Doro, C.A., Neto, J.Z., Cunha, R., & Doro, M.P. (2017). Music therapy improves the mood of patients undergoing hematopoietic stem cells transplantation (controlled randomized study). Supportive Care in Cancer, 25, 1013–1018.
To examine the effect of music on patients undergoing HCT with the purpose of reducing social confinement in this group of patients
Patients were assigned to music and control groups by a throw of dice. Live music sessions with a therapist were done in the patient’s room twice weekly for 30 minutes each. Study assessments were done at the end of music therapy sessions.
PHASE OF CARE: Active anti-tumor treatment
RCT
Visual analog scale (VAS) for pain and anxiety
Anxiety was lower in the music group after the first (p < 0.001) and last sessions (p = 0.002). Pain was lower after the first music session in the music group but, at study completion, there was no difference between groups in pain.
Music may help to alleviate anxiety associated with social isolation in patients undergoing HCT.
This study showed that music therapy may be helpful for patients undergoing HCT in terms of anxiety. This study has multiple design limitations. Music therapy is a low-risk intervention; however, it does require staff time of a music therapist. Further research regarding benefit of live music therapy versus listening to music would be helpful.
Boyd, C., Crawford, C., Paat, C.F., Price, A., Xenakis, L., Zhang, W., & Evidence for Massage Therapy (EMT) Working Group. (2016). The impact of massage therapy on function in pain populations—A systematic review and meta-analysis of randomized controlled trials: Part II, cancer pain populations. Pain Medicine, 17, 1553-1568.
STUDY PURPOSE: To assess the evidence of efficacy of massage in treating pain and function and quality-of-life issues in cancer populations
TYPE OF STUDY: Meta analysis and systematic review
DATABASES USED: PubMed CINAHL, Embase, PsycINFO
INCLUSION CRITERIA: Patients with pain, massage therapy, if provided as part of multimodal interventions, effects could be separately evaluated, RCT,
EXCLUSION CRITERIA: Interventions provided by tools, such as chair massage
TOTAL REFERENCES RETRIEVED: 4,099
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Scottish Intercollegiate Guidelines Network checklist for study quality, and the External Validity Assessment Tool to measure generalizability of results. Standards for reporting interventions for clinical trials of acupuncture (STRICTA) were adapted for application to studies using massage, and applied for study evaluation. Most studies were determined to be acceptable–four were deemed low quality. Only 18.8% of studies described the amount of time massaging a location.
FINAL NUMBER STUDIES INCLUDED: 16, with 12 in meta analysis
PHASE OF CARE: Not specified or not applicable
APPLICATIONS: Palliative care
Massage versus no treatment: three studies (167 patients) compared massage to no treatment for pain severity, Although the SMD overall was significant, heterogeneity was high. No recommendation could be made regarding massage versus no treatment.
Massage versus active comparator: 10 studies (708 patients) compared massage to various attention control comparisons or usual care. Six of these were pooled for analysis, and showed reduction in pain intensity, but this was not statistically significant.
Massage versus active comparators for fatigue: six studies (539 patients) yielded an SMD of -1.06, but this was not statistically significant, and there was high heterogeneity.
This analysis showed favorable effects of massage for fatigue and pain intensity; however, overall results were not statistically significant.
Massage is a low-risk intervention that might be helpful for some people in dealing with pain and fatigue. This analysis provided only weak evidence in favor of this intervention
Abdelsattar, J.M., Boughey, J.C., Fahy, A.S., Jakub, J.W., Farley, D.R., Hieken, T.J., . . . Saint-Cyr, M. (2016). Comparative study of liposomal bupivacaine versus paravertebral block for pain control following mastectomy with immediate tissue expander reconstruction. Annals of Surgical Oncology, 23, 465–470.
To compare the effects of local infiltration of bupivacaine with nerve block for pain control with mastectomy
Electronic health records of all patients who had mastectomy with immediate tissue expander reconstruction were used for data collection. Pain scores from the recovery room and surgical units were obtained and average pain scores for postoperative days 1-2 were used in analysis. All opioids used intraoperatively and postoperatively were converted to oral morphine equivalents.
PHASE OF CARE: Active anti-tumor treatment
Retrospective cohort analysis
Opioid use in the recovery room was significantly lower in those who had local bupavacaine injection (p < 0.001). Day of surgery pain scores were lower with bupavacain (p = 0.008). Fewer patient in the bupavaine group required antiemetics (p = 0.03) and waited longer for the first dose of opioid after surgery (p = 0.006). Daily average pain was lower with bupivacaine (p = 0.05), and total opioid consumption was slightly lower.
Local infusion of bupivacaine appeared to be more effective that paravertebral block for postoperative pain control in this group of patients.
Nurses can advocate for consideration of local anesthetic infiltration for pain control in patients undergoing mastectomy.
Mercadante, S., Klepstad, P., Kurita, G.P., Sjøgren, P., Pigni, A., & Caraceni, A. (2016). Minimally invasive procedures for the management of vertebral bone pain due to cancer: The EAPC recommendations. Acta Oncologica, 55, 129–133.
STUDY PURPOSE: To review the evidence that supports the performance of percutaneous procedures in adult patients with cancer with vertebral pain for updating the European Association for Palliative Care recommendations for cancer pain management.
TYPE OF STUDY: Systematic review
DATABASES USED: Medline, Embase and Cochrane Central Register of Controlled Trials electronic databases
INCLUSION CRITERIA: Studies in which the interventional studies were compared with analgesic drugs, or sham procedure, adult patients with cancer pain, pain as an outcome, and written in English.
EXCLUSION CRITERIA: Retrospective data, data from mixed cancer and non-cancer populations, proceeding abstracts, double publications.
TOTAL REFERENCES RETRIEVED: 754
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Quality scoring system ranged from +4 or A to +1 or D or +4 or A = high quality, +3 or B = moderate, +2 or C = low, +1 or D = very low. Study quality, consistency, directness, and imprecise or sparse data were considered while grading the studies.
FINAL NUMBER STUDIES INCLUDED: Nine studies were fully examined and the final review included five studies
TOTAL PATIENTS INCLUDED IN REVIEW: 485
SAMPLE RANGE ACROSS STUDIES: Three studies with 100-134 patients, two studies with 50-65 patients
KEY SAMPLE CHARACTERISTICS: Adult patients with cancer with tumor metastases, most of the studies included patients with myeloma with mets to vertebra; techniques used in patients: kiphoplasty, vertebroplasty. Studies with radiofrequency ablation, cryoablation procedures did not meet the inclusion criteria.
PHASE OF CARE: End-of-life care
APPLICATIONS: Palliative care
Kyphoplasty: Two studies reviewed. One study showed efficacy in treating osteolytic vertebral compression fracture, but it had a low sample size (< 100) and pain outcomes were not clearly presented. The other study (RCT with 134 patients) was very low quality. Vertebroplasty: One study showed 86% good efficacy. Other two studies showed reduced pain intensity and improved disability. One study showed reduced analgesic requirement. These studies were observational in nature; therefore, the results should be considered with caution.
Although the authors recommended kiphoplasty in patients with vertebral tumors and metastases, the quality of study designs are very low and some studies showed the procedure resulting in adverse effects or complications. More RCTs are needed to improve the strength of these findings.
As findings are not strong enough and given the considerable number of complications, the decision for recommending these procedures should be made by the physician on a individual basis.
Bruel, B.M., & Burton, A.W. (2016). Intrathecal therapy for cancer-related pain. Pain Medicine, 17, 2404–2421.
STUDY PURPOSE: Summarize the evidence regarding use of intrathecal therapy for management of cancer-related pain.
TYPE OF STUDY: Systematic review
DATABASES USED: MEDLINE
INCLUSION CRITERIA: Use of intrathecal approach for pain management
EXCLUSION CRITERIA: Not stated
TOTAL REFERENCES RETRIEVED: 231
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: 2 RCTs and 8 observational studies were included. Method for quality evaluation not reported
FINAL NUMBER STUDIES INCLUDED: 10
TOTAL PATIENTS INCLUDED IN REVIEW: 807
SAMPLE RANGE ACROSS STUDIES: 22 to 200
KEY SAMPLE CHARACTERISTICS: All had refractory pain
Duration of follow-up ranged from 11 days to up to 16 months. Comparison of those treated with conventional medical management versus implanted intrathecal drug delivery showed significantly reduced pain scores among implanted patients (p = 0.007) across all studies. Both morphine and zicontide demonstrated efficacy.
Intrathecal pain management is shown to be effective in patients with refractory cancer-related pain.
Intrathecal delivery of pain medication is shown to be effective in patients with refractory pain. The decision to implant an intrathecal drug delivery device needs to be based on weighing benefits for pain control against risks from surgery, drug management issues, and against other palliative care options
Beuth, J., Schneider, B., Van Leendert, R., & Uhlenbruck, G. (2016). Large-scale survey of the impact of complementary medicine on side-effects of adjuvant hormone therapy in patients with breast cancer. In Vivo, 30, 73-75.
Assess effects of complementary treatment with a combination of sodium selenite, proteolytic plan enzymes, and Len culinaris lectin on side effects of hormone therapy
Women with breast cancer undergoing adjuvant hormone therapy were included in the analysis. Complementary treatments were used for four weeks.
PHASE OF CARE: Active anti-tumor treatment
Retrospective observational
Symptom severity scored from 1 (no side effects) to 6 (extreme side effects)
After four weeks of treatment, mean score for arthralgia went from 4.83 to 3.23 (p < 0.001). Women also experienced less mucosal dryness (p < 0.001). There were no severe adverse effects reported.
Findings suggest that the complementary intervention assessed here may be beneficial in reducing symptoms of arthralgia induced by adjuvant hormonal therapy in women with breast cancer without significant side effects.
This study has several design limitations, but does suggest that the complementary therapy with sodium selenite, proteolytic enzymes, and L culinaris might be helpful in reducing some side effects of adjuvant hormonal therapy.
Ba, Y.F., Li, X.D., Zhang, X., Ning, Z.H., Zhang, H., Liu, Y.N., . . . Li, Y. (2015). Comparison of the analgesic effects of cryoanalgesia vs. parecoxib for lung cancer patients after lobectomy. Surgery Today, 45, 1250–1254.
To compare analgesic effects of cryoanalgesia and parecoxib for patients undergoing lobectomy for lung cancer
Patients undergoing open thoracotomy either received cryoanalgesia or parecoxib. Cryoanalgesia was performed on four intercostal nerves. The cryoprobe was placed on each nerve and application was done to induce a temperature of -55 to -65 degrees centigrade. For the other group, 40 mg of parecoxib was given IV push. Postoperative pain and respiratory function was assessed and recorded for seven days.
PHASE OF CARE: Active anti-tumor treatment
Observational
Visual analog scale for pain
During the first week, pain scores of those who received cryoanalgesia were significantly lower than those who received parecoxib (p < 0.05). One month after surgery, those who had cryoanalgesia felt no apparent pain, while the other group had persistent incisional and abdominal pain (p < 0.05). There was no difference between groups 6 months after surgery. Patients in the cryoanalgesia arm used less morphine postoperatively (p < 0.05)
Cryoanalgesia may be an effective approach for short-term postoperative patient management.
Cryoanalgesia appears in this study to have beneficial effects for postoperative pain management for patients undergoing lobectomy for lung cancer. Further research is warranted to evaluate effects of cryoanalgesia in comparison to other known effective approaches.
Tateo, S. (2017). State of the evidence: Cannabinoids and cancer pain--A systematic review. Journal of the American Association of Nurse Practitioners, 29, 94–103.
STUDY PURPOSE: Determine the current state of the science regarding use of cannabinoids for cancer pain
TYPE OF STUDY: Systematic review
DATABASES USED: CINAHL, BIOSIS, PUBMED, Cochrane collaboration
INCLUSION CRITERIA: RCT examining effects of cannabis or cannabinoids on cancer pain
EXCLUSION CRITERIA: Non-cancer pain, non-RCTs
TOTAL REFERENCES RETRIEVED: 81
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale used to evaluate study quality. Six studies used a crossover design and two were parallel group design. All were deemed to be of low to moderate quality
FINAL NUMBER STUDIES INCLUDED: 8
TOTAL PATIENTS INCLUDED IN REVIEW: 683
SAMPLE RANGE ACROSS STUDIES: 10 to 360
KEY SAMPLE CHARACTERISTICS: All patients had moderate to severe pain
PHASE OF CARE: Not specified or not applicable
APPLICATIONS: Palliative care
Studies examined oral THC, nabiximols, oral synthetic analog of THC, and oral benzypranoperidine. The majority of studies showed analgesic effects when compared to placebo and strongest evidence was seen for nabiximols.
Cannabinoids appear to be useful adjuncts for cancer pain not completely relieved by opioids, but there is a lack of high-quality evidence.
Cannabinoids may be useful adjuncts to analgesics for cancer-related pain management. However, the evidence reviewed here was mainly of low to moderate quality. Further well-designed research is warranted.
Cote, M., Trudel, M., Wang, C., & Fortin, A. (2016). Improving quality of life with nabilone during radiotherapy treatments for head and neck cancers: A randomized double-blind placebo-controlled trial. Annals of Otology, Rhinology, and Laryngology, 125, 317–324.
To compare effects of nabilone versus placebo on quality of life and symptoms
Patients were randomized to receive placebo or nabilone 0.5 mg at bedtime during the first week, and increased as needed to a maximum of 1 mg twice daily. Concomitant use of other analgesics was permitted.
PHASE OF CARE: Active anti-tumor treatment
Placebo-controlled RCT
There were no significant differences between groups in pain or quality of life. There were no differences between groups in use of other analgesics.
No benefit of nabilone was found in this study.
Small sample (< 100)
Nabilone was not found to be of benefit for patients with head and neck cancer during radiation therapy in this study.
Porta-Sales, J., Garzón-Rodríguez, C., Llorens-Torromé, S., Brunelli, C., Pigni, A., & Caraceni, A. (2017). Evidence on the analgesic role of bisphosphonates and denosumab in the treatment of pain due to bone metastases: A systematic review within the European Association for Palliative Care guidelines project. Palliative Medicine, 31, 5–25.
STUDY PURPOSE: To critically appraise and synthesize evidence regarding the safety and effectiveness of bisphosphonates and denosumab for controlling pain from bone metastasis
TYPE OF STUDY: Systematic review
DATABASES USED: MEDLINE, EMBASE, Cochrane Collaboration, through January 2014
INCLUSION CRITERIA: RCT or meta analysis design, adult patients reported efficacy of pain reduction and/or side effects.
EXCLUSION CRITERIA: Abstracts, studies dealing only with prevention of skeletal-related events, economic or quality of life impact.
TOTAL REFERENCES RETRIEVED: 1,585
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: GRADE system used for study evaluation. Overall quality of evidence was rated as very low.
FINAL NUMBER STUDIES INCLUDED: 43
TOTAL PATIENTS INCLUDED IN REVIEW: 15,064
SAMPLE RANGE ACROSS STUDIES: 9 to 5,544
KEY SAMPLE CHARACTERISTICS: Patients with bone metastases
PHASE OF CARE: Late effects and survivorship
APPLICATIONS: Palliative care
Medications included clodronate, etidronate, pamidronate, ibandronate, zoledronic acid, and denosumab. Some of these had very few studies, and results comparing effectiveness of one over another for pain relief showed mixed findings. The authors concluded that evidence of any of these for direct pain relief is weak, mainly due to methodologic concerns.
Direct evidence for effectiveness of bone-modifying agents for relief of pain is weak; however, evidence suggests that these medications may help prevent pain by delaying onset of bone pain.
Findings suggest that bisphosphonates and denosumab may benefit patients by delaying onset of bone pain, and that overall these medications are safe. Findings also suggest that this is probably most beneficial in patients with a relatively long life expectancy (months to years). Benefits may not be gained for patients with life expectancy of only weeks to months given the mechanism by which bone pain is affected.