Bourke, L., Thompson, G., Gibson, D. J., Daley, A., Crank, H., Adam, I., . . . Saxton, J. (2011). Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study. Archives of Physical Medicine and Rehabilitation, 92, 749–755.
To investigate the feasibility of an intervention aimed at increasing exercise participation and improving dietary behavior in survivors of colon cancer and obtain preliminary data on the effect of the intervention on fatigue, exercise, and dietary outcomes.
Patients were randomly assigned to intervention or standard care control groups. The 12-week intervention included supervised and home-based exercise and dietary advice. During the first six weeks, the experimental group attended two group supervised exercise sessions of 30 minutes of aerobic exercise. Participants were asked to continue the same time of activities at home once a week during the same period and were asked to keep an exercise log. During the last six weeks, participants attended a supervised session once a week and were to perform two weekly home-based exercise sessions. Participants were given a dietary advice information pack and periodically attended healthy eating seminars encouraging reduction in saturated fat, increased fiber intake, reduction in refined carbohydrates, and limited alcohol intake.
Patients were undergoing the transition phase after initial treatment.
This was a randomized, controlled trial that was single-blinded for some outcome measures.
There was an overall 90% attendance rate at supervised exercise sessions and a 77% attendance rate at dietary seminars. Of those in the intervention group, 66.6% returned exercise logs, and among these, there was a 94% rate of adherence to independent aerobic exercise for 25 to 30 minutes. There was no significant difference between groups in exercise behavior. Fatigue scores improved significantly in the intervention group (p = 0.005) compared to controls. There was a significant increase in dietary fiber intake (p = 0.044), with no other differences in dietary habits. Compared to controls, there were significant improvements in chair sit to stand performance (p = 0.003) and aerobic exercise tolerance (p = 0.01).
Combined supervised group and home-based individual exercise with dietary education was shown to be feasible and demonstrated preliminary positive effects on fatigue and dietary fiber intake.
Findings suggested that an intervention combining some group supervised exercise and some home-based exercise is feasible and can be effective in reducing fatigue. Further research in this area is warranted as researchers attempt to determine the most effective ways to provide exercise interventions that patients will adhere to. The combination of some group periodic supervised sessions may improve patient motivations to adhere to a program, given the relatively low dropout rate seen here. This study was performed after completion of cancer treatment.
Botrel, T.E., Clark, O.A., Clark, L., Paladini, L., Faleiros, E., & Pegoretti, B. (2010). Efficacy of palonosetron (PAL) compared to other serotonin inhibitors (5-HT3R) in preventing chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately or highly emetogenic (MoHE) treatment: Systematic review and meta-analysis. Supportive Care in Cancer, 19, 823–832.
To analyze randomized, controlled trials (RCTs) comparing a single IV palonosetron dose to other serotonin antagonists for prevention of chemotherapy-induced nausea and vomiting (CINV)
Databases searched were Embase, LILACS, MEDLINE, SCI, CENTRAL, National Cancer Institute Clinical Trials service, Clinical Trials Register of Trials Central, American Society of Clinical Oncology, and American Society of Hematology and European Society for Medical Oncology abstracts.
Search keywords were palonosetron, random, chemotherapy, clinical trial, meta-analysis, practice guideline, randomized controlled trial, and review.
Studies were included in the review if they
Initially, 324 references were identified. Five trials were used for final analysis. Two independent reviewers extracted study data and evaluated study quality and risk of bias. No specific methodology for this was described.
Boström, A., Lindman, H., Swartling, C., Berne, B., & Bergh, J. (2001). Potent corticosteroid cream (mometasone furoate) significantly reduces acute radiation dermatitis: Results from a double-blind, randomized study. Radiotherapy and Oncology, 59, 257–265.
To determine if use of mometasone furoate (MMF), a corticosteroid cream could reduce intensity of erythema in acute radiation dermatitis
Patients were randomized to receive tubes of either MMF cream 0.1% or an emollient cream as a placebo control. Patients were instructed to apply the cream on the irradiated area twice a week up to 24 Gy and then once daily for the rest of treatment and three weeks after completion of radiation therapy. All patients in both study groups also applied the emollient cream over the radiated area once daily throughout the entire study period.
The study took place in Uppsala, Sweden.
The study used a randomized double-blind controlled design.
MMF patients showed less pronounced erythema, less itching and less burning than emollient group. MMF may provide a benefit.
Bortolussi, R., Zotti, P., Matovic, M., Morabito, A., Bertuzzi, C., Caserta, M., . . . Roscetti, A. (2016). A phase II study on the efficacy and safety of procedural analgesia with fentanyl buccal tablet in cancer patients for the placement of indwelling central venous access systems. Supportive Care in Cancer, 24, 1537–1543.
To determine the effectiveness of using fentanyl buccal tablets (FBT) to reduce pain related to placing indwelling vascular access ports in opioid-naïve patients with cancer
Patients were assessed on anxiety and pain preoperatively. Ten minutes prior to the procedure, 100 mcg FBT was administered. Patients were assessed postoperatively on pain during the procedure. Side effects and symptoms were monitored during, after, and four hours after the procedure. Those with anesthesia-related nausea received one metoclopramide tablet one hour prior to the procedure, and those with extreme pain during the procedure received rescue therapy of 30 mg ketorolac or 20 drops of tramadol if allergic to NSAIDS/ASA.
Use of FBT pre-procedure to reduce pain perception is a plausible intervention for pain control in those receiving a port but is not without side effects. Further consideration to prevent or ameliorate side effects and further studies with a larger population should be considered.
Nursing would need to be prepared for management of side effects and potential fall risk post-procedure. Side effects could require restructuring the postoperative environment to meet the needs of the patients or require follow-up beyond four hours.
Borjeson, S., Hursti, T.J., Tishelman, C., Peterson, C., & Steineck, G. (2002). Treatment of nausea and emesis during cancer chemotherapy: Discrepancies between antiemetic effect and well-being. Journal of Pain and Symptom Management, 24, 345–358.
To evaluate the relationship between antiemetic effect and well being over four different antiemetic treatment strategies
This study was conducted in the greater Stockholm, Sweden, area, with two gynecologic oncology wards.
Patients were randomly admitted to one of the two hospital wards for the study. Study II was a randomized, double-blind trial on the same hospital wards.
Borinstein, S.C., Pollard, J., Winter, L., & Hawkins, D.S. (2009). Pegfilgrastim for prevention of chemotherapy-associated neutropenia in pediatric patients with solid tumors. Pediatric Blood and Cancer, 53, 375–378.
To provide information about organizational experience with use of pegfilgrastim following dose intensive chemotherapy for solid tumors in pediatric patients with cancer.
Medical records of patients receiving myelosuppressive therapy supported with pegfilgrastim were reviewed (cases from 2007–2008). By protocol, pegfilgrastim was given in the outpatient clinic by subcutaneous injection at 0.1 mg/kg to a maximum does of 6 mg 24–48 hours after completion of chemotherapy. Complete blood counts (CBCs) were routinely monitored every 7–10 days during therapy cycles, then every 2–5 days until neutrophil recovery. Analysis was limited to the first four courses of chemotherapy.
Retrospective descriptive
There were no significant adverse effects observed with pegfilgrastim. Leukocytosis was observed in 73% of patients, with no adverse sequelae. Severe neutropenia occurred in 57% of chemotherapy courses, and febrile neutropenia was seen in 28% of courses. Course delay occurred in 9% of courses, with a mean duration of two days of delay.
This report provides evidence regarding the safety and efficacy of pegfilgrastim among a pediatric cancer population.
Findings suggest that pegfilgrastim is effective and can be safety given to pediatric patients.
Bordin, N.A., Guerreiro Godoy Mde, F., & Pereira de Godoy, J.M. (2009). Mechanical lymphatic drainage in the treatment of arm lymphedema. Indian Journal of Cancer, 46(4), 337–339.
To evaluate a method of mechanical lymphatic drainage using the RAGodoy apparatus
Lymphedema was confirmed with lymphoscintigraph and volumetry and defined as a difference in arm volumes of more than 200 ml. Patients had a one-hour session with the RAGodoy mechanical apparatus, which provides 15–25 elbow bending and stretching exercises per minute. Pre- and post-treatment volumetry was taken.
The study took place at a single outpatient site in Brazil.
The study used a prospective trial design.
The reduction in the volume was an average of 59.2 ml (p < 0.001). In two cases, there was an increase in volume with the intervention. In the remaining 23, there was a decrease in volume. It appeared that for those where there was an increase, the patients did not fully allow the device to passively work.
Passive mechanical exercise for lymphatic drainage may be helpful in the management of lymphedema
Use of a device for provision of passive limb exercise in the management of lymphedema requires further study.
Bordeleau, L., Pritchard, K., Goodwin, P., & Loprinzi, C. (2007). Therapeutic options for the management of hot flashes in breast cancer survivors: An evidence-based review. Clinical Therapeutics, 29, 230–241.
STUDY PURPOSE: To explore the effectiveness of pharmalogic and nonpharmalogic agents in treating hot flashes in breast cancer survivors
TYPE OF STUDY: Systematic review
PHASE OF CARE: Transition phase after active treatment
APPLICATIONS: Elder care
CAM therapies and vitamin E appear to have some effect, but data are limited. Gabapentin and some of the newer antidepressants were the most effective, with some side effects. These studies had small to moderate sample sizes, which makes overall effectiveness difficult to establish.
Nurses need to know the negative effects of hormonal agents on safety. Nonpharmacologic agents, such as soy phytoestrogens, black cohosh, and vitamin E, appear to be ineffective and limited because of the methodological limitations of studies. Gabapentin and some of the newer antidepressants were the most effective but still have side effects.
Bordeleau, L., Pritchard, K. I., Loprinzi, C. L., Ennis, M., Jugovic, O., Warr, D., . . . Goodwin, P. J. (2010). Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 28(35), 5147-5152.
Evaluate the efficacy of venlafaxine versus gabapentin for hot flashes in breast cancer survivors
Patients were randomly assigned to receive venlafaxine for 4 weeks, then after a 2-4 week washout receive gabapentin for 4 weeks, or to have the medications in the reverse order. Patients were given venlafaxine 37.5 mg daily for 7 days and then 75 mg daily for 21 days. Gabapentin was given at 300 mg at bedtime for 3 days, then 2 times daily for 3 days, then 3 times daily for 22 days. Patients completed a hot flash diary daily. At baseline, and at the end of each study period, they completed a symptom rating and study questionnaires.
PHASE OF CARE Late effects and survivorship
Crossover RCT
Only 38 patients completed all 4 weeks of both drugs, and 12% of those initially entered dropped out. Of patients who provided data regarding drug preference, the majority preferred venlafaxine (p = .01). There were no significant differences between treatments on hot flash outcomes, and hot flash scores were reduced from baseline in both groups (p<.001). Venlaxafine was associated with loss of appetite (p<.01), nausea ( p = .02), constipation (p =.05), and fewer negative mood changes (p = .003). Gabapentin was associated with more dizziness ( p = .005) and increased appetite (p<.001). Hot flash scores in all subjects increased during the 2-4 weeks off therapy. There were no serious adverse effects of the medications.
The findings suggest that either venlafaxine or gabapentin can be effective in reducing hot flash symptoms in breast cancer survivors. More patients preferred venlafaxine. Both drugs have side effects.
Booth, S., Moosavi, S.H., & Higginson, I.J. (2008). The etiology and management of intractable breathlessness in patients with advanced cancer: A systematic review of pharmacological therapy. Nature Clinical Practice Oncology, 5(2), 90-100.
The objective of this study was to discuss the evidence for our present understanding of the symptom of dyspnea and unanswered questions regarding the genesis and management of cancer-related breathlessness.
Databases searched were MEDLINE, CINAHL, and EMBASE (1966-2006).
Search keywords were breathlessness, cancer, lung cancer, cancer, dyspnea/dyspnoea, intervention, management, and nonpharmacological.
Studies were included in the review if they were double-blind, randomized, randomized- controlled, or placebo-controlled trials, case reports, or uncontrolled trials that
Older reviews were excluded.
Volume of studies retrieved, methods of study evaluation, and specific information about studies retrieved were not provided. Authors reviewed articles they deemed important to the science of dyspnea in patients with cancer and its management from the perspective of content experts.
The sample characteristics were not described.
Progression of the science of understanding breathlessness in patients with cancer requires collaboration between the research and clinical practice of cardiology, oncology, palliative medicine, social sciences, and physiology. Because dyspnea is a dynamic process that may manifest differently in unique populations and situations, possible variables should be well delineated and interventions should be varied to learn the most information about management of this complex symptom.
This review provides a summary of the evidence in multiple interventions, but the report is limited due to lack of provision of study sample characteristics and information regarding the search strategy and methods of evaluation of the strength of the evidence. These limit the level of confidence in findings and conclusions.
The first step to managing breathlessness is careful assessment of the patient and investigation of potential correctable etiologies of breathlessness. The interview should include a patient and caregiver accounting the dyspnea and its triggers, intensity, aggravating factors, alleviating factors, and response to pharmacologic and nonpharmacologic interventions.