Bozkurt, M., Palmer, L.J., & Guo, Y. (2016). Effectiveness of decongestive lymphatic therapy in patients with lymphedema resulting from breast cancer treatment regardless of previous lymphedema treatment. The Breast Journal, 23, 154–158.
To compare the effects of decongestive therapy in patients who did and did not receive previous treatment for lymphedema
Data were obtained retrospectively from medical records. Patient were grouped according to having received lymphedema treatment or not. Patients had undergoing assessment and 4–12 lymphedema treatments for four to six weeks. Consecutive patients referred for lymphedema treatment were included in the analysis. The intervention included MLD and compression, as well as teaching about good skin care, limb exercises, and deep breathing.
Retrospective cohort comparison
Both groups had a reduction in limb volume.
Complete decongestive therapy was effective in reducing lymphedema for both patients who had prior treatment for lymphedema and those who did not.
The findings add to the body of knowledge that complete decongestive therapy is effective in reducing lymphedema volume whether or not patients had undergone previous treatment for lymphedema.
Bozcuk, H., Artac, M., Kara, A., Ozdogan, M., Sualp, Y., Topcu, Z., . . . Savas, B. (2006). Does music exposure during chemotherapy improve quality of life in early breast cancer patients? A pilot study. Medical Science Monitor, 12, CR200–CR205.
Patients were exposed to the same kind of music played from a music set located within the chemotherapy unit while their chemotherapies were administered. Music included pieces from the album “Love Songs” by James Galway, distributed by BMG music, 2001 of which were instrumental pieces of international classical music. Patient outcomes were evaluated before and after a baseline cycle of chemotherapy and before and after a chemotherapy cycle with the musical intervention.
Outpatient clinics
This was a pilot study.
European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
The music intervention did not demonstrate improvement in fatigue outcomes.
Future studies may want to account for personal preferences of the patients for the type of music listened to during chemotherapy.
Boyden, J.Y., Connor, S.R., Otolorin, L., Nathan, S.D., Fine, P.G., Davis, M.S., & Muir, J.C. (2015). Nebulized medications for the treatment of dyspnea: A literature review. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 28, 1–19.
STUDY PURPOSE: To complete a thorough systematic review of the evidence available in the literature regarding the use of nebulized medications in the treatment of dyspnea in chronic obstructive pulmonary disease (COPD), cancer, interstitial lung disease (ILD), and cystic fibrosis
TYPE OF STUDY: Systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics, elder care, palliative care
Results delineated by disease populations.
Although many studies evaluated nebulized medications, this review included a wide variety of studies with varied goals, including systemic reviews, evaluation of opioids and furosemide, and delivery via ultrasound versus jet nebulizer across many disease processes and populations. The authors of this review suggested considering the use of nebulized medications on a case-by-case basis. No broader recommendations can be made at this point.
The oncology nurse should be aware of the use of nebulized medications as a delivery method for dyspnea but that there has not been any high-quality evidence to support the use of any specific medication. Although the delivery method may be more acceptable, the increased cost and lack of evidence do not support its use at this time.
Boyd, K.J., & Kelly, M. (1997). Oral morphine as symptomatic treatment of dyspnoea in patients with advanced cancer. Palliative Medicine, 11, 277–281.
To assess the effect of regularly administered extended-release morphine for dyspnea in patients receiving standard hospice care
Decline in dyspnea VAS scores for six patients was not statistically significant (p = 0.06). No clinically significant decline was found in respiratory function. No change was seen in anxiety, but actual scores were not reported. The authors stated that the high incidence of sedation and dizziness was of concern and indicated a need to monitor patients carefully. The authors also stated that the use of immediate-release morphine on an as-needed basis might be effective and cause less sedation.
Although the authors claimed that morphine should be trialed in patients, the evidence from this study does not support that. The problem may be the use of modified-release morphine 10 mg opposed to immediate release.
Boyages, J., Kastanias, K., Koelmeyer, L.A., Winch, C.J., Lam, T.C., Sherman, K.A., . . . Mackie, H. (2015). Liposuction for advanced lymphedema: A multidisciplinary approach for complete reduction of arm and leg swelling. Annals of Surgical Oncology, 22, 1263–1270.
To evaluate a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities
Liposuction was performed under general anesthesia following limb exsanguination and tourniquet application. Using specialized Helixed Tri-Port III cannulas (22 and 30 cm long, 4–5 mm wide) connected to a vacuum pump, subcutaneous tissue was removed through multiple small incisions along the limb. Presurgical limb volume determined how much tissue was removed to equalize volume relative to the unaffected limb. Compression garments were applied to the affected limb immediately postsurgery prior to tourniquet release (custom-made 30 mmHg JOBST® Elvarex for arms, or Ready Wraps® [Solaris] for legs). From one week postsurgery, all leg patients wore JOBST Elvarex custom-made compression garments 50–80 mmHg. Initial postsurgical garments were measured using the circumference of the unaffected limb. Subsequent measurements were obtained from the operated limb by a trained garment fitter. Every order consisted of two garments, allowing one to be worn while the other was washed. Throughout follow-up, compression garments alone were used in areas where liposuction was performed. However, decongestive lymphatic therapy was used when indicated in areas where liposuction was not performed (hands or feet) or areas that could not be adequately compressed (shoulder or hip).
Prospective clinical study, one arm, pre and post measures
Liposuction was safe and may be an effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.
Liposuction is a surgical approach to lymphedema. It should be noted that even with continuous compression therapy, postliposuction, patients’ lymph fluid level was elevated beyond normal. Nurses should continue observing the impact of liposuction on patients’ physiological, functional, and emotional aspects. Nurses should also advise patients according to current evidence.
Box, R.C., Reul-Hirsch, H.M., Bullock-Saxton, J.E., & Furnival, C.M. (2002). Physiotherapy after breast cancer surgery: Results of a randomised controlled study to minimise lymphoedema. Breast Cancer Research and Treatment, 75(1), 51–64.
The purpose of the study was to evaluate the incidence of lymphedema after axillary dissection to determine the effects of prospective monitoring and early physiotherapy intervention
The study sample (N = 65) was comprised of a treatment group and a control group.
The study used a randomized controlled trial design.
Both arms of patients were measured for circumference, volumetry, and multi-frequency bioimpedance analysis preoperatively and 5 days and 1, 3, 6, 12, and 24 months postoperatively.
A small number of women detected with clinically significant lymphedema (n =12); 91% of women completed measures at two years after surgery. Two women had bilateral surgeries within the first month after enrollment. At 24 months, three times as many women in the control group compared to treatment group showed secondary lymphedema (except for volume criteria). Using volume criteria, a trend toward increased lymphedema in patients with mastectomy complete with breast conservation therapy existed. Hand or arm dominance did not influence lymphedema by these measurements. Logistic regression used to determine risk factors for development of lymphedema included
Clinical incidence of lymphedema in the study was 21% at two years.
The study was very well done and well designed.
Nurses should advocate ongoing measurement to detect changes early and intervene.
Bower, J. E., Garet, D., Sternlieb, B., Ganz, P. A., Irwin, M. R., Olmstead, R., & Greendale, G. (2012). Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer, 118, 3766–3775.
To examine, relative to a health education control, the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent posttreatment fatigue.
Outcome assessors of the performance tasks were blinded to group assignment. The intervention was briefly but fully described, and then participants were randomly assigned to a group that received a 12-week, Iyengar-based yoga intervention or a group that received 12 weeks of a health education (control group).
The study was a randomized, controlled trial.
Relative to the control group, fatigue severity in the intervention group declined significantly (p = 0.032) from baseline to posttreatment and over the three-month follow-up. In addition, relative to the control group, the yoga group had significant (p = 0.011) increases in vigor. Both groups had positive changes in symptoms of depression and perceived stress (p < 0.05). The authors noted no significant changes in sleep or physical performance.
One adverse protocol-related event occurred: a participant with a history of back problems experienced a back spasm in yoga class. After evaluation by her physician, she returned to class.
A targeted yoga intervention led to a significant reduction in fatigue and improvement in vigor among breast cancer survivors with persistent fatigue symptoms. This conclusion should be understood in the context of the study: participants were relatively healthy and without comorbid conditions found in the general population.
This study offered minimal conclusive data in support of the intervention. Preliminary findings indicated that the yoga intervention is feasible and safe and has a positive effect on fatigue. A larger trial that includes participants with common comorbid conditions—a study more representative of the general population of women with breast cancer posttreatment—is warranted. Secondary outcomes included vigor, symptoms of depression, sleep, perceived stress, and physical performance.
Bower, J.E., Bak, K., Berger, A., Breitbart, W., Escalante, C.P., Ganz, P.A., . . . American Society of Clinical Oncology. (2014). Screening, assessment, and management of fatigue in adult survivors of cancer: An American Society of Clinical Oncology clinical practice guideline adaptation. Journal of Clinical Oncology, 32, 1840–1850.
PHASE OF CARE: Late effects and survivorship
Adapted from three guidelines by multidisciplinary experts using supplementary evidence and clinical experience. Most recommendations listed verbatim but some modified to include updated evidence or current practice beliefs.
Recommendations focused on patients who have completed active treatment or are considered in clinical remission. Treat underlying causes, moderate physical activity after cancer treatment with PT and lymphedema referrals as needed (meta-analysis, systematic review, [randomized controlled trial [RCT]; 10 cited), cognitive behavioral therapy (meta-analysis, RCT, systematic reviews; 6 cited), psychoeducational therapies (systematic, RCT; 3 cited), psychosocial services, mindfulness-based interventions (RCT; 3 cited), yoga (RCT; 2 cited), acupuncture (RCT; 2 cited), psychostimulants/wakefulness agents (limited evidence in patients who are post-treatment disease-free). Additional areas in which research needed include biofield therapies, massage, music therapy, relaxation, Reiki, Qigong, ginseng, and vitamin D.
Guidelines were tailored to survivors with current evidence as not all evidence done is survivors.
Screening, assessment, and treatment guidelines summarized for use in cancer survivors.
Bow, E.J., Vanness, D.J., Slavin, M., Cordonnier, C., Cornely, O.A., Marks, D.I., . . . Schlamm, H. (2015). Systematic review and mixed treatment comparison meta-analysis of randomized clinical trials of primary oral antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients. BMC Infectious Diseases, 15, 128-015-0855-6.
STUDY PURPOSE: To compare clinical trials examining outcomes with use of oral antifungal agents for prophylaxis in patients undergoing hematopoietic cell transplantation
PHASE OF CARE: Transition phase after active treatment
Network meta-analysis using Bayesian statistical techniques were used. Results showed that voriconazole was the agent most likely to reduce incidence of overall probable or proven invasive fungal infection at 180 days post-transplantation. Mold-active agents voriconazole, itraconazole, and posaconazole were overall more likely to be effective than fluconazole as primary antifungal prophylaxis.
Findings suggest that primary antifungal prophylaxis with mold-active agents are more effective for patients undergoing allogeneic HCT.
Primary antifungal prophylaxis with mold-active agents may be preferred to reduce probable or proven invasive fungal infections. Aspergillus tends to predominate invasive fungal infections in this group of patients. There is limited data directly comparing the various mold-active agents.
Bow, E.J., Laverdiere, M., Lussier, N., Rotstein, C., Cheang, M.S. & Ioannou, S. (2002). Antifungal prophylaxis for severely neutropenic chemotherapy recipients: A meta analysis of randomized-controlled clinical trials. Cancer, 94, 3230–3246.
The evaluated treatment was antifungal prophylaxis with azoles (fluconazole, itraconazole, ketoconazole, and miconazole) or an amphotericin B formulation compared with placebo or no prophylaxis controls.
The search used MEDLINE and EMBASE (1966–2000); additional studies were identified from bibliographies/reference lists of articles, topical reviews, and information from the pharmaceutical industry and investigators in the field.
38 randomized, controlled trials
7,014 patients who received cytotoxic therapy for acute leukemia or hematopoietic stem cell transplantation (HSCT) sufficient to result in neutropenia (an absolute neutrophil count [ANC] of less than 1,000) lasting one week or more.
In severely neutropenic patients (ANC less than 1,000 for a week or more), antifungal prophylaxis reduced the use of:
In subgroup analyses, superficial fungal infections were not reduced for:
However, superficial fungal infections were reduced in HSCT recipients on azoles.
In subgroup analyses, fluconazole was more effective than itraconazole or low-dose amphotericin B formulations to prevent superficial fungal infections.
In subgroup analyses, a reduction in fungal infection-related mortality was not observed in:
There was a reduction in fungal infection-related mortality in trials using fluconazole for antifungal prophylaxis.
Antifungal prophylaxis did not affect: