Beek, M.A., Gobardhan, P.D., Schoenmaeckers, E.J., Klompenhouwer, E.G., Rutten, H.J., Voogd, A.C., & Luiten, E.J. (2016). Axillary reverse mapping in axillary surgery for breast cancer: An update of the current status. Breast Cancer Research and Treatment, 158, 421–432.
STUDY PURPOSE: To review the evidence for axillary reverse mapping (ARM) and discuss the feasibility, safety, and relevance of this procedure
TYPE OF STUDY: General review/"semi" systematic
PHASE OF CARE: Active antitumor treatment
Evidence shows a wide range of visualization rates from 20%–90% and notes that rates are lower with sentinel lymph node biopsy (SNLB) than with axillary lymph node dissection (ALND). The definition of successful ARM, the volume of blue dye used, and the experience of the surgeon varied, all of which may affect these rates. Blue dye, flourescent dye, and radioisotopes have been used for visualization. No adverse events from the procedures have been noted. At present, no axillary recurrence has been reported in patients in whom lymph nodes were preserved. ARM may contribute to a reduction in upper extremity lymphedema, although current evidence is not strong enough to draw firm conclusions.
The preservation of lymph nodes with ARM appears to be safe and may contribute to a reduction in the incidence of upper extremity lymphedema.
The preservation of axillary lymph nodes in women undergoing surgery for breast cancer with ARM appears to be safe. The evidence suggests that ARM with lymph node preservation may reduce the prevalence of arm lymphedema; however, multiple limitations in the available evidence exist. Ongoing research of the long-term effects on patient outcomes is needed and underway.
Becker, G., Galandi, D., & Blum, H.E. (2007). Peripherally acting opioid antagonists in the treatment of opiate-related constipation: A systematic review. Journal of Pain and Symptom Management, 34, 547-565.
To evaluate evidence on the effectiveness of the peripherally acting mu-receptor antagonists alvimopan and methylnaltrexone in the management of opioid-induced constipation.
Databases searched were Ovid MEDLINE, Biological Abstracts, BIOSIS Previews, CINAHL, Evidence-Based Medicine Reviews (EBMR) (Cochrane Database of Systematic Reviews, ACP [American College of Physicians] Journal Club, Database of Abstracts of Reviews of Effectiveness [DARE], and the Cochrane Central Register of Controlled Trials [1966-May 2005]), PubMed (1996-May 2005), CancerLit (1963-June 2005), and Embase (1980-May 2002). A hand search also was conducted on bibliographies of books about palliative care. From that hand search, reference citations concerning constipation were identified to find additional clinical trials to include in the review.
Search keywords were constipation, intestinal obstruction, opioid bowel dysfunction, opioid related constipation, opioid-related disorders, peripherally acting opioid antagonist, opioid antagonist, opioid mu receptors, narcotic antagonists/naltrexone, methylnaltrexone, and alvimopan.
Studies were included in the review if
Studies were excluded if they had a small sample size (fewer than 10 participants) or used the Rome Diagnostic Criteria to define constipation.
Ten studies were appropriate for this review. However, four of the 10 had two or three parts performed in different populations or using different dosing regimens. The differing parts were treated as different studies and assessed individually, yielding 15 studies (10 randomized controlled trials and five phase II studies addressing dose and toxicity).
This systematic review looked mainly at the efficacy of using the peripherally acting opioid antagonists methylnaltrexone (nine studies) and alvimopan (six studies) in managing opioid-induced constipation. Internal validity of the studies was high, indicating methylnaltrexone and alvimopan may be effective in relieving opioid-induced constipation. However, most study participants were healthy volunteers or members of methadone programs.
Beck, M., Wanchai, A., Stewart, B.R., Cormier, J.N., & Armer, J.M. (2012). Palliative care for cancer-related lymphedema: A systematic review. Journal of Palliative Medicine, 15(7), 821–827.
To a conduct a systematic review of the published literature related to the effectiveness of cancer-related lymphedema management in palliative care
Databases searched were PubMed, MEDLINE, CINAHL, Cochrane Library databases, PapersFirst, Proceedings First, Worldcat, PEDro, National Guidelines Clearing House, ACP Journal Club, and Dare.
Search keywords were lymphedema (lymphoedema, lymphodema, elephantiasis, swelling, edema, and oedema) and palliative care (advanced disease and metastatic cancer).
Studies were included in the reivew if they related to lymphedema management in the setting of palliative care, including randomized controlled trials, cohort studies, case-control studies, meta-analyses, and systematic reviews.
Studies were excluded if they
Patients were undergoing end-of-life and palliative care.
The study identified four categories of lymphedema in the palliative care settings.
Only a few studies (4 out of 11) included objective measures of outcomes. All studies were in the category of \"Effectiveness Not Established\" assessed by the Oncology Nursing Society Putting Evidence Into Practice classification.
A lack of rigorously designed clinical research studies have been conducted pertaining to the treatment of lymphedema in patients with advanced or metastatic cancer.
This systematic review indicated that the identified procedures (closed-controlled subcutaneous drainage, MLD, compression therapy, and CDT) are relatively safe. Nurses may consider recommending these procedures to individuals with lymphedema and advanced or metastatic cancer. Nurse scientists need to conduct more rigorously designed studies to test the effectiveness of management of cancer-related lymphedema in palliative care.
Bechtel, T., McBride, A., Crawford, B., Bullington, S., Hofmeister, C.C., Benson Jr, D.M., . . . Devine, S.M. (2014). Aprepitant for the control of delayed nausea and vomiting associated with the use of high-dose melphalan for autologous peripheral blood stem cell transplants in patients with multiple myeloma: A phase II study. Supportive Care in Cancer, 22, 2911–2916.
To evaluate the efficacy of adding aprepitant to an antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV)
Participants received aprepitant at 125 mg orally on day 1 followed by 80 mg orally at 24 and 48 hours after the initial dose of aprepitant. Ondansetron was given at 16 mg orally on day 1, and dexamethasone was given at at 12 mg orally on day 1 and at 8 mg orally on days 2–4. Breakthrough medications were used as needed. There was no comparison or control group. To evaluate nausea and vomiting, patients were assessed four to six times per day for the presence or absence of vomiting, the frequency of emetic episodes, the need for breakthrough antiemetic medication, and a nausea score provided by the nurse. Mean nausea scores were assessed every 24 hours beginning 24 hours after chemotherapy and continuing 120 hours after chemotherapy.
Prospective, single-arm study
Complete response was defined as no more than one emetic episode during the evaluation period. Of the 26 participants, 25 (96%) completely responded and needed no additional breakthrough medication. Twenty-four (92%) had no documented emetic episodes during the study period. Some degree of nausea was reported by 23 out of 26 (88%) patients, and the mean nausea score for the entire group during the study period was 0.7 (range = 0–10).
Adding aprepitant to a standard antiemetic regimen may result in lower rates of CINV associated with high-dose melphalan and stem cell transplant.
Adding aprepitant to standard antiemetic regimens may result in better controlled CINV. However, with such a small sample size and no comparison group, attributing these results to the intervention is difficult.
Bazire, L., Fromantin, I., Diallo, A., Lande, B., Pernin, V., Dendale, R., . . . Kirova, Y.M. (2015). Hydrosorb® versus control (water based spray) in the management of radio-induced skin toxicity: Results of multicentre controlled randomized trial. Radiotherapy and Oncology, 117, 229–233.
To report the efficacy of Hydrosorb versus water-based spray (control) to treat G1-2 radiodermatitis in patients with early stage breast cancer (BC) treated with normo-fractionated radiotherapy (RT)
PHASE OF CARE: Active treatment
Randomized, prospective, open-label, placebo-controlled study
No significant difference existed between Hydrosorb and placebo in the treatment of acute radioinduced dermatitis. A trend in improvement in pain was observed with the use of Hydrosorb; however, any additional treatment given for pain, which was allowed, was not described.
The ingredients of the patients' applied moisturizer were not defined and could have altered skin physiology in both arms. The frequency of Hydrosorb application was not defined. No actual grading of dermatitis existed per se. Changes in local treatment were allowed, but no information was provided regarding what additional treatments were done.
This study did not show that Hydrosorb was effective in preventing the increase of radiodermatitis severity. Patient instructions used here included outdated information, such as the need to avoid use of deodorants. Very limited evidence shows that topical treatments effectively prevent radiodermatitis.
Bauters, T.G., Verlooy, J., Robays, H., Benoit, Y., & Laureys, G. (2013). Emesis control by aprepitant in children and adolescents with chemotherapy. International Journal of Clinical Pharmacy, 35, 1021–1024.
To investigate the efficacy of aprepitant in children and young adolescents receiving highly or moderately emetogenic chemotherapy who experienced uncontrollable emesis in previous cycles
This was a retrospective, observational analysis in children and adolescents aged greater than three years treated with aprepitant at a hospital in Belgium. Patients were identified through pharmacy records. Data on the use of antiemetics and emesis control were retrieved from pharmacy and nursing files. Emesis was defined as at least one episode of vomiting during the current chemotherapy cycle. Complete vomiting control was defined as no vomiting during the current cycle while incomplete control was defined as at least one episode of vomiting. The use of aprepitant was recorded and analyzed for each patient and for every chemotherapy cycle in which aprepitant was given.
Retrospective, observational analysis over three years
Half the patients, representing a sizable percentage of episodes with complete emesis control, benefited from the use of aprepitant in combination with other antiemetics. This suggested the added value of aprepitant in patients receiving moderately or highly emetogenic cycles of chemotherapy, especially as all the included patients experienced uncontrollable emesis in previous cycles. Patients or parents with a positive experience with aprepitant asked for the availability of the product in subsequent cycles, which highlights its value.
Aprepitant achieved good results in preventing or reducing vomiting in children, which might improve compliance and patient and family satisfaction.
Bausewein, C., Booth, S., Gysels, M., & Higginson, I. (2008). Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database of Systematic Reviews (Online), 2(2), CD005623.
The objectives of the study were to
The study reported on a sample of 2,532 participants in 47 studies categorized into single intervention or multi-component interventions.
The following single interventions were identified.
The following multi-component interventions were identified.
A meta-analysis of the included studies was not possible due to hetereogeneity of the studies. Strong evidence suggests that neurologic muscular electrical stimulation and chest wall vibrations provide helpful relief of breathlessness in patients with COPD. However, the practical implications of the chest wall vibration interventions were only conducted in the respiratory laboratory. The evidence is moderately strong for walking aids having some benefits for patients with COPD with breathlessness by reducing the work of chest muscles. Moderate strength of evidence exists for breathing training being beneficial for breathless patients. Finally, not enough evidence exists to recommend usage of acupuncture, distractive auditory stimuli, relaxation, fan, counseling and support programs, or counseling and support programs in combination with relaxation and breathing training, case management, and psychotherapy.
Moderate evidence strength for walking aids and breathing retraining for COPD suggests these may be helpful interventions. Applicability in patients with cancer may be worth investigation.
Bausewein, C., Booth, S., Gysels, M., Kuhnbach, R., & Higginson, I.J. (2010). Effectiveness of a hand-held fan for breathlessness: A randomised phase II trial. BMC Palliative Care, 9, 22.
The objective of the study was to determine effectiveness and acceptance of use of a handheld fan to relieve breathlessness in patients with advance chronic obstructive pulmonary disease (COPD) and cancer.
Patients were randomly assigned to the fan or control groups. Control patients were given a wristband and instructed to wear it constantly and pull it at short intervals when breathless. Patients in the intervention group were given a handheld fan, shown how to use it (aimed at the central part of the face), and given a booklet with instructions for use. Data were collected at baseline and by monthly postal questionnaires for six months or until the patient died.
The study was conducted in an unspecified single site in the United Kingdom.
The study was a randomized controlled trial.
A modified Borg scale was used.
This study shows that use of a handheld fan for breathlessness was not effective.
Findings do not show any benefit of a handheld fan to help patients with the sensation of breathlessness.
Baumann, F.T., Zopf, E.M., Nykamp, E., Kraut, L., Schüle, K., Elter, T., . . . Bloch, W. (2011). Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: Benefits of a moderate exercise intervention. European Journal of Haematology, 87, 148–156.
To demonstrate the effects of an exercise program on endurance, strength, lung function, and quality of life in patients undergoing allogeneic transplantation.
Forty-seven patients undergoing allogeneic transplantation during a three-year period were recruited and randomized into either the exercise group (EG) or the control group (CG). The EG received daily aerobic endurance training with a cycle and ADL training, involving relaxation, stair climbing coordination, and strengthening. Exercise was done 20–30 minutes per day, twice daily. CG patients received standard physiotherapy for 20 minute five days per week, consisting of active and passive mobilization with low intensity. Fatigue measurement was conducted two days after admission and one day before discharge. Exercise began the first day after transplantation.
Increase in the experience of fatigue in the CG. Deterioration of physical function was seen in both study groups. There was improved emotional state for patients in the EG (p = .028). Relative endurance improved in EG both groups. There was no significant group by time effect on fatigue. No effect for strength, lung function, or anthropometric assessments reached significance in either group.
The only significant difference between the two groups was found in relative endurance in favor of EG.
Physical activity during acute phase of transplantation appears safe and can improve physical endurance and strength.
Baumann, F.T., Drosselmeyer, N., Leskaroski, A., Knicker, A., Krakowski-Roosen, H., Zopf, E.M., & Bloch, W. (2011). 12-week resistance training with breast cancer patients during chemotherapy: Effects on cognitive abilities. Breast Care, 6, 142–143.
To evaluate the effectiveness of resistance training on cognitive abilities in patients with breast cancer undergoing neoadjuvant chemotherapy
The intervention group (IG) participated in 60 minutes of resistance training (three sets of 8–12 reps for 10 different exercises at 55%–75% maximum effort) twice a week for 12 weeks. The control group (CG) did not receive any information. Cognitive evaluations were performed in the IG prior to them receiving the intervention and at study conclusion (one to two weeks after end of chemotherapy) for both groups.
Patients were undergoing active treatment.
Prospective, non-randomized controlled trial
The IG's d2 Test of Attention scores improved (p = 0.049), but no significant differences were observed in comparison to the CG. The IG d2 error rate decreased from baseline by 1.12 points (p = 0.017) but was significantly different from the CG at baseline (p = 0.040) and post-intervention (p = 0.019). The IG short-term verbal memory was marginally improved from baseline (p = NS) but was significantly better than CG scores (p = 0.048). IG Wilde test scores for working memory showed significant improvement from baseline (p= 0.049), but no significant difference existed between IG and CG scores.
Improvements were seen in focused attention and concentration, working memory, and verbal memory for the IG. Although no differences were observed in verbal memory and attention between the IG and CG, the CG did not have baseline evaluations performed for adequate group comparisons.
Benefits of physical activity, predominately aerobic exercise, have improved symptoms of fatigue, sleep disturbances, affect, and cognitive function. Using resistance training may improve short-term verbal memory, working memory, attention, and concentration. Further study is warranted.