Mazumdar, A., Mishra, S., Bhatnagar, S., & Gupta, D. (2008). Intravenous morphine can avoid distressing constipation associated with oral morphine: A retrospective analysis of our experience in 11 patients in the palliative care in-patient unit. American Journal of Hospice and Palliative Care, 25, 282–284.
To describe differences in bowel function with oral or IV opioids.
Patients who were admitted to a palliative inpatient unit for pain management had data retrospectively collected related to morphine-induced constipation. After IV morphine was administered and dose requirements were determined, patients were converted to oral morphine and then discharged.
The study has clinical applicability to end-of-life and palliative care.
This was a retrospective, descriptive study.
Visual analog scale
Patients on IV morphine were less likely to need laxative therapy to promote bowel function compared with patients on oral morphine. All patients on oral morphine needed laxative therapy.
Implications are limited because of the small sample size and other uncontrolled variables. More research is needed to determine whether IV morphine is less constipating than oral morphine and the applicability of this information in patient care.
Mazlum, S., Chaharsoughi, N.T., Banihashem, A., & Vashani, H.B. (2013). The effect of massage therapy on chemotherapy-induced nausea and vomiting in pediatric cancer. Iranian Journal of Nursing and Midwifery Research, 18(4), 280–284.
To determine if massage therapy was effective relief for chemotherapy-induced nausea and vomiting (CINV) in children with cancer
Patients in the intervention group received a 20 minute massage 24 hours and 30 minutes before a chemotherapy infusion and 24 hours postinfusion. A trained massage therapist used a Swedish massage technique with effleurage, petrissage, friction, and tapping movements. Mild to moderate pressure was used. Subjects were randomized by a randomized number table. Patients could elect to use olive oil with the massage. No music was used during the therapy. The control group received normal care, but the therapist was present 24 hours and 30 minutes before an infusion as well as 24 hours postinfusion. Data were collected during chemotherapy and 48 hours postinfusion.
Randomized, controlled trial
There were no significant differences between the intervention and the control group in terms of gender, type of cancer, or emetic potential of chemotherapy. There was no difference between groups in regard to nausea during chemotherapy. There was a significant difference in frequency (p = 0.001), duration (p = 0.002), and severity (p = 0.002) of nausea 48 hours after chemotherapy. There was no difference in vomiting at the time of chemotherapy, but there was a significant difference in the severity (p = 0.005) and frequency (p = 0.013) of vomiting 48 hours postinfusion.
Massage therapy may effectively decrease nausea and vomiting 48 hours after chemotherapy infusion in children.
Massage therapy, administered both before and after a chemotherapy infusion, may be effective in limiting CINV in the pediatric population. Massage was not effective at relieving anticipatory CINV that occurred at the time of infusion.
Mayyas, F., Fayers, P., Kaasa, S., & Dale, O. (2010). A systematic review of oxymorphone in the management of chronic pain. Journal of Pain and Symptom Management, 39(2), 296–308.
To assess the effectiveness of oxymorphone in the treatment of chronic pain
The search retrieved nine studies. Authors chose six studies for analysis. Five of the chosen studies were appropriate for meta-analysis. Only one study involved chronic pain resulting from a malignancy. Investigators, using guidelines published by the National Health Service Centre for Reviews and Dissemination, evaluated allocation procedures, concealment of allocation, blinding procedures, distribution of known confounders between groups, whether study groups were treated the same except for the intervention, and whether intention-to-treat analysis was performed. Two reviewers independently reviewed and assessed all studies.
In this study, oxymorphone 40–100 mg was associated with a significant reduction in the pain intensity experienced by patients with chronic pain unrelated to a malignancy. Total mean difference across studies was –12.88 (CI –17.08 through –8.68, p < 0.00001). Studies in which doses were titrated rather than fixed showed greater effect size. Adverse events were mild to moderate and similar to those associated with other opioids. The study of pain associated with malignancy, though small, demonstrated that oxymorphone was effective in the treatment of cancer pain and that switching between oxymorphone and oxycodone was feasible.
Findings suggest that oxymorphone is effective in chronic pain management. Note that the conversion ratio, oxymorphone to oxycodone, was 1:2.
Authors noted the high discontinuation rates in placebo groups; the high rates relate to the fact that some studies do not allow use of rescue medication. This fact has important implications regarding the design of studies in the field of pain management. Authors noted that regulators mandate placebo-controlled trials, and the authors highlighted the ethical concerns that such a requirement raises. In addition, authors noted the lack of placebo-controlled studies of patients with cancer pain.
Mayo, N.E., Moriello, C., Scott, S.C., Dawes, D., Auais, M., & Chasen, M. (2014). Pedometer-facilitated walking intervention shows promising effectiveness for reducing cancer fatigue: A pilot randomized trial. Clinical Rehabilitation, 28, 1198–1209.
To contribute preliminary evidence for the feasibility and potential effectiveness of a structured walking intervention on reducing cancer-related fatigue in order to plan for a full-scale study of effectiveness
The study consisted of an eight-week program with three intervention groups: one with the STEPS (a walking program using a pedometer) during rehabilitation, one with STEPS after rehabilitation, and one group with only the rehabilitation program for people with advanced cancer and a > 4 fatigue level on a Visual Analog Scale (VAS).
A pilot randomized trial. The STEPS program was based on the participants’ current walking status and progressed according to fatigue level.
Instruments chosen to measure fatigue and symptoms of anxiety and depression included the following.
Results demonstrated that the pedometer-facilitated walking intervention adapted to fatigue levels (STEPS program) showed promise as an intervention to decrease cancer-related fatigue.
Compared to rehabilitation alone, the eight-week adaptive walking intervention reduced fatigue and improved physical function and well-being over a 16-week period and was sustained to six months.
Walking intervention is associated with a trend toward less fatigue; however, this study needs replication in the advanced cancer population. Effectiveness not established.
Mayer, K., Hahn-Ast, C., Muckter, S., Schmitz, A., Krause, S., Felder, L., . . . von Lilienfeld-Toal, M. (2015). Comparison of antibiotic prophylaxis with cotrimoxazole/colistin (COT/COL) versus ciprofloxacin (CIP) in patients with acute myeloid leukemia. Supportive Care in Cancer, 23, 1321–1329.
To compare efficacy and development of bacterial resistance with prophylactic antibiotic regimens of either COT/COL or CIP
Patients with acute myeloid leukemia (AML) were given antibiotic prophylaxis with either 960 mg cotrimoxazole twice daily and colistin 200 mg three times daily or 500 mg ciproloxacin twice daily. Those receiving CIP were also given cotrimoxazole twice daily two times per week for pneumocystis prophylaxis. All received antifungal prophylaxis. Colony-stimulating factors were given to some patients at the doctor's discretion. Patients receiving CIP did not receive antiviral prophylaxis. Infection-related outcomes were compared between these two cohorts. The study included patients over a four-year span of time. Environmental antimicrobial interventions were standard across both groups.
In both groups, the incidence of febrile neutropenia was about 80%. There were no differences between groups in infections. There were no differences between groups in detection or colonization of resistant organisms. There were no differences between groups in ICU useor differences in mortality related to underlying disease, infection, or septic shock. In both groups, infection was the major cause of death (70%). Overall, 8% of patients died. There were no differences between groups in treatment toxicity.
Both antibiotic prophylactic regimens resulted in similar patient outcomes, and both appeared to have similar efficacy.
Although antibiotic prophylaxis with quinolones is generally preferred, antibiotic prophylaxis with COT/COL was essentially equally effective in this study, and might be considered an effective combination. Some studies have shown increase in quinolone-resistant organisms with standard quinolone prophylaxis. COT/COL prophylaxis may provide an alternative.
Mayer, D.J. (2000). Acupuncture: An evidence-based review of the clinical literature. Annual Review of Medicine, 51, 49-63.
MEDLINE was searched for the 14 medical conditions for which the National Institutes of Health Acupuncture Consensus Development Panel (NIHCDP) concluded acupuncture was effective or could be useful. The two conditions in which acupuncture was found to be effective are the treatment of chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting. The remaining 12 conditions reviewed in the article were the effect of acupuncture on pain and the treatment of other conditions (e.g., addiction, stroke rehabilitation, and asthma).
Three of the studies reviewed examined the effect of P6 acupuncture on CINV. Although the chemotherapy agents were variable and various carcinomas were studied, strong evidence supported the use of acupuncture for greater antiemetic effect than antiemetics alone.
Evidence supports the use of acupuncture in the treatment of CINV and postoperative nausea and vomiting.
Mattiuzzi, G.N., Cortes, J.E., Blamble, D.A., Bekele, B.N., Xiao, L., Cabanillas, M., … Kantarjian, H. (2010). Daily palonosetron is superior to ondansetron in the prevention of delayed chemotherapy-induced nausea and vomiting in patients with acute myelogenous leukemia. Cancer, 116, 5659–5666.
To compare the efficacy of two schedules of palonosetron versus ondansetron given by continuous IV infusion for treatment of chemotherapy-induced nausea and vomiting (CINV)
The study was conducted at an inpatient setting at the University of Texas M.D. Andersen Cancer Center.
All patients were in active treatment.
This was a randomized prospective study.
Palonosetron was superior to ondansetron in reducing the prevalence of delayed nausea.
The study has potential bias because no control group or blinding was used.
Daily palonosetron appears to be more effective than the alternative used here for the prevention of delayed nausea. All the regimens here were similar in the early days of the therapy course, but palonosetron was significantly better in later days. Findings suggest that different drugs might be more helpful on different days throughout the course of chemotherapy, in concert with patterns seen in nausea.
Matthews, E.E., Berger, A.M., Schmiege, S.J., Cook, P.F., McCarthy, M.S., Moore, C.M., & Aloia, M.S. (2014). Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: A randomized, controlled trial. Oncology Nursing Forum, 41, 241–253.
To examine the effect of cognitive behavioral therapy (CBT) on sleep-wake outcomes in breast cancer survivors
Women who met criteria for chronic insomnia and had completed breast cancer treatment randomly were assigned to CBT intervention or a placebo behavioral intervention. Individual, weekly CBT sessions consisted of education, stimulus control, sleep hygiene education, and cognitive therapy provided by an advanced practice nurse with specialized training. The placebo intervention was based on desensitization therapy that had been used in previous insomnia trials as a placebo treatment. For both groups, sessions 1, 3, and 6 were provided in person, and sessions 4 and 5 were provided by telephone. Sessions were audiotaped and independently reviewed by a CBT therapist to ensure fidelity. Women were evaluated at three- and six-month follow-ups.
The CBT group did not show a significantly greater improvement in sleep outcomes immediately after the intervention, but scores were significantly better by the follow-up period (p = .003). Sleep efficiency increased by more than 11% in the CBT group, compared to an increase of 6.34% in the control group (d = 0.63). Sleep latency also improved more in the CBT group (d = 0.48, p = .007). No differences between groups were found for anxiety, depression, or fatigue.
Findings show that patients receiving CBT for sleep improved several sleep outcomes compared to individuals receiving a control intervention. The intervention did not demonstrate an effect on anxiety, depression, or fatigue.
Results of this study provide evidence of a moderate and significant effect of CBT on sleep outcomes among breast cancer survivors. This adds to the body of evidence that suggests effectiveness of this approach in managing sleep-wake disturbances.
Matsuura, M., Satohisa, S., Teramoto, M., Tanaka, R., Iwasaki, M., Nishikawa, A., . . . Saito, T. (2015). Palonosetron in combination with 1-day versus 3-day dexamethasone for prevention of nausea and vomiting following paclitaxel and carboplatin in patients with gynecologic cancers: A randomized, multicenter, phase-II trial. The Journal of Obstetrics and Gynaecology Research, 41, 1607–1613.
To examine the proportion of patients who achieve a complete response (no emetic episodes and no rescue medication during the overall phase in each arm) with the treatment
Patients were receiving chemotherapy with carboplatin and paclitaxel for a gynecologic malignancy. All patients received a single IV dose of palonosetron (0.75 mg) on day 1 as a bolus given 30 minutes prior to chemotherapy, dexamethasone at 9.9 mg if patients were on dose-dense chemotherapy, and 20 mg for traditional carboplatin paclitaxel within 45 minutes prior to chemotherapy. Patients were then randomly assigned to two groups. Dexamethasone 8 mg was given on days 2 and 3, but no additional dexamethasone. Rescue medication was allowed. Evaluation of emetic events and nausea were measured using a diary and a 4-stage Likert-type scale. Randomization was done at a registration center with a minimization method with stratification according to institution, cancer type, age, and chemotherapy regimen.
PHASE OF CARE: Active antitumor treatment
Randomized, controlled, non-placebo trial
In the overall period, total control was 49.1% in the three-day dexamethasone group and 37.5% of the one-day dexamethasone group. In the acute phase, it was 90.6% in the three-day group and 92.9% in the one-day group. For delayed, it was 50.9% in the three-day group and 39.3% in the one-day group. Complete control in the overall period was 67.9% in the three-day group and 58.9% in the one-day group. In the acute phase, it was 98.1% in the three-day group and 96.4% of the one-day group. When looking at the responses, there were differences with motion sickness (p = 0.037), favoring the three-day dexamethasone regimen.
The authors concluded that one day of dexamethasone is as effective as three days of dexamethasone, except in special populations, such as those with motion sickness or severe hyperemesis gravidarum. Differences in efficacy were not found in patients with other risk factors, such as alcohol use and age.
Findings not generalizable
Nurses play a key role in assessing patient risk for chemotherapy-induced nausea and vomiting. Knowing past history of morning sickness or motion sickness should clue nurses into collaborating with providers to consider three days of dexamethasone as opposed to one day.
Matsuoka, H., Makimura, C., Koyama, A., Otsuka, M., Okamoto, W., Fujisaka, Y., . . . Nakagawa, K. (2012). Pilot study of duloxetine for cancer patients with neuropathic pain non-responsive to pregabalin. Anticancer Research, 32,1805–1809.
To investigate the effect of duloxetine for cancer-related neuropathic pain in patients for whom treatment with pregabalin was unsuccessful
Data were retrospectively reviewed for patients experiencing neuropathic pain who were treated with duloxetine because pregabalin could not be administered, was ineffective, or where the dosage could not be increased due to side effects. Patients were given 20 mg of duloxetine per day, increased to 40 mg/day if needed. Pain was assessed for two weeks.
A retrospective study design was used.
Numeric rating scale for pain
Pain was reduced in 7 of the 15 patients. Baseline pain ranged from 5 to 10. After two to four weeks, pain ratings ranged from 2 to 9.
Duloxetine may be effective for relief of neuropathic pain.
Findings suggest that duloxetine may be helpful for patients with neuropathic pain as an alternative to pregabalin. This study provides weak evidence due to multiple study limitations. Further well-designed research is needed to identify the most effective management for cancer-related neuropathic pain.