McGreevy, K., Hurley, R.W., Erdek, M.A., Aner, M.M., Li, S., & Cohen, S.P. (2013). The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: A pilot study. Pain Practice, 13, 89–95.
To determine the success rate and duration of relief following repeat celiac plexus neurolysis (CPN) for pancreatic cancer pain
CPN was performed using either fluoroscopy or computed tomography (CT). All CPN and neurolytic procedures were performed under sterile conditions with IV sedation provided as needed at the discretion of the attending physician. The decision to use fluoroscopy versus CT was based on several factors, including patient condition, resource availability, and radiologic demonstration of tumor distribution. A diagnostic/prognostic block was performed first; in patients who obtained relief, subsequent neurolysis with 80%–100% ethanol was administered. Volume was variable and dependent on clinical circumstances. All procedures were performed in the prone position using a posterior approach. Patients were kept prone for 30 minutes to avoid spread to posterior nerves.
Those participants with a successful response to initial CPN were more likely to have pain symptoms in the back and abdomen and have a shorter time interval from diagnosis of pancreatic cancer to initial CPN. The overall success rate decreased from 67% after initial CPN to 29% following repeat CPN (p = 0.13). The mean duration of pain relief also decreased from 3.4 months following initial CPN to 1.7 months after repeat CPN (p = 0.03). The proportion of individuals with successful repeat CPN after unsuccessful initial CPN was 50% (four out of eight), which favorably compared to 19% (3 out of 16) in those who had successful initial CPN (p = 0.13). In multivariate analysis, the presence of metastases was associated with a 90% decrease in success rate. No statistically significant differences were found between repeat CPN success, and failure groups were observed for age, sex, baseline pain score, location of tumor, presence of metastasis, encasement of celiac axis, opioid use, peritoneal tumor involvement, use of repeat diagnostic block, radiologic guidance used for procedure, needle approach or technique used, or the use of sedation for the procedure. Disease progression on imaging and a longer period between blocks were contributors to treatment failure.
This study demonstrated that the magnitude and duration of pain relief following repeat CPN were significantly less than after the initial procedure. Results suggest that a subset of patients may benefit from repeat CPN. Thirty percent of individuals reported positive responses to repeat CPN, which warrants further analysis.
Evaluation of a repeat procedure may be warranted when pain levels begin to escalate following a successful initial procedure. However, this is a preliminary suggestion warranting more well-controlled studies. As patient advocates and proponents of pain management, nurses are in a position to further research regarding patient responses to pain management interventions and techniques, such as CPN and repeat CPN. In the outpatient setting, oncology nurses focus on pain management at every visit and direct patients to follow up with the appropriate interdisciplinary team member(s) to address as needed. Nurses are involved in every aspect of patient care, including pre-, post-, and during interventions (e.g., the various CPNs described here), and in outpatient, inpatient, hospice, and palliative settings.
McGough, C., Wedlake, L., Baldwin, C., Hackett, C., Norman, A.R., Blake, P., … Andreyev, H.J. (2008). Clinical trial: Normal diet vs. partial replacement with oral E028 formula for the prevention of gastrointestinal toxicity in cancer patients undergoing pelvic radiotherapy. Alimentary Pharmacology & Therapeutics, 27(11), 1132–1139.
To determine whether replacing a third of the normal diet with an elemental formula (E028) during the first three weeks of pelvic radiotherapy is feasible and effective in decreasing acute gastrointestinal (GI) toxicity
Patients with a gynecologic, urologic, or lower GI malignancy who were scheduled to receive radical or adjuvant radiotherapy to the pelvis were randomized to receive either an elemental diet, which involved replacing one normal meal per day with the elemental formula E028 Extra, or no intervention for the first three weeks of treatment.
The study was conducted in an oupatient care setting in the United Kingdom.
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized-controlled trial.
The Inflammatory Bowel Disease Questionnaire – Bowel specific sub-set (IBDQ-B), Vaizey Incontinence Questionnaire (VIQ), and Radiation Therapy Oncology Group (RTOG) tool were used.
Patients in the intervention group exhibited poor compliance, ingesting only 65% of the proposed oral elemental formula. The intervention group did not experience a reduction in bowel symptoms or fecal calprotectin compared to the control group.
This study did not show a benefit to ingesting elemental formula. Orally ingested elemental formulae are known to be unpalatable, and the intervention group had poor compliance with consuming the proposed amount of formula.
McDougall, G.J., Becker, H., Acee, T.W., Vaughan, P.W., & Delville, C.L. (2011). Symptom management of affective and cognitive disturbance with a group of cancer survivors. Archives of Psychiatric Nursing, 25, 24–35.
To evaluate effectiveness of a memory training intervention as compared to a health training group intervention for management of cognitive impairment in older adult cancer survivors
Measures were performed pre-intervention, post-intervention, post-booster intervention, and six months afterwards. The memory training intervention consisted of eight sessions incorporating 20 minutes of relaxation, a targeted memory topic, and 30 minutes of targeted practice with role model. Participants received a memory improvement book at end of the memory intervention. The health training consisted of providing 18 health-related topics over two months; the frequency of the training was not provided. Booster sessions consisted of four weekly mandatory two-hour sessions over one month conducted within three months after completion of initial training.
Randomized clinical trial
Visual memory as measured by the BVMT-R was improved (p < 0.1 for the group by time interaction) for participants who received the memory training intervention. Trends toward improvement in verbal memory as measured by the HVLT-R and overall memory as measured on the standardized profile scale of the REBMT were observed for participants who received the memory intervention, but they were not significant. Improvements were seen in self-reported memory components in locus, capacity, and control (p < 0.05 for the group by time interaction) and use of internal strategies (p < 0.1 for time). Memory complaints decreased (p < 0.05 for the group by time interaction).
Significant improvements in visual memory were obtained and sustained, and trends for improving verbal and global memory were observed in those who participated in the memory training. In addition, those who participated in memory training maintained their use of internal compensatory strategies and reported significant improvements in subjective aspects of cognitive function, including increased confidence, greater capacity, belief that they could better manage issues with their memory, and decreased complaints of their memory performance.
Cognitive impairments present ongoing symptom management issues for older adult cancer survivors. Memory training has been effective in older individuals and may offer opportunities for improvements in memory difficulties for older adult cancer survivors. The authors suggested that their memory training intervention may be adjusted to meet the specific cognitive issues that older cancer survivors report. Further studies are needed to determine feasibility and generalizability to patients with cancer.
McDougall, G.J., Jr. (2001). Memory improvement program for elderly cancer survivors. Geriatric Nursing, 22(4), 185–190.
The study was conducted to determine the effect of a rehabilitative intervention on cognitive function, depression, and functioning.
The study framework included two intervention groups and one wait-list control group. Participants were randomized into intervention group 1 (receiving eight classes and a memory book) or the wait-list control group (Group 3). Wait-list control group participants were further randomized into intervention group 2 (receiving only the memory book) or group 3.
Intervention group 1 received a memory book and classes on day 1; intervention group 2 received a memory book on day 1 and began classes four weeks later. Wait-list control group participants received a memory book on day 1. Participants from intervention group 2 and the wait-list control group were placed in classes together based on location. All classes were identical.
The study took place at a comprehensive retirement community in the Midwest that included independent and assisted-living dwellers.
The study utilized a randomized, controlled trial.
Cancer survivors showed significant improvements after the intervention in
The cancer survivors scored higher on managing finances (p = 0.01). They had lower total IADL scores compared with the control group, and scored lower on baseline metamemory capacity, with an average score of 2.5 (p = 0.03). They showed worsening after the intervention on the RBMT Immediate Route test (p = 0.03) and the RBMT Delayed Route test (p = 0.0001). The cancer survivors were older, with an average age of 84.12 years (p = 0.02).
Significant associations were observed for the total sample between
There were no significant pre-test differences between groups on memory performance, memory self-efficacy scores, or MMSE scores. The total sample had a relatively high perception of health status and a low incidence of depression (13%).
Post-intervention tests showed no improvements in objective memory performance, despite reported improvements in subjective memory and memory self-efficacy.
McDonald, J., Swami, N., Hannon, B., Lo, C., Pope, A., Oza, A., . . . Zimmermann, C. (2016). Impact of early palliative care on caregivers of patients with advanced cancer: Cluster randomised trial. Annals of Oncology, 28, 163–168.
To report the effect of an early palliative care intervention on quality of life (QOL) and satisfaction with care of caregivers of patients with advanced cancer
A cluster randomization process involving patients and their caregivers in 24 Canadian medical oncology clinics supported two randomized arms: an intervention with early palliative care team referral or usual oncology care with palliative care only as needed. Further stratification of clinics by tumor site supported the two study arms. Both arms included caregivers of patients with advanced cancer, defined as having a clinical prognosis of 6–24 months and an ECOG score of 0–2, who completed previously validated instruments on care satisfaction (FAMCARE-19) and QOL (SF-36v2 Health Survey, Caregiver Quality of Life Index-Cancer [CQOL-C]). A mixed effect model evaluated intervention group improvement over the control group at baseline assessment and monthly for as many as four months.
Cluster randomized trial design
Canadian caregivers of patients with advanced cancer that receive early palliative care team intervention experience increased satisfaction with care compared to those who receive standard oncology care. Additional work to explore the impact of an early palliative care team intervention on caregiver QOL with an attention on factors like sample size and contextual factors of care will contribute to the science in this area.
Few clinical trials assess the effect of early palliative care interventions on caregivers of patients with advanced cancer. Current standards of care for patients with advanced cancer include integrating palliative care to improve patient care satisfaction and QOL. This study shows evidence that including those patient caregivers in such an approach improves their satisfaction with care, although it is unclear whether it improves their overall QOL.
McDonagh, M., Peterson, K., & Thakurta, S. (22 July, 2010). Consideration of evidence on antiemetic drugs for nausea and vomiting associated with chemotherapy or radiation therapy in adults. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK254005/
PHASE OF CARE: Active antitumor treatment
The strongest evidence suggested that three-drug regimens (5HT3 antagonists plus corticosteroids and aprepitant) with mixed delivery methods (PO plus IV) offered maximal relief of chemotherapy-induced nausea and vomiting (CINV).
The addition of aprepitant to standard antiemetic regimens with mixed PO and IV antiemetics can greatly improve CINV in patients with cancer.
McCorkle, R., Siefert, M.L., Dowd, M.F., Robinson, J.P., & Pickett, M. (2007). Effects of advanced practice nursing on patient and spouse depressive symptoms, sexual function, and marital interaction after radical prostatectomy. Urologic Nursing, 27, 65–77; discussion 78–80.
To determine the effect of a standardized nursing intervention on protocol (SNIP) on newly diagnosed men and their female spouses on marital interaction, sexual function, and depressive symptoms following radical prostatectomy over a six-month period
Couples were randomly assigned to an intervention (SNIP) or a usual care group. The usual care group received care according to standards identified by the urology clinic group, and the SNIP group dyads received 16 contacts (twice per week: home visit and telephone call) from an advanced practice nurse (APN) specially trained for the study to deliver an evidence-based protocol. Dyad conversations with APNs evolved from reading of a common public education booklet given to couples during the SNIP intervention. Measurement of outcome variables (depression, marital interaction, and sexual function) occurred in both the usual and intervention groups at baseline and one, three, and six months following radical prostatectomy.
The study design was secondary data analysis of a prospective, randomized clinical trial with repeated measures.
Analysis of variance procedures indicated that among patients, outcome measures showed no indication of main effects due to group assignment. However, spouses had significant differences for some of the measures at six months, with the SNIP group spouses having higher depression scores that approached significance. The SNIP spouses also had a higher average sexual function distress score and a significantly higher marital interaction distress score than did the control group spouses. Spouses reported significantly higher levels of depressive symptoms and more marital interaction distress as compared to patients. However, patients reported significantly more sexual function distress than did their spouses. The SNIP intervention had no group effect on depressive symptoms, but such symptoms improved over time in both patients and spouses. The SNIP intervention showed a modest effect on patients’ sexual function and marital interaction over time, with SNIP patients and spouses reporting increased distress. However, control group women reported significantly lower rates of sexual functioning distress over time compared to the SNIP group. Pearson correlations showed patient depressive symptoms related to patient marital interaction, spousal depressive symptoms, and spousal marital interactions.
An intervention such as SNIP can effectively address depressive symptoms of newly diagnosed patients with prostatectomy and their spouses, as well as relevant issues such as patient sexual function and marital interaction that change with radical prostatectomy. A trained nurse, delivering an evidence-based intervention focused on the needs of these dyads, can assist them in understanding expected postsurgical changes and implementing actions to foster hope and recovery within the dyad.
Nurses should routinely assess depressive symptoms of patients and their primary support system to define needed interventions during cancer treatment. Patient and spouse (caregiver) teaching about common side effects of cancer treatment, ways of responding to those side effects, and the potential for recovery of earlier functions should be included at each patient encounter. Support groups for both patients and caregivers may further bolster networking with others who have “moved beyond” the early consequences of prostate surgery and offer hope to recent surgical patients and their spouses. An evidence-based intervention delivered by APNs, such as the one used in this study, offers structure and process of care to promote quality care of those individuals.
McClure, M.K., McClure, R.J., Day, R., & Brufsky, A.M. (2010). Randomized controlled trial of the Breast Cancer Recovery Program for women with breast cancer-related lymphedema. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 64(1), 59–72.
To determine effect of completion of a recovery program including gentle exercise and deep breathing on breast cancer-related lymphedma
Patients assigned to the treatment group attended biweekly one-hour exercise and educational sessions for five weeks, then followed a three-month self-monitored home program. Those in the treatment group were instructed to complete use of a video and relaxation daily at home. Exercises included gravity-resistive arm movements incorporating shoulder flexion, abduction, and external rotation. Exercise and compression hose adherence was assessed with a self-report tool designed for the study. Control patients received usual care. Patients were assigned into four groups of treatment and controls.
The study sample (N = 32) was comprised of female patients aged 21–80 years with stage I or II unilateral breast cancer-related lymphedema.
The study took place in an outpatient site in Pittsburgh, PA.
The study used a randomized controlled single blind trial design.
Bioimpedance mean differences of those in treatment compared with controls showed a positive main effect for treatment (p = 0.049). There was no significant effect on volume measures. Patients who complied with compression demonstrated improvement over time. Range of motion, mood, and quality of life improved in those in the treatment group.
The program of combined exercise activity and self-directed practice related to coping and relaxation were associated with improvement in lymphedema and other symptoms.
Findings support the positive benefit of patient upper-extremity exercises in the management of lymphedema.
McAleese, J.J., Bishop, K.M., A’Hern, R., & Henk, J.M. (2006). Randomized phase II study of GM-CSF to reduce mucositis caused by accelerated radiotherapy of laryngeal cancer. British Journal of Radiology, 79(943), 608–613.
GM-CSF 2 mcg/kg (-1) (150 mcg) daily for 14 days starting on day 14 of a 21-day course of RT.
Note: Placebo injections were not given; observer was blinded to treatment.
The study was comprised of 29 patients (GM-CSF = 14).
Power analysis was completed, but not met (n = 17 in each group).
Patients with proven T1 N0 or T2 N0 glottic carcinoma were being treated with radiotherapy using a 16 fraction 3-week regimen.
Required to have a WHO performance status of grade 0 or higher, no renal or hepatic issues, serious infections requiring antibiotics, or likely need for corticosteroids.
Prospective, randomized, observer blind phase II trial
Significant difference in the incidence of mucositis p < 0.05, mean time of healing improved but not significant p = 0.25.
No differences in dysphagia, odynophagia, analgesic use, candida infection, of laryngeal edema.
Mazzocato, C., Buclin, T., & Rapin, C.H. (1999). The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: A randomized double-blind controlled trial. Annals of Oncology, 10(12), 1511–1514.
Subcutaneous (SC) morphine 5 mg or placebo in opioid-naïve patients and regular oral morphine dose plus half of the every-four-hour (q4h) dose given SC in patients on regularly scheduled opioids
The study was conducted in an inpatient geriatric hospital.
The study was a double-blind, placebo controlled, randomized, cross-over trial.
Intermittent injections of morphine at the doses used reduce cancer-related dyspnea. The changes in respiratory effort and rate but not anxiety support the theory that the benefit of morphine is unlikely related to somnolence or an effect on anxiety.