Liu, H.J., Gao, X.Z., Liu, X.M., Xia, M., Li, W.Y., & Jin, Y. (2014). Effect of intrathecal dexmedetomidine on spinal morphine analgesia in patients with refractory cancer pain. Journal of Palliative Medicine, 17, 837–840.
To investigate the effects of intrathecal dexmedetomidine on analgesia receiving intrathecal morphine for refractory cancer-related pain
Patients were initially provided intrathecal morphine at 0.4 mg/ml at a continuous dose of 0.1 ml per hour, a bolus dose of 0.5 ml, and then pump parameters were adjusted if pain score were > 4 or more than eight bolus doses were needed on the previous day. An external catheter was connected to a computerized ambulatory delivery pump. Patients were monitored for seven days and then were crossed over to receive intrathecal morphine at the same initial dose plus dexmedetomidine at 1 mcg/ml in a continuous infusion for seven days. Daily average pain scores and other study measures were recorded at baseline and at the end of each seven-day study period.
Double-blinded, crossover, randomized trial
Pain intensity and frequency declined significantly with intrathecal morphine (p < 0.05) and then declined more with the addition of dexmedetomidine (p < 0.05). Sleep deprivation was improved in the same pattern (p < 0.05). With morphine alone, daily morphine consumption was 7.9 mg (SD = 1.1) and bolus dose frequency was 6.9 (SD = 1.3). With the addition of dexmedetomidine, morphine consumption decreased to 5.3 mg (SD = 0.8), and the frequency of bolus doses decreased to 2.8 times (SD = 0.7). The most frequent side effects were nausea, vomiting, difficulty urinating, and somnolence. Constipation decreased from baseline.
The addition of intrathecal dexmedetomidine to morphine analgesia decreased morphine consumption and improved pain control in patients with refractory cancer-related pain.
Dexmedetomidine is an alpha adrenergic receptor agonist that has sympatholytic, sedative, and analgesic effects. The findings of this study suggest that the addition of this medication to morphine analgesia administered intrathecally may improve pain control and reduce morphine consumption and the number of bolus doses needed for pain control. It also demonstrated sedative effects. Refractory pain can be very difficult to manage to achieve adequate pain control. The approach studied here may provide an option for the management of refractory pain. Additional studies are needed to fully establish the safety profile and efficacy of this treatment.
Liu, J., Tan, L., Zhang, H., Li, H., Liu, X., Yan, Z., . . . Zhang, D. (2015). QoL evaluation of olanzapine for chemotherapy-induced nausea and vomiting comparing with 5-HT3 receptor antagonist. European Journal of Cancer Care, 24, 436–443.
To evaluate the effect of olanzapine on quality of life (QOL) during chemotherapy compared with a 5HT3 receptor antagonist
Patients receiving multiple different chemotherapy regimens were randomized to one of two groups. Group one received olanzapine 10 mg PO, azasetron 10mg IV, and dexamethasone 10 mg IV, followed by olanzapine 10 mg PO on days 2-5. The control group received azasetron 10 mg IV and dexamethasone 10 mg IV, followed by dexamethasone 10 mg IV on days 2-5. Use of breakthrough antiemetics was permitted based on clinical circumstances. It is not reported whether patients received one cycle only. Patients were not all chemotherapy naive, but this was not controlled in the sample description.
There was no significant difference in acute CINV, but delayed CINV showed complete response rates of 76.85% in the olanzapine group and 46.2% in the 5HT3 group (p < 0.05). CINV was also better controlled in five days post chemotherapy, with 85.95% in the olanzapine arm and 67.59% in the control arm. Not all patients completed QOL. Global health status, emotional functioning, social functioning, fatigue, CINV, and insomnia were improved in the olanzapine group. Pain and dyspnea improved in both groups.
CINV influences QOL for patients undergoing chemotherapy. Although olanzapine did not change CINV in the acute phase, it showed significance in the delayed CINV group. This demonstrated improvements in global health status, fatigue, and insomnia. 5HT3 antagonists were effective against acute CINV but not effective in delayed CINV.
Olanazapine offers another option for treatment of CINV. Other symptoms may also be controlled with this medication, such as insomnia, appetite loss, fatigue, and global health status. Nurses can consider this when standard medications are ineffective.
Liu, C.J., Hsiung, P.C., Chang, K.J., Liu, Y.F., Wang, K.C., Hsiao, F.H., . . . Chan, C.L. (2008). A study on the efficacy of body–mind–spirit group therapy for patients with breast cancer. Journal of Clinical Nursing, 17, 2539–2549.
To examine the effects of body–mind–spirit group therapy on anxiety, depression, and well-being in women with breast cancer
The intervention was 10 group sessions based on positive psychology and forgiveness therapy to enhance physical strength, increase emotional release, and develop positive meaning of life. Specific exercises included things such as self-care planning, massage of acupuncture points, drawing, creating love cards for others, and sharing strategies.
Patients were undergoing the active treatment phase of care.
A mixed-methods study design was used: randomized controlled trial with focus group interview.
There was no difference over time for depression or well-being. The intervention group had a greater reduction in anxiety (p = 0.03) compared to the control group, with an effect size estimate of 0.56, suggesting a medium clinical significance. Qualitative analysis demonstrated that reduced anxiety was facilitated through a group process.
Results of focus group interviews demonstrated that these effects were facilitated through a group process. There were no apparent effects of the intervention on depression or well-being.
Qualitative results suggest that the main effects of the intervention were associated with provision of information and the peer group interactions. It is not clear if the philosophic foundations and exercises used in the interventions were essential to these effects.
Liu, M., Li, Y., Zhang, Y., Zhao, X., Zhai, B., Zhang, Q., . . . Yu, L. (2014). Secondary antifungal prophylaxis in hematological malignancy patients with previous invasive fungal disease: A retrospective analysis. PloS One, 9(12), e115461.
To investigate efficacy of various secondary antifungal prophylaxis regimens
Patients with hematological malignancy that had a previous diagnosis of probable or proven invasive fungal disease were reviewed retrospectively and followed for 180 days post-chemotherapy or transplantation. Antifungal prophylaxis was provided with voriconazole, itraconazole, amphotericin B, liposome, or caspofungin. Secondary prophylaxis began on the first day of conditioning or within two days before chemotherapy and was continued throughout the duration of neutropenia. It was ended when immunosuppression was finished in all patients undergoing HCT, or neutrophil recovery or failure of the prophylaxis.
Not applicable.
121 patients received secondary antifungal prophylaxis. The recurrence rates were 16.5% and 46.5% in those receiving and not receiving prophylaxis, respectively (p = 0.000). There was no difference in recurrence rates according to the specific prophylactic agents used.
Findings suggest that secondary antifungal prophylaxis is beneficial in reducing the rate of recurrent fungal infections in patients with cancer.
Secondary antifungal prophylaxis in patients who had previous invasive fungal infections was shown to be effective in reducing the rate of new fungal infections; however, it did not prevent fungal infection in all patients. Nurses need to closely monitor and assess these types of patients for signs of infection so that they can be treated aggressively when needed.
Litterini, A.J., Fieler, V.K., Cavanaugh, J.T., & Lee, J.Q. (2013). Differential effects of cardiovascular and resistance exercise on functional mobility in individuals with advanced cancer: A randomized trial. Archives of Physical Medicine and Rehabilitation, 94, 2329–2335.
To compare effects of cardiovascular and resistance exercise on functional mobility in people with advanced cancer
Individuals were randomly assigned to either resistance or cardiovascular exercise groups. Exercise sessions were held in a hospital-based fitness facility twice weekly for 10 weeks. Both groups participated in flexibility exercises. Sessions lasted 30–60 minutes and were supervised by oncology-trained exercise specialists. Participants completed the study assessments at baseline and one week after study completion.
On average, participants attended 70% of exercise sessions. SPPB scores improved in all over time (p < .001), but improved slightly more in the cardiovascular group (p = .045). Intent-to-treat analysis did not confirm this difference between groups. Fatigue declined over time in all (p = .05), with no difference between groups. There were no significant changes in pain by group or by time.
Findings show improved functional mobility and reduced fatigue over time. This study did not show a difference associated with the type of exercise provided.
This study suggests that both cardiovascular and resistance exercise can be used in appropriate patients with advanced disease, and findings showed that there were no significant changes in pain or fatigue with these interventions.
Litterini, A. J., & Fieler, V. K. (2008). The change in fatigue, strength, and quality of life following a physical therapist prescribed exercise program for cancer survivors. Rehabilitation Oncology, 26, 11–17.
To determine if there was an improvement in fatigue, strength, and quality of life (QOL) in individuals within one year of treatment for an individualized physical therapist–prescribed exercise intervention.
Cancer survivors participated in an exercise class (one hour two times weekly) that included instruction and supervision in cardiovascular, strength training, and flexibility exercises. Measurement of fatigue, strength, and repetition of prescribed exercises occurred. The individualized exercise program was prescribed by a single therapist and was based on the patient’s medical history, diagnosis, age-related changes, treatment stage, and goals. Flexibility, strength, and balance assessments were conducted, and participants were retested at the conclusion of the program. Patients were encouraged to exercise two times weekly.
This study included a pre- and posttest and a two-tailed t test.
Overall fatigue improved significantly (p = 0.004). Overall lower-extremity anaerobic endurance increased significantly (p = 0.000). Overall nondominant grip strength increased significantly (p = 0.000). Overall QOL improved significantly (p < 0.01). The intervention was well tolerated in all of the diagnostic, stage, and age groups with no adverse events. The 81- to 90-year-old group had the highest completion rate, followed by the 71- to 80-year-old group. Survivors with stage IV disease had statistically significant improvement in lower extremity anaerobic endurance and QOL, whereas survivors of lung cancer had statistically significant reductions in their fatigue.
Virtually all patients with various cancer diagnoses and stages of disease, as well as a wide age range and both genders, can safely participate in and will benefit from a strength training program in terms of less fatigue, improved QOL, and increased strength. Oncology rehabilitation is necessary for survivors of cancer.
Exercise can be performed safely with careful planning. Exercise programs do not need to be restricted to those who are relatively well. Oncology rehabilitation is as necessary for survivors as cardiac rehabilitation. This study is supportive of a comprehensive exercise program.
Lipszyc, M., Winters, E., Engelman, E., Baurain, M., & Barvais, L. (2011). Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization. BJA: The British Journal of Anaesthesia, 106(5), 724–731.
To compare the analgesic effects of remifentanil target-controlled infusion via patient-controlled analgesia (PCA) to morphine PCA after uterine artery embolization
Nineteen patients were randomized into either the remifentanil group or the morphine group. Pain was evaluated every 15 minutes for 2 hours after the procedure and then at 4, 8, 12, and 16 hours after the procedure. Hemodynamic stability and respiratory stability were also measured.
Phase of care: active treatment
Double-blinded randomized controlled trial
The study concludes that, in the first four hours after surgery, remifentanil was more effective than morphine in reducing pain scores and that remifentanil PCA was as safe as morphine PCA.
The study had a small sample size, with fewer than 30 patients.
Further studies should evaluate the ability of remifentanil to control pain after uterine artery embolization.
Lipov, E. G., Joshi, J. R., Sanders, S., Wilcox, K., Lipov, S., Xie, H., … Slavin, K. (2008). Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncology, 9, 523–532.
To investigate the hypothesis that stellate ganglion block (SGB) can be a safe and effective treatment for hot flushes (HF) and sleep dysfunction in patients with breast cancer.
Thirteen women with breast cancer (in remission) experiencing severe HF and night awakenings were treated with SGB at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy. Patients recorded HF in a daily diary by use of the Hot Flash Score and night awakenings by use of the Pittsburgh Sleep Quality Index (PSQI). Both instruments were used one week before the procedure and then weekly after the procedure for 12 weeks. The generalized-estimating-equations method was used to analyze the longitudinal measurements of the number of HF and night awakenings over time.
This pilot study used a prospective, single-arm, pre/post design.
No adverse events resulted from the SGB, although patients had temporary Horner's syndrome, indicating the effectiveness of the block. Five patients had only one SGB, and eight had two SGBs. The total number of HF decreased from a mean of 79.4 (standard deviation [SD] = 37.4) per week before the procedure to a mean of 49.9 (SD = 39.9) per week during the first two weeks after the procedure (p = 0.0002). The total number of HF continued to decrease over the remaining follow-up period (weeks 3–12) and stabilized at a mean of 8.1 (SD = 5.6) per week (p < 0.0001). The number of very severe HF was decreased to near zero by the end of the follow-up period (week 12; p < 0.0001). Night awakenings decreased from a mean of 19.5 (SD = 14.8) per week before the procedure to a mean of 7.3 (SD = 7.1) per week during the first two weeks after the procedure (p < 0.0001). The total number of night awakenings continued to decrease over the remaining follow-up period (weeks 3–12) and stabilized at a mean of 1.4 (SD = 1.2) per week (p < 0.0001).
The findings suggest that SGB can provide survivors of breast cancer with relief from HF and sleep dysfunction, with few or no side effects. Long-term symptom relief has the potential to improve overall quality of life (QOL) and increase compliance with antiestrogen medications for breast cancer.
The findings suggest that SGB can provide breast cancer survivors with relief from HF and sleep disturbances, with potential to improve overall QOL.
Lipov, E.G., Joshi, J.R., Sanders, S., Wilcox, K., Lipov, S., Xie, H., … Slavin, K. (2008). Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: A pilot study. Lancet Oncology, 9, 523–532.
Researchers employed a pilot study to investigate the safety and effectiveness of a stellate-ganglion block to ameliorate hot flashes in women with breast cancer .
Anesthetic was injected at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy.
The study treated 13 breast cancer survivors who were experiencing severe hot flashes, night awakenings.
Participants recorded hot flashes in a daily diary by use of the Hot-Flash Score. Scores were recorded 1 week before the procedure and then weekly after the procedure for 12 weeks.
The total number of hot flashes decreased from 79.4 mean episodes to 49.9 in the first two weeks, and continued to decrease during the follow-up period to 8.1 per week. Night awakenings decreased from 19.5 mean episodes per week to 7.3 during treatment then to 1.4 per week during follow up. Very severe hot flash episodes decreased to near zero at follow up.
No adverse events resulting from the stellate-ganglion block were reported, although patients had temporary Horner’s syndrome indicating the effectiveness of the block.
This was a limited pilot study with a very small sample size.
Lipman, A.G., Karver, S., Cooney, G.A., Stambler, N., & Israel, R.J. (2011). Methylnaltrexone for opioid-induced constipation in patients with advanced illness: A 3-month open-label treatment extension study. Journal of Pain and Palliative Care Pharmacotherapy, 25, 136-145.
To provide access to methylnaltrexone for patients who participated in a prior study of the agent, and to continue to evaluate the safety and efficacy of methylnaltrexone in patients with opioid-induced constipation.
This open-label drug extension study recruited participants from both the control and active treatment groups of a prior methylnaltrexone study. All patients were at the end of life, were not pregnant, and were using birth control. Patient received methylnaltrexone 0.15 mg/kg subcutaneously as needed once per day. The dose was increased to 0.3 mg/kg if the agent was not effective in four hours. The dose was reduced to 0.075 mg/kg if the patient had adverse events.
This was a nonrandomized, single-arm, drug continuation study.
All patients (control group and active treatment group, as defined in the prior study) received a minimum of one drug dose. Patient laxation effect was similar between the active treatment (45.3%) and control (48.3%) groups. Most patients had an effect in less than one hour. Side effects included abdominal pain, nausea, and vomiting. Serious adverse events considered drug related were muscle spasms, abdominal pain, and pain exacerbation. The effect on patient pain levels was minimal. Opioid withdrawal symptoms ranged from none to mild.
Patients obtained benefit from methylnaltrexone for up to three months, and the agent was well tolerated.
Patients at the end of life who have an ongoing need for methylnaltrexone may continue to receive an effect from the drug for up to three months when it is used as needed.