Rao, S., Dinkar, C., Vaishnav, L.K., Rao, P., Rai, M.P., Fayad, R., & Baliga, M.S. (2013). The Indian spice turmeric delays and mitigates radiation-induced oral mucositis in patients undergoing treatment for head and neck cancer: An investigational study. Integrative Cancer Therapies, 13, 201–210.
To evaluate the efficacy of turmeric in preventing radiation-induced mucositis. Secondary endpoints included the efficacy of turmeric rinses on treatment breaks and weight loss.
The trial held the same recommended oral care for the treatment and comparison groups. Participants also were asked to swish after oral intake and wait 30 minutes to eat after swishing with the prescribed solution. The treatment group (turmeric rinses) was instructed to have a caregiver dissolve the contents of one 400 mg capsule of turmeric in 80 ml of boiled and cooled water. The patient was then instructed to swish 10 ml of the solution one hour prior to radiation; one, two, four, and six hours after radiation; and at HS. The comparison group was instructed to mix a povidone-iodine solution at 1 ml Betadine® to 100 ml water and swish 10 ml twice per day for six weeks.
There was a significantly (p < 0.0001) lower rate of intolerable mucositis (grades 3 and 4) in the turmeric group. There was no significant change in treatment days lost between groups. Weight loss in the turmeric group was less (p < 0.001).
Turmeric rinses are beneficial in reducing grade 3 and 4 mucositis in patients with head and neck cancer undergoing chemotherapy or chemotherapy and carboplatin, compared with twice-daily povidone-iodine rinses.
Turmeric rinses may provide some protection against oral mucositis for patients with head and neck cancer undergoing radiation and radiation plus chemotherapy; however, more research is needed. The treatment was reported as well tolerated, and there was no mention of adverse side effects.
Rao, R.M., Raghuram, N., Nagendra, H.R., Usharani, M.R., Gopinath, K.S., Diwakar, R.B., . . . Rao, N. (2015). Effects of an integrated yoga program on self-reported depression scores in breast cancer patients undergoing conventional treatment: A randomized controlled trial. Indian Journal of Palliative Care, 21, 174–181.
To evaluate the effects of a yoga program versus supportive care on symptoms of depression among women with breast cancer during treatment
Patients were randomized to the yoga program or a control supportive therapy program. Yoga included education, breathing exercises, meditation, and relaxation techniques with imagery. Subjects were provided with audiotapes of the practices for use at home. Home practice was monitored via telephone calls, weekly home visits, and a daily patient log. Subjects were to practice at home for at least one hour three times per week. The comparison group used supportive, expressive therapy and education provided by therapists in an unstructured approach aimed at addressing fears and concerns and improving support from others among other issues. The intervention took place over a 24-week period including the time of surgery and following adjuvant chemotherapy or radiotherapy. There were four to six study assessments, depending on the treatment, that were scheduled pre- and postsurgery and mid- and postradiation or chemotherapy. Interventions were done on an individual basis.
Single, blinded, randomized, controlled trial
Both groups reported decreased depression over time. An analysis of covariance showed a larger decrease in depression at all time points measured in the yoga group (p < 0.01). The study sample was appropriate according to the authors' power analysis. Depression scores were directly and strongly correlated (ranged from 0.49–0.77, p < 0.001) with symptom distress scores.
Yoga was shown to be beneficial in reducing symptoms of depression among women with breast cancer during the trajectory of active treatment. Depression was strongly related to symptom scores.
The findings of this study suggest that yoga is beneficial to women with breast cancer during active treatment to manage depressive symptoms. They also show that adverse symptoms were strongly related to depression, and depression was higher with more severe adverse symptoms. This points to the importance of effective symptom management as part of the overall reduction of depression.
Randheer, S., Kadambari, D., Srinivasan, K., Bhuvaneswari, V., Bhanumathy, M., & Salaja, R. (2011). Comprehensive decongestive therapy in postmastectomy lymphedema: an Indian perspective. Indian Journal of Cancer, 48(4), 397–402.
To evaluate the effectiveness of complete decongestive therapy (CDT) in Indian patients
Patients had clinical evidence of lymphedema (with a difference in arm volumes of at least 200 ml) and were being treated with CDT. They also were at least four months since surgery or radiation therapy. CDT consisted of intensive therapy using manual lymph drainage for 45 minutes four times a week followed by multilayer compression bandaging. Patients were educated on skin and nail care, use of isotonic exercises with bandages on, and re-application of bandages. After the intensive phase, patients were to massage themselves twice daily, perform isotonic limb exercises, and care for skin and nails three times a day. They also applied low-stretch compression bandages and elevated the limb at night. Assessments were performed before and after the intensive phase and monthly for three months.
The phase of care was the transition phase after active treatment.
The study used a prospective trial design.
After intensive therapy, the mean reduction in absolute limb volume was 485 ml by volumetry and 2,274 ml by measurement (p < 0.001). In the maintenance phase, there was a non-significant increase in limb volume of 20.3 ml. Reductions in skin and subcutaneous thickness showed the same pattern as the volume reduction. Three patients developed skin irritation and blistering following bandage application, and one patient who developed recurrent cellulitis following bandaging in the maintenance phase was excluded from the study.
The study demonstrates effectiveness of intensive CDT for management of lymphedema.
Findings demonstrated effectiveness of intensive CDT for lymphedema management and effectiveness of maintenance therapy for several months. Findings also showed the need for patients and caregivers to closely monitor skin condition with use of compression bandaging as well as have knowledge of related self care. It appears that self massage and bandaging can be used effectively for maintenance. It is important for patients to know how to perform self care and mointor side effects and be able to adhere to self-care regimens.
Ramaswami, R., Villarreal, M.D., Pitta, D.M., Carpenter, J.S., Stebbing, J., & Kalesan, B. (2015). Venlafaxine in management of hot flashes in women with breast cancer: A systematic review and meta-analysis. Breast Cancer Research and Treatment, 152, 231–237.
PHASE OF CARE: Transition phase after active treatment
APPLICATIONS: Elder care, palliative care
Venlafaxine is superior compared to placebo or other nonhormonal therapies in the management of hot flashes. Clonidine also demonstrated benefits.
Dose of 75 mg venlafaxine is efficacious for hot flashes in women with breast cancer and should be considered as a first-line treatment. Venlafaxine or clonidine is safe and not associated with breast cancer mortality or CYP2D6 activity.
There was a high heterogeneity among trials. None was analyzed as intention to treat (ITT) analysis. Concealment of allocation was unclear among three of six. Blinding was not feasible in the study with acupuncture. In five of six studies, blinding of outcome assessment was unclear or absent. Incomplete data or missing was not equal in groups in all studies.
This is important for cancer survivors without clear guidelines on symptom management after cancer treatment. North American population, mostly tool validation; expected differences in other populations. An apparent benefit exists in reducing hot flashes, but it needs a multicentered trial to confirm. Nurses should advise further research in standardizing hot flash scoring and need a standardized scoring approach.
Ramachandra, P., Booth, S., Pieters, T., Vrotsou, K., & Huppert, F.A. (2009). A brief self-administered psychological intervention to improve well-being in patients with cancer: Results from a feasibility study. Psycho-Oncology, 18, 1323–1326.
Authors recruited for the study were patients with stable metastatic breast cancer or prostate cancer who had at least a six-month life expectancy. Patients were randomized into an immediate treatment group and a wait-list control. All participants had follow-up at 6, 12, and 18 weeks. The intervention consisted of keeping a well-being diary, using a CD with a 10-minute recording to complete a mindfulness body scan, and planning a pleasurable activity.
Active treatment and transition
Randomized controlled trial
Positive qualitative feedback reflected a statistically significant (p = 0.046) improvement in quality of life. Although HADS scores improved after the intervention, the change was not significant, and SOFAS scores did not change significantly. Adherence to the intervention was 67% for CD listening, 71% for writing in the diary, and 46% for activity planning.
The intervention was associated with some improvement in quality-of life-measures, but there was no effect on depression or anxiety.
Findings do not indicate that mindfulness-based intervention, as used in this study, had an impact on well-being.
Ramachandra, P., Booth, S., Pieters, T., Vrotsou, K., & Huppert, F.A. (2009). A brief self-administered psychological intervention to improve well-being in patients with cancer: Results from a feasibility study. Psycho-Oncology, 18, 1323–1326.
To test the feasibility of a brief self-administered psychological intervention to improve well-being in patients with cancer
The intervention consisted of patient diary and CD meditation for home use with brief telephone support. Patients were requested to record three positive experiences each day in the diary and to plan one enjoyable activity each week and record in the diary. A recorded mindfulness “body scan” (meditation approach) 10 minutes in length was provided to each patient, and he or she was instructed to use this twice a day. Brief telephone contact was made in weeks 1, 2, and 4 to answer questions and encourage continued home practice.
Patients were undergoing the transition phase of care after initial treatment.
A randomized controlled trial design was used.
The drop-out rate was almost 50% at the six-week point. Quality of life showed significant improvement at the six-week point (p = 0.046). No other significant differences were identified.
Compliance rates of patients remaining in the study suggest that the approaches used here were easy enough to use and acceptable to them; however, the extremely high drop-out rate suggests that the actual feasibility of this approach for any length of time is questionable.
This study involved multiple follow-up periods and several self-report questionnaires. The burden of this activity may have contributed to the high drop-out rate.
Ram, S., Narayanasamy, R., & Barua, A. (2013). Effectiveness of group psycho-education on well-being and depression among breast cancer survivors of Melaka, Malaysia. Indian Journal of Palliative Care, 19(1), 34–39.
Determine the effectiveness of group psycho-education on well-being and depression among breast cancer survivors in Malaysia
In this cluster, non-randomized trial conducted over a one-month period, 34 adult women with non-metastatic breast cancer participated in a group psycho-education class on well-being status and depression. The class was designed to inform and discuss cancer and treatment. They were evaluated with a pre/post-test questionnaire, as well as a pretest socio-demographic questionnaire.
PHASE OF CARE: Active antitumor treatment
Cluster, non-randomized trial
The study showed that psycho-education decreased depression and increased the state of well-being among participants. Post-test results significantly improved for three of the five items on the WHO-5 Well-being Index.
Psycho-education may be one way to improve the overall well-being of patients diagnosed with breast cancer. More research is needed with larger numbers and a multi-site setting to validate improved well-being.
Psycho-education may be one way to improve the overall well-being of patients diagnosed with breast cancer, but as nursing professionals, taking a holistic approach to patient care and recognizing and addressing other contributing factors, such as biological and social factors, are important.
Rakhman, E., Shmain, D., White, I., Ekstein, M.P., Kollender, Y., Chazan, S., . . . Weinbroum, A.A. (2011). Repeated and escalating preoperative subanesthetic doses of ketamine for postoperative pain control in patients undergoing tumor resection: A randomized, placebo-controlled, double-blind trial. Clinical Therapeutics, 33(7), 863–873.
To determine whether the effect of ketamine on postoperative pain can be enhanced and prolonged if ketamine is administered IM in repeated and escalating subanesthetic doses before surgery; to determine if administration of ketamine as specified can reduce consumption of analgesia
Patients were randomized to receive a placebo (saline) or ketamine.
Postoperatively, for two days, all patients received IV morphine, by means of patient-controlled analgesia (PCA), to control pain for as long as requested. PCA was initiated in the postanesthesia care unit. The PCA consisted of a bolus of 1.5 mg morphine. After a morphine dose, a patient could not access another dose for seven minutes.
Double-blind, placebo-controlled randomized controlled trial
Group K2's mean 48-hour score (P = 0.0004) and group K3's mean 48-hour score (P = 0.046) were lower than the corresponding scores of the placebo groups. Compared to the placebo groups, patients in K2 and K3 used less morphine. PCA use was approximately 50% less than PSA use in placebo-group counterparts (P < 0.05). Ketamine at 25 mg caused dizziness for two minutes.
Two or three injections of ketamine before surgery for cancer attenuated postoperative pain and decreased opioid requirements for 48 hours after surgery.
Ketamine injections before cancer surgery may attenuate postoperative pain. Ketamine can be associated with dizziness and other side effects.
Rajotte, E. J., Yi, J. C., Baker, K. S., Gregerson, L., Leiserowitz, A., & Syrjala, K. L. (2012). Community-based exercise program effectiveness and safety for cancer survivors. Journal of Cancer Survivorship, 6, 219–228.
To determine the effectiveness and safety of a disseminated community-based exercise program for cancer survivors who completed cancer treatment.
Twice weekly over a period of 12 weeks, YMCA personal trainers supervised groups of seven to 14 study participants during 90-minute exercise sessions at 13 YMCA sites. Study measures were administered at baseline and after the 12-week exercise program. The standardized protocol included aerobic warm-up (10 minutes), resistance training (50 minutes), and community building time (e.g., sharing personal experiences, didactic and experiential training in breathing, relaxation, stress management, and nutrition). Precautions or contraindicated movements were noted for each participant, and resistance training was individualized. YMCA personal trainers had at least one year of personal training experience and received a specialized 16-hour group training by a cancer rehabilitation physical therapist. Additional training to address emotional issues for participants and trainers was provided by a licensed clinical psychologist with expertise in cancer survivorship. Participants and immediate family received access to YMCA facility branches and were encouraged to exercise outside of the sessions.
Patients were undergoing long-term follow-up postcancer treatment.
This was a prospective pre/post (nonrandomized) study design.
Validated patient-reported outcomes measures included
The study indicated that the community-based exercise program has important beneficial effects on physiologic, symptom, and quality of life health outcomes for cancer survivors and is safe to implement. Findings suggested that the program is helpful for improving fatigue, insomnia, physical function, overall musculoskeletal symptoms, mental health, social support, and physical activity in cancer survivors. Average baseline insomnia ratings of 1.63 (SD = 0.93) differed significantly from postintervention ratings of 1.43 (SD = 0.85) (p < 0.001). Additionally, the exercise program indicated notable improvements in physiologic measures (blood pressure, upper and lower body strength, walking endurance, and flexibility).
Community-based exercise groups for cancer survivors of mixed diagnoses and ages, who have completed active treatment, have physiologic and psychosocial benefits and appear to be safe. Because the participants self-selected to be part of the study and were screened for their ability to participate, findings cannot be generalized to the larger cancer survivor population.
Survivors may benefit from participating in a community-based exercise program tailored to meet their individual needs as a survivor; however, exercise programs should be preceded by consultation with health care providers. Additional nursing research is needed to determine the effect of resistance training and other exercise protocols in more diverse cancer survivor populations.
Rajasekaran, M., Edmonds, P.M., & Higginson, I.L. (2005). Systematic review of hypnotherapy for treating symptoms in terminally ill adult cancer patients. Palliative Medicine, 19, 418–426.
Databases searched were MEDLINE and Index Medicus, EMBASE, CINAHL, CancerLIT, Allied and Complementary Medicine Database (AHMED), PsycINFO, CISCOM, Cochrane Database, and Database of Abstracts and Reviews of Effects (DARE).
The search yielded 27 studies from 1974–2003, only one of which was a randomized controlled trial (RCT). Authors analyzed only the RCT.
Results of one RCT documented effectiveness of hypnotherapy in treating symptoms in terminally ill adult cancer patients.
The lack of well-designed studies to be analyzed calls for further research, involving effectively designed studies, to establish the effectiveness of hypnotherapy.