Legert, K.G., Remberger, M., Ringden, O., Heimdahl, A., & Dahllof, G. (2014). Reduced intensity conditioning and oral care measures prevent oral mucositis and reduces days of hospitalization in allogeneic stem cell transplantation recipients. Supportive Care in Cancer, 22, 2133–2140.
To compare the incidence of oral mucositis (OM) in patients conditioned with myloablative conditioning (MAC) versus reduced-intensity conditioning (RIC) and to determine the effect of a new oral care protocol
A radiographic full-mouth exam and an oral exam by an investigating dentist were performed one week prior to hematopoietic stem cell transplantation (HSCT). Prior to the start of conditioning, daily oral exams began three days prior to HSCT for 25 days or until discharge. A dentist or dental hygienist assessed oral cavities three times per week. From 2007 to 2010, 142 patients used a protocol (soft tooth brushing twice daily only; no interdental brushes, toothpicks, or flossing were allowed). From 2010 to 2011, 29 patients received the intensive protocol (intensive protocol brushing, interdental brushes or flossing, sucking on ice chips every two to three hours while awake, rinsing normal saline solution every two hours while awake from transplantation until neutrophil count was > 0.5). Dental infections foci were treated conservatively.
Quasi-experimental
Patients treated with the oral protocol in 2011 had significantly lower OM scores than those treated with the previous protocol (p = 0.013).
MAC conditioning was correlated with significantly higher OM scores (p < 0.001). Lower OM scores were associated with the intensive oral protocol intervention. Patients treated in later years (2011) demonstrated a decrease in OM scores, which were caused by an increased use of RIC and improved standards of oral care.
Oral mucositis is a side effect of the conditioning regimens for HSCT. This study revealed that with consistent assessment, support, and a more intensive oral care protocol using ice and normal saline rinses, there is a potential to reduce the severity of this side effect. More nursing research is needed in this area.
Legeby, M., Jurell, G., Beausang-Linder, M., & Olofsson, C. (2009). Placebo-controlled trial of local anaesthesia for treatment of pain after breast reconstruction. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery/Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi, 43(6), 315–319.
To compare, in patients undergoing breast reconstruction, the efficacy of levobupivacaine in conjunction with oral paracetamol and IV morphine to the efficacy of placebo in conjunction with oral paracetamol and IV morphine
Levobupivacaine 2.5 mg/ml or normal saline (NS) was administered through an indwelling catheter every 3 hours for 45 hours with
Prospective placebo-controlled, double-blind study
When patients were at rest, levobupivacaine significantly reduced pain (p < 0.05) 15 hours postoperatively. With movement, levobupivacaine significantly reduced pain for 6 hours (p = 0.01) and significantly reduced pain for 18–24 hours (p = 0.045). Total dose of morphine used did not differ between groups. Two patients in the levobupivacaine group became infected. Authors noted no significant intergroup differences related to nausea or length of hospital stay.
Compared with patients who received placebo, those who were intermittently injected with levobupivacaine had better pain relief at rest for the first 15 hours after surgery. Those who received intermittently injected levobupivacaine also had better pain relief during mobilization, for the first 6 hours and for 18–24 hours.
Boluses of local anesthetic, delivered via patient-controlled anesthesia, tend to have good results because patients prefer to control their own treatment.
Lee, M.S., Kim, K.H., Choi, S.M., & Ernst, E. (2009). Acupuncture for treating hot flashes in breast cancer patients: A systematic review. Breast Cancer Research and Treatment, 115, 497–503.
STUDY PURPOSE: To access the effectiveness of acupuncture as a treatment option for hot flashes in patients with breast cancer through a systematic review
TYPE OF STUDY: Systematic review
PHASE OF CARE: Transition phase after active treatment
Of the six studies that were reviewed, three compared the effects of manual acupuncture with sham acupuncture, one compared the effects of electroacupuncture (EA) with hormone replacement therapy, one compared acupuncture with venlafaxine, and one compared manual acupuncture with relaxation therapy. Of the studies examined, all were randomized, controlled trials. Of the three comparing manual acupuncture with sham, one showed favorable results of acupuncture reducing the frequency of hot flashes, whereas the other two studies failed to do so. The study comparing EA with hormone therapy demonstrated that hormone replacement therapy was more effective in controlling hot flashes than EA. The study comparing acupuncture and venlafaxine showed no difference. When relaxation therapy was compared with acupuncture, no intergroup difference occurred.
This systematic review of six articles using acupuncture to treat hot flashes in women with breast cancer failed to demonstrate that acupuncture was a clearly effective treatment tool. When comparing acupuncture with sham acupuncture, the three studies were not consistent in their findings, with one demonstrating that acupuncture was effective and two that did not. In the additional three studies, acupuncture was not found to be superior to hormone replacement therapy, venlafaxine, or relaxation therapy.
This review of randomized studies did not demonstrate that acupuncture was a superior therapy to hormone replacement, venlafaxine, or relaxation therapy in controlling hot flashes in women with breast cancer.
Lee, M.S., Kim, K.H., Shin, B.C., Choi, S.M., & Ernst, E. (2009). Acupuncture for treating hot flushes in men with prostate cancer: A systematic review. Supportive Care in Cancer, 17, 763–770.
STUDY PURPOSE: To evaluate the effect of acupuncture on hot flashes in men with prostate cancer
TYPE OF STUDY: Systematic review
PHASE OF CARE: Not specified or not applicable
APPLICATIONS: Elder care
Five of the six studies included were uncontrolled observational studies. All six studies showed a reduction in the severity and frequency of hot flashes in men with prostate cancer. Some studies reported no follow-up; one study followed patients for 12 months. Mild adverse effects reported included distress, fatigue, hematoma at the insertion site, and a very short (few seconds) increase of vasomotor symptoms.
The researchers concluded that the evidence from these six studies is not convincing to recommend acupuncture as an effective treatment for hot flashes in men treated for prostate cancer. The researchers recommended more research with larger randomized, controlled trials. Mild adverse effects were noted with acupuncture.
The six studies did not provide convincing evidence that acupuncture is an effective treatment for reducing hot flash frequency and severity in men diagnosed with prostate cancer. More large randomized, clinical trials are need to evaluate the effectiveness of acupuncture. Such studies should include longer periods of follow-up to determine the long-term effectiveness.
Lee, H., Schmidt, K., & Ernst, E. (2005). Acupuncture for the relief of cancer-related pain—A systematic review. European Journal of Pain, 9, 437–444.
To summarize a systematic review of existing evidence regarding the effect of acupuncture on cancer-related pain
Databases searched were MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database (AMED), PsycINFO, British Nursing Index, the Cochrane Library, and databases relative to Journal of Korean Society for Acupuncture and Moxibustion and Journal of Korean Oriental Medicine. Investigators performed manual searches of department files and the reference lists of all located articles.
Search keywords were acupuncture, electroacupuncture, cancer, neoplasm, and tumor.
Studies were included if they were
Studies were excluded if they related to laser acupuncture, acupressure, or moxibustion or used transcutaneous electrical nerve stimulation or other cointerventions that were complementary or alternative medicine modalities; were case series, case reports, or abstracts with no details about the intervention; and involved acupuncture for postoperative pain in patients with cancer.
Investigators reviewed 29 studies initially and chose 7 for analysis. Two authors, working independently, read all articles in full and extracted data about trial methods, study design, participants, interventions, type of pain, pain outcomes, and adverse effects. Authors used a modified Jadad scale to rate the studies. (The study summary cites rating criteria.) Authors met to reach consensus, and discrepancies were settled by discussion with the third author. The Jadad scale was modified because of the near impossibility of blinding the acupuncturist to the treatment.
Data from this study do not support the use of acupuncture as an effective analgesic adjunctive method for the treatment of cancer pain. Note that 2003 is the most recent date of an article in this systematic review; articles excluded were published 1974–2003.
Appropriately powered randomized controlled trials that investigate the efficacy of acupuncture are needed.
Lee, E.Q., Muzikansky, A., Drappatz, J., Kesari, S., Wong, E.T., Fadul, C.E., . . . Wen, P.Y. (2016). A randomized, placebo-controlled pilot trial of armodafinil for fatigue in patients with gliomas undergoing radiotherapy. Neuro-Oncology, 18, 849–854.
To evaluate if armodafinil versus placebo reduced fatigue and improved quality of life when measured via the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) subscale at baseline and 42 days.
Prior to starting treatment, participants completed several questionnaires rating fatigue and quality of life. The participants were randomly assigned 1:1 to the armodafinil group or placebo group, and questionnaires were completed again at day 22, day 43, and day 56, with the primary end point being day 43, as this was the end of radiation therapy for most patients enrolled. Participants in the armodafinil group received 150 mg daily for eight weeks.
PHASE OF CARE: Active antitumor treatment
Randomized, placebo-controlled, pilot trial
No statistically significant findings using any questionnaire were reported between the treatment arm and the placebo arm at any point measured (day 21, 42, or 26).
Based on this study, one can conclude that armodafinil is not effective in reducing fatigue or improving quality of life in this patient population. It would be helpful to know if the FACIT-F questionnaire has been used in this patient population previously with no concurrent interventions.
The findings of this study indicate that more education regarding the multiple factors that can cause fatigue in this patient population is needed, as well as tools to measure this fatigue more effectively to better gauge interventions. The study stated that fatigue is reported during radiation therapy in this patient population, but the questionnaires used did not capture that.
Lee, C., You, D., Jeong, I.G., Hong, J.H., Choo, M.S., Ahn, H., . . . Kim, C.S. (2015). Antibiotic prophylaxis with intravenous ceftriaxone and fluoroquinolone reduces infectious complications after transrectal ultrasound-guided prostatic biopsy. Korean Journal of Urology, 56, 466–472.
To compare the effectiveness of standard fluoroquinolone prophylaxis with fluoroquinolone plus ceftriaxone in the prevention of infection post prostate biopsy
Patients received one of three prophylaxis regimens: (a) 500 mg fluoroquinolone by mouth twice a day for three days, (b) 500 mg fluoroquinolone by mouth twice a day for three days plus 2 g IV ceftriaxone once before biopsy, or (c) 500 mg fluoroquinolone by mouth twice a day for more than seven days plus 2 grams IV ceftriaxone once before biopsy.
Infection post prostate biopsy was defined as any of the following: a temperature greater than 38 degrees Celsius, a white blood cell count greater than 12,000/mm3, a urinary tract infection, or acute prostatitis.
A significant decrease of infections was observed post prostate biopsy for patients that received prophylaxis with fluoroquinolone plus ceftriaxone (p < 0.001). One percent of patients who received fluoroquinolone prophylaxis had infectious complications compared to 0.3% of patients who received fluoroquinolone plus ceftriaxone. Patients who received fluoroquinolone prophylaxis for more than seven days had no added reduction of infection compared to patients who received fluoroquinolone prophylaxis for three days.
Infection prophylaxis with fluoroquinolone alone after prostate biopsy may be insufficient because of increasing resistance among pathogens, including Escherichia coli. The addition of 2 grams IV ceftriaxone before prostate biopsy was correlated with a significant reduction in infectious complications at one hospital in South Korea.
Adequate patient education on potential infectious complications is necessary post prostate biopsies. To tailor infection prophylaxis, nurses should consider assessing for individual risk factors for infection (e.g., diabetes, history of organ transplant, etc.) and collect rectal swabs to identify quinolone-resistance organisms.
Lee, H., Lim, Y., Yoo, M. S., & Kim, Y. (2011). Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study. Cancer Nursing, 34, E22–E30.
To examine the effects of nurse-led cognitive-behavior therapy (CBT) on fatigue and quality of life (QOL) experienced by patients with breast cancer who were currently undergoing radiotherapy.
An oncology nurse-led six-week intervention program that included cognitive restructuring, education about breast cancer and medical treatment, relaxation therapy, and rehabilitation exercise was offered to women receiving radiation therapy at a university hospital in Korea. Nurses who led the course attended the beginner’s course of CBT for 36 hours.
Single site
Patients were undergoing the active antitumor treatment phase of care.
The study used a quasiexperimental pre-/posttest design with a nonequivalent control group.
Levels of fatigue increased in both groups at the posttests. Increases in the levels of fatigue were greater in the control group than in the experimental group. Levels of QOL increased in the experimental group and decreased in the control group.
Nurse-led CBT did not show a significant effect in reducing the levels of cancer-related fatigue, although the increments of fatigue were significantly lower than the control group. Nurse-led CBT was effective in increasing QOL.
There is a role for oncology nurses to lead a structured cognitive-based intervention program to help alleviate cancer-related fatigue in women with breast cancer receiving radiotherapy.
Lee, E. J., & Frazier, S. K. (2011). The efficacy of acupressure for symptom management: a systematic review. Journal of Pain and Symptom Management, 42, 589–603.
To systematically review randomized, controlled trials that investigated the efficacy of acupressure for the management of symptoms.
Databases searched were CINAHL, MEDLINE, and PubMed.
Search keywords were acupressure, clinical trial, human, and/or randomized.
Studies were included in the review if
Studies were excluded from the review if they
In total, 108 references were screened.
Each experimental study was evaluated for quality using the Cochrane risk of bias (RoB) tool. Articles were evaluated for the presence of each of the six domains, and one point was assigned for each domain present. Scores ranged from zero to six, with higher values indicating higher quality and less risk for bias. All trials were evaluated by two authors, and agreement between them was 100%. A significant likelihood of bias was found in the evaluation.
Only six randomized, controlled trials included were performed to determine the efficacy of acupressure on the reduction of fatigue and improvement of sleep in adults in various populations. Fatigue and insomnia were grouped together because those investigations were typically studied simultaneously.
Patients were undergoing the active treatment phase of care.
Only three studies conducted included a measure of fatigue. Six studies concluded that acupressure was effective in improving fatigue and reducing insomnia. Multiple symptoms were discussed in topic areas; findings from other symptom reviews were not included in the summary.
The review did not provide rigorous support for the use of acupressure for the efficacy of symptom management.
Well-designed randomized, controlled trials are needed to determine the utility and efficacy of acupressure to manage various symptoms in several patient populations. Issues exist when looking at fatigue and insomnia concurrently, such as determining whether fatigue is an intervening variable for insomnia or an outcome variable of insomnia or whether insomnia is an intervening variable for fatigue. A conceptual framework is needed to guide how concurrent or symptom clusters are studied.
Lee, J.J., & Lee, J.J. (2010). A phase II study of an herbal decoction that includes Astragali Radix for cancer-associated anorexia in patients with advanced cancer. Integrative Cancer Therapies, 9, 24–31.
To assess the efficacy and safety of an herbal decoction including Astragali Radix in improving appetite and body weight and changing cytokine levels in patients with advanced cancer experiencing anorexia
The herbal decoction consisted of a combination of herbs including Astragali Radix made in the hospital pharmacy every week. The decoction was administered 30 minutes after meals, three times a day for three weeks. The decoction was stopped for treatment refusal, the aggravation of anorexia or weight loss in the midst of therapy, or physician decision. Assessments of appetite were performed at baseline and then weekly until termination of the study. Cytokines were checked at baseline and at the third week.
A prospective, phase II trial design was used.
Toxicity was assessed as well as tumor response using Recist criteria.
Primary endpoint: VAS anorexia scores before and after the herbal decoction were significantly improved (p = 0.008). Secondary endpoints: 55% of patients had improvements in both anorexia and body weight at the third week (p = 0.009). The correlation of improvement of anorexia and body weight at the best point was also significantly positive (p = 0.003). The changes in skinfold thickness of the triceps, subscapula, and suprailiac did not significantly change (p = 0.182). The cytokines did not significantly change. Lactate and lactate dehydrogenase (LDH) levels were significantly worse at three weeks. Eight patients were administered the full treatment of the herbal decoction, three patients had the decoction for two weeks, one patient had treatment stopped due to toxicity of concomitant chemotherapy, and two patients had disease progression. Grades 1/2 diarrhea occurred in two patients. Grade 1 dyspepsia occurred in two patients. Grade 1 alanine transaminase abnormality occurred in one patient. Grade 2 neutropenia and grade 2 anemia occurred in two patients who also received concomitant chemotherapy.
This small study demonstrated potential for a combination herbal product to improve anorexia in patients with advanced cancers. Although patients showed significant improvements in anorexia scores and weight gain, cytokine and lactate and LDH values did not improve significantly and in some cases worsened, which is contrary to current thinking regarding the chemical picture of anorexia. Results of this study should be interpreted with caution.
Anorexia is a common symptom in patients with cancer. There are some drugs such as corticosteroids and megestrol acetate that can help to control anorexia. Complementary and alternative medicines may help treat cancer-related symptoms. Nurses need to remain knowledgeable about potential medications and complementary agents that may be useful in managing patients’ symptoms.