy (p = 0.05)
In this study, ONS-EPA supplementation appears to be effective in improving nutritional status and decreasing side effects (appetite loss) in patients receiving chemotherapy for non-small cell lung cancer.
More studies need to be done with EPA supplementation in this and other cancers.
Sanaati, F., Najafi, S., Kashaninia, Z., & Sadeghi, M. (2016). Effect of ginger and chamomile on nausea and vomiting caused by chemotherapy in Iranian women with breast cancer. Asian Pacific Journal of Cancer Prevention, 17, 4125–4129.
To determine the effect of ginger and chamomile capsules on chemotherapy-induced nausea and vomiting (CINV)
PHASE OF CARE: Active antitumor treatment
Randomized, double-blind clinical trial
VAS for frequency and severity of nausea and vomiting
Ginger and chamomile did not affect the intensity of nausea, whereas both had an effect on the frequency of vomiting (p < 0.0001). Ginger also was shown to be have a statistically significant effect on the frequency of nausea (p = 0.006). Neither had an effect on intensity of nausea.
Ginger and chamomile may have some benefit as adjuncts to antiemetics for the prevention of CINV. Additional research is needed to evaluate these.
Ginger may be beneficial in CINV, but ongoing studies are needed.
Samulak, D., Michalska, M., Gaca, M., Wilczak, M., Mojs, E., & Chuchracki, M. (2011). Efficiency of postoperative pain management after gynecologic oncological surgeries with the use of morphine + acetaminophen + ketoprofen versus morphine + metamizol + ketoprofen. European Journal of Gynaecological Oncology, 32(2), 168–170.
To compare the efficacy of two medication schemes for the management of pain after gynecologic surgery
Consecutive patients were randomly assigned to two groups. Group 1 received, on the day of surgery, 1 mg morphine/10 kg body mass subcutaneously (SC) every four hours. After surgery Group 1 received 1 g acetaminophen IV every six hours and 500 mg naproxen per rectum every 12 hours daily. Group 2 received 1 mg morphine/10 kg body mass SC every 4 hours, 1 g metamizol IV every 6 hours, and 500 mg naproxen per rectum every 12 hours. For all patients, in instances of pain rated 5 or more, an additional 100 mg of ketoprofen IV was administered. Pain was rated throughout hospitalization.
Randomized parallel group
Numeric pain rating scale of 0–10
For the management of postoperative pain following gynecologic surgery, the combination of morphine, acetaminophen, ketoprofen, and metamizol as used in this study was more effective than the combination of morphine, metamizol, and ketoprofen.
This study describes a perioperative pain management regimen that appears to have decreased the pain of patients who underwent extensive gynecologic surgery. Note, however, that the more effective regimen did not provide complete control for more than 30% of patients on the day of surgery and for more than 15% on the first postoperative day. This study adds to the growing research regarding perioperative adjuvant medications for acute pain control.
Samdariya, S., Lewis, S., Kauser, H., Ahmed, I., & Kumar, D. (2015). A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck cancer patients. Indian Journal of Palliative Care, 21, 268–273.
To study the analgesic effect of honey for mucositis-related pain in patients with head and neck cancer receiving chemotherapy and radiation therapy
Patients were randomized to honey treatment and control groups. Patients were given 20 ml of honey 15 minutes before, 15 minutes after, and six hours after radiation treatment (RT). They were instructed to rinse the honey on the oral mucosa then swallow slowly to smear it on oral and pharyngeal mucosa. All patients also were told to gargle salt soda and benzydamine alternatively every three hours throughout RT and for three months after completion. Pain scores were obtained weekly. As needed, IV antibiotics were given for positive oral cultures, steroids were given for grade 3 mucositis, and gentian violet was applied for moist desquamation.
Randomized, controlled trial
In the experimental group, pain scores ranged from 1.83–3.08, and in the control group, scores ranged from 1.36–6.54 across the seven weeks of RT. From week 2 onward, the mean pain score in the experimental group was lower than that of control group (p = 0.000). After RT, mean scores ranged from 1.36–0.36 in patients using honey and from 4.87–1.57 in controls (p < 0.002). Some patients experiened dyspepsia, nausea, and vomiting with honey.
The use of honey was associated with less pain from mucositis in this study.
The findings of this study suggested that honey may be beneficial in reducing pain associated with mucositis caused by chemoradiation therapy in patients with head and neck cancer. Honey is known to have antioxidant and anti-inflammatory properties, which may be helpful for this purpose. Honey is a low-risk intervention, and based on this study's findings, additional well-designed research in larger samples is warranted.
Salvo, N., Barnes, E., van Draanen, J., Stacey, E., Mitera, G., Breen, D., . . . De Angelis, C. (2010). Prophylaxis and management of acute radiation-induced skin reactions: A systematic review of the literature. Current Oncology (Toronto, Ont.), 17(4), 94–112.
To review the evidence for approaches to prevention and management of radiodermatitis
Databases used were MEDLINE, PubMed, and Cochrane Library. Keywords searched were skin reactions, radiation, radiation adverse effects, erythema, desquamation, and radiodermatitis. Studies were included in the review they
Studies were excluded from the review if they were letters, comments, editorials, case reports, practice guidelines, systematic reviews, or meta-analyses.
The total references retrieved and the quality rating approach were not reported.
Patients were undergoing active antitumor treatment.
Washing practice, topical corticosteroids, aloe vera, biafine, hyauronidase-based creams, sucralfate, miscellaneous creams, Amifostine, oral enzymes, pentosifylline, dressings, non-steroidal topical cream, topical colony-stimulating factors supplements, and mode of radiation delivery were reviewed. Other agents studied included beladonna 7CH and a Chinese remedy, lian bai liquid.
There is lack of support for Biafine use. There is some evidence to suggest that topical corticosteroids may be beneficial. Evidence for non-steroidal topical agents is conflicting. Evidence does not support use of Aloe Vera or sucralfate cream. Some evidence to suggest that light-emitting diode, pentoxifylline, sliver-leaf dressings, washing, zinc supplements and intensity-modulated radiation therapy are beneficial.
Further research is needed in this area. Intervention goals, prevention or treatment need to be clear and further work is needed to develop and validate more sensitive assessment tools. Further work is also needed to evaluate differences in risk based on anatomical sites.
Salvador, P., Azusano, C., Wang, L., & Howell, D. (2012). A pilot randomized controlled trial of an oral care intervention to reduce mucositis severity in stem cell transplant patients. Journal of Pain and Symptom Management, 44, 64–73.
To assess the effectiveness and feasibility of implementing an oral cryotherapy plus oral care protocol to reduce oral mucositis (OM) severity in patients with multiple myeloma undergoing autologous stem cell transplant (ASCT)
Participants were randomized into an oral cryotherapy study group or a standard oral care control group. Patients in the oral cryotherapy study group received verbal and written instructions on oral cryotherapy plus an oral care protocol in place at the study site. Oral cryotherapy consisted of sucking on ice chips five minutes before, during, and after melphalan administration for a total of 60 minutes. The standard oral care protocol included education regarding oral self care, brushing with Toothette® brushes dipped in sodium bicarbonate, mouth rinsing with sodium bicarbonate mouthwash, and applying moisturizer to lips or the oral cavity. Patients were permitted to floss until their platelet counts fell below 50,000. Patients in the standard oral care control group received only the instructions on the oral care protocol (no cryotherapy). Outcomes were evaluated on days 3, 6, 9, and 12 after stem cell rescue. A research assistant who was blinded to group assignment assessed each participant and recorded the results of the assessment on data collection forms.
The study was conducted at a single-site, inpatient setting in Ontario, Canada.
This was a prospective, pilot, randomized control trial with repeated measures.
Cryotherapy in addition to an oral care protocol (as described above) is likely to be beneficial in reducing the severity of OM as well as decreasing pain and the need for opioid analgesics. In terms of lengths of stay, cryotherapy offered a clinical benefit, although not statistically significant.
Cryotherapy is inexpensive, and the protocol is relatively simple. In conjunction with an oral care protocol, this is a reasonable approach to take. A larger trial would be helpful.
Salpeter, S.,R., Buckley, J.,S., & Bruera, E. (2013). The use of very-low-dose methadone for palliative pain control and the prevention of opioid hyperalgesia. Journal of Palliative Medicine, 16, 616–622.
To evaluate the effect of low-dose methadone as the primary long-acting opioid in a hospice setting
Two hundred and forty charts of patients who were admitted to a community-based hospice setting from July 1, 2011–April 1,2012 were reviewed. Patients received short-acting doses of opiates equivalent to 5 mg every four hours as needed. Once two or more doses were needed, 2.5 mg methadone was initiated and titrated up by 2.5 mg increments every four to seven days as needed. Median dose of methadone was 5 mg daily, but max dose was 15 mg. Haloperidol was the most commonly prescribed adjuvant nonopoid medication, with a median dose of 3 mg daily. Pain was assessed during each nursing visit on a 0–10 scale and every time the short-acting opiate dose was used more than two times a day. If patients were on long-acting opiates and their life expectancy was greater than a week, they were offered conversion to methadone. Nonopioid agents were used for pain and other symptoms, with Haldol® being the primary agent for the purpose of NMDA inhibition. If patients were unresponsive, their pain was assessed by their caregiver.
A retrospective review of electronic records in those admitted to a community-based hospice service from July 1, 2011–April 1, 2012. Information was reviewed until patients were discharged from hospice or until April 30, 2012.
Two-thirds of patients never reported a score greater than 3 on a 0–10 numeric scale. The median reported score was 2 with a peak pain score of 3, with similar reports looking at cancer versus noncancer groups separately.
Methadone provided good pain control for the majority of patients. Methadone could be used with Haldol in pain control, particularly in circumstances in which patients experience a paradoxical reaction (caused by desensitization because of tolerance) and sensitization of the NMDA pathway responding to opioid receptor stimulation. More controlled trials will need to be conducted to consider this as a first-line treatment for management of pain.
Methadone is low-cost. Education to providers would be needed because the use of methadone may not be a common practice and conversion may be difficult. Risk of constipation is lower with the use of methadone, which may improve quality of life for those suffering from pain and perhaps lower overall pain. Working with high doses of methadone comes with large risk, so careful consideration should be used when prescribing.
Salehi, A., Marzban, M., & Zadeh, A.R. (2016). Acupuncture for treating hot flashes in breast cancer patients: An updated meta-analysis. Supportive Care in Cancer, 24, 4895–4899.
STUDY PURPOSE: To evaluate the effectiveness of acupuncture in treating hot flashes in women with breast cancer
TYPE OF STUDY: Systematic review and meta-analysis
PHASE OF CARE: Transition phase after active treatment
APPLICATIONS: Elder care
The meta-analysis without any subgroup or moderator did not support favorable effects of acupuncture in reducing the frequency of hot flashes after the intervention in women with breast cancer.
This meta-analysis did not conclude that data support the effectiveness of using acupuncture therapy to decrease the frequency of hot flashes in women with breast cancer. Limitations of the study included heterogeneous studies with a limited number of patients. The author noted the poor quality of the primary data.
The findings did not support the therapeutic use of acupuncture to decrease the frequency of hot flashes in women with breast cancer.