Hassler, M.R., Elandt, K., Preusser, M., Lehrner, J., Binder, P., Dieckmann, K., . . . Marosi, C. (2010). Neurocognitive training in patients with high-grade glioma: A pilot study. Journal of Neuro-Oncology, 97, 109–115.
To evaluate the effectiveness of small group neurocognitive training to improve cognitive impairment in patients with brain tumors
Pre- and post-intervention cognitive testing was performed. The 10-week-long intervention consisted of 90-minute weekly group sessions of holistic mnemonic training, which included exercises to train perception, concentration, attention, memory, retentiveness, verbal memory, and creativity.
Pilot study with pre-/post-test design
Although comparison of mean group differences found improvement in all neuropsychological tests, separate dependent t-tests revealed statistically significant improvement only in verbal memory total learning (p < 0.05) as measured by the HVLT. Significant improvement was not seen in verbal memory delayed recall (p = 0.11) as measured by the HVLT, psychomotor speed (p = 0.22) as measured by the TMT-A, sustained attention (p = 0.17) as measured by the TMT-B, or verbal fluency (p = 0.29) as measured by the COWAT.
Significant improvement was found in verbal memory (total learning). However, it is not possible to distinguish whether the improvement was a benefit of the intervention or resulted from practice effects associated with the repeated measures occurring 12 weeks from baseline. Additionally, any assumptions regarding effectiveness of the intervention would need to be supported by a larger sample with an appropriate comparison control group.
Although neurocognitive training has been suggested as a potential intervention for cognitive impairment, further studies are needed (including feasibility). Effectiveness of this intervention cannot be established based on this pilot study.
Hashemi, A., Bahrololoumi, Z., Khaksar, Y., Saffarzadeh, N., Neamatzade, H., & Foroughi, E. (2015). Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: A systematic review. Iranian Journal of Pediatric Hematology and Oncology, 5, 106–112.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Pediatrics and palliative care
None of the mouth rinses were definitely effective in preventing chemotherapy-induced oral mucositis in children. Normal saline had a preventive effect in patients receiving chemotherapy, radiotherapy, and hematopoietic stem cell transplantation, but other studies have shown less efficacy than chlorhexidine or honey with saline. Benzydamine was less effective than chlorhexidine.
There was limited evidence for agents to prevent or manage oral mucositis in children.
Mouth rinses are an important component to oral care in the prevention of mucositis in pediatric patients receiving chemotherapy. Nurses need to continue research to develop evidence-based practice guidelines for this debilitating side effect of chemotherapy.
Hart, S.L., Hoyt, M.A., Diefenbach, M., Anderson, D.R., Kilbourn, K.M., Craft, L.L., . . . Stanton, A.L. (2012). Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. Journal of the National Cancer Institute, 104, 990–1004.
To evaluate the effectiveness of psychotherapeutic and pharmacologic therapy, in depressed patients with cancer, by means of a meta-analysis and systematic review
Researchers used the PEDro scale to evaluate study quality.
Multiple phases of care
Across all included trials, Hedges's g = 0.43 (95% CI, 0.48–1.54, p < 0.001) in favor of the intervention. Analysis of effect size at various follow-up periods showed that effect declined over time. Hedges's g effect size at 24 months poststudy entry was 0.19 and was not statistically significant. Follow-up at 18 months still showed a significant effect (g = 0.37, p < 0.001). Overall effect of pharmacologic interventions was g = 0.44 (p < 0.001); of cognitive behavioral therapy, g = 0.83 (p < 0.001); and of problem-solving therapy, g = 0.33 (p < 0.001).
For patients with cancer who had elevated symptoms of depression, psychotherapeutic and pharmacologic interventions were at least moderately effective in reducing symptoms of depression; however, efficacy may decline over time. Comparison of approaches showed that cognitive behavioral therapy had a substantially larger effect than did problem-solving therapy or medications.
Although the heterogeneity in analysis was not high, samples did vary substantially in terms of cancer stage, time elapsed since diagnosis, ethnicity, gender, and sample size.
Antidepressants, problem-solving therapy, and cognitive behavioral therapy were effective in reducing symptoms of depression in patients with cancer who had elevated symptoms of depression. Assessment of the symptoms of depression can identify patients who can benefit from these treatments. Since medication, problem-solving therapy, and cognitive behavioral therapy were efficacious, treatment selection should be based on each patient's characteristics and preferences. It appears that efficacy may diminish over time, pointing to the need for long-term follow-up and management of depression in patients such as those who met the research criteria.
Harris, S.R., Schmitz, K.H., Campbell, K.L., & McNeely, M.L. (2012). Clinical practice guidelines for breast cancer rehabilitation: Syntheses of guideline recommendations and qualitative appraisals. Cancer, 118(8 Suppl.), 2312–2324.
To identify and review clinical practice guidelines (CPGs) related to the assessment and management of physical impairment outcomes of breast cancer and the interventions used to treat the disease. The patient population was patients with breast cancer.
Relevant health science databases were searched to identify evidence-based CPGs. The CPGs were evaluated using the AGREE II Instrument. The recommendations for updating current guidelines and for future guidelines were developed. Nineteen guidelines were included. Databases used were MEDLINE®, Google, Google Scholar, Physiotherapy Evidence Database (PEDro), Grey Matters and Intuit, CINAHL®, and Embase (OvidSP). Keywords were breast cancer, rehabilitation, and guidelines. CPGs were included if they focused on breast cancer-related upper-extremity physical impairments, upper-extremity or breast lymphedema, pain, fatigue, chemotherapy-induced peripheral neuropathy (CIPN), cardiotoxicity, or bone health. CPGs also had to be evidence-based recommendations related to weight management in breast cancer, published between 2001–2011 in a peer-reviewed journals or endorsed by a national or multinational government agency or health professional provider group, and available in English. CDPs were excluded if they pertained specifically to metastatic breast cancer.
Volume measurements using an opto-electric volumeter (perometer) and bioimpedance spectroscopy are recommended to be used in place of arm circumference measures. The use of compression garments is recommended in the management of lymphedema, but only limited evidence support compression bandaging with manual lymph drainage based on the reviewed guidelines.
High-quality evidence is insufficient to make clinical recommendations in the form of guidelines. There is an urgent need for updating the guidelines on lymphedema. Recommendations include physical therapy beginning the first day after surgery and active stretching exercises after removal of drains. Progressive resistive exercises with light weights within four to six weeks after surgery is also recommended. There is insufficient evidence regarding use of laser treatment and electrical stimulation, and there are published precautions for their use in people with neoplasms. Compression garments and bandaging and complete decongestive therapy are currently recommended.
The AGREE II Instrument fails to assess the quality of evidence supporting the guideline’s recommendations.
The findings from this review have highlighted the importance of conducting more rigorously designed studies related to lymphedema assessment ,measurement, and management. Nurse scientists can play a key role in this needed area.
Harris, A.C., & Jackson, J.M. (1977). Lactulose in vincristine-induced constipation. Medical Journal of Australia, 2, 573–574.
To measure the efficacy of lactulose as a treatment for vincristine-induced intractable constipation or for the prevention of vincristine-associated constipation in patients with cancer.
Patients received lactulose 20 ml BID to 25 ml TID.
This was a descriptive study.
Time-to-first bowel movement after vincristine treatment and initiation of lactulose therapy.
All patients obtained relief of constipation within two days of initiating lactulose.
Hardy, J., Randall, C., Pinkerton, E., Flatley, C., Gibbons, K., & Allan, S. (2016). A randomised, double-blind controlled trial of intranasal midazolam for the palliation of dyspnoea in patients with life-limiting disease. Supportive Care in Cancer, 24, 3069–3076.
To investigate the effect of a short-acting intranasal benzodiazepine on dyspnea, which is extremely common in those with life-limiting disease and negatively impacts quality of life (QOL)
Participants were given six identical bottles of nasal spray, three of which contained a placebo and three of which contained midazolam (benzodiazepine being studied) with the concentration of 0.5 mg per spray. The bottles were numbered one through six in random sequence. Patients were instructed to inhale a total of three times on each occasion of use with the total dose of active drug delivered being 1.5 mg. The participants were asked to use bottle number 1 on the first day, number 2 on the second day, and so on, using no single nasal spray for more than 24 hours. The dosages were not to be delivered more frequently than every four hours, and if participants did not experience dyspnea on a certain day, they were not required to use a nasal spray that day. The participants were formally assessed by investigators at baseline, day 7, and day 14. The participants were also contacted by phone throughout the study on specific days to ensure compliance. The participants formally scored the first dose administered each day, and at the end of each study day, participants documented how many times they used the nasal spray and if there was any benefit using a variety of tools and surveys.
The Covi Anxiety Scale (CAS) and the Cancer Dyspnea Scale (CDS) were completed by clinicians and examined verbal reports, patient behaviors, and somatic symptoms of anxiety. Participants documented how many times they had used the nasal spray in 24 hours and if they found any benefit in a daily log. Participants rated dyspnea, anxiety, and drowsiness on an 11-point numerical rating scale (NRS).
No significant benefit of the intranasal midazolam on anxiety scores was noted. No difference at any time point of investigation existed between the midazolam and the control group, and no difference in the dyspnea scores or positive change in dyspnea existed between the control bottles of nasal spray and the midazolam when looking closer into age, gender, baseline anxiety, depression, and disease. The greatest benefit was seen at 30 minutes after the use of both the control spray and the midazolam, with no difference between the two groups. When questioned about adverse events, participants revealed that side effects worse than they were at baseline were low grade and most likely from the use of the nasal spray, with the most common being nasal cavity irritation and sinus reactions.
The study failed to demonstrate a meaningful benefit of intranasal midazolam on dyspnea or anxiety. Though the nasal cavity is thought to be a good way to deliver the effects of medications quickly, intranasal midazolam did not effectively relieve the participants’ dyspnea.
The study findings demonstrated that intranasal midazolam was not effective in relieving dyspnea. This study magnified the importance of finding ways to better control dyspnea in terminally ill patients and the impact on quality of life if not done. The effectiveness of benzodiazepines on dyspnea needs further investigation, and nurses should continue with the administration of low-dose opioids to treat patient dyspnea, as this remains the evidence-based medication of choice.
Hardy, J. R., Carmont, S. A., O'Shea, A., Vora, R., Schluter, P., Nikles, C. J., . . . Mitchell, G. K. (2010). Pilot study to determine the optimal dose of methylphenidate for an n-of-1 trial for fatigue in patients with cancer. Journal of Palliative Medicine, 13, 1193–1197.
To identify a dose of methylphenidate to test formally in a subsequent N-of-one trial of fatigue.
Patients with fatigue 4/10 or more at baseline received titrated doses of methylphenidate beginning at 5 mg/day up to 15 mg twice daily (BID) at three-day intervals.
Patients were undergoing the transition phase on “stable treatment,” not on chemotherapy.
The study was a prospective trial.
Methylphenidate 5 mg BID was chosen as the ideal dose to test against placebo.
Nurses in research can use a 5-mg BID dose of methylphenidate to test against placebo.
Hardy, J., Quinn, S., Fazekas, B., Plummer, J., Eckermann, S., Agar, M., … Currow, D.C. (2012). Randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain. Journal of Clinical Oncology, 30, 3611–3617.
To determine whether ketamine, delivered subcutaneously with dose titration over five days, has greater clinical benefit than placebo when used in conjunction with opioids and standard adjuvant therapy in the management of cancer pain
This was a multisite, inpatient study conducted in Australia.
This was a randomized, double-blinded, placebo-control study.
Ketamine was only associated with improvement in worse pain compared to placebo, and it was associated with more adverse events and psychotoxicity.
Ketamine as an adjunct to opioids to manage chronic refractory cancer pain only appeared to affect worst pain rating and may cause adverse effects and increase psychotoxicity. Incidence of adverse events with ketamine infusion adjunctively with opioids in the management of refractory pain should be reevaluated when considering the patient population of advanced cancer.
Harding, M. (2015). Effect of nurse navigation on patient care satisfaction and distress associated with breast biopsy. Clinical Journal of Oncology Nursing, 19, E15–E20.
To evaluate how nurse navigation affected care satisfaction and distress among women who were undergoing breast biopsy. Specifically, were there significant differences in women undergoing breast biopsy with and without nurse navigators?
No significant between-group differences were noted in depression. Lower scores were shown for anxiety (significance p < 0.05) among patients who had navigation. There was no difference in overall satisfaction with care though there was an association between satisfaction and distress: that is, women with more satisfaction reported less distress. The population with nurse navigators shows stronger relationship-based characteristics. Significant differences were shown in five categories (accessibility, communication, finances, interpersonal manner, and time) for the navigated population and in two categories (accessibility, general satisfaction) for the non-navigated or usual care population.
Nurse navigation increased satisfaction with care. General satisfaction measured significantly higher in the non-navigated sample when compared to the navigated group. Distress screening followed by interventions of emotional support, education, and facilitating communication between and among providers are roles nurses can fulfill to improve satisfaction outcomes and lower distress levels.
Train nurse navigators in addressing key areas of patient-center interface: accessibility to care, communication among providers, financial support, interpersonal manner, time with care provider, and technical quality. Nurse navigators have knowledge and skill to manage care of women undergoing needle biopsy and, thereby, improve general satisfaction in specific areas.
Harding, C., Harris, A., & Chadwick, D. (2008). Auricular acupuncture: A novel treatment for vasomotor symptoms associated with luteinizing-hormone releasing hormone agonist treatment for prostate cancer. British Journal of Urology International, 103, 186–190.
To evaluate the role of auricular acupuncture (AA) in men receiving luteinizing-hormone releasing hormone (LHRH) analogues for prostate cancer on hot flash incidence and severity
The study enrolled 60 consecutive men with prostate cancer who were receiving on LHRH agonist treatment. Their median age was74 years, and they received weekly AA for 10 weeks.
Patients recorded the frequency of hot flash episodes during the day and at night at 0, 4, and 10 weeks. Participants were asked to grade the intensity of their hot flashes on a 0–6 scale, with 6 representing maximum intensity, and they recorded these data at 0, 4, and 10 weeks.
95% of patients reported a decrease in the severity of symptoms, from a mean of 5.0 to 2.1 (Student’s test, p < 0.01).
Limitations of this study included using a convenience sample and absence of a control group.