Tausch, C., Baege, A., Dietrich, D., Vergin, I., Heuer, H., Heusler, R.H., & Rageth, C. (2013). Can axillary reverse mapping avoid lymphedema in node positive breast cancer patients? European Journal of Surgical Oncology, 39, 880–886.
To report the experience with a new technique, axillary reverse mapping (ARM), in patients scheduled for axillary lymph node dissection (ALND) and to evaluate its usefulness for reducing the incidence of lymphedema
For the intervention group, blue dye was injected subcutaneously along the intermuscular groove of the upper inner arm; radioisotope was injected subcutaneously in the interdigital webspace of the hand. All blue and radioactive lymph vessels and lymph nodes were recorded. Only unsuspicious ARM lymph nodes located in the lateral part of the axillary basin were preserved. All other level I and II axillary lymph nodes were removed. One follow-up was conducted at a median of 19 months.
ARM was performed in 143 patients subsequently undergoing ALND. ARM lymph nodes were successfully identified in 112 patients (78%). In 55 patients, at least one ARM lymph node had to be removed. In 14 of these, tumor involvement was confirmed. In 71 patients, one or more ARM nodes were preserved. During a median follow-up time of 19 months, no axillary recurrence was noted. Thirty-five of 114 evaluated patients developed lymphedema. Preservation of ARM lymph nodes did not significantly decrease the incidence of lymphedema
ARM is feasible for patients with node-positive breast cancer. However, the study found no evidence that it reduces the incidence of lymphedema.
Larger studies with rigorous design are needed to evaluate whether preservation of clinically unsuspicious ARM nodes is oncologically safe and effective in preventing secondary lymphedema in patients with breast cancer.
Tatsushima, Y., Egashira, N., Narishige, Y., Fukui, S., Kawashiri, T., Yamauchi, Y., & Oishi, R. (2013). Calcium channel blockers reduce oxaliplatin-induced acute neuropathy: A retrospective study of 69 male patients receiving modified FOLFOX6 therapy. Biomedicine & Pharmacotherapy, 67, 39-42.
Determine whether treatment with calcium channel blockers prevented oxaliplatin-induced acute neuropathy
Retrospective chart review was conducted to obtain data, and analysis was performed to determine differences in neuropathy symptoms between patients who were and were not on calcium channel blockers.
PHASE OF CARE: Active antitumor treatment
Two-group, retrospective, cross-sectional
The incidence of acute neurotoxicity was lower in the calcium channel group; however, no differences existed related to chronic neuropathy.
Patients receiving calcium channel blockers may experience less acute neurotoxicity than those not receiving calcium channel blockers, but more well-designed studies are needed before any conclusions can be made.
More studies are needed before any clinical implications can be made.
Tatrow, K., & Montgomery, G.H. (2006). Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis. Journal of Behavioral Medicine, 29(1), 17–27.
To determine effectiveness of cognitive behavioral therapy (CBT) techniques in alleviating distress and pain in patients with breast cancer
The search retrieved 61 studies. Investigators eliminated some on the basis of the exclusion criterion; meta-analysis involved 20 studies. Authors defined CBT very broadly: Interventions included relaxation; guided imagery; hypnosis; biofeedback; and approaches combining cognitive restructuring, skill trainingt, and other strategies to enhance problem solving and coping. Authors do not describe the specific procedure used to evaluate study quality.
Authors noted that 69% of patients in treatment groups did better than controls with respect to pain. Regarding pain, effect size (d) was 0.49 (95% CI 0.09–0.90, p < 0.05). Subgroup analysis comparing individual versus group interventions showed that intervention format had no effect on pain.
Findings suggest that CBT techniques produced a small to medium effect, as defined by the study, regarding the reduction of the pain of women with breast cancer.
Findings suggest that, for women with breast cancer, CBT may be a helpful adjunct to pain management. This finding is limited by the broad definition of CBT that this study employed. This study determined effect size on the basis of statistics. Future studies should define the type of change that is meaningful to patients—that is, change in symptoms.
Tassinari, D., Sartori, S., Tamburini, E., Scarpi, E., Raffaeli, W., Tombesi, P., & Maltoni, M. (2008). Adverse effects of transdermal opiates treating moderate–severe cancer pain in comparison to long-acting morphine: A meta-analysis and systematic review of the literature. Journal of Palliative Medicine, 11(3), 492–501.
To compare the safety profiles, adverse effects, and patients' preferences regarding slow-release oral morphine and transdermal opiates
Compared to slow-release oral morphine, transdermal opiates were associated with fewer cases of constipation. Patients tended to prefer transdermal opiates to slow-release formulations.
Compared to slow-release oral morphine, transdermal opiates appear to be associated with fewer cases of constipation; transdermal opiates may be a better alternative for pain control in patients with constipation. This review suggests that patients may prefer pain medication via the transdermal route. Clinicians should consider constipation and preference in individualizing pain management.
Tassinari, D., Sartori, S., Tamburini, E., Scarpi, E., Tombesi, P., Santelmo, C., & Maltoni, M. (2009). Transdermal fentanyl as a front-line approach to moderate-severe pain: A meta-analysis of randomized clinical trials. Journal of Palliative Care, 25, 172–180.
To compare transdermal fentanyl to slow-release oral morphine—in terms of safety, efficacy, and patient compliance—in patients who have stable opiate requirements for pain control
Of the 117 trials retrieved, 11 were considered potentially eligible. The analysis included five trials. Three trials included patients with cancer, and two included patients without cancer. The quality of the reports was evaluated using the Jadad scale.
Side-effect profiles of transdermal fentanyl and oral slow-release morphine differ, but in this analysis authors observed no significant differences in overall side effects and patient preference regarding the two approaches. Transdermal fentanyl appears to be a valid alternative to oral opiates.
Findings should be interpreted with caution, given the limitations of this meta-analysis. Additional research comparing transdermal and other medication delivery routes for pain control is warranted. Transdermal opiates may be particularly useful for patients using opiate switching. Addressing individual patients' needs and concerns may mean that side-effect profiles play an important role in the selection of a medication delivery route.
Taspinar, A., & Sirin, A. (2010). Effect of acupressure on chemotherapy-induced nausea and vomiting in gynecologic cancer patients in Turkey. European Journal of Oncology Nursing, 14, 49–54.
To evaluate the effect of a wristband acupressure for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancers
Patients completed diaries daily for five days while they were receiving chemotherapy. Based on their treatment protocol, patients received a wristband 21 to 28 days later, along with written and verbal instructions and demonstration on its use. Patients were instructed to wear the wristbands constantly and to complete the patient diaries for the five days while receiving chemotherapy. On the sixth day, patients completed questionnaires about the wristbands. All patients received standard antiemetics and recorded medication use in their diaries.
The study was conducted at multiple outpatient sites in Turkey.
All patients were in active treatment.
This was a prospective clinical trial with a pre/post-test design.
Acupressure wristbands worn by patients with gynecologic cancers during chemotherapy administration were associated with a significant reduction in nausea but not vomiting or retching. Less antiemetic medication was used with the acupressure wristband.
Acupressure wristbands may provide some relief of nausea during chemotherapy treatment; however, they do not appear to provide relief from retching or vomiting.
Taso, C.J., Lin, H.S., Lin, W.L., Chen, S.M., Huang, W.T., & Chen, S.W. (2014). The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: A randomized controlled trial. The Journal of Nursing Research, 22, 155–164.
To examine the effectiveness of an eight-week yoga program on depression, anxiety, and fatigue in women undergoing adjuvant chemotherapy for breast cancer
Patients were randomized to yoga and control groups. Control group patients received usual care and maintained ordinary daily activity routines. The yoga group had 60-minute sessions including meditation and breathing exercise, yoga exercises, and a cool-down. The program was provided twice per week over eight weeks. Study measures were obtained at baseline, at week 4, at week 8, and at four weeks after the conclusion of the intervention. It is not clear if yoga sessions were provided in a group setting or what the timing was related to chemotherapy treatments.
Randomized, controlled trial
Fatigue level and its influence on daily life were lower in the experimental group after eight weeks, which was maintained at three weeks postintervention (p < .001). In the control group, the fatigue level increased after eight weeks (p < .001). In the control group, the influence of fatigue on daily life initially declined but increased from baseline after eight weeks. In those participants with higher baseline fatigue levels, in the first four weeks, benefits were fewer in the experimental group. There were no differences between groups in anxiety or depression. Participation in the yoga sessions was 90% overall.
Yoga participation was associated with improvement in fatigue and the influence of fatigue on daily activities after four weeks. Yoga had no effect on measures of anxiety or depression.
Yoga can be beneficial for patients to reduce fatigue during active treatment as shown in this study. Findings that those with higher fatigue scores did not show fatigue reduction until after four weeks suggest that patients with greater fatigue may need a longer program than others to derive full benefits. There was no apparent effect of participation in yoga sessions on anxiety or depression.
Tasmacioglu, B., Aydinli, I., Keskinbora, K., Pekel, A.F., Salihoglu, T., & Sonsuz, A. (2009). Effect of intravenous administration of paracetamol on morphine consumption in cancer pain control. Supportive Care in Cancer, 17, 1475–1481.
To examine the effectiveness of IV administration of paracetamol on the control of cancer pain and its possible contribution as reduction of opioid consumption
Patients were randomized to receive IV administration of saline (control) or 1 g of paracetamol on top of morphine.
The study was double-blind, placebo-controlled, and randomized.
Both treatments resulted in improved VAS and PRI scores compared to baseline. However, groups did not differ in terms of VAS and PRI scores, morphine consumption, side-effect frequencies, laboratory values, ECOG stats, and patient satisfaction. The study failed to confirm any benefits of add-on treatment with IV administration of paracetamol.
There was no benefit derived from adding IV paracetamol to morphine in an effort to enhance the effectiveness or contribute to reduction in opioid consumptions.
The study had a small sample.
This study further supports the growing body of evidence that adding paracetamol to an opioid does not necessarily improve pain control or minimize the need for opioid. Pain management needs to be individualized. Further study in this area is warranted.
Tas, D., Uncu, D., Sendur, M.A., Koca, N., & Zengin, N. (2014). Acupuncture as a complementary treatment for cancer patients receiving chemotherapy. Asian Pacific Journal of Cancer Prevention, 15, 3139–3144.
To investigate the effects of acupuncture on nausea, vomiting, pain, sleep quality, and anxiety in patients who were hospitalized or undergoing chemotherapy
Acupuncture was given for three days. On the day of hospitalization and after three days, study assessments were completed. Chemotherapy-induced nausea and vomiting (CINV) was not measured in patients receiving chemotherapy for the first time.
The sign test was used to show the pre- and post-treatment significance of differences, and these were shown for all symptoms (p < 0.001). However, the pretreatment score for insomnia was equal to one before and after treatment, and a larger proportion of patients did not improve (57.8%) than improved (42.2%) in terms of sleep quality. In other symptoms, the percentage that improved was similar to the percentage that did not improve. The intervention group appeared to have the greatest number of patients whose nausea improved.
Acupuncture may be a useful adjunctive therapy for the management of pain, CINV, anxiety, and insomnia in hospitalized patients receiving chemotherapy. The design of this study limits the strength of its findings.
Acupuncture is a complementary therapy that may be beneficial as an adjunct treatment for symptom management in patients with cancer. This individual study has multiple limitations, and additional evidence is needed to evaluate the effectiveness of acupuncture.
Tarumi, Y., Wilson, M.P., Szafran, O., & Spooner, G.R. (2013). Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. Journal of Pain and Symptom Management, 45(1), 2–13.
To determine the efficacy of docusate in patients in hospice
Patients were randomly assigned via a code generated by a public domain computer. Randomization was assigned by a pharmacist, and the research assistant, patient, proxy, attending physician, and nurses were blinded to study treatment. The intervention group received two 100 mg docusate tablets in the morning and late afternoon plus one to three sennoside tablets (8.6 mg per tablet) one to three times per day. The placebo group received two cornstarch tablets in the morning and afternoon in addition to one to three sennoside tablets (8.6 mg per tablet) one to three times per day. All medications were administered by hospice nursing staff for a period of 10 days. Docusate pills were rolled in cornstarch and placed into nontransparent blue capsules, and the placebo pills were only cornstarch in blue capsules so that both the intervention and placebo pills looked the same. All patients were allowed to take laxatives and receive other bowel interventions as needed throughout the study. Nurses received multiple education sessions on stool consistency and volume to ensure inter-rater reliability. Nurses recorded data daily for 10 days.
Randomized, double-blind, placebo-controlled study
The results revealed no significant difference in stool frequency, volume, or consistency between the two groups. Data showed no significant differences in patients’ perception of the difficulty or completeness of defecation. ESAS scores showed no difference in symptoms experienced between the two groups. No difference was seen in the number of additional bowel-care interventions provided to patients in this study.
There were no significant differences between the docusate group and the placebo group, suggesting that the use of docusate should be considered on a patient-by-patient basis.
Nurses must assess patient needs versus what is actually happening. Frequent abdominal inspections should be made with or without the use of docusate. Other things that should be assessed include bowel sounds and pattern of bowel function as well as the color, consistency, and amount of stool produced without regard to docusate use.