Ashamalla, H., Jiang, M. L., Guirguis, A., Peluso, F., & Ashamalla, M. (2011). Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. International Journal of Radiation Oncology, Biology, Physics, 79(5), 1358-1363.
To study the effect of acupuncture on hot flashes in men with prostate cancer treated with androgen deprivation
Men with hot flashes occurring at least 3 or more times per day for at least three days before enrollment were enrolled. They completed hot flash diaries with resulting hot flash scores at baseline, daily for at least 6 weeks, and then monthly for 8 months (targeted time was 36 months). Acupuncture was administered by same acupuncturist twice a week for 4 weeks to the same 10 points with electro stimulation applied to 8 of the 10 points per protocol.
The study enrolled men with locally advanced prostate cancer, who had been treated with androgen deprivation therapy as an adjuvant to radiation therapy, radical prostatectomty, or brachytherapy. All men must have had hot flashes occurring at least 3 or more times per day for at least three days before enrollment. Patients could not be receiving medications for hot flashes nor have a history of acupuncture treatment.
PHASE OF CARE: Active Treatment
APPLICATIONS: Late effects & survivorship; Elderly care
Prospective single arm trial
Mean initial Hot Flash Score (HFS) was 28.3, which decreased to 10.3 (p= 0.0001) at 2 weeks post-treatment, 7.5 (p = 0.0001) at 6 weeks post-treatment, and 7.0 (p= 0.0001) at 8 months post-treatment. Clinical improvement for each patient was defined as the percent decrease in the mean HFS at each time point. The mean improvement at weeks 2 and 6 was 68.4% and 89.2%.
In this limited sample size, acupuncture appeared to reduce hot flash symptoms experienced by men treated with androgen deprivation for their locally advanced prostate cancer.
Further research is needed in larger sample sizes to determine effectiveness, and the reproducibility of the study when using multiple providers. The study explored the long term benefits of using acupuncture and suggested (demonstrated) an 80.3% decrease in HFS at the 8-month follow-up.
Arving, C., Sjödén, P. O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., & Brandberg, Y. (2007). Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19.
To compare if individual psychosocial support for patients with breast cancer provided by oncology nurses specially trained in cognitive behavioral techniques was as effective as that given by psychologists or standard care.
Patients received individualized psychosocial support interventions using cognitive behavioral techniques, such as relaxation, distraction, activity scheduling, and ways to improve communication. The frequency of sessions varied based on patients' perceptions of need. Patients were randomized in blocks of nine into one of three alternatives: 60 received individual psychosocial support by a specially trained oncology nurse, 60 received it from a psychologist, and 59 received standard care. Outcomes measured were quality of life (QOL), fatigue, nausea, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties.
The study was conducted at the Department of Oncology, Uppsala University, Sweden.
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized, quasiexperimental study using repeated measures at baseline and at one, three, and six months.
The results revealed statistically significant group by time interactions for global QOL and health status, nausea and vomiting, and systemic therapy side effects. Intervention groups showed statistical differences on the insomnia, dyspnea, and financial difficulties EORTC subscales, in favor of one or both of the interventions.
Arving, C., Sjödén, P. O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B. & Brandberg, Y. (2007). Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19.
Patients were randomized to two intervention groups: Individual Psychosocial Support, provided by a trained oncology nurse (INS), and Individual Psychosocial Support, provided by a psychologist (IPS). Both interventions used the same techniques of relaxation, distraction, activity scheduling, and ways to improve communication. The number of sessions and time intervals between sessions varied according to the needs and desires of individual patients. Each session lasted 45 to 60 minutes, in which patients' problems were identified and developments were made to help manage these problems. Patients were provided with written and oral instructions on how to practice these strategies. Quality of life questionnaires were administered at baseline and at one, three, and six months.
Department of Oncology, Uppsala University Hospital
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized study.
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
Intervention groups had lower fatigue scores on the EORTC-QLQ-C30 at baseline, one month, and six months; these differences were minimal and not statistically significant.
Arving, C., Sjödén, P.-O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., et al. (2007). Individual psychosocial support for breast cancer patients: A randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19.
To compare individual psychosocial support (cognitive behavioral therapy [CBT]) for patients with breast cancer provided by oncology nurses specially trained in psychologic techniques (INS), or the same support given by psychologists (IPS), versus standard care provided in Sweden.
Measures were done at one, three, and six months after inclusion in study.
The sample was comprised of 179 patients with breast cancer who were about to start adjuvant therapy.
A prospective, randomized study design was used.
Results indicated that CBT offered by specially trained nurses is just as effective as CBT offered by psychologists. Statistically significant improvements in anxiety over time (p < 0.01) were shown between the INS and IPS groups versus the standard care group.
Arvaniti, K., Lathyris, D., Clouva-Molyvdas, P., Haidich, A.B., Mouloudi, E., Synnefaki, E., . . . Catheter-Related Infections in ICU (CRI-ICU) Group. (2012). Comparison of oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: A multicenter, randomized, controlled study. Critical Care Medicine, 40, 420–429.
To evaluate the effectiveness of oligon central venous catheters (CVC) and chlorhexidine biopatch to reduce CVC-related infections. Oligon catheters are impregnated with antimicrobial silver, platinum, and carbon.
Patients were randomized to receive either a standard polyurethane catheter, a standard catheter plus biopatch, or an oligon catheter. All catheters were triple lumen. Standard maximum barrier insertion techniques were used, and dressing change frequency was every three days with a transparent dressing. Those getting the biopatch had the biopatch changed with regular dressing changes. The primary study endpoint was catheter colonization. A decision to remove the catheter was made by individual physicians.
There were no differences in catheter colonization rates, CRI, or CLABSI between groups. There were no differences between groups in number of catheter days, CLABSI incidence per 1,000 catheter days, or other factors potentially associated with development of CLABSI. Analysis showed that use of jugular or femoral insertion site and cancer diagnosis were significantly associated with development of catheter colonization (p < 0.05).
Findings did not support efficacy of BIOPATCH dressings or antimicrobial catheters for prevention of catheter-related colonization or infections.
Findings did not show efficacy of chlorhexidine-BIOPATCH CVC dressings or antimicrobial impregnated short-term catheters to prevent catheter colonization and related CVC-infection related outcomes.
Arslan, M., & Ozdemir, L. (2015). Oral intake of ginger for chemotherapy-induced nausea and vomiting among women with breast cancer. Clinical Journal of Oncology Nursing, 19, E92–E97.
To determine the effects of ginger on chemotherapy-induced nausea and vomiting (CINV) in women receiving adjuvant anthracycline for breast cancer
Patients were randomly assigned to control and treatment groups. Women in the intervention group consumed 500 mg of powdered ginger mixed with yogurt twice daily after an initial dose 30 minutes prior to chemotherapy. Both groups received triplet antiemetic therapy. Patients were followed for five days and were asked to record episodes of vomiting and retching and to evaluate their nausea using a numeric 10-point scale four times per day in a diary. The numeric scale also was used on the first day of chemotherapy to collect baseline data. Patient diaries were collected at the end of the five-day study period.
Randomized, controlled trial
Nausea severity was significantly lower in the experimental group after the intervention on study days 2–5 (p = 0.0001). The number of vomiting episodes also was lower in the experimental group on some study days (p < 0.05).
The use of ginger as an adjuvant to triplet antiemetics among women receiving anthracycline-based chemotherapy resulted in lower acute and delayed nausea severity.
Advances in antiemetic drugs have substantially improved the prevention and control vomiting in the acute and delayed phases of CINV. However, the prevention of nausea has been difficult to achieve. Findings from this study suggest that the use of ginger in combination with triplet antiemetics can be beneficial in reducing the severity of nausea.
Arrieta, O., Vega-Gonzalez, M.T., Lopez-Macias, D., Martinez-Hernandez, J.N., Bacon-Fonseca, L., Macedo-Perez, E.O., . . . de la Garza-Salazar, J. (2015). Randomized, open-label trial evaluating the preventive effect of tetracycline on afatinib-induced skin toxicities in non-small cell lung cancer patients. Lung Cancer (Amsterdam, Netherlands), 88, 282–288.
To evaluate the effectiveness of prophylactic tetracycline on afatinib-induced skin toxicities
Afatinib was given after disease progression with chemotherapy. Patients receiving afatinib were randomly assigned to receive general dermatological recommendations (control group) or 250 mg tetracycline every 12 hours in addition to general recommendations. All were receiving 40 mg afatanib every day until disease progression or toxicity. Dosage of afatinib was reduced to 30 mg daily for grade 3 or prolonged grade 2 toxicity. General recommendations provided to all patients were brief baths with lukewarm water, use of sunscreen, emollient creams, hypoallergenic soap, and fingernail care. Study assessments were conducted at baseline, week 2, and week 4 by a blinded assessor.
PHASE OF CARE: Active antitumor treatment
Most common toxicities were rash (65.6%), pruritus,(42.2%), mucositis (41.1%), paronychia (33.3%), skin fissures (24.4%), folliculitis (24.4%), and trichomegaly (22.2%). No grade 5 toxicities existed. Rash incidence was 75.5% in the control group versus 55.5% in the tetracycline group (relative risk [RR] = 0.4, p = 0.046), and rash severity of grade 2 or higher was 15.6% in the tetracycline group compared to 35.6% among controls (RR = 0.35, p = 0.03). Incidence of paronychia was lower in the tetracycline group, but group differences were not statistically significant. No other differences existed between groups in skin effects, and no differences existed between groups in the proportion of patients who required afatinib dose reductions. Most patients developed maximum rash intensity between weeks 1 and 4 of treatment. No relationship existed between rash incidence or severity and general disease outcomes.
Prophylactic tetracycline was effective in reducing the incidence and severity of rashes associated with afatinib use.
Very limited evidence exists for effective interventions to prevent or treat skin toxicities associated with epidermal growth factor receptor inhibitor (EGFRI) administration. Although the use of antibiotics has been suggested, currently little research demonstrates their efficacy. This study begins to fill that evidence gap, showing that tetracycline can be effective in reducing the incidence and severity of skin toxicity. This is a relatively low-cost and generally safe intervention to reduce adverse skin effects in patients receiving EGFRIs.
Arora, H., Pai, K.M., Maiya, A., Vidyasagar, M.S., & Rajeev, A. (2008). Efficacy of he-ne laser in the prevention and treatment of radiotherapy-induced oral mucositis in oral cancer patients. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, 105(2), 180-186, 186.e1.
To evaluate the efficacy of low level laser therapy (LLLT) for the prevention and treatment of radiotherapy-induced oral mucositis in patients with oral cancer
Patients with primary oral cancer were randomized to the laser group or a control group. All patients had oral prophylaxis before starting radiation therapy, and all had the same oral care during treatment. All patients were evaluated daily for pain severity, functional impairment, and oral mucositis. The clinical exams were performed by a single examiner. All the laser treatments were administered by one operator. The treatment consisted of use of a laser scanner for the first eight days followed by treatment to six areas on the right and left sides of the oral cavity for 25 days.
This was a single site, inpatient and outpatient study conducted at Kasturba Medical College of Manipal University in Karnataka, India.
This was a randomized controlled trial.
Pain increased gradually and was the greatest at the end of seven weeks. The laser group had a statistically significant lower level of pain than did the control group (p < 0.03). In week 3, the laser group had grade I functional impairment, while the control group progressed to grade II and III functional impairment, with one individual having grade IV impairment. Overall, the laser group had lower mucositis severity than the control group (p = 0.033).
Prophylactic laser therapy during radiation therapy can reduce the severity of mucositis, as well as the severity of functional impairment and pain.
This form of laser therapy is effective in the prevention of severe mucositis, but it is very high tech and requires special equipment and highly trained personnel.
Arora, R. S., Roberts, R., Eden, T. O., & Pizer, B. (2010). Interventions other than anticoagulants and systemic antibiotics for prevention of central venous catheter-related infections in children with cancer. Cochrane Database of Systematic Reviews, 12, CD007785.
The primary objective was to find which interventions, if any, were effective in preventing central venous catheter (CVC)-related infections in children with cancer. The secondary objective was to examine the effectiveness of each intervention in the subgroups of (a) implanted venous external catheters, (b) hematologic versus nonhematologic malignancies, and (c) in those receiving hematopoietic stem cell transplantation (HSCT) versus no HSCT.
Databases searched were the Cochrane Central Register of Controlled Trials (2008), MEDLINE (January 1950–January 2009), EMBASE (January 1980–January 2009), and CINAHL (January 1982–March 2009), as were reference lists from relevant articles and international conference proceedings (2004–2008).
Reviews examined were randomized, controlled trials and quasi-randomized, controlled trials of children (younger than 18 years) with cancer who had long-term tunneled CVCs with a CVC infection-prevention intervention other than anticoagulants, systemic antibiotics, and antibiotic lock techniques versus no intervention, placebo, or other intervention to prevent CVC-related infections.
Studies with interventions to treat other catheter-related complications were excluded.
Twenty-eight total references were retrieved.
For dichotomous outcomes, risk ratio and 95% confidence interval (CI) were used to express the estimate of effect; for continuous outcomes, weighted mean differences, standard deviation (SD), and 95% CI were used to summarize the data for each group; and for rare events, rate ratio as a summary statistic and meta-analysis of rate ratios via a generic inverse-variance approach were used.
The initial total search yielded 876 citations, 216 of which were duplicates. From this, 28 full-text articles were reviewed and three were kept for final analysis. The overall study quality was low.
Meta-analysis for the comparison of catheter flushing with urokinase (with or without heparin) versus heparin alone demonstrated an effect on the catheter-associated infection (CAI) rate with the rate ratio of CAI rate = 0.72 (95% CI [0.12, 4.41]) with use of urokinase in adults. One study reviewed reported an incidence of CAI of 2.6 per 1,000 CVC days with urokinase and 3.9 per 1,000 CVC days with heparin (p = 0.04). Studies involving different frequencies of dressing changes were difficult to analyze because adherence to every 14-day change was very low.
There were fewer CAIs with urokinase flushes, with or without heparin versus heparin alone, suggesting that urokinase use in catheter flushes may be beneficial. These findings are limited by the wide CI in findings and the fact that how CAI was defined for this systematic review was not described. No firm conclusions can be drawn from this review regarding urokinase, but the results suggest that further research in this area is warranted, although the difference between the groups was not statistically significant. There were no differences between groups who received dressing changes every 15 days versus every four days regarding the premature removal of the catheter due to infection. Catheter-related infections were not evaluated in the dressing change study, and adherence to the dressing change intervention was poor.
The results highlight need for clear and consistent outcomes definitions to further the research in this area.
Arnold, M., & Taylor, N. F. (2010). Does exercise reduce cancer-related fatigue in hospitalised oncology patients? A systematic review. Onkologie, 33, 625–630.
Databases searched were AMED, EMBASE, MEDLINE, and PubMed via the Ovid platform and CINAHL via EBSCO.
Search keywords were oncology, chemotherapy, radiotherapy, strength training, aerobic exercise, walking program, physical activity, and fatigue.
Studies were included if they reported
Studies were excluded if they reported additional diversional interventions.
Initially, 2,954 studies were retrieved. After exclusions, there was a final set of five studies. The PEDro scale was applied for evaluation of study quality.
This review showed no significant effect of aerobic exercise interventions for fatigue outcomes in hospitalized patients with cancer. As this study only included hospitalized patients, the findings may not be applicable in other patient groups.
The study was limited by the small number of included trials, with most having small sample sizes.
Effectiveness of exercise for fatigue may vary greatly depending on the phase of care and time in the cancer disease trajectory at which the intervention is provided. Lack of significant positive findings here may be related to the timing of the intervention with all patients in acute or rehabilitation hospitals.