Bardia, A., Barton, D.L., Prokop, L.J., Bauer, B.A., & Moynihan, T.J. (2006). Efficacy of complementary and alternative medicine therapies in relieving cancer pain: A systematic review. Journal of Clinical Oncology, 24, 5457–5464.
To evaluate the efficacy of various complementary and alternative medicine (CAM) therapies to reduce cancer pain
The type of article is systematic review.
The initial search identified 101 articles, of which investigators excluded 85. Investigators included an additional two articles, which were found through manual scans of reference lists. Investigators appraised articles by using the Jadad scale.
The result of this systematic review was that none of these interventions can be recommended as effective. The most promising therapies appear to be mind-body interventions. In particular, hypnosis and relaxation might have some effect in decreasing cancer pain. Effect may be limited by cognitive impairment caused by cancer or cancer treatment. Support groups may have some positive effects. Whether these benefits are due to increased patient awareness, with more frequent visits to care providers, better compliance with medication regimens, or as a result of group interaction and social or emotional support is unclear. One study found that benefit occurred only in those patients who were more distressed at baseline. It is possible that effect sizes of therapies may be more discernible among patients with higher pain ratings, demonstrating a floor effect related to the symptom of pain.
Current evidence does not support the efficacy of the cited CAM interventions in the management of pain of patients with cancer. Methodologically strong research that incorporates appropriate attentional and sham controls, sufficient sample sizes, and longer duration of follow-up is needed.
Bardellini, E., Amadori, F., Schumacher, R.F., D'Ippolito, C., Porta, F., & Majorana, A. (2016). Efficacy of a solution composed by verbascoside, polyvinylpyrrolidone (PVP) and sodium hyaluronate in the treatment of chemotherapy-induced oral mucositis in children with acute lymphoblastic leukemia. Journal of Pediatric Hematology/Oncology, 38, 559–562.
To determine the efficacy of a mouthwash solution composed of verbascoside, polyvinylpyrrolidone, and sodium haluronate (Mucosyte) in the treatment of chemotherapy-induced oral mucositis (OM)
Patients undergoing chemotherapy for acute lymphoblastic leukemia (ALL) on the same protocol treatment (ALL 2009 standard protocol) were included in the study. Patients were randomized to either the group A (intervention group) or group B (placebo group). Each group were to rinse with 15 ml of the solution for two minutes three times a day for a total of eight days. OM scoring was conducted on day 1 (day of diagnosis of OM), three days after treatment, and again on day 8. Pain scores were determined at the same time as the oral examination for the OM scoring.
Randomized, double-blinded study. Each participant was randomized with an automatically generated list.
Group A showed a reduction in OM of T1 on day 3. On day 8, group A and group B had a reduction of T2, with group A revealing a statistically significant decline compared to group B (p = 0.0038). Group A showed a reduction in pain scores for both TI and T2, resulting in a reduction in additional analgesia needed, compared to group B.
The use of Mucosyte mouthwash in children with chemotherapy-induced OM revealed a reduction in the grade of OM and pain scores during an eight-day treatment and, therefore, may be recommended as a supportive treatment.
Small sample (< 100)
The implications of this study are promising for treatment with Mucosyte mouthwash for reducing OM and pain during chemotherapy for ALL. More studies may need to be conducted, because this study took into account only patients on the same treatment regimen. Other treatment regimens including chemotherapy, radiation, and or laser therapy may affect the severity and duration of OM and, therefore, may reveal different results.
Barclay, J., Vestey, J., Lambert, A., & Balmer, C. (2006). Reducing the symptoms of lymphoedema: Is there a role for aromatherapy? European Journal of Oncology Nursing, 10(2), 140–149.
To assess the effectiveness of self-massage and skin care using a base cream containing aromatherapy oils versus using a base cream without aromatherapy oils in terms of objective reduction in limb volume and patient-reported symptom improvement and well-being after simple lymphatic drainage
Self-massage and skin care significantly improved patient-identified symptom relief and well-being for patients. It also, but not significantly, reduced limb volume. Aromatherapy oils did not appear to influence any improvement in these measures. In the experimental group, 69% had limb reduction, compared to 57% in the control group (p = 0.38). Both groups combined showed slight improvement (p = 0.034). The finding supports the use of simple lymphatic drainage. Well-being, pain, discomfort, mobility, and body image were evaluated and showed significant improvement in patient-identified symptom relief and well-being. No difference was observed using aromatherapy.
Barber, C., Powell, R., Ellis, A., & Hewett, J. (2007). Comparing pain control and ability to eat and drink with standard therapy vs. Gelclair: A preliminary, double centre, randomised controlled trial on patients with radiotherapy-induced oral mucositis. Supportive Care in Cancer, 15(4), 427–440.
RCT was designed to evaluate pain control and the ability to eat and drink using standard therapy (sucralfate and Mucaine® [Wyeth-Ayerst Laboratories]) versus Gelclair® (EKR Therapeutics, Inc.) in patients with radiotherapy-induced oral mucositis.
Patients used medication 30 minutes to 1 hour before eating or drinking.
Gelclair: Patients used undiluted or could mix a single dose in a glass with up to 40 ml of water. Patients swished and gargled for at least one minute to coat the tongue, roof of mouth, throat, and inside of cheeks. If unable to do that, patients used sponge applicators. Patients spat the product out and did not swallow it.
Sucralfate and Mucaine: Patients swished 10 ml in mouth for at least 1 minute to coat all areas, then swallowed the product.
Study was 24 hours only. Baseline was 1, 3, and 24 hours after initiation of treatment.
Patients in both groups had additional analgesia available throughout the trial.
Patients swallowed standard therapy but not Gelclair.
The sample was comprised of 20 patients (n = 10 in the Gelclair group and n = 10 in the standard [sucralfate and Mucaine] group).
Patients with head and neck cancer received daily radation therapy over a 4–6 week period and showed at least grade 1 oral mucositis and pain not alleviated by paracetamol, co-codamol, or aspirin.
The mean age was 61.1 years (range = 28-79 years).
Three patients were smokers.
Double-center, prospective RCT
Single blind trial with the administrating nurse specialist unaware of medication used
Conducted as feasibility study for future sample size calculation
Oral mucositis NCI-CTC for radiation
General pain and pain on speaking VAS 0–10
Swallowing assessment was self-recorded (normal to swallowing own saliva only).
Compliance was queried by the researcher.
Using NCI grading, nine patients had grade 3 or 4 (three in the intervention arm and six in the control arm). The remaining 11 patients had grade 1 or 2 (seven in the Gelclair group and four in the standard therapy group).
No observations of relevance with regard to general pain, pain on speaking, or ability to eat and drink for those with higher grades of oral mucositis.
Number of coanalgesics of strong opiate type
One patient was noncompliant for sucralfate and Mucaine.
General pain: No significant difference was observed between the intervention and the control group across time intervals (p = 0.236).
Reduction in pain on speaking was not significant (p = 0.616).
Swallow: Effects of standard therapy appeared to last longer than Gelclair (NS).
Because the study was only 24 hours, effectiveness with more severe mucositis is not known.
Barber, F.D. (2013). Effects of social support on physical activity, self-efficacy, and quality of life in adult cancer survivors and their caregivers. Oncology Nursing Forum, 40, 481–489.
To explore the relationships between adult cancer survivors’ and caregivers’ social support, self-efficacy for physical activity, physical activity, and quality of life, and to understand their perceptions of social support in physical activity participation
Participants attended the FitSTEPS for Life® (FSFL) for one month. FSFL is an individually tailored and supervised community-based exercise program for cancer survivors and their caregivers established by the Cancer-Foundation For Life nonprofit organization. Survivors required a referral from their oncologists to be able to attend FSFL and were expected to exercise at least three times a week.
Only data on caregivers were included in this summary.
Mixed-method, quasi-experimental study with written responses to questions and recorded interviews of the caregivers of patients who enrolled in FSFL based on oncologist referrals
Participation in FSLP did not have a significant effect on caregivers' PA, quality of life, social support, or SEPA. Qualitative data supported relationships between social support, PA, and quality of life.
Nurses should consider the role of social support in designing interventions to influence the PA, self efficacy, and quality of life of caregivers. Nurses should encourage cancer survivors and their caregivers to openly discuss their needs for social support. This study was too small to evaluate the effects of exercise, and the high drop out rate suggests that continued involvement in this type of effort may not be acceptable for patients and caregivers.
Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology, 16, 980–984.
The intervention consisted of once weekly art therapy sessions to teach patients to act in a more conscious way by painting with water-based paints. The intervention was provided by an art therapist. The duration of the sessions varied. Those who completed four or more sessions (n = 19) were compared to those who participated for two weeks or less (n = 41).
The study was conducted in an ambulatory setting of a cancer center in northern Israel.
The study used a single-arm, open-label design.
For treatment with art therapy, a patient requires referral to an art therapist.
Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology, 16, 980–984.
An anthroposophy art therapy intervention (watercolor painting) in weekly group sessions was administered by an art therapist in northern Israel. Participants chose the amount of time to spend in the session, ranging from a few minutes to more than an hour. Data were collected at baseline and before every session.
A single-arm, pilot study design was used.
A Mann-Whitney U test compared HADS and BFI in the intervention group and the participation group. A Wilcoxon signed-rank test assessed changes in HADS and BFI scores in the two groups. There were no significant difference between the two groups for reducing anxiety (p = 0.2).
Bao, Y.J., Hua, B.J., Hou, W., Lin, H.S., Zhang, X.B., & Yang, G.X. (2010). Alleviation of cancerous pain by external compress with Xiaozheng Zhitong Paste. Chinese Journal of Integrative Medicine, 16, 309–314.
To observe the clinical effectiveness of a topical application of Xiaozheng Zhitong Paste (XZP) in alleviating the cancerous pain of patients with middle/late-stage cancer
Patients were randomized into either the treatment group (64 patients) or the control group (60 patients). In addition to utilization of three-ladder (3L) analgesia therapy in both groups, topical application of XZP was given to patients in the treatment group for pain alleviation. Analgesic efficacy was recorded in terms of pain intensity, analgesia initiating time and sustaining time, and the optimal analgesic effect revealing time. Quality of life and adverse reactions that occurred in patients were also recorded.
The extent of pain, the analgesic effect initiating time and sustaining time of medication, and the optimal effect revealing time were recorded before medication and 24 hours after medication. Quality of life was estimated by Karnofsky scoring and the Brief Pain Inventory (BPI).
Intensity of pain was evaluated per standards of the World Health Organization with the numeric rating scale (NRS), expressed as digits from 0–10 (0 for no pain, 10 for extreme pain). Intensity of pain was ranked into four grades: 0 = no pain; grade I = endurable pain, normal daily life, sleep not affected, NRS 1–3; grade II = obvious pain, unendurable, patients asked for analgesia, daily life and sleep affected, NRS 4–6; grade III = severe pain, could hardly endure, analgesia necessary, sleep interfered with, impact on motion, forced posture, painful complexion, and incessant groaning, NRS 7– 10.
Effectiveness on pain treatment was classified into four grades: completely remitted (CR), partially remitted (PR), mildly remitted (MR), and no palliation (NP). Comparison of the total effective rate (sum of CR+PR+MR) between the two groups showed no significant difference (p > 0.05). Analgesic effect initiating time was decreased, and its sustaining time was elongated in both groups after medication (p < 0.01), but the initiating time was shorter in the treatment group than in the control group (p < 0.01). The mean optimal analgesia effect was shorter in the treatment group, demonstrating a significant difference (p < 0.01).
Compared by the effect of pain on patients, the effect was attenuated by both groups after medication, but the mental condition, walking capacity, social acceptability, sleep, and joy of living were all better with those in the control group, showing statistical significance (p < 0.01).
The combination of 3L analgesia and XZP compress demonstrates the similar effects in pain alleviation as compared with 3L analgesia alone.
XZP paste was prepared at the pharmaceutical department of the author’s hospital.
Chinese medicine may prove to be beneficial for patients with cancer-associated pain management issues, as well as in end-of-life and palliative care; however, these findings do not provide support for the intervention tested here. Nursing participation in these evaluations is essential.
Bao, T., Ye, X., Skinner, J., Cao, B., Fisher, J., Nesbit, S., & Grossman, S.A. (2011). The analgesic effect of magnetic acupressure in cancer patients undergoing bone marrow aspiration and biopsy: A randomized, blinded, controlled trial. Journal of Pain and Symptom Management, 41(6), 995–1002.
To compare the analgesic effect of applying magnetic acupressure to the L14 point to that of applying magnetic acupressure to a sham point
Patients were stratified by the number of prior bone marrow aspiration biopsies (BMABs) and randomized to one of two groups. In the first group, a practitioner delivered acupressure to the L14 acupoint (the dorsum of the first interosseus space of the hand). In the second group, a practitioner delivered acupressure to a sham point (the fourth interosseus space of the hand). Two HACI magnetic acupressure suction cups (HMASCs) were applied to the designated area of both the patient's hands for the duration of the BMAB procedure. The same two HMASCs were used on all study patients. All patients received standard local analgesics as ordered by the BMAB provider. The same BMAB provider and acupressure practitioner were used throughout the study. The patient, BMAB provider, and outcome evaluator were blinded to the location of the acupressure. The patient’s pain intensity was measured at baseline and after the BMAB.
Multiple phases of care
Single-center randomized single-blind clinical trial
Authors noted no significant difference in median pain scores between the patients treated at the L14 site versus the sham site (3.0 versus 3.0, p = 0.08, Mann-Whitney test). Eight patients (20%) in the sham-site group experienced severe pain. One patient (2.7%) in the L14 group experienced severe pain (p = 0.03, two-tailed Fisher’s exact test). The unadjusted risk of patients experiencing severe pain in the sham-site group was nine times higher (95% CI 1.07–75.9, p = 0.04). After accounting for age, number of prior BMABs, baseline pain scores, and the number of times the cup fell during the procedure, patients in the sham-site group were more likely to experience severe pain than were those in the L14 group (risk ratio 9.3; 95% CI 1.01–85.6; p = 0.049). The acupressure point was the only statistically significant factor associated with BMAB-related pain.
Magnetic acupressure delivered at L14 may reduce the number of patients who experience severe pain during BMAB.
The combination of magnetic acupressure at the L14 site and local anesthetics may reduce severe pain during BMAB. Acupressure is inexpensive, and it requires minimal training to deliver.
Bao, T., Goloubeva, O., Pelser, C., Porter, N., Primrose, J., Hester, L., . . . Badros, A.Z. (2014). A pilot study of acupuncture in treating bortezomib-induced peripheral neuropathy in patients with multiple myeloma. Integrative Cancer Therapies, 13, 396–404.
To determine the effectiveness, safety, and convenience of acupuncture in decreasing bortezomib-induced peripheral neuropathy (BIPN)
Patients were treated with 10 acupuncture treatments twice a week for two weeks, then once a week for four weeks, and then every other week for four weeks. Patients remained on their prescription PN medications.
PHASE OF CARE: Active antitumor treatment
Prospective study
The Clinical Total Neuropathy Score was considered invalid because of reliability and validity issues in this setting. The FACT/GOG Neurotoxicity (Ntx) subscale and NPS scores demonstrated significant decreases in BIPN symptoms. Improvements in buttoning and walking at weeks 10 and 14 (p values < 0.0001) were observed. No differences in nerve conduction evaluations were reported from baseline to the completion of the study. No change in serum biomarkers were reported.
Acupuncture was demonstrated as a safe although inconvenient treatment for BIPN. Patients reported improvements in BIPN symptoms.
The intervention produced a decrease in some BIPN symptoms. Acupuncture needs to be administered by a licensed therapist, which may not be a realistic treatment for all patients. A large, randomized trial is indicated for future research.