Radbruch, L., Elsner, F., Trottenberg, P., Strasser, F., & Fearon, K. (2010). Clinical practice guidelines on cancer cachexia in advanced cancer patients. Retrieved from www.epcrc.org/getpublication2.php?id=TERNkkdssZelXeVZGTkB
RESOURCE TYPE: Evidence-based guideline
PROCESS OF DEVELOPMENT: Development according to NICE recommendations. An international expert group identified clinical priorities and questions to scope literature reviews. The draft was made available for public input. GRADES was used to identify the level of evidence and formulate draft recommendations. Consensus on recommendations was obtained using a Delphi technique. The specifics of the literature search strategy are not provided.
No information about results of literature searching are provided.
There was limited reporting and no summary of the evidence base for recommendations in this document.
This review provides weak evidence that shows no support for use of cannabinoids to improve appetite in patients with cancer. Individual patients may report some benefit of cannabinoids in terms of appetite, but there is no real evidence to support efficacy for this symptom.
Rada, G., Capurro, D., Pantoja, T., Corbalán, J., Moreno, G., Letelier, L. M., & Vera, C. (2010). Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database of Systematic Reviews, (9) CD004923.
To assess the efficacy of non-hormonal interventions for the treatment of hot flushes in women with a history of breast cancer
TYPE OF STUDY Combined systematic review and meta analysis
TOTAL REFERENCES RETRIEVED : N =1012
APPLICATIONS Late Effects and Survivorship
Racca, P., Fanchini, L., Caliendo, V., Ritorto, G., Evangelista, W., Volpatto, R., . . . Ciuffreda, L. (2008). Efficacy and skin toxicity management with cetuximab in metastatic colorectal cancer: Outcomes from an oncologic/dermatologic cooperation. Clinical Colorectal Cancer, 7, 48–54.
To evaluate the effectiveness of treatments for several cutaneous reactions.
Rash was treated with erythromycin 4% gel, phosphate clindamycin 1.2 g and oil 100 g in cream BID, and oral doxycycline 100 mg daily for two months. Patients with grade 2 or 3 pruritus were treated with antihistamines (e.g., cetirizine). Finally, xerosis was treated with topical antibiotic ointments, soap substitutes, bath oil, and moisturizing emollients.
The study reported on a sample of 34 patients with metastatic colorectal cancer who were receiving cetuximab and irinotecan.
The trial was conducted at two sites in Italy.
This was an open-label, uncontrolled phase 2 trial. A series of cases with significant dermatologic events (DEs) was described, and management of DEs was discussed.
Rash:
Pruritus:
Xerosis:
Interventions were effective in resolving the dermatologic effects of cetuximab and irinotecan.
Rabin, C., Pinto, B., Dunsiger, S., Nash, J., & Trask, P. (2009). Exercise and relaxation intervention for breast cancer survivors: feasibility, acceptability and effects. Psycho-Oncology, 18, 258–266.
To assess the feasibility, acceptability, and preliminary effects of a 12-week combined physical activity and relaxation intervention for sedentary, early stage breast cancer survivors after completing all primary treatment.
Early stage breast cancer survivors participated in a 12-week combined physical activity (PA) and relaxation intervention, with baseline and 12- and 24-week assessments. Participants received a theoretically grounded intervention modeled after on the “Moving Forward” intervention based on the principles of the transtheoretical model (TTM) and the social cognitive theory (SCT). Participants were instructed to do moderate-intensity level exercise with pre-/post stretching. The goal was to walk 30 minutes five times a week by the twelfth week of the intervention. The relaxation component included instruction on progressive muscle relaxation (PMR); a CD with PMR instructions was included. Participants were telephoned weekly to provide counseling, a review of their practice activities, reinforcement, identification of barriers, and negation of the next week's goals.
The study used a prospective, single-arm, repeated measures design.
Participant evaluations of the intervention indicated that it was feasible and acceptable (e.g., 100% would recommend it to others); objective data further supported its feasibility (e.g., 83% completed the trial, and 91% of the intervention calls were received). In addition, when comparing 12- and 24-week follow-up data to baseline data, participants demonstrated significantly increased PA, improved mood and sleep quality, and reduced fatigue (p < 0.05).
The pilot study suggested that the intervention is feasible, acceptable, and produces promising effects on mood, sleep, and fatigue.
Multibehavior interventions, such as exercise and relaxation, hold promise for cancer survivors and may improve quality of life (i.e., fatigue, sleep, mood, and disturbance).
Rabin, C., Pinto, B., Dunsiger, S., Nash, J., & Trask, P. (2009). Exercise and relaxation intervention for breast cancer survivors: feasibility, acceptability and effects. Psycho-Oncology, 18, 258–266.
To assess the feasibility, acceptability, and preliminary effects of a 12-week combined physical activity and relaxation intervention for breast cancer survivors.
Participants met with an intervention coordinator to complete baseline questionnaires and an activity assessment. They were then provided with exercise education about types of exercise and stretches, using a pedometer, setting activity goals, progressive muscle relaxation, and how to record these activities. Participants were then called weekly for 12 weeks during the intervention to provide further counseling.
The study used a pre-/post design.
Fatigue was statistically reduced from baseline to weeks 12 (p < 0.05) and 24 (p < 0.01). Sleep quality was also improved from baseline to weeks 12 (p < 0.01) and 24 (p < 0.05).
Participants found the intervention feasible without interrupting their levels of physical activity. Fatigue and sleep quality were improved significantly from baseline, suggesting a benefit from physical activity and relaxation as a combined practice. Further research is needed with control groups.
Behavioral interventions for breast cancer survivors are a feasible and safe practice and may improve quality of life in participants. These interventions can be taught by nurses to patients.
Raber-Durlacher, J.E., von Bultzingslowen, I., Logan, R.M., Bowen, J., Al-Azri, A.R., Everaus, H., … Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). (2013). Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients. Supportive Care in Cancer, 21(1), 343–355.
To review the literature and define clinical practice guidelines for use of cytokines and growth factor agents for the prevention or treatment of oral mucositis from chemotherapy or radiation therapy in patients with various types of cancer receiving radiation, chemotherapy, or hemapoietic stem cell transplant (HSCT)
In this evidence-based guideline, two independent reviewers scored level of evidence by Somerfield and Hadorn criteria. Following panel consensus, findings were integrated into guidelines.
Databases searched were Ovid, MEDLINE, and hand searching.
Search keywords included all types of cytokines and growth factors.
Inclusion and exclusion criteria were not specified.
Patients were undergoing the active antitumor treatment phase of care.
Out of 1,718 papers that were initially retrieved, 64 studies were included in the systematic review.
Palifermin 60 mcg/kg/day for three days prior to conditioning and three days post-transplantation was recommended in patients receiving HSCT. No guideline was possible for palifermin use in other patient types. For granulocyte colony-stimulating factor (G-CSF), no guideline was possible. No guidelines were possible for granulocyte macrophage colony-stimulating factor (GM-CSF) mouthwash, topical transforming growth factor beta, mil-derived growth factor, epidermal growth factor, interleukin-II, ALT 104, or recombinant human intestinal trefoil factor.
Very limited research has been done in children. Guidelines do not specify if recommendations are for adults and children. Most studies had relatively low levels of evidence. Sample sizes were not reported.
Use of palifermin for mucositis prevention in HSCT recipients was recommended.
Raanani, P., Gafter-Gvili, A., Paul, M., Ben-Bassat, I., Leibovici, L., & Shpilberg, O. (2009). Immunoglobulin prophylaxis in chronic lymphocytic leukemia and multiple myeloma: Systematic review and meta-analysis. Leukemia and Lymphoma, 50, 764–772.
The purpose of the article is to examine whether prophylactic administration of IV immunoglobulin (IVIG) reduces mortality, major infections, and the rate of documented microbial infection in patients with lymphoproliferative and plasma cell disorders.
The PubMed, Cochrane Library, and LILACS databases as well as numerous conference proceedings published from 2002–2008. Hand searching of references was also done.
Key words were immunoglobulins, gammaglobulins, specific gammaglobulins names, hematologic neoplasms, or hematologic malignancies, multiple myeloma, plasma cell dyscrasias, leukemia, lymphoma or lumphoproliferative disorders.
Inclusion criteria:
The search strategy identified 613 trials. Trials were graded according to allocation concealment according to the Cochrane Handbook guidelines. Sixteen trials were considered relevant and included in the initial review. Seven of these were excluded due to duplication, route of administration, and study design.
The final sample included in the systematic review was nine studies. Five studies had usable information for meta analysis. Study samples ranged from 16–42, and the review included a total sample of 408 patients across all studies.
Use of IVIG did not appear to affect overall mortality. The rate of major infections requiring inpatient treatment was significantly lowered by IVIG prophylaxis.
Based on these results, contemporary studies of IVIG prophylaxis are warranted.
Qutob, A.F., Gue, S., Revesz, T., Logan, R.M., & Keefe, D. (2013). Prevention of oral mucositis in children receiving cancer therapy: A systematic review and evidence-based analysis. Oral Oncology, 49, 102–107.
To investigate, critically appraise, and rate the evidence regarding agents used for the prevention of mucositis in children
Databases searched included CINAHL, Cochrane library, Ovid MEDLINE, PubMed, BioMed Central, and other internet-based sources. A total of 19 databases were searched.
Search keywords were mucositis, stomatitis, oral inflammation, mouth mucosal inflammation, prophylaxis, management, and prevent; in addition to keywords to identify children and all types of cancer therapy.
Studies were included in the search if they
Studies were excluded if they
The authors concluded that oral care protocols should be used; oral sucralfate suspension, prostaglandin E2, and GM-CSF mouthwash should not be considered based on current evidence; and chlorhexidine (without use as part of an oral care protocol), laser therapy, and glutamine should not be considered because of conflicting evidence.
Findings provide further support for use of oral care protocols. Results provided no other useful recommendations for preventive therapies but identified the need for further research in this area.
Quist, M., Adamsen, L., Rorth, M., Laursen, J.H., Christensen, K.B., & Langer, S.W. (2015). The impact of a multidimensional exercise intervention on physical and functional capacity, anxiety, and depression in patients with advanced-stage lung cancer undergoing chemotherapy. Integrative Cancer Therapies, 14, 341–349.
To determine the effects of a supervised group exercise intervention on aerobic capacity, anxiety, depression, and quality of life in patients with advanced lung cancer
The intervention consisted of physical and relaxation training in groups of 10–12 patients provided twice weekly for six weeks. Exercises included cycling and strength training supervised by a physiotherapist. Study assessments were done at baseline and at six weeks.
Quasi-experimental
There were significant reductions in anxiety scores (ES 0.21, -0.9 change, p = 0.007). There was no effect on depression scores. Aerobic capacity, functional capacity, and muscle strength improved significantly.
The findings of this study suggest that group exercise sessions may benefit the managing anxiety and increase functional capacity among patients with advanced lung cancer. Changes were statistically significant; however, actual change scores were small. The clinical relevance of these changes is not clear.
The findings of this study suggest that group exercise sessions can improve function and might reduce anxiety among patients with advanced lung cancer. This type of approach may not be feasible or acceptable for patients with very poor baseline functional capabilities. Additional well-designed research in this area would be helpful, and studies should include attentional control conditions to differentiate the affects of group support versus other aspects of the intervention.
Quintard, B., & Lakdja, F. (2008). Assessing the effect of beauty treatments on psychological distress, body image, and coping: A longitudinal study of patients undergoing surgical procedures for breast cancer. Psycho-Oncology, 17, 1032–1038.
To evaluate, postsurgically, the impact of beauty treatments, in combination with routine cancer care, on body image, psychological distress, and coping in patients with breast cancer
Intervention beauty treatments occurred at the hospital during the first week postsurgery. Intervention treatments included manicures, pedicures, makeup, depilation, hairdressing, and massages. The control group received routine medical care. Data collection occurred at baseline (the day before surgery), at six days postsurgery (Time 1), and at three months postsurgery (Time 2).
Active treatment
Randomized prospective controlled trial
Depression scores measured by HADS increased significantly over time in both groups (p < 0.001). Anxiety scores measured by HADS decreased significantly over time in both groups (p < 0.001). Investigators noted no significant intergroup difference or interaction effect for both depression and anxiety. Three months after surgery, the intervention group reported higher body-image scores. Patients' perception of helplessness and hopelessness increased over time in the control group but not in the intervention group (p < 0.05).
Overall, this study did not find that beauty treatment had an effect on psychological distress and coping styles.
Cost-effectiveness needs to be examined, particularly given the fact that the investigation yielded no significant findings.