Meneses-Echavez, J.F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: A systematic review and meta-analysis. BMC Cancer, 15, 77-015-1069-4.
PHASE OF CARE: Multiple phases of care
All trials included aerobic training, and six included resistance training. The average duration of training was 21 weeks, and the average sessions per week was 2.5. Supervised aerobic exercise was more effective than usual care in improving fatigue (SMD = –0.51, 95% confidence interval [CI] [–0.81, –0.21]). SMD for resistance training was –0.41 (95% CI [–0.76, –0.05]). No dose response for training intensity was seen. Studies conducted during active treatment showed a significant benefit in reducing fatigue (SMD = –0.66, p < 0.05). In four studies conducted after cancer treatment, the effects of exercise on fatigue were not significant. Exercise improved physical well-being, but no significant effects were observed for social and emotional domains.
Supervised aerobic training during cancer treatment was associated with a significant improvement in fatigue.
Exercise during cancer treatment has been shown to reduce fatigue. This study suggests that the results may be best with aerobic exercise. The optimum intensity and “dosage” of exercise at various time points in cancer treatment remain unclear.
Melchart, D., Ihbe-Heffinger, A., Leps, B., von Schilling, C., & Linde, K. (2006). Acupuncture and acupressure for the prevention of chemotherapy-induced nausea: A randomised cross-over pilot study. Supportive Care in Cancer, 14, 878-882.
To study the effectiveness of acupuncture and acupressure in reducing chemotherapy-induced nausea
Patients were treated for one cycle of chemotherapy with acupuncture and acupressure at point P6 and for one cycle at a close sham point. Participants were randomized to acupuncture at P6 or at a close nonacupuncture point, and it was delivered by one of two physicians with training and experience in acupuncture. Participants wore acupressure bands for 72 hours at the same points on both arms and could wear them for an additional four days if needed. The bands were covered with a mull bandage to blind the staff. Participants completed diaries for seven days, documenting intensity (on a 0-6 rating scale), frequency, and duration of nausea and vomiting; additional antiemetics taken; and, on day 7, rate the effectiveness of side effects or impairment by acupuncture or acupressure. Patients completed the Morrow Assessment of Nausea and Emesis (MANE). Oncology staff checked that the diaries were completed accurately, standard antiemetics regimens were followed, and if any adverse reactions related to acupuncture occurred.
The study was conducted by the hematology and gastroenterology departments of a large university hospital in Germany.
This was a randomized, crossover pilot study.
Meissner, W., Leyendecker, P., Mueller-Lissner, S., Nadstawek, J., Hopp, M., Ruckes, C., . . . Reimer, K. (2009). A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. European Journal of Pain (London, England), 13, 56-64.
To assess the impact of orally administered prolonged-release (PR) naloxone on the analgesic effectiveness of PR oxycodone and on constipation in patients with severe chronic pain.
The study comprised three phases:
This was a prospective, placebo-controlled, randomized, double-blind, parallel-group, phase II study.
The study provided evidence that a combination of PR oxycodone/PR naloxone in a 2:1 ratio could enable patients with chronic pain to achieve both adequate pain control and bowel evacuation function.
The study only looked at oxycodone for pain control and did not include many patients with cancer.
An oral combination of PR oxycodone/PR naloxone in a 2:1 ratio seems to improve bowel function without compromising analgesia in patients with chronic pain. Additional study should include patients with cancer and a variety of other opioids.
Meissner, W., Schmidt, U., Hartmann, M., Kath, R., & Reinhart, K. (2000). Oral naloxone reverses opioid-associated constipation. Pain, 84, 105–109.
To evaluate the use of oral naloxone for the management of opiate-associated constipation in patients with cancer.
Patients were observed for six days without intervention. Afterward, oral naloxone was titrated as follows: 3 mg TID (day 1), 6 mg TID (day 2), 9 mg TID (day 3), 12 mg TID (day 4; maximum). Titration was stopped with laxation or increased peristalsis.
Hospital in Germany
This was a controlled study with a control period, but not a control group.
Starting with a low dose of naloxone and titrating up is recommended.
Meirow, D., Rabinovici, J., Katz, D., Or, R., & Ben-Yehuda, D. (2006). Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer, 107, 1634–1641.
Medical information was collected from a computer database. Patients received either DMPA or D- tryptophan -6-leutenizng hormone-releasing hormone agonist (GnRH-a) or no treatment before myelosuppressive chemotherapy.
Four patients were excluded because of gynecologic pathology. Average days of thrombocytopenia was 24.75 +/- 23.6 days. There was no statistical significant difference between groups regarding duration of thrombocytopenia. There was no difference in moderate to severe nonvaginal bleeding. There was no difference in platelet /packed red blood cells and fresh frozen plasma transfusions. Moderate/severe vaginal bleeding occurred in 16.8%—both treatment groups had lower rates of menorrhagia than untreated groups. None of the GnRH-a group had moderate/severe vaginal bleeding (p-0.002). There was a need for urgent gynecologic consult—untreated versus treated (P < 0.0001). Urgent treatment with estrogen was needed in the DMPA group but not the GnRh-a group (P = 0.004).
Meiri, N., Ankri, A., Hamad-Saied, M., Konopnicki, M., & Pillar, G. (2016). The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2–10 years undergoing venous blood drawing—A randomized controlled study. European Journal of Pediatrics, 175, 373–379.
To compare the use of medical clowning with the use of local anesthetic cream or the use of no intervention on pain in children undergoing a procedure
The study authors evaluated the use of a trained medical clown with the application of an anesthetic cream or no intervention on the effect on children’s pain and anxiety associated with a procedure. The control group underwent a blood draw/venipuncture without any intervention. The medical clown group had the clown distract and entertain the child from 10 minutes before as well as during and after the procedure. The final group had children given a local anesthetic containing a mixture of lidocaine and prilocaine 50 minutes prior to the blood draw/venipuncture. Duration of crying was measured by an independent observer, pain level was assessed by the child using the visual analog scale (VAS) for pain, and pain and anxiety were also assessed from the parents' perspective using VAS for pain and anxiety during a follow-up phone call.
The duration of the child crying was significantly shorter with the clown group than in the control group (p = 0.01). The duration of crying prior to the procedure was significantly shorter in the clown group compared to the EMLA cream group (p < 0.05) and control group (p < 0.01). The child’s assessment of pain was significantly less in the EMLA group compared to the control group (p = 0.04), but no difference existed between the clown and control groups. The parent’s assessment of the child’s pain was lowest in the clown group (p < 0.05 between all groups). Parent’s assessment of future anxiety was significantly lower in the clown group than the EMLA group or control group (p < 0.05).
The use of the medical clown had a positive effect on parents’ anxiety for future venipuncture as well as anticipatory crying duration and perception of pain in children.
Nurses should be aware of alternative methods such as the use of a medical clown for distracting or controlling children’s pain. Although medicine is shown to have a significant effect on the child’s pain, these methods can assist with both children and parents’ anxiety and management of pain.
Meiri, E., Jhangiani, H., Vredenburgh, J.J., Barbato, L.M., Carter, F.J., Yang, H.M., Baranowski, V. (2007). Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Current Medical Research and Opinion, 23(3), 533-543.
To compare the effectiveness of dronabinol alone or in combination with ondansetron versus ondansetron alone for delayed, chemotherapy-induced nausea and vomiting (CINV) among patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in multiple cancer centers
The study was conducted at multiple cancer centers.
This was a randomized, double-blind, placebo-controlled, parallel-group study.
The following measurement instruments were used.
Difficulties in enrollment led to early termination of this study.
Meijer, A., Roseman, M., Milette, K., Coyne, J.C., Stefanek, M.E., Ziegelstein, R.C., . . . Thombs, B.D. (2011). Depression screening and patient outcomes in cancer: A systematic review. PloS One, 6(11), e27181.
To evaluate, by means of a systematic review, whether evidence supports systematic screening for depression as part of cancer care
Data from this analysis do not support the hypothesis that screening for depression improves depression-related outcomes.
More work is needed to determine how screening directly or indirectly affects depression-related outcomes. All patients should have access to depression care from a multidisciplinary team.
Mehnert, A., Veers, S., Howaldt, D., Braumann, K.M., Koch, U., & Schulz, K.H. (2011). Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie, 34, 248–253.
To investigate whether an exercise intervention reduces anxiety and depression, and improves quality of life, body image, and physical fitness in women with breast cancer
Patients were randomly assigned to the intervention or a wait list control group after a sports medicine assessment. The intervention group received structured group exercise training twice weekly for 10 weeks. Training sessions lasted 90 minutes, were done in small groups (five patients), and included two main components: (a) warm-up, dance and movement games, physiotherapeutic exercises, and relaxation, and (b) moderate walking and jogging outdoors. Patients wore heart monitors during exercise. Sessions were led by a physio- or sports medicine therapist. Outcome variables were measured at baseline and at the end of the 10-week study period.
A randomized controlled trial design was used.
Anxiety declined over time in all patients (p = 0.08), and ANOVA showed a significant interaction of the intervention (p = 0.03). The effect size in anxiety with the intervention was -0.54 (95% CI -1.06 to -0.02). Depression declined over time in all patients (p = 0.02), but there was no interaction effect with the intervention. Body image improved over time in all patients (p = 0.003), and there was a significant interaction effect of group assignment (p = 0.006); however, body image at baseline was also better in the intervention group. There were no differences between groups in symptom burden or quality of life.
Participation in this exercise intervention was associated with a significant decline in anxiety.
Study findings suggest that group exercise can be helpful in reducing anxiety in patients with breast cancer after completion of adjuvant treatment. These study results should be interpreted with caution given the high drop-out rate and study limitations.
Meghrajani, C.F., Co, H.S., Arcillas, J.G., Maano, C.C., & Cupino, N.A. (2015). A randomized, double-blind trial on the use of 1% hydrocortisone cream for the prevention of acute radiation dermatitis. Expert Review of Clinical Pharmacology, 9, 483–491.
To evaluate the efficacy of 1% hydrocortisone cream for the prevention of acute radiodermatitis
Patients were randomized to receive either 1% hydrocortisone or placebo cream. Patients were to apply the cream to the irradiated field twice daily beginning on the first day of radiation therapy until one week after the last radiation session. The cream was to be applied at least two hours prior to therapy. Patients were instructed not to use any other topical medications or deodorants during the study. In case of severe radiodermatitis, additional treatment was determined by the dermatologist. These patients were considered treatment failures and were included in the analysis. Patients were evaluated at one, two, three, four, and five weeks.
PHASE OF CARE: Active antitumor treatment
Four patients from each group developed moist desquamation by week 5. No difference existed between groups in preventing moist desquamation. At week 1, a higher incidence of grade 1 dermatitis was observed in the placebo group (p = 0.038), and at week 4, a higher occurrence of grade 2 dermatitis was observed in the placebo group (p = 0.017). Groups were comparable at weeks 3–5. The incidence of pruritus was less in the steroid group in weeks 4 and 5 (p < 0.04).
The findings suggest that the use of topical 1% hydrocortisone cream reduced pruritus and delayed the onset of radiation dermatitis. However, it did not prevent moist desquamation compared to the placebo.
Topical steroid cream was associated with less pruritus from radiodermatitis and may delay the onset of skin problems; however, it was not effective in preventing severe skin toxicity. Whether stronger formulations would be more beneficial is unclear. Patients can benefit from the use of topical steroids to reduce itching.