Gennaro, P., Gabriele, G., Mihara, M., Kikuchi, K., Salini, C., Aboh, I., . . . Ungari, C. (2016). Supramicrosurgical lymphatico-venular anastomosis (LVA) in treating lymphoedema: 36-months preliminary report. European Review for Medical and Pharmacological Sciences, 20, 4642–4653.
To evaluate the effects of lymphaticovenular anastomosis (LVA) on patients with lymphedema
APPLICATIONS: Pediatrics, elder care
Retrospective
Measuring tape
The LVA appears to successfully establish alternate lymphatic drainage pathways in the lymph damaged limb. It is minimally invasive requiring considerably less surgery than the lymph node transplantation procedures and potentially better outcomes. The patients tolerate it well and recovery quickly. It is unclear whether patients no longer needed to use compression garments, but the study reported that all had a reduction in compression class. The researchers reported outcomes that did reflect disease progression: Stage IV limbs did not improve, as well as stage II.
The findings suggest that LVA may be helpful for patients to reduce lymphedema. Nurses need to be aware of patient education needs if this procedure is used.
Gennaro, M., Maccauro, M., Sigari, C., Casalini, P., Bedodi, L., Conti, A. R., . . . Bombardieri, E. (2013). Selective axillary dissection after axillary reverse mapping to prevent breast cancer–related lymphoedema. European Journal of Surgical Oncology, 39, 1341–1345.
To assess the occurrence of breast cancer–related lymphedema (BCRL) and the feasibility of selective axillary dissection (SAD) after axillary reverse mapping (ARM)
ARM was performed on 60 patients undergoing SAD. Patients received follow-up after 6–36 months and were assessed for BCRL.
The intervention group participated in the SAD intervention, and the control group usually had axillary lymph node dissection.
SAD was successful in 45 of 60 patients. Four of 45 patients in the intervention group and five of 15 patients in the control group developed lymphedema (p = .072).
BCRL with SAD technique after median follow-up of 16 months had 33% the rate of lymphedema occurence than conventional ALND. SAD technique requires a separate surgery from sentinel lymph node biopsy. Authors concede there may be a learning curve to this technique, and further research is needed to determine appropriate patient selection.
New surgical techniques may result in lowering patient morbidity but does not eliminate the possibility of patients developing BCRL. Education should continue to be provided to all patients regarding early identification of signs and symptoms of BCRL.
Geng, C.J., Liang, Q., Zhong, J.H., Zhu, M., Meng, F.Y., Wu, N., . . . Yuan, B.Y. (2015). Ibandronate to treat skeletal-related events and bone pain in metastatic bone disease or multiple myeloma: A meta-analysis of randomised clinical trials. BMJ Open, 5(6), e007258-2014-007258.
STUDY PURPOSE: To evaluate the effects of ibandronate relative to placebo or zolendronate for treatment of skeletal-related events and bone pain in patients with cancer
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Late effects and survivorship
APPLICATIONS: Palliative care
IV or oral ibandronate was significantly better than placebo for pain reduction (WMD = -0.41, p < 0.00001). No significant differences in pain outcomes were seen between ibandronate and zoledronate. Incidence of renal toxicity was lower with ibandronate compared to zoledronate (RR = 0.71, p = 0.006). Incidence of skeletal-related events was lower with ibandronate compared to placebo (p = 0.002). There was no significant difference in skeletal-related events between ibandronate and zolendronate and no difference in other adverse events.
IV ibandronate every three to four weeks or daily oral medication was effective in reducing skeletal events and pain in patients with bone metastases, and was associated with lower incidence of renal toxicity than zoledronate.
Ibandronate is effective in reducing pain from bone metastases and multiple myeloma, and in preventing skeletal events in these patients, with efficacy similar to that of zoledronate. This analysis also showed that ibandronate was associated with lower prevalence of renal toxicity compared to zoledronate, so it may be a preferred choice for some patients with relevant comorbid conditions. Further research is needed to fully compare efficacy of oral versus IV administration.
Ekti Genc, R., & Conk, Z. (2008). Impact of effective nursing interventions to the fatigue syndrome in children who receive chemotherapy. Cancer Nursing, 31, 312–317.
The primary aim was to examine the effects of a nursing intervention for fatigue on children aged seven to 12 years who received chemotherapy. The secondary aim was to examine the relationship between fatigue and demographic variables, diagnoses, and therapy-related variables.
The experimental group received education about fatigue with chemotherapy and a fatigue handbook. Education provided included specific activities that decreased fatigue. Children were also walked in the hallway for physical activity. The control group was given routine nursing care. These activities were performed for one week. Participants were randomly assigned.
This was a randomized, controlled trial.
The difference between the two mean values on the FS-C between the experimental and control groups was statistically significant (p < 0.00). The difference between the two mean values of the FS-P between the experimental and control groups was statistically significant (p < 0.00).
The study showed some promise for an intervention to reduce fatigue. However, fatigue was not eliminated in the experimental group, and baseline fatigue scores were not collected from either group.
It would be feasible to perform the study procedure for the experimental group in practice if the education continued to prove effective on fatigue.
Genc, F., & Tan, M. (2014). The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. Palliative & Supportive Care. Advance online publication.
To determine the effects of acupressure applied to the pericardium 6 (P 6) acupuncture point on chemotherapy-induced nausea and vomiting (CINV) and anxiety in patients with breast cancer undergoing chemotherapy
Stage 1–3 patients with breast cancer who were receiving cycle two and more advance-cycle chemotherapy in an ambulatory setting were trained to apply P 6 acupressure. Patients were randomly selected from a sample that met the study inclusion criteria. An acupressure wrist band was utilized with the research group. Patients were taught how to use the band with repeat demonstration. Patients continuously wore the acupressure band on both wrists for five days. Antiemetic medications used for the experimental and control group were not described.
The authors concluded that acupressure wristbands applied at the P 6 point decreased patients' nausea occurrence and experience and the overall experience and occurrence of nausea, vomiting, and retching combined. There was no effect on the occurrence or experience of vomiting or retching. Acupressure is an inexpensive intervention that may be able to provide additional relief to patients above and beyond recommended antiemetic therapy. Effects on anxiety are unclear.
Acupressure is inexpensive, is easy to use, and can be considered in conjugation with medication or CINV prophylaxis. Acupressure can be considered in addition to recommended antiemetic therapy for additional support of patients experiencing CINV.
Genç, A., Can, G., & Aydiner, A. (2012). The efficiency of the acupressure in prevention of the chemotherapy-induced nausea and vomiting. Supportive Care in Cancer, 21, 253–261.
To examine the efficiency of acupressure in controlling chemotherapy-induced nausea and vomiting (CINV) and to determine the factors that affect this efficiency
Turkish researchers recruited patients with lung, breast, and gynecological cancer who were undergoing active treatment with medicines such as doxorubicin- or cisplatin-based drugs. The researchers randomized and assigned 67 patients in the experimental group and 53 patients in the control group. The experimental group was given a real nausea wristband (Sea-Band), and the control group was given a placebo nausea band. All patients in both groups also were given standard antiemetic treatment. They were instructed to use the wristband on both of their wrists for five days, except when sleeping at night, washing their hands, and taking a shower.
The study was conducted at a single site in Turkey. The setting type was not specified.
Patients were undergoing the active treatment phase of care.
The study was a cross-sectional, single blinded study.
The researchers stated that they created a patient description form to collect the demographic information, chemotherapy medications, and characteristics of the condition of the patients. They also used two measurements.
The researchers investigated whether acupressure affected the patients’ quality of life, as well as their experiences and development of nausea, vomiting, and retching. After five days of treatment, the results indicated that no statistically meaningful difference was observed between the control and experimental groups. Therefore, real acupressure application was not an effective strategy to increase the quality of life or to decrease the experience of CINV.
The statistical results show that after five days, both experimental and control groups had almost identical scores. Therefore, the real nausea wristband does not affect CINV or the quality of life.
The study shows that wristband acupressure is not effective in controlling CINV in patients with cancer. Additional studies are needed to confirm or refute this conclusion. Acupressure may need to be organ-site specific to control CINV.
Gehring, K., Patwardhan, S.Y., Collins, R., Groves, M.D., Etzel, C.J., Meyers, C.A., & Wefel, J.S. (2012). A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor. Journal of Neuro-Oncology, 107, 165–174.
To compare the effectiveness of immediate-release or sustained-release methylphenidate versus modafinil in improving cognitive function in patients with primary brain tumors.
Patients were randomized to receive one of the following three interventions for a total of four weeks.
Neurocognitive tests were done prior to the initiation of the intervention and repeated approximately 30 days later after completion of the intervention.
Patients were in mutliple phases of care.
The study was conducted as a randomized clinical trial.
Objective Cognitive Function Instruments
Subjective Anxiety Instruments
Subjective Depression Instruments
Subjective Fatigue Instruments
Subjective Sleep-Wake Disturbance Instrument
In regards to cognitive function, no differences were found over time with either stimulant in attention or motor function. Mixed results were found over time with stimulant use in speed of processing: significant improvement was found with the WAISIII digit symbol test (p = 0.02), but not with TMT-A. Similarly, a significant decline was found in memory as measured by the delayed recognition subtest of the HVLT (p = 0.03), but not with other subtests of that measure. When evaluating any stimulant use over time in regard to executive function, a significant improvement was found as measured by the TMT-B (p = 0.02) but a significant decline was found as measured by the COWA (p = 0.02). When evaluating differences between the methylphenidate and modafinil treatment groups over time, a significant difference was found in attention (p = 0.05): patients on methylphenidate had stable scores as measured by the digit span test and those on modafinil had worse scores over time. Likewise, a difference was seen in speed of processing (only as measured by the TMT-A) that found patients on modafinil improved in comparison to patients on methylphenidate, who either remained stable or had slight declines (p = 0.05)
In subjective measures of other symptoms, significant improvement was found over time with any stimulant use in depression as measured by the BDI (p < 0.01) and the POMS-Depr (p < 0.01), fatigue as measured by the BFI (p = 0.04) and POMS-fatigue (p < 0.01), and anxiety as measured by the STAI-state (p = 0.03). In contrast, no differences were seen over time for sleep-wake disturbances. No differences were found between treatment groups in subjective symptom measures over time.
Although the study found some improvements in specific cognitive domains over time (e.g., executive function, speed of processing), it is unclear whether these improvements were because of the use of a stimulant, a specific medication (modafinil versus methylphenidate), or other variables such as practice effects (related to the absence of alternative forms for neuropsychological tests). It is difficult to make any definitive interpretations based on this small study, because findings are confounded by the use of two different stimulants (one with two different dosing schedules) and the lack of a control group (patients who were not receiving stimulants).
The study does not provide any support at this time to recommend the use of stimulants to improve cognitive function. Future research studies with larger sample sizes and randomized clinical trials with a nonintervention arm are warranted.
Gehring, K., Patwardhan, S. Y., Collins, R., Groves, M. D., Etzel, C. J., Meyers, C. A., & Wefel, J. S. (2012). A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor. Journal of Neuro-Oncology, 107, 165–174.
To compare the effectiveness of immediate-release and sustained-release methylphenidate versus modafinil in improving cognitive function in patients with primary brain tumors.
Patients were randomized to receive one of the following three interventions for a total of four weeks: immediate-release methylphenidate, 10 mg twice daily; sustained-release methylphenidate, 18 mg daily; or modafinil, 200 mg daily. Neurocognitive tests were performed prior to the intervention and were repeated approximately 30 days later, after completion of the intervention.
Patients were undergoing multiple phases of care.
The study was a randomized, clinical trial.
Objective Cognitive Function Instruments
Subjective Anxiety Instruments
Subjective Depression Instruments
Subjective Fatigue Instruments
Subjective Sleep-Wake Disturbance Instrument
Although this study revealed some improvements in specific cognitive domains over time (e.g., executive function, speed of processing), it is unclear whether these improvements were due to the use of a stimulant; a specific medication (modafinil versus methylphenidate); or other variables, such as practice effects related to the absence of alternative neuropsychological tests. Making definitive interpretations based on this small study is difficult because the findings were confounded by the use of two stimulants (one with two different dosage schedules) and the lack of a control group (patients who were not receiving stimulants).
No evidence was provided to support the use of stimulants to improve cognitive function. The study supports the conduct of future research of this topic in studies with larger sample sizes and in randomized, clinical trials with a nonintervention arm.
Gehring, K., Sitskoorn, M.M., Gundy, C.M., Sikkes, S.A.M., Klein, M., Postma, T. J., . . . Aaronson, N.K. (2009). Cognitive rehabilitation in patients with gliomas: A randomized, controlled trial. Journal of Clinical Oncology, 27, 3712–3722.
The study was conducted to evaluate the effectiveness of a multifaceted cognitive rehabilitation program's (CRP's) measures of cognitive functioning in patients with gliomas whose disease was in remission.
An eligibility screening was conducted through
The randomization procedure was a minimization method balancing age, sex, education, tumor grade, hemisphere, radiotherapy, neurosurgery, disease duration, and institution.
The control group received standard care without cognitive intervention, and had contact with research staff at similar intervals as the intervention group. Control participants received a telephone-based empathy session during which attention to possible cognitive problems occurred without the provision of advice. At the study's completion, control participants were offered the opportunity to receive the intervention.
The intervention group received six weekly individual sessions of two hours each, carried out by seven neuropsychologists. Two techniques were incorporated.
Patients were recruited from 11 Dutch hospitals, including 10 neurosurgical centers.
The study utilized a randomized, controlled trial.
Eighty percent of CRP subjects reported that the intervention addressed their problems; 87% used compensation strategies regularly, and 79% indicated a decrease in the impact of cognitive problems on daily functioning. The intervention group had significantly better combined attention scores (in four out of seven tests) than the control group (p = 0.004) at the six-month follow-up. Verbal memory and attention were improved for the intervention group at the six-month follow-up, suggesting the intervention's success with some sustainment in learned skills.
Effect sizes for the CRP ranged from 0.23 to 0.55. The intervention group had significantly better combined scores on verbal memory tests than the control group (p = 0.009). Effect sizes for the intervention group on two of three tests were 0.48 and 0.43. Mental fatigue on the MFI was improved in the intervention group at the six-month follow-up (p = 0.044), with an effect size of 0.41.
Self-reported cognitive function (CFS, CFQ, burden) was better in the intervention group on completion of the CRP (p = 0.001). Effect sizes ranged from 0.31 to 0.48. However, at the six-month follow-up this improvement was maintained, while the control group continued to improve.
There were no significant differences between groups on neuropsychiatric assessment scores at baseline. There were no statistically significant group differences in attention or verbal memory scores at completion of the CRP.
CRP was useful in improving cognitive function, with sustained improvements in verbal memory and attention over time.
Gebruers, N., & Tjalma, W.A. (2016). Clinical feasibility of axillary reverse mapping and its influence on breast cancer related lymphedema: A systematic review. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 200, 117–122.
LITERATURE EVALUATED: Studies were independently evaluated by two reviewers for quality using the checklists from the Dutch Cochrane center with a 1, 0, or ? (1 = if sufficient information was available and no likelihood of bias, 0 = sufficient information but missing a criterion, ? = no information available). No meta-analysis was done.
PHASE OF CARE: Diagnostic
A total of 27 studies were systematically reviewed for content on the type of ARM, its safety, and whether it decreased the incidence of lymphedema. Three ARM procedures were described: (a) dermally injected blue dye, (b) injected radioisotope Tc-99m Nanocoll with subsequent lymphoscintigraphy, and (c) lymphofluoroscopic assessment using an intradermal injection of indocyanine green (ICG). The ARM detection rate was less in the sentinel lymph node biopsy (SLNB) cases (19.9%–100% with 100% representing one sample) than the ALND cases (46.6%–94.9%). Crossover nodes (those representing ARM and sentinel nodes) were identified in 5.6%–20% of ALND cases and 0%–14% of SLN cases. The recurrence of cancer in nodes that were ARM preserved would determine oncologic safety, in which studies from a referenced source deemed the ARM procedure as oncologically safe in clinically node negative, SLN positive cases, with the exception of the ARM and positive SLN being synonymous. The incidence of lymphedema reported for all ALND cases was 0%–30% and for all SLNB was 0%–4%. Lymphedema ranges for non-ARM ALND cases was 11.8%–53.5% and for SLN samples was 0%–15.8%.
The implications for nursing would be in the area of patient education, if and when the ARM procedure becomes a standard of care. For the present, nurses need to be knowledgeable of clinical trials involving ARM.