Suadoni, M.T. (2014). Are probiotics more efficacious than placebo at preventing radiotherapy-induced diarrhoea in adults with cancer. Journal of Radiotherapy in Practice, 13, 226–235.
DATABASES USED: MEDLINE, EMBASE
PHASE OF CARE: Active antitumor treatment
The Chitapanarux and Delia studies were most robust and the Giralt study was least robust. The Germain study could not be determined. There were no adverse events reported in the studies. The Chitapanarux and Delia studies determined that probiotics were beneficial and produced statistically significant results in the study population. The Germain study reported benefits that were statistically significant at standard dose and at high dose, which was not statistically significant. Studies revealed high clinical significance.
Evidence supporting contention that probiotics are beneficial is low quality.
More research is needed on the use of probiotics with rigorous randomized placebo controlled studies.
Su, C.K., Mehta, V., Ravikumar, L., Shah, R., Pinto, H., Halpern, J., … Quynh-Tu, L. (2004). Phase II double-blind randomized study comparing oral aloe vera versus placebo to prevent radiation-related mucositis in patients with head-and-neck neoplasms. International Journal of Radiation Oncology, Biology, Physics, 60, 171–177.
Patients were given 20 mL aloe vera solution or placebo to swish and swallow four times per day beginning on the first day of radiation therapy (RT) and continuing throughout the treatment course. The solution consisted of 94.5% aloe juice, 5.0% pear juice concentrate, 0.4% lemon-lime flavor, and 0.1% citric acid. The placebo solution was taste-matched with identical astringency, consistency, and ingredients, except that the aloe vera juice was replaced with water.
The study reported on 58 patients with stage II-IV M0 head and neck cancer who were scheduled to receive radiation of at least 50 Gy to at least one site; 28 patients were given aloe vera, and 30 were given placebo.
The study was conducted from February 1999 through March 2002.
This was a double-blind, placebo-controlled, randomized trial.
Findings were not significant.
This study did not accrue adequate patients according to statistical analysis.
Su, C.X., Wang, L.Q., Grant, S.J., & Liu, J.P. (2014). Chinese herbal medicine for cancer-related fatigue: A systematic review of randomized clinical trials. Complementary Therapies in Medicine, 22, 567–579.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Palliative care
CHM used alone or in combination with chemotherapy or supportive care showed significant relief in CRF compared to placebo, chemotherapy, and supportive care based on single trials. CHM plus chemotherapy or supportive care was superior to chemotherapy or supportive care in improving quality of life. Data from one trial demonstrated that CHM exerted a greater beneficial effect on relieving anxiety but no difference in alleviating depression. Seven trials reported adverse events, and no severe adverse effects were found in CHM groups.
The work suggests that CHM may be effective and safe in the treatment of CRF. However, the current evidence is insufficient to draw a confirmatory conclusion due to the poor methodological quality of included trials.
Quality of methods:
It is necessary to conduct rigorously designed trials on potential CHM.
Styczynski, J., Gil, L.; & EBMT Paediatric Diseases Working Party. (2008). Prevention of infectious complications in pediatric HSCT. Bone Marrow Transplantation, 42, S77–S81.
To analyze the current guidelines and recommendations for the prevention of infectious complications in adults and children undergoing hematopoietic stem cell transplantation (HSCT).
This resource is a guideline. A mini-review of evidence-based recommendations was conducted on the prevention of infections after HSCT in children. These recommendations were rated based on the strength of the recommendation and supporting evidence quality. The evidence-based system (A-E, I-III) was used to establish the strength of the recommendations and the quality of the supporting evidence.
Databases searched were not stated. The authors stated that they reviewed current guidelines, but the guidelines were not specifically identified.
Search keywords were prophylaxis, infection, hematopoietic SCT, strategy, and vaccination.
Studies were included in the review if they reported adults and children undergoing HSCT. The exclusion criteria were not reported.
The study has clinical applicability for pediatrics.
In the hospital environment, cleaning all surfaces to prevent dust accumulation, separating patient wards from outside air, and housing patients in rooms with high-efficiency particulate absorption filters were category AII recommendations. Having patients wear masks when going to unprotected areas and providing rooms with positive pressure were category BIII recommendations. Hand washing to minimize hospital-acquired candidal and bacterial infections was rated AIII. Antibacterial prophylaxis for all patients from conditioning through engraftment was strongly recommended (AI), with ciprofloxacin, levofloxacin, and amoxicillin-clavulanate. Fungi prophylaxis was recommended with fluconasole, voriconazole, posaconazole, or (BII) itraconazole for all patients. Cytomegalovirus prophylaxis with ganciclovir was recommended (AI) for high-risk patients. Herpes simplex virus prophylaxis for IgG-positive patients was recommended (AI) with valacyclovir. Varicella-zoster virus prophylaxis was recommended for IgG-positive patients. Vaccinations were not supported by any AI recommendations. Annual inactivated influenza viral vaccine and conjugated Streptococcus pneumonia vaccine for all patients undergoing HSCT both received a category AII recommendation. Viral polio inactivated, hepatitis B, bacterial conjugated Haemophilus influenzae B, toxoid tetanus, toxoid diphtheria, and polysaccharide S. pneumonia vaccines all received category recommendations. (See Table 1 for the evidence-based rating.)
Table 1 (as shown in the article)
“Category definition to determine strength of recommendation:
Category definitions to determine quality of supporting evidence
Table 2 provides antimicrobial prophylaxis type, indication, first and second recommendation using A-E, I–III ratings, and when to begin and end therapy. Table 3 lists recommendations for vaccinations after HSCT by delineating viral and bacteria vaccines, type of vaccine, time to begin, number of doses, indications, and recommendations using A-E, I–III categories.
Conflict of Interest: Jan Styczynski and Lidia Gil have received speakers’ fees from Medagro and MSD.
Cotrimoxazole or quinolones antibacterial prophylaxis has demonstrated efficacy for patients with cancer who are neutropenic and after autologous HSCT (category AI), but well-designed clinical trials specifically for patients undergoing allogeneic HSCT are not available. Studies with mostly adults receiving fluoroquinolones for HSCT were analyzed to deem the safety for children. Using fluoroquinolones safely in children is based on one double-blind, placebo-controlled, randomized pediatric clinical trial using amoxicillin clavulanate, and patients undergoing HSCT were not included. High- and intermediate-risk patients should be offered antifungal prophylaxis. Fluconazole, micafungin (both category AI), and itraconazole (category BI) are recommended during pre-engraftment for antifungal prophylaxis. In adults with severe acute or extensive chronic graft-versus-host disease, oral posaconazole has been shown to be effective in reducing invasive mycoses. No data on dose and schedule were reported for pediatric dosing. Oral valganciclovir has been shown to be effective when compared to intravenous ganciclovir, but no pediatric data were available, and the drug was not available in liquid suspension, which is often desirable for children. Vaccination against influenza and S. pneumoniae for HSCT was strongly recommended (category AII for both). Live tuberculosis should never be offered (EII). Other vaccinations have the potential for decreasing post-HSCT risks for vaccine-preventable infections. High quality supporting evidence used in this guideline was based on as little as one randomized, controlled trial, with no discussion of sample size, risk of bias, etc., making this a relatively low threshold for highly rated evidence.
Sturtzel, B., & Elmadfa, I. (2008). Intervention with dietary fiber to treat constipation and reduce laxative use in residents of nursing homes. Annals of Nutrition and Metabolism, 52(Suppl. 1), 54–56.
To determine whether the addition of oat bran to the diets of older adult residents of a long-term care facility would lead to a reduction in laxative use.
The control group (15 patients assigned) received usual diet.
The intervention group had oat fiber containing 8.3 g of nondigestible fermentable fiber and 9.7 g of nondigestible nonfermentable fiber per 100 g incorporated into their diet for 12 weeks.
Single ward of a long-term care facility in Vienna, Austria
The study has clinical applicability to older adult care.
This was a controlled, parallel, blind intervention trial.
Fiber supplementation with oat bran may be an alternative to laxatives for treating constipation in an older adult population.
Increasing fiber supplementation with oat bran may be an alternative to laxative use for treating constipation in older adults. Additional study is warranted in a larger population that includes patients with cancer.
Sturm, I., Baak, J., Storek, B., Traore, A., & Thuss-Patience, P. (2014). Effect of dance on cancer-related fatigue and quality of life. Supportive Care in Cancer, 22, 2241–2249.
To evaluate the effect of dance on relieving fatigue in patients with cancer undergoing active cancer treatment
This study consisted of two groups, one with supportive consultation, fatigue counseling, nutrition counseling, psychooncology, and 10 60-minute dance classes for five weeks, and the other with everything except the dance class.
Nonrandomized intervention
Fatigue was measured at baseline and at the end of the study for both groups. There was significant reduction in fatigue in the dance group while fatigue essentially was unchanged in the control group. The study also demonstrated improved scores on the social and emotional functioning scales and in physical performance in the dance group.
Dance could be an appropriate, multidimensional approach for the treatment of cancer-related fatigue.
To encourage exercise or movement, this study offers a less monotonous approach compared to conventional fitness programs addressing cancer-related fatigue. Replication and a randomized study is needed to establish effectiveness.
Sturgeon, M., Wetta-Hall, R., Hart, T., Good, M., & Dakhil, S. (2009). Effects of therapeutic massage on the quality of life among patients with breast cancer during treatment. Journal of Alternative and Complementary Medicine, 15, 373–380.
To test hypotheses regarding the effect of massage on anxiety, pain, nausea, sleep, and quality of life (QOL).
Patients were referred by their physicians and were provided a physician order for massage. Patients completed self-administered instruments prior to massage therapy and one week after therapy. Massage treatments lasted 30 minutes and were provided during treatment with chemotherapy and/or radiation therapy (RT) once per week for three weeks.
Patients were undergoing the active treatment phase of care.
The study used a pre-/posttest design.
STAI scores were lower after massage therapy (p = 0.03). Sleep scale items that showed improvement with massage were soundness of sleep (p = 0.05), time from settling down to sleeping (p = 0.02), and overall sleep satisfaction (p = 0.01). FACT-B scores also showed improvement in several areas after massage therapy (p < 0.05). Effect sizes in these areas were moderate (≥0.3).
Provision of massage therapy during treatment for breast cancer may reduce anxiety and improve sleep and aspects of QOL.
Massage therapy may assist women undergoing breast cancer treatment to better tolerate the impact of treatment, reduce anxiety, and improve sleep during active treatment.
Stuiver, M.M., Ten Tusscher, M.R., Agasi-Idenburg, C.S., Lucas, C., Aaronson, N.K., & Bossuyt, P.M. (2015). Conservative interventions for preventing clinically detectable upper-limb lymphoedema in patients who are at risk of developing lymphoedema after breast cancer therapy. Cochrane Database of Systematic Reviews, 2, CD009765.
STUDY PURPOSE: To assess the effects of conservative (nonsurgical and nonpharmacologic) interventions on lymphedema after breast cancer treatment
TYPE OF STUDY: Systematic review
DATABASES USED: Cochrane Breast Cancer Group’s (CBCG) Specialized Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro, PsycINFO, and the World Health Organization International Clinical Trials Registry Platform in May 2013 (reference lists of included trials and other systematic reviews were searched)
PHASE OF CARE: Late effects and survivorship
The evidence from this review was insufficient to draw firm conclusions.
All included studies were deemed to be of low or very low quality.
The quality of the evidence regarding interventions for reducing the risk of lymphedema remains low. More research is needed.
Stubblefield, M.D., Vahdat, L.T., Balmaceda, C.M., Troxel, A.B., Hesdorffer, C.S., & Gooch, C.L. (2005). Glutamine as a neuroprotective agent in high-dose paclitaxel-induced peripheral neuropathy: A clinical and electrophysiologic study. Clinical Oncology, 17, 271–276.
The study examined the neuroprotective effect of glutamine.
Seventeen patients received 10 g of glutamine administered three times daily for a total of four days beginning 24 hours after completion of paclitaxel. The remaining 29 patients made up the control group. Neurologic assessments and electrodiagnostic (nerve conduction) studies were carried out at baseline and at least two weeks (median 32 days) after treatment by a neurologist. Neurologic signs and symptoms also were assessed.
The study sample consisted of 46 patients who received high-dose paclitaxel prior to stem cell transplantation.
The study had a retrospective, non-randomized design.
Patients who received glutamine developed less weakness, less loss of vibratory sensation, and less toe numbness compared to those in the control group. A trend toward reducing symptoms of finger numbness was noted. In the comparison group, three patients developed foot drop and four patients developed tibialis weakness.
The mechanism of neuroprotection conferred by glutamine is unclear; some evidence suggests a correlation between treatment-induced reduction in nerve growth and severity of neurotoxicity.
The limitations of this study include it not being randomized or blinded as well as the fact that no placebo control group was used.
Results of this study should be interpreted with caution because of the small sample size and the non-randomized, retrospective design.
Stubblefield, M.D., Burstein, H.J., Burton, A.W., Custodio, C.M., Deng, G.E., Ho, M., . . . Von Roenn, J.H. (2009). NCCN task force report: Management of neuropathy in cancer. Journal of the National Comprehensive Cancer Network, 7(Suppl., 5), S1–S26.
This study outlines the common antineoplastic agents known to cause neuropathy and provides information on incidence, onset dosages, the signs and symptoms, and general course and patterns of resolution. Agents identified include platinum compounds, vinca alkaloids, taxanes, bortezomib, ixabepilone, thalidomide, and lenalidomide. In addition to outlining the mechanisms of neuropathy development in cancer, the study discusses neurophysiologic and objective testing, noting that findings on electromyographic (EMG) and nerve conduction studies (NCS) can lag behind clinical symptoms. The study also identifies commonly used physician-based grading systems, including the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) and Eastern Cooperative Oncology Group (ECOG) systems, and notes that these two grading systems lack inter-rater reliability. Patient-based instruments for assessment include the Functional Assessment of Cancer Treatment (FACT) and the Patient Neurotoxicity Questionnaire (PNQ). The authors note that the routine assessment of pain secondary to neuropathy, using instruments such as the Brief Pain Inventory (BPI), is useful.
Routine assessment should be conducted and continued throughout therapy. Key points in assessment that should be included are:
Proposed agents for prevention of CIPN identified include:
Agents used for pain management:
Current literature is inconclusive on the benefits of neurostimulation in treating CIPN. The authors note that evidence is scarce on efficacy of complimentary and alternative medicine (CAM) therapies and the need for appropriately powered and controlled studies in this area. However, acupuncture was identified as a promising adjunct option. The article also provides safety tips and issues for management of functional deficits in PIN, including situations in which to avoid or discontinue physical training, footwear selection, orthosis, and safety aspects of the household environment. Finally, the article addresses how autonomic neuropathy from chemotherapy occurs, but has not been well documented or studied.
The article provides a comprehensive review of current knowledge about CIPN and common approaches toward assessment, prevention, and management. The authors do not make specific recommendations for treatment, research to validate evaluation tools, and exploration of combinations and scheduling of pain medications. In addition, testing of the safety and effectiveness of therapeutic interventions and dietary supplements are needed.