Sidiropoulou, T., Buonomo, O., Fabbi, E., Silvi, M.B., Kostopanagiotou, G., Sabato, A.F., & Dauri, M. (2008). A prospective comparison of continuous wound infiltration with ropivacaine versus single-injection paravertebral block after modified radical mastectomy. Anesthesia and Analgesia, 106, 997–1001.
To compare the efficacy of continuous wound infiltration with a local anesthetic with thoracic paravertebral block after breast surgery
Before surgery, patients were randomized to receive an ipsilateral paravertebral block or postoperative continuous wound infiltration with 0.5% ropivacaine. Two catheters delivered ropivacaine at a 2 m/L rate for each catheter. Pain assessments were done every four hours. All patients received the same anesthesia protocol.
Randomized, parallel-group trial
Patients in the paravertebral block group had lower pain scores and less restriction of shoulder movement in the first four hours (p < 0.005), and at 16–24 hours, patients in the continuous wound infiltration group had lower pain scores (p < 0.02). There were no differences between groups in overall analgesic consumption. The incidence and severity of postoperative nausea and vomiting were higher in the wound infiltration group (p = 0.017). Median pain scores were low across all time points.
Both paravertebral blocks and continuous wound infiltration were effective for the management of postoperative pain. Although pain was lower in patients receiving continuous infiltration at later hours of observation, their incidence of postoperative nausea and vomiting was higher.
Both neural blocks and continuous wound anesthetic infusions were effective methods for postoperative pain management in this study although wound infiltration was associated with more nausea and vomiting. Nurses need to consider the potential for postoperative nausea and vomiting associated with pain control interventions as well as the anesthetics used.
Siddique, R., Hafiz, M.G., Rokeya, B., Jamal, C.Y., & Islam, A. (2011). Ondansetron versus granisetron in the prevention of chemotherapy-induced nausea and vomiting in children with acute lymphoblastic leukemia. Mymensingh Medical Journal, 20(4), 680–688.
To determine if ondansetron or granisetron is more effective at alleviating chemotherapy-induced nausea and vomiting (CINV) in children with acute lymphoblastic leukemia (ALL)
Children receiving high-dose methotrexate were randomized to receive ondansetron (4 mg) or granisetron (1 mg) orally in 5 ml of water 30 minutes before chemotherapy infusion. Pills were crushed and stored prior to distribution. Patients could receive an additional dose of the drug within 24 hours for moderate vomiting. Patients were assessed at baseline before the infusion and every 24 hours after chemotherapy. Patients did not have any antiemetic drugs in the 24 hours preceding chemotherapy infusion.
RCT, double-blind
Children in the ondansetron group had a 70% complete response and a 30% partial response to acute CINV (24 hours following infusion). Children in the granisetron group had a 90% complete response and a 10% partial response to acute CINV. There was a significant difference between the group for acute CINV (p < 0.05). Of the children receiving ondansetron, 58.6% had a complete response to delayed CINV and 41.4% had a partial response on day 3, whereas 86.7% in the granisetron group had a complete response and 13.3% had a partial response to delayed CINV on day 3. The difference between groups was significant (p < 0.01). Results on day 4 were similar, with 58.6% of children in the ondansetron group experiencing a complete response and 37.9% experiencing a partial response while 96.7% had a complete response and 3.3% had a partial response in the granisetron group. These results were also significant (p < 0.01). Thirty percent of children receiving ondansetron received additional drug compared to 3.3% in the granisetron group (p < 0.01).
In children with ALL, granisetron is more effective at alleviating both acute and delayed CINV in patients who are on high-dose methotrexate.
Nurses can advocate for the use of granisetron rather than ondansetron in children who are receiving highly emetic chemotherapy infusions. Granisetron may be more effective for both acute and delayed CINV.
Shum, N.F., Lui, Y.L., Law, W.L., & Fong, Y.T.D. (2014). A nurse-led psycho-education programme for Chinese carers of patients with colorectal cancer: Nga Fan Shum and colleagues report on a randomised controlled trial of the effectiveness of telephone support in Hong Kong. Cancer Nursing Practice, 13, 31–39.
To evaluate the effectiveness of a nurse-led telephonic psychoeducational intervention on caregiver strain and burden
Patients were randomized to receive the study intervention or usual care. In the intervention group, caregivers received structured telephone calls at two, four, and eight weeks after hospital discharge from colorectal nurse specialists. Calls were used to identify caring problems or psychological issues, provide related information, educate caregivers according to patient needs at different stages of recovery, and provide support. A checklist for the telephone call was used, and nurses compiled field notes during the calls. These were reviewed to ensure intervention accuracy and consistency. Usual care patients received an information sheet for home care education on discharge and were provided with a telephone hotline number. Study data were collected via phone interview.
Single, blinded, randomized, controlled trial
Main concerns of the caregivers were dietary advice, chemotherapy advice, and the management of wounds, bowel function, and pain. Depression and anxiety declined over time in all subjects. At two and four weeks, the reduction in depression scores was greater for those in the intervention group (p = 0.013 and p < 0.001, respectively). The mean decline in anxiety scores was greater in the intervention group at two and four weeks as well (p < 0.004). Psychological health scores improved more for those in the intervention group (p < 0.007). Scores for care burden declined more for the intervention group at all follow-up periods (p < 0.001). Baseline depression and anxiety scores were mild. There were significant group-by-time effects for depression, care burden, psychological health, and social relationships.
The findings of this study demonstrated the effectiveness of this nurse-led telephonic psychoeducational intervention to reduce caregiver burden.
This study showed that the provision of telephonic psychoeducation for caregivers was effective in reducing caregiver burden. The intervention also may benefit in terms of symptoms of depression and anxiety. However, the initial levels of these symptoms were not indicative of a clinically significant problem, and results declined in all caregivers over time. The provision of a telephonic intervention by nurses can be an effective and practical method of providing education and support to caregivers.
Shukla, P.N., Gairola, M., Mohanti, B.K., & Rath, G.K. (2006). Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: A prospective randomized study. Indian Journal of Cancer, 43, 180–184.
To determine the difference in occurrence of wet desquamation on axillary skin with use of beclomethasone dipropionate spray
Study participants were randomized to two groups. One group received beclomethasone dipropionate spray on irradiated axilla (200 mcg) seven days a week from day one of radiation therapy. Steroid spray was stopped after development of wet desquamation. The other group was not allowed to apply anything in the irradiated area. Both groups were instructed against using soap, oil, or cream in treatment area; shaving in the irradiated area; and wearing anything other than loose cotton clothing. A clinical examination was done weekly while on treatment.
The study used a randomized controlled trial design.
Wet desquamation of axillary skin at the end of radiation developed in 13.33% of patients in the steroid group and 36.66% of patients in the control group (p = 0.0369). There was no significant difference in median dose of radiation causing wet desquamation (42 versus 43.54 Gy).
Topical steroid (beclomethasone dipropionate spray) for skin during radiation may reduce risk of wet desquamation of the skin.
Shpilberg, O., Blumenthal, R., Sofer, O., Katz, Y., Chetrit, A., Ramot, B., . . . Ben-Bassat, I. (1995). A controlled trial of tranexamic acid therapy for the reduction of bleeding during treatment of acute myeloid leukemia. Leukemia & lymphoma, 19, 141–144.
During induction, there was no difference between the study and control regarding period of thrombocytopenia less than 20, number of bleeding episodes, number of platelet or RBC transfusions, or score of bleeding events. During consolidation, there was significantly less bleeding in the TA group, resulting in less platelets (3.7 +/- 4.1 [p < .05]); there was no significant difference in the number of RBCs transfused. No thromboembolic event or fatal bleeds occurred in either group.
Shinohara, A., Ikeda, M., Okuyama, H., Kobayashi, M., Funazaki, H., Mitsunaga, S., . . . Saitoh, S. (2015). Efficacy of prophylactic minocycline treatment for skin toxicities induced by erlotinib plus gemcitabine in patients with advanced pancreatic cancer: A retrospective study. American Journal of Clinical Dermatology, 16, 221–229.
To evaluate the effects of prophylactic minocycline on skin toxicities associated with epidermal growth factor receptor inhibitor (EGFRI) treatment
PHASE OF CARE: Active antitumor treatment
Significantly fewer patients who had received prophylactic minocycline developed an acneiform rash (p < 0.001). No differences existed between groups in incidence of rash of grade 2 or higher, and no difference existed between groups in the incidence of paronychia or xerosis.
The findings suggest that prophylactic minocycline may reduce the incidence of low-grade acneiform rash among patients receiving erlotinib and gemcitabine.
The findings suggest that prophylactic minocycline might be helpful in preventing low-grade acneiform rash among patients receiving EGFRIs; however, it did not appear to have any beneficial effect in terms of the development of more severe skin effects. The study design limits the strength of this evidence. Skin toxicities associated with EGFRIs have been well documented, and little evidence exists regarding interventions that are effective to prevent and treat them. Further well designed research in this area is needed.
Shinohara, A., Yoshiki, Y., Masamoto, Y., Hangaishi, A., Nannya, Y., & Kurokawa, M. (2013). Moxifloxacin is more effective than tosufloxacin in reducing chemotherapy-induced febrile neutropenia in patients with hematological malignancies. Leukemia and Lymphoma, 54, 794–798.
To evaluate the efficacy of antibiotic prophylaxis with tosufloxacin or moxifloxacin in adult patients (aged 16 years or older) with hematologic malignancies who were treated with chemotherapy that induced neutropenia and had an absolute neutrophil count less than 500/mcL for five days or longer
From 2004–2006, patients were treated with prophylactic tosufloxacin 150 mg three times daily, and from 2007–2008, patients were treated with prophylactic moxifloxacin 400 mg daily. All patients in both groups were treated with prophylactic antifungal therapy with either fluconazole or itraconazole.
Comparison of moxifloxacin to tosufloxacin demonstrated a significantly decreased cumulative incidence of febrile neutropenia (74.7% [59 of 79] and 81.1% [219 of 270], respectively, p = 0.044]; increased incidence of fungal infection in the moxifloxacin group (10.1% compared to 4.1% in the tosufloxacin group, p = 0.048); and no cases of CDAD in either group. No significant difference was seen between groups for the mean duration of neutropenia (17.6 days and 17.9 days, respectively, p = 0.853); documented infection (20.3% and 25.9%, respectively, p = 0.373); mortality (0% and 1.9%, respectively, p = 0.592); or fluoroquinolone-resistant infections (7.6% and 9.3%, respectively, p = 0.823). A subgroup analysis of patients with AML showed a higher incidence of febrile neutropenia in the tosufloxacin group (94.1% versus 71.1%, p = 0.013), perhaps related to the observation that the patients with AML had a longer duration of neutropenia (mean = 20.6 days) than the other patients (mean = 13 days) (p < 0.01). A second subgroup analysis showed that moxifloxacin was more effective in preventing febrile neutropenia in patients with neutropenia lasting 15 days or longer (incidence: 73.8% and 89.7%, respectively, p = 0.008) and had no effect on the incidence in patients with neutropenia lasting 14 days or less (p = 0.930).
Moxifloxacin was more effective than tosufloxacin in preventing febrile neutropenia in patients with AML who were most likely to have a longer duration of neutropenia (15 days or longer). No differences in the incidence of documented infections, fluoroquinolone-resistant infections, or overall mortality were observed.
Antibiotic prophylaxis with moxifloxacin is more effective than tosufloxacin in reducing the incidence of febrile neutropenia in high-risk patients who are expected to have a long duration of neutropenia. However, moxifloxacin was associated with more fungal infections. Nurses need to educate and counsel patients regarding antibiotic prophylaxis to enhance adherence, appropriate side effect reporting, and self-monitoring for signs of infection.
Shinde, S.S., Seisler, D., Soori, G., Atherton, P.J., Pachman, D.R., Lafky, J., . . . Loprinzi, C.L. (2016). Can pregabalin prevent paclitaxel-associated neuropathy? An ACCRU pilot trial. Supportive Care in Cancer, 24, 547–553.
To investigate the potential role of pregabalin in the prevention of chemotherapy-induced neuropathy
Patients were randomized to receive placebo or pregabalin 75 mg twice daily starting on the first night of chemotherapy and throughout 12 weeks of chemotherapy. In week 13, the dose was reduced to once daily at bedtime. Patients were instructed to use acetaminophen or oxycodone as needed for breakthrough pain. For the first six days, pain severity and analgesic use were obtained daily; on day 8, they were obtained prior to each subsequent paclitaxel treatment; and they were obtained for six months 30 days after the completion of paclitaxel treatment.
PHASE OF CARE: Active antitumor treatment
Double-blind, placebo-controlled trial
No differences existed between groups in worst, average, or least pain scores, or in analgesic use. No differences existed in the motor neuropathy or autonomic neuropathy subscale scores of the EORTC instrument. No significant differences were observed in adverse events.
The findings did not support any effect of pregabalin for the prevention of chemotherapy-induced neuropathic symptoms.
Professional guidelines have suggested that gabapentinoids may be considered as an option to treat chemotherapy-induced neuropathy, although their effectiveness has not been established. This study provides limited evidence to suggest that pregabalin, a type of gabapentinoid, is effective for the prevention or reduction of paclitaxel-induced neuropathic symptoms. Given these results, it may not effectively treat established neuropathic symptoms. Currently, limited treatment options exist for the prevention or management of chemotherapy-induced peripheral neuropathy. Nurses need to be aware of chemotherapy agents that have neurotoxic effects, and monitor patients for early detection of such effects to identify the need for potential treatment dose modification.
Shin, S.H., Lee, H.S., Kim, Y.S., Choi, Y.J., Kim, S.G., Kwon, H.C., . . . Chung, J.S. (2014). Clinical usefulness of hydromorphone-OROS in improving sleep disturbances in Korean cancer patients: A multicenter, prospective, open-label study. Cancer Research and Treatment, 46, 331.
To evaluate the efficacy of hydromorphone-OROS (HM-OROS) in the treatment of sleep disturbances associated with cancer-related pain
Patients took an equianalgesic dose of HM-OROS for two weeks. The dose of HM-OROS was individualized and based on the total dose of previous opioids that were administered on the last day of the screening phase.
Multicenter, prospective, open-label study with a pre- and post-test
HM-OROS improved sleep disturbances in patients with moderate to severe cancer-related pain.
HN-OROS may be an effective drug to treat cancer-related pain and improve sleep disturbance.
Shin, Y.H., Kim, T.I., Shin, M.S., & Juon, H. (2004). Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patients. Cancer Nursing, 27, 267-274.
The study took place in a university medical center in metropolitan South Korea. Participants were on inpatient oncology wards.
This study had a nonequivalent control group design for a single cycle of chemotherapy.
Significant differences existed between the control and intervention groups in the severity of nausea and vomiting, duration of nausea, and frequency of vomiting.