Armes, J., Chalder, T., Addington-Hall, J., Richardson, A., & Hotopf, M. A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue. Cancer, 110, 1385–1395.
To test the effectiveness of a brief intervention using a cognitive and behaviorally oriented approach on symptoms of fatigue.
Patients were randomly assigned to the intervention or usual care control group. The intervention included three individual face-to-face, sixty-minute sessions that coincided with chemotherapy treatment schedules. These were aimed at clarifying meanings, setting goals, educating patients about cancer-related fatigue, developing and discussing coping strategies, and cognitive restructuring. Sessions were audiotaped to ensure treatment fidelity. Study assessments were performed at baseline (cycle three of chemotherapy), the end of treatment, four weeks after the end of treatment, and nine months after study entry.
Patients were undergoing the active antitumor treatment phase of care.
The study was a randomized, controlled trial.
VAS fatigue scores were significantly lower in the experimental group at Time 2, end of treatment (p = 0.03), but not at any other time point. EORTC physical functioning scores were higher in the experimental group at the end of treatment (p = 0.001) and at four weeks after treatment ended (p = 0.02). There was an overall trend over time favoring the experimental group; however, the trend was not significant and was smaller when data were controlled for medical conditions and HADS scores. No data for the nine-month time after treatment were provided.
Findings suggest that a cognitive-behavioral approach intervention can be beneficial in reducing fatigue during the short term after cancer treatment.
Findings suggest that cognitive-behavioral approach interventions to restructure thinking, set goals and coping strategies, and improve self-efficacy may be helpful in reducing fatigue immediately after chemotherapy treatment. This evidence is not strong, given the study limitations here, but the findings are potentially promising.
Akhavan-Karbassi, M.H., Yazdi, M.F., Ahadian, H., & SadrAbad, M.J. (2016). Randomized double-blind placebo-controlled trial of propolis for oral mucositis in patients receiving chemotherapy for head and neck cancer. Asian Pacific Journal of Cancer Prevention, 17, 3611–3614.
To test the effectiveness of propolis as a mouthwash to reduce chemotherapy-induced oral mucositis
Patients were randomized to receive a propolis mouth rinse (30% extract) or sterile water placebo rinse. Patients were to swish 5 ml of the rinse in the mouth for 60 seconds, gargle, and expectorate. Rinses were used three times daily for seven days.
PHASE OF CARE: Active antitumor treatment
Double-blind, randomized, controlled trial
World Health Organization (WHO) mucositis grading
By day seven, erythema, wounding, and general mucositis grades were lower in the propolis group (p < 0.006). Mucositis grades were lower in the propolis group.
The findings suggest that propolis mouth rinses may be helpful to manage oral mucositis in patients with head and neck cancer receiving chemotherapy and radiation therapy. Well designed research is needed to confirm these findings.
This study report has multiple flaws and provided only weak evidence of the potential effectiveness of propolis for the reduction of oral mucositis. Well designed research is needed to further evaluate the potential effects of this intervention.
Aridome, K., Mori, S. I., Baba, K., Yanagi, M., Hamanoue, M., Miyazono, F., . . . Natsugoe, S. (2016). A phase II, randomized study of aprepitant in the prevention of chemotherapy-induced nausea and vomiting associated with moderately emetogenic chemotherapies in colorectal cancer patients. Molecular and Clinical Oncology, 4, 393–398.
To study the efficacy of aprepitant in the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately emetogenic chemotherapy (MEC) for colorectal cancer
Patients with advanced or recurrent colorectal cancer were treated with standard MEC regimens including FOLFOX, XELOX, OR FOLFIRI and received either standard antiemetic therapy with 5-HT3 receptor antagonist (RA) plus dexamethasone or aprepitant regimen including 5-HT3 RA plus reduced-dose dexamethasone plus aprepitant. Patients were followed from the initiation of chemotherapy through day 5 using patient diaries to record emetic episodes, nausea, or rescue antiemetics in 24-hour intervals.
PHASE OF CARE: Active antitumor treatment
Multicenter, phase II, open-label, randomized, parallel, comparative study
The outcomes in both groups were analyzed using chi-squared tests for primary end points, secondary end points, and patients characteristics by treatment group. Two-sided sample t tests were used when appropriate. P < 0.05 was considered to be a statistically significant difference.
The percentage of patients with complete response in the overall phase was 79.6% in the standard group versus 79.7% in the aprepitant group. The acute phase was 94.9% complete response in both groups, and the delayed phase was 79.6% versus 79.7%. The overall incidence of adverse events were similar in both groups.
No significant differences existed between the standard treatment and aprepitant regimen in terms of complete suppression of vomiting, nausea, and time to treatment failure. This study demonstrates that aprepitant in combination with a 5-HT3 RA and reduced dose of dexamethasone is well tolerated and effective for preventing CINV associated with MEC in patients with colorectal cancer.
The addition of aprepitant to standard antiemetic therapy for MEC in patients with colorectal cancer is well tolerated and effective for control of CINV, but the lack of significant difference suggests that the added cost of an additional medication is not warranted.
Argyriou, A.A., Chroni, E., Koutras, A., Ellul, J., Papapetropoulos, S., Katsoulas, G., . . . Kalofonos, H.P. (2005). Vitamin E for prophylaxis against chemotherapy-induced neuropathy: A randomized controlled trial. Neurology, 64, 26–31.
Patients were enrolled to test vitamin E as prophylaxis against chemotherapy-induced peripheral neuropathy.
Patients were randomly divided into groups assigned to receive chemotherapy treatment with (group I) or without vitamin E supplementation (group II). Group II served as control. Patients assigned to group I received alpha-tocopherol (i.e., vitamin E) orally at a dose of 300 mg per day twice daily during chemotherapy and as long as three months after chemotherapy was completed.
The study had a pilot, randomized, controlled, open label with blind assessment design.
The clinical evaluation of neuropathy was based on a modified Neurologic Symptom Score (NSS) and Neurologic Disability Score (NDS). NSS selected symptoms such as weakness, numbness, or pain, scoring as present (1) or absent (0). Clinical signs (i.e., cranial nerves function; joint position, pin prick, and vibration sensation; muscle strength and deep tendon reflexes) were assessed using a modified version of NDS ranging from 0 (no deficit) to 4 (absence of function/severest deficit). Electrophysiologic examination included motor conduction of ulnar and peroneal nerves. Measures were taken at baseline and repeated after the third and sixth cycles as well as three months after cessation by the same neurologist.
Vitamin E supplementation significantly decreased the incidence of neurotoxicity, with 25% of patients receiving Vitamin E experiencing chemotherapy-induced peripheral neuropathy compared to 73.3% in the control group.
This pilot study with a small sample size and many variables assessed make achieving a statistically significant result by chance alone more likely.
Small sample size
Arcidiacono, P.G., Calori, G., Carrara, S., McNicol, E.D., & Testoni, P. A. (2011). Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database of Systematic Reviews (Online), 3, CD007519.
To assess the efficacy and safety of celiac plexus neurolysis in reducing pancreatic cancer pain; to identify adverse effects and differences associated with various techniques of celiac plexus neurolysis
The initial search retrieved 102 studies. Investigators reviewed the studies in terms of risk of bias. Investigators performed a meta-analysis on studies that they selected to include.
Celiac plexus block appears to be a safe and effective means of reducing bone pain associated with pancreatic cancer. Results show that celiac plexus block has a slight but statistically significant advantage over usual analgesic treatment. Investigators noted that the studies included in the analysis had some identified risk of bias. Three of the studies were blinded; three were not. The studies Arcidiacono et al. reviewed were the same studies that Yan and Myers reviewed in 2007.
Data are insufficient to allow researchers to evaluate the differences between CT-guided and posterior percutaneous celiac plexus block techniques.
Nurses should be aware of celiac plexus block as a means of pain management in patients with cancer of the pancreas. Nurses should advocate for the patient and inform him or her of potential treatment options. Findings of this meta-analysis are based on follow-up at four weeks, and results showed significant heterogeneity at eight weeks. This suggests that efficacy may not be sustainable over the long term. Further research, including long-term follow-up, is needed.
Archie, P., Bruera, E., & Cohen, L. (2013). Music-based interventions in palliative cancer care: A review of quantitative studies and neurobiological literature. Supportive Care in Cancer, 21, 2609–2624.
STUDY PURPOSE: To review the evidence for efficacy of music interventions for patients with cancer receiving palliative care and review the neurobiological evidence to explain pathways by which music may have an effect
TYPE OF STUDY: Systematic review
DATABASES USED: PubMed, CINAHL, Plus, Ovid, PsycINFO, PoQuest, and the Cochrane Library
KEYWORDS: music; music therapy; cancer; oncology; palliative care; pain; anxiety; depression; mood; quality of life; neuroscience; endogenous opioids; dopamine; GABA; 5HT; permutations
INCLUSION CRITERIA: RCT; meta-analysis or systematic review from 1970–2012
EXCLUSION CRITERIA: Not reported
TOTAL REFERENCES RETRIEVED: Not reported
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not reported
In the acute pain setting, music had a moderate analgesic effect with SMD of -.059, 95% CI -0.90, -0.27 (p = .0003). Effect for chronic pain is not known and has not been well studied. The study cites results of a Cochrane review of effects of music on anxiety (SMD -11.2, p = .0088). It is noted that effect on anxiety only has been studied in the acute, situational setting. Longer-term effects and application in palliative care are unknown. Review of neurobiologic evidence suggests that music may affect specific pathways that are implicated in the pathophysiology of pain, anxiety, and depression.
Music interventions have a moderate positive effect on procedural pain and acute, situational anxiety.
Music may be helpful to reduce acute anxiety and procedure-related pain. This is a simple intervention nurses could use in a variety of settings. Longer-term effects and effects in different situations are not known.
Archer, S., Buxton, S., & Sheffield, D. (2015). The effect of creative psychological interventions on psychological outcomes for adult cancer patients: A systematic review of randomised controlled trials. Psycho-Oncology, 24, 1–10. doi:10.1002/pon.3607
Depression and anxiety were shown to improve in three of the studies although the interventions were different (music therapy, art therapy, and mindfulness-based art therapy). Other psychological factors also improved: lower ratings of somatic symptoms in an art therapy study and a creative arts study, and psychiatric symptom improvement. Improvements in various measures of quality of life were reported in studies of mindfulness-based art therapy, art therapy, music therapy, creative arts therapy, and dance/movement therapies. Art therapy showed improvements in coping resources and mood states. Music therapy showed improvements in stress and anger. Creative arts therapy showed improvements in specific aspects of the Profile of Mood States (POMS) that were reported: tension-anxiety, depression-dejection, anger-hostility, and confusion-bewilderment.
Evidence reviewed in this study is inconclusive regarding effectiveness of various creative interventions.
The therapies were implemented by qualified therapists and were varied in nature, although not exhaustive of available therapies. The value of music, art, and movement therapies are shown to effectively reduce symptoms of anxiety and depression and improve quality of life, coping, and mood. Suggestions for further research are offered.
Arch, J.J., & Mitchell, J.L. (2016). An Acceptance and Commitment Therapy (ACT) group intervention for cancer survivors experiencing anxiety at re-entry. Psycho-Oncology, 25, 610–615.
To test the hypothesis that an Acceptance and Commitment Therapy (ACT) group intervention would reduce anxiety and increase positive outcomes among cancer survivors at the re-entry phase
Groups were facilitated by a trained clinical psychologist and oncology social worker and provided in seven weekly two-hour sessions. Participants were assisted in cultivating awareness and acceptance of thoughts and emotions about cancer, disentangling from rigid thoughts and beliefs, clarifying personal values, and committing to pursue activities aligned with those values through experiential exercises, metaphors, discussion, and homework. Study outcomes were measured at 3.5, 2, and 0.5 weeks baseline prior to the intervention, midintervention, one week following the last session, and three months after the last session.
PHASE OF CARE: Transition phase after active treatment
Quasiexperimental
Anxiety declined following the intervention at immediate postmeasurement (p < 0.001) and three-month follow-up (p < 0.001). Depression symptoms also declined after the intervention (p < 0.001) and at three-month follow-up (p < 0.001). Fear of cancer recurrence decreased (p < 0.05) and at follow-up (p = 0.001).
The findings suggest that the group ACT intervention can help reduce anxiety and depression at healthcare re-entry among cancer survivors.
The group psychotherapy approach used here may be helpful to patients who are suffering from anxiety and/or depression after completion of initial treatment for cancer. Further research is needed.
Arbabi-Kalati, F., Arbabi-Kalati, F., & Moridi, T. (2013). Evaluation of the effect of low level laser on prevention of chemotherapy-induced mucositis. Acta Medica Iranica, 51, 157–162.
To evaluate the efficacy of low-level laser therapy for prevention of chemotherapy-induced mucositis and xerostomia
Patients were randomized to receive the laser or sham procedure. The laser group had laser therapy prior to each episode of chemotherapy with a 630-nm laser with a dose of 5 J/cm2. Patients in the sham control group underwent procedures with the laser unit turned off. All patients received the same instruction for ongoing oral care and underwent mucous and salivary health assessment by an oral medicine specialist prior to beginning chemotherapy, after two weeks, and then every two weeks until the end of chemotherapy treatment. Severity of pain, mucositis, and xerostomia was assessed at these times, and observers were blinded to patients’ study group assignments. Data were collected for 14 weeks.
This was a single-site, outpatient study conducted in Iran.
Patients were undergoing the active antitumor treatment phase of care.
This was a randomized, double-blind, sham-controlled study.
In the laser group, over the course of the study, 8.3% of patients experienced grade 2 mucositis and none experienced a higher grade of mucositis, compared to 91.6% of patients in the control group who developed grade 2 or higher mucositis (p = 0.001). By week two, xerostomia intensity was significantly lower in the laser group than the control group (p < 0.005). Across all time points, pain intensity in the laser group was significantly lower (p = 0.001). Difference in pain was substantial, with a mean of 0.7 in the laser group compared to 6.8 in the control group at week 2. The magnitude of these differences in pain intensity was large at all study assessment times.
Findings showed that provision of low-level laser treatment was effective in preventing chemotherapy-induced mucositis, xerostomia, and associated pain.
The results here support the effectiveness of low-level laser treatment for prevention of chemotherapy-induced mucositis. The actual number of laser treatments given was not clear. One of the difficulties in evaluating laser evidence for prevention of mucositis is the different treatment schedules and doses used in the research. Further research to identify the most effective laser dosages and schedules would be helpful to facilitate clinical translation of this evidence.
Arakawa, S. (1997). Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nursing, 20, 342-349.
To evaluate the use of progressive muscle relaxation training in the management of nausea, vomiting, and anxiety induced by chemotherapy
The experimental group received training that consisted of tensing and releasing 16 muscle groups and breathing deeply for a total of 25 minutes. Each subject was provided with an audiotape and instructed to practice independently twice daily before meals or two hours afterward. The investigator met with the control group for 15 minutes per day to discuss concerns.
This study was conducted at a 415-bed, hospital-based cancer center in Japan.
The study was a randomized pretest, post-test control group design with repeated measures.
The Rhodes Index of Nausea and Vomiting-Form 2 (Japanese version) and the Spielberger State-Trait Anxiety Inventory were used. Reliability and validity were described in depth.
Progressive muscle relaxation may contribute to a reduction in delayed nausea and vomiting. This study did confirm the usefulness of progressive muscle relaxation in decreasing the incidence of vomiting. Progressive muscle relaxation decreased subjective feelings of anxiety.