Mehdipour, M., Taghavi, Z., A., Asvadi, K., I., & Hosseinpour, A. (2011). A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru Journal of Faculty of Pharmacy Tehran University of Medical Sciences, 19(1), 71-73.
To evaluate the effectiveness of a zinc-containing mouthwash on chemotherapy-induced oral mucositis in comparison with chlorhexidine gluconate mouthwash as control.
Patients with acute myeloid leukemia under chemotherapy were allocated to an experimental and control groups of 15 patients each. The required dilution of 0.2% zinc sulphate and chlorhexidine gluconate mouthwashes. Subjects instructed to rinse with 10 ml of 0.2% zinc sulphate mouthwash twice a day for 14 days in the experimental group. The control group used 0.2% chlorhexidine mouthwash in the same manner. The mouthwashes were coded with A and B letters on the bottles, and the investigator, as well as the subjects were blinded to the type of the mouthwash, which was administered to the groups by a simple random method. All subjects were examined every other week for eight weeks.
The study was comprised of 30 patients, over 15 years of age.
MALES (%) Not specified, FEMALES (%) Not specified
KEY DISEASE CHARACTERISTICS: Acute myeloid leukemia
OTHER KEY SAMPLE CHARACTERISTICS: Subjects receiving an established treatment plan of Cytarabine in the induction phase and Novantrone in the consolidation phase were included in the study. Exclusion criteria included no subject <15 years of age. Allergy to zinc or chlorhexidine mouthwashes. Any systemic disease with other diagnosis of malignancies or chemotherapy-induced oral mucositis, any oral ulcers, or mucositis developed before starting chemotherapy.
SITE: Single site
LOCATION: The oncology ward of Shahid Gazi Hospital in Tabriz, Iran
PHASE OF CARE: Active treatment
APPLICATIONS: Acute myeloid leukemia
Randomized, double-blind, controlled
There were no significant differences between the case and control groups in the first week (p = 0.124). The trends of changes in the assessed oral mucositis index during the course of the study were similar in both groups. The mean a (alpha) index in both groups increased from the first week to the third week and then decreased in the fourth week. Although the mean a (alpha) index was generally lower in the test group compared to the control group at all four time intervals evaluated, repeated measure ANOVA revealed that the difference was statistically significant in weeks 2 and 3 (p = 0.025).
Zinc mouthwash used in conjunction with chemotherapy may reduce the severity of oral mucositis lesions in patients with leukemia.
The double-blind study is the most efficacious. Within the field of oncology, the occurrence of mucositis has always been associated as a side effect of chemo-radiation therapies. Mucositis is a result of radiotherapy and chemotherapy or a combination of the two. Thus, mucositis needs immediate and timely nursing interventions. The zinc mouthwash appears to be cost effective and easy to use. To this, clinical trials with randomized testing within the United States that support zinc mouthwash may be beneficial. Nurses who are in the oncology setting face challenges to plan and provide care that promotes the best possible health related outcomes for their patients.
Mego, M., Chovanec, J., Vochyanova-Andrezalova, I., Konkolovsky, P., Mikulova, M., Reckova, M., . . . Drgona, L. (2015). Prevention of irinotecan induced diarrhea by probiotics: A randomized double blind, placebo controlled pilot study. Complementary Therapies in Medicine, 23, 356–362.
To determine if the probiotic Colon Dophilus is able to prevent irinotecan-induced diarrhea in patients with metastatic colon cancer
Placebo versus probiotic Colon Dophilus. The probiotic was given three times per day for 12 weeks while the patient received irinotecan.
Probiotics reduced the incidence of grade 3 or 4 diarrhea compared with placebo (0% versus 17.4% for control group). Patients who used probiotics reported using fewer antidiarrheal medications.
Probiotics appear to be safe and may be of use in irinotecan-induced diarrhea.
More research on the use of probiotics and irinotecan-based chemotherapy is needed.
Meghrajani, C.F., Co, H.C., Ang-Tiu, C.M., & Roa, F.C. (2013). Topical corticosteroid therapy for the prevention of acute radiation dermatitis: A systematic review of randomized controlled trials. Expert Review of Clinical Pharmacology, 6, 641–649.
STUDY PURPOSE: To assess the efficacy of topical corticosteroids in the prevention of acute radiation dermatitis compared with placebo, other topical medication, or no treatment
PHASE OF CARE: Active antitumor treatment
Together, the studies showed that the prophylactic application of topical corticosteroids reduced the incidence of moist desquamation and lowered the mean acute radiation dermatitis scores.
The results of this systematic review and meta-analysis show that topical steroids may be likely to reduce the incidence of radiotherapy-induced moist desquamation of the breast. Additional well-constructed studies consistently implementing blinding and testing the same steroid formulation and route of administration are needed. Studies examining other radiation treatment sites are indicated.
Meegan, M.A., & Haycocks, T.R. (1997). An investigation into the management of acute skin reactions from tangential breast irradiation. Canadian Journal of Medical Radiation, 28, 169–173.
To determine if there is an adverse effect to irradiated skin when patients use their normal skin care regimens
Two consecutive groups of patients received tangential breast irradiation. The first group (group A) used the traditional skin care advice of using warm water only, avoiding the use of all lotion, soaps, and deodorants in the treatment field. The second group (group B) continued with their normal skin care regimen with no product restriction. Patients and therapists scored the skin reaction weekly and three weeks after treatment.
The study used a prospective trial design.
There were no significant differences found in skin assessment scores between groups. Reactions peaked at 7–10 days from completion of radiation. There was no difference in the skin scores between the two groups at that point. Patient self-scoring of the severity of the skin reaction revealed that group A consistently scored higher than group B, indicating greater level of problems.
There is no difference between the severity of skin reactions of patients using no products and those using their usual skin care products.
Mebel, D., Akagami, R., & Flexman, A.M. (2016). Use of tranexamic acid is associated with reduced blood product transfusion in complex skull base neurosurgical procedures: A retrospective cohort study. Anesthesia and Analgesia, 122, 503–508.
To determine the effect of tranexamic acid (TA) upon transfusion frequency and to explore the safety of TA in patients undergoing complex skull base neurosurgical procedures
The authors retrospectively examined records of patients undergoing complex skull base neurosurgical procedures. Patients were placed into one of two cohorts based upon administration of TA or not to determine the effect of TA on transfusion rates and TA-associated complications. Data were collected from patients undergoing the surgical procedure from 2001 to 2013.
PHASE OF CARE: Active antitumor treatment
Retrospective, observational cohort study
Multivariate regression was used to identify predictors of transfusion.
The administration of TA was associated with a decreased incidence of transfusions (95% confidence interval [CI] [0.15, 0.65], p = 0.002). No evidence of an adverse event profile (95% CI) existed for either thrombotic events (adjusted odds ratio (OR) = –0.09, 95% CI [–3.5, 1.8]) or seizure activity (OR = 1.1, 95% CI [–1.7, 3.9]) associated with TA.
In patients undergoing complex skull base neurosurgical procedures, this retrospective observational study compared transfusion frequency and TA-related adverse events between two cohorts based upon the administration of TA. A significantly decreased frequency of transfusions was associated with the administration of TA; no significant increase in TA-related adverse events was reported between the two cohorts.
Neurosurgical nurses caring for patients perioperatively may anticipate less need for transfusions in patients who receive TA perioperatively. However, the retrospective nature of this study needs confirmation of findings from future randomized, controlled trials.
Meattini, I., Francolini, G., Scotti, V., Cardillo, C.D.L., Cappelli, S., Meacci, F., . . . Mangoni, M. (2015). Aprepitant as prophylaxis of chemotherapy-induced nausea and vomiting in anthracyclines and cyclophosphamide-based regimen for adjuvant breast cancer. Medical Oncology, 32, 1–5.
To appraise the effectiveness and safety of a three-drug antiemetic prophylaxis treatment in patients with breast cancer receiving a regimen of 5-fluorouracil, epirubicin, and cyclophosphamide
All patients received the same antiemetic prophylaxis regimen consisting of aprepitant (oral 125 mg on day 1 and oral 80 mg on days 2 and 3), palonosetron (0.25 mg IV on day 1), and dexamethasone (12 mg IV on day 1). The acute phase was defined as the first 24 hours after chemotherapy, and the delayed phase was defined as days 2–5 following chemotherapy. Complete response (CR) was defined as no vomiting or rescue treatment, and complete protection was defined as no vomiting, no rescue treatment, and no significant nausea. Total control was defined as no vomiting, no rescue treatment, and no nausea. Data were collected for five days following the administration of chemotherapy.
Cross-sectional, descriptive, single-arm design (design was not specifically mentioned in the article)
Only cycle 1 data were used in this study. In the acute phase, 89.1% of patients achieved CR, and 81.5% achieved CR in the delayed phase. Complete protection was achieved in 67.4% of patients in the acute phase and 62.0% of patients in the delayed phase. Total control was achieved in 52.2% of patients in the acute phase and 48.9% of patients in the delayed phase.
Prophylaxis consisting of aprepitant, palonosetron, and dexamethasone was safe, effective, and highly recommended in patients receiving anthracycline-based regimens (although it is not classified as a highly emetogenic chemotherapy by all international guidelines). Additional controlled trials are strongly needed to better define the optimal approach in emesis prophylaxis.
The majority of patients in this study experienced CR in the acute and delayed phases after chemotherapy administration. Triple-drug therapy was an appropriate intervention for chemotherapy-induced nausea and vomiting prophylaxis in patients with breast cancer receiving anthracycline and cyclophosphamide treatment.
McQuade, J., Prinsloo, S., Chang, D.Z., Spelman, A., Wei, Q., Basen-Engquist, K., . . . Cohen, L. (2016). Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: A randomized controlled trial. Psycho-Oncology. Advance online publication.
To examine the efficacy of qigong or tai chi to alleviate treatment-related fatigue and disturbed sleep in men who were undergoing radiotherapy for prostate cancer
PHASE OF CARE: Active antitumor treatment
Randomized, controlled trial
This study did not show improvements in fatigue scores reported in any group either during treatment or after. Improvements in sleep duration was reported by those in the qigong group when compared to the light exercise group and the wait-list control. Sleep disturbance remained higher than clinical cutoff for all groups. Adherence to attendance at intervention in all classes was 64%. Additional practice at home after radiotherapy ended was not assessed.
Men undergoing radiotherapy for prostate cancer are able and willing to participate in physical activity interventions, such as qigong and/or light exercise. Fatigue and sleep disturbance are common symptoms experienced by men undergoing radiotherapy for prostate cancer and may persist after treatment is complete. However, qigong improved sleep duration for participants during radiotherapy treatment. This study did not detect improvements in fatigue or sleep disturbance that were sustained over the three-month period of the study.
No side effects were reported in either intervention group (qigong or light exercise).
McNichol, E., Strassels, S.A., Goudas, L., Lau, J., & Carr, D.B. (2005). NSAIDs or paracetamol, alone or combined with opioids, for cancer pain. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD005180.
The search retrieved 42 trials. Eight trials compared an NSAID with a placebo, 13 compared one NSAID with another, 23 compared an NSAID with an opioid or an NSAID-opioid combination, and 9 assessed the effect of increasing the NSAID dose. Sixteen of the 42 studies were conducted over seven days or longer, and 11 studies were single-dose studies. No study lasted longer than 12 weeks. Treatments studied included weak opioids, strong opioids, and agonist or antagonists. Nine studies examined dose range. Outcomes measured included differences in pain intensity, pain relief, and incidence and severity of adverse effects. Many studies used a visual analog scale; few studies used validated scales.
The 42 trials reviewed included 3,084 patients.
On the basis of limited data, NSAIDs appear to be more effective than placebo in treating cancer pain. Data to support the use of one NSAID over another, in regard to safety or efficacy, are insufficient. Compared to an NSAID alone or an opiod alone, NSAID-opioid combinations were no more effective or, at most, had a slight statistical advantage. The World Health Organization (WHO) method of cancer pain relief is considered the gold standard. Regarding the first step in the WHO method, the management of mild pain, results of this review support the WHO recommendations: Results strongly suggest that an NSAID alone is superior to placebo and adequate for at least short-term pain relief. Regarding the second step: Evidence is insufficient to refute or support the WHO recommendation to use an NSAID-opioid combination as a means to manage moderate cancer pain. Increasing the dose of an NSAID or adjuvant drug to the maximum acceptable dose may be the better course.
Clinicians should be cautious regarding the use of NSAIDs, especially in the population studied. This population takes many prescription drugs, some of which may increase NSAID-related toxicity.
McNeely, M.L., Peddle, C.J., Yurick, J.L., Dayes, I.S., & Mackey, J.R. (2011). Conservative and dietary interventions for cancer-related lymphedema: A systematic review and meta-analysis. Cancer, 117(6), 1136–1148.
To update evidence from randomized controlled trials (RCTs) regarding benefits of conservative and dietary interventions for all cancer-related lymphedema
Databases searched were MEDLINE, EMBASE, CINAHL, PubMed, Dissertation Abstracts, PEDro, and Cochrane Collaboration. Keywords were neoplasm, axillary dissection lymph node excision, lymphedema, conservative treatments (e.g., stockings compression, manual drainage), and publication types of random allocation and clinical trial. Studies were included in the review if they were RCTs with a sample of at least 80% patients with cancer comparing a conservative or dietary intervention to placebo, control, or comparison intervention in secondary lymphedema from cancer. Exclusion criteria were not specified.
Of the 157 papers that were initially retrieved, a final set of 25 were included. A modified Jadad scoring was used to evaluated the quality of the evidence. Only eight studies met criteria for high quality. Meta-analysis was done for studies examining the effect of manual lymph drainage (MLD)for upper-extremity lymphedema with breast cancer.
Results were synthesized in terms of effects on lymphedema volume and patient-rated outcomes of pain, heaviness, tenderness and quality of life for nine interventions. Most studies were limited to upper extremities; where lower extremities were included is stated below.
Meta-analysis demonstrated significant but relatively small benefit from the addition of MLS in patients with breast cancer-related lymphedema. Findings support the growing body of evidence that participation in exercise does not exacerbate lymphedema and can reduce the severity of symptoms. Only two studies were found that examined nutrition and dietary interventions; these reported benefit in terms of volume reduction, but were of relatively low quality. Evidence suggests that compression garments and bandaging are effective in reducing limb volume with various types of cancer.
Only eight studies in this review were deemed to be of high quality.
Inclusion of MLD provides a relatively small added benefit and may be associated with substantial costs. It is not clear if the benefits outweigh the cost and MLD may be most useful for patients who do not achieve sufficient improvement with other effective approaches. Findings related to dietary interventions are promising, pointing to the value of additional research in this area. Breast cancer continues to be the most frequently studied group. Research in other groups and with lower-limb lymphedema is needed.
McNeely, M.L., Campbell, K., Ospina, M., Rowe, B.H., Dabbs, K., Klassen, T. P., . . . Courneya, K. (2010). Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database of Systematic Reviews (Online), 6, CD005211.
To examine the evidence of effectiveness from randomized controlled trials involving exercise interventions for preventing, minimizing, and improving upper-limb dysfunction because of breast cancer treatment
Databases searched were Specialised Register of the Cochrane Breast Cancer Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008). Experts, hand-searched reference lists, conference proceedings, clinical practice guidelines and other unpublished literature sources were also considered. Search keywords were neoplasm, tumor, tumour, mastectomy, axillary dissection, sentinel node dissection, adhesive capsulitis, cording, axillary web syndrome, physical therapy, physiotherapy, rehabilitation, exercise, stretching, mobilization, physical activity, exertion, range of motion, strength, lymphedema, pain, and quality of life. Studies were included if they were randomized controlled trials evaluating the effectiveness and safety of exercise for upper-limb dysfunction. Studies were excluded if they included cancers other than breast cancer (e.g., melanoma) unless separate data were available for a breast cancer subgroup.
The total number of studies reviewed initially was 82. Two authors independently performed the data abstraction. One author performed the initial pre-screen of all the databases to identify potential trials and screened the results to exclude articles that were clearly irrelevant. Two independent authors screened the reduced search results. If either or both authors felt that the article potentially met the inclusion criteria, or if there was inadequate information to make a decision, full-text copies of the article were retrieved. Using the defined eligibility criteria, the two authors independently decided on trial inclusion. A priori, authors made the decision to exclude any data that were available only in abstract form. Review authors were not blinded to study authors, journal, or study results. Agreement was measured and assessed using kappa statistics. Three investigators independently assessed quality of the trials and extracted data independently using a standardized form. Investigators were contacted for missing data.
Exercise can result in a significant and clinically meaningful improvement in shoulder ROM in women with breast cancer. There is evidence that patients benefit from exercise interventions that include more structured instruction and supervision when compared to exercise instruction through a pamphlet or no exercise instruction. Of note, larger benefits were found for shoulder range of motion and shoulder function outcomes from physical therapy treatment that was introduced in the early weeks following surgery. There was no evidence of a negative effect from upper-extremity exercise on the incidence of upper-limb lymphedema at any time point following surgery.
In the postoperative period, consideration should be given to early implementation of exercises, although this approach may need to be carefully weighed against the potential for increases in wound drainage volume and duration. High-quality research studies that closely monitor exercise prescription factors (e.g., intensity) and address persistent upper-limb dysfunction are needed.