Quinn, B. (2013). Efficacy of a supersaturated calcium phosphate oral rinse for the prevention and treatment of oral mucositis in patients receiving high-dose cancer therapy: A review of current data. European Journal of Cancer Care, 22, 564–579.
To summarize the literature on calcium phosphate oral rinse for the prevention and treatment of oral mucositis (OM)
Caphosol was found to reduce OM grade, duration, or both in 24 out of 30 studies. Caphosol was associated with a reduction in OM-associated pain in 14 of 17 studies with more than 30 patients and 6 studies with fewer than 30 subjects. Data regarding nutrition, patient compliance, and length of hospitalization were conflicting, but the majority demonstrated a benefit with Caphosol. Two studies reported potential cost savings with the use of Caphosol. Three studies with 30 patients and three single-center studies with controls of standard mouth care and MuGard® did not find significant differences in OM grade or duration. Two studies of more than 30 patients did not demonstrate a benefit associated with OM-related pain. One study did not find a significant difference in nausea or dysphasia for Caphosol-treated patients. Three studies failed to demonstrate any differences in length of stay.
The majority of the studies included in the review reported some benefit from Caphosol use. The data demonstrate the opportunity to further study the role of supersaturated calcium phosphate oral rinse in the prevention and treatment of OM.
The effects from OM remain a significant challenge for patients receiving cancer treatment. Nursing involvement in prospective, randomized, blinded studies could provide the best practice data needed to recommend treatments for OM. The limitations for the studies included in this review are significant and do not provide rigorous scientific support for the use of Caphosol.
Quigley, C. (2008). Opioids in people with cancer-related pain. Clinical Evidence, 2008, 2408.
To determine the effects of various opioids in treating cancer-related pain
Investigators reviewed 34 studies. Investigators used 22 studies as the basis of their report. Investigators evaluated studies by performing a GRADE evaluation of the evidence, using the following criteria: type of evidence, quality, consistency (similarity of results across studies), directness (generalizability), and effect size. Evidence ratings were very low, low, moderate, and high.
Authors reported results relative to pain, need for rescue analgesia, function, quality of life, patient preference, and adverse events.
Morphine is the standard opioid in the management of moderate to severe cancer pain. Evidence from this study was insufficient to allow authors to compare other opioids to it. Evidence from this study was insufficient to allow conclusions about codeine. Investigators categorized the effectiveness of dihydrocodeine, a newer option for pain control, as unknown. Evidence from this study was insufficient to allow authors to rate the effectiveness of transdermal fentanyl. Hydromorphone may be as effective as morphine or oxycodone and may cause fewer adverse effects. Methadone may be as effective as morphine or oxycodone, for reducing pain, and the two opioids' rates of associated adverse effects are similar. Oxycodone and morphine may be equally effective in reducing pain. Tramadol may be as effective as morphine, but morphine seems to have quicker onset.
Authors deemed all evidence cited in this review to be of very low or low quality.
Quigley, E.M., Vandeplassche, L., Kerstens, R., & Ausma, J. (2009). Clinical trial: The efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation—A 12-week, randomized, double-blind, placebo-controlled study. Alimentary Pharmacology and Therapeutics, 29, 315–328.
To evaluate the effectiveness and safety of prucalopride, a 5-HT4 receptor agonist, in patients with chronic constipation.
Patients with self-reported chronic constipation for at least six months could enroll in the study. The 12-week study procedure comprised a two-week placebo run-in period to determine frequency of bowel movements (BMs). Patients with two or fewer spontaneous complete BMs per week were randomized to one of three treatment groups (2-mg prucalopride, 4-mg prucalopride, or placebo), with study medication taken once daily with breakfast for 10 weeks.
This was a randomized, double-blind, placebo-controlled, parallel-group phase III trial.
Prucalopride 2-mg and 4-mg administration improved the frequency, consistency, and quality of defecation and led to complete bowel evacuation in adults with chronic constipation.
Prucalopride (2 mg or 4 mg daily) appeared effective in the treatment of chronic constipation in adults. Research for applicability in patients with cancer is warranted.
Quigley, C., Joel, S., Patel, N., Baksh, A., & Slevin, M. (2002). A phase I/II study of nebulized morphine-6-glucuronide in patients with cancer-related breathlessness. Journal of Pain and Symptom Management, 23, 7–9.
A single dose of nebulized morphine-6-glucuronide (M6G) (the active metabolite of morphine) was given to patients with cancer who had breathlessness. Three dose levels were studied: 5, 10, and 20 mg of M6G. The single dose of morphine was inhaled using an Acorn Porta-Neb jet nebulizer over 15 minutes.
This was an open, uncontrolled study that randomized patients to one of three dose levels.
All patients reported a subjective improvement in breathlessness by the VAS and the Borg scale. A significant difference (p = 0.023) in dyspnea VAS was observed with time across all time points. No significant difference existed among the three treatment groups across all time points (p = 0.176), suggesting no difference among the three doses. A significant difference in dyspnea was found between patients. No significant changes existed in anxiety VAS and effort of breathing VAS with time or with dose. Minimal adverse effects were noted.
Nebulized M6G was relatively safe and possibly therapeutic in patients with cancer-related breathlessness.
A randomized study is planned.
Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2003). Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. Journal of Consulting and Clinical Psychology, 71, 189–200.
The study used a two-phase, multimodal, cognitive-behavioral therapy (CBT) combined strategy: (a) over 3 to 10 weeks and (b) over eight weeks; eight weekly sessions lasted 90 minutes.
The purposes were to establish treatment objectives, stimulus control, sleep restriction, coping strategies for fatigue, and reframe maladaptive cognitions.
Outcomes were sleep, mood, fatigue, and global and cognitive quality of life (QOL).
Patients were undergoing the long-term follow-up phase of care.
The study used a prospective, nonrandomized, repeated measures, quasiexperimental, single-case design comparing each individual over time.
Most women experienced a statistically significant improvement in sleep efficiency and decreased total wake time pre- and posttreatment. Sleep efficiency continued at the six-month follow-up, but total wake time did not. Findings on sleep diaries were corroborated by objective measures.
Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2003). Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. Journal of Consulting and Clinical Psychology, 71, 189–200.
Patients received multimodal cognitive-behavioral therapy (CBT) that combined cognitive, behavioral, and educational strategies. Treatment consisted of eight weekly sessions administered in a group of five participants combined with use of stimulus control, sleep restriction, cognitive therapy, sleep hygiene, and fatigue and stress management. The treatment protocol was based on clinical procedures developed by Morin (1993) and adapted by the investigators for the cancer population.
Ten breast cancer survivors participated in this pilot study.
Patients were included in the study if they
Patients who regularly used psychotropic medications other than hypnotics were excluded unless the dosage use was stable in the last month and did not increase during the study. Individuals currently receiving psychotherapy were also excluded.
Patients were undergoing the long-term follow-up phase of care.
This was a single-arm study with no control group.
Multidimensional Fatigue Inventory (MFI)
Nonparametric statistical testing revealed significant improvements in the general and physical subscales of the MFI; there was no significant change between pre- and posttreatment on the mental, activities, and motivation subscales of the MFI. There was no significant change observed from posttreatment through six-month follow-up on the MFI general and physical subscales, suggesting that the treatment gains were sustained over time.
Quéré, I., Presles, E., Coupé, M., Vignes, S., Vaillant, L., Eveno, D., . . . POLIT Study investigators. (2014). Prospective multicentre observational study of lymphedema therapy: POLIT study. Journal des Maladies Vasculaires, 39, 256–263.
All patients received DLT divided into two phases. The intensive treatment phase was administered over a one to three-week time period (daily treatment for at least five consecutive days), and the maintenance phase mainly was carried out by the patient and his or her family members at home. Limb volume was measured on days 5, 12, 19, and 195.
Observational, prospective, longitudinal cohort study
Initial intensive lymphedema treatment resulted in a 31% volume reduction, but the benefits were somewhat abolished when volume increased by 16.5% during the six-month maintenance phase. The only independent variable predictive of volume reduction after intensive therapy was the presence of previous intensive DLT. The most frequent adverse events were skin redness (18.4% of patients) and compression marks (42.3% of patients). Blisters requiring that treatment be stopped were uncommon (1.4% of patients).
There is a need for large, randomized trials to identify which components or combinations of components are most effective. There is a need to identify techniques to improve patient outcomes during the maintenance phase in trials for the long-term control of lymphedema.
Nurses should be aware of this intervention as a potential treatment for patients with lymphedema, making this an important point of education. The early identification of lymphedema using \"heaviness\" as a descriptor may help refer patients for treatment sooner. The fact that results may diminish after intensive treatment should be considered, and this could point to the importance of adhering to strict maintenance schedules and encouraging physical activity for long-term benefits.
Quella, S.K., Loprinzi, C.L., Barton, D.L., Knost, J.A., Sloan, J.A., LaVasseur, B.I., … Novotny, P.J. (2000). Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: A North Central Cancer Treatment Group trial. Journal of Clinical Oncology, 18, 1068–1074.
The study evaluated soy phytoestrogens for the treatment of hot flashes in breast cancer survivors.
After a baseline documentation week, women received four weeks of either soy tablets or placebo. They then crossed-over to the opposite for the last four weeks. The soy product was formulated in 600 mg tablets. Participants took one tablet three times per day (150 mg of isoflavones day), an amount similar to that consumed with three glasses of soy milk.
Participants included 177 women with a history of breast cancer; 149 participants (84%) provided useable efficacy data for the entire nine weeks of the study.
All participants were randomized in a double-blind crossover design to one of two groups (soy or placebo) and crossed-over after four weeks. Participants were stratified according to age, duration of hot flashes, and the average daily hot flash frequency using a dynamic allocation procedure that balances marginal distributions. They were also stratified by current tamoxifen or raloxifene use (yes or no).
The instrument was a daily questionnaire documenting hot flashes frequency, intensity, and perceived side effects.
The soy product did not alleviate hot flashes in breast cancer survivors. No toxicity was observed. These data failed to suggest any patient preference for the soy compound over the placebo preparation.
Optimal daily dose of soy required to recognize a clinical response may be questioned. Data related to estimated intake of 150–200 mg daily in the Asian diet endorsed the choice of 150 mg/day. Experience from conventional HRT suggests that length of time on the soy isoflavones (four weeks) may be too short to elicit a clinical response. Study durations of less than three months have been excluded from overviews of the effects of HRT.
Quattrin, R., Zanini, A., Buchini, S., Turello, D., Annunziata, M.A., Vidotti, C., . . . Brusaferro, S. (2006). Use of reflexology foot massage to reduce anxiety in hospitalized cancer patients in chemotherapy treatment: Methodology and outcomes. Journal of Nursing Management, 14, 96–105.
To reduce anxiety caused by chemotherapy (not the diagnosis)
The intervention was reflexology foot massage in hospitalized patients undergoing their second or third cycle of chemotherapy (30-minute foot massage on both feet by an RN student). The Spielberger State-Trait Anxiety Inventory was administered before and after reflexology and 24 hours post-reflexology.
The study reported on a sample of 30 patients: 15 in the control group and 15 in the reflexology foot massage group.
Italian research hospital
Spielberger State-Trait Anxiety Inventory
There was an average decrease of 7.9 points on the state-anxiety scale in the treatment group (p < 0.0001) after the short time frame (immediate decrease in anxiety).
Quaas, A.M., & Ginsburg, E.S. (2007). Prevention and treatment of uterine bleeding in hematologic malignancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 134, 3–8.
PHASE OF CARE: Active antitumor treatment
In the four studies reviewed, the administration of LA in premenstrual women with hematologic malignancy at risk of bleeding demonstrated efficacy in reducing episodes of uterine bleeding. The route of administration (IV, IM, or SQ) did not appear to have an effect upon efficacy. Efficacy was improved when LA was administered at least two weeks prior to the onset of thrombocytopenia.
Leuprolide acetate administration to premenopausal women at risk of uterine bleeding demonstrates efficacy in the prevention of uterine bleeding. In addition, there was no documentation of adverse effects from the hormone.
The number of studies and participants included was small (4 and 94, respectively). In addition, there was not a randomization of participants.
Uterine bleeding in premenopausal females undergoing therapy for hematologic malignancy poses a significant risk. Administration of LA has the potential to mitigate this. There is a place for further research to define dose, administration, and timing of administration.