Rithirangsriroj, K., Manchana, T., & Akkayagorn, L. (2015). Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecologic Oncology, 136, 82–86.
To compare the efficacy of ondansetron versus acupuncture in the prevention of delayed chemotherapy-induced nausea and vomiting (CINV)
Patients were randomized to receive acupuncture (applied to wrists) or ondansetron (8 mg IV for 30 minutes) before chemotherapy. Acupuncture also was applied the day after chemotherapy. All patients received dexamethasone at 5 mg orally twice per day for three days following chemotherapy. Ondansetron at 4 mg was administered orally every 12 hours for vomiting. During subsequent chemotherapy infusions, patients received the other intervention in a crossover design. Data on CINV were collected for five days after the administration of chemotherapy, and quality-of-life data were collected on the seventh day following chemotherapy.
Randomized, crossover study
Patients in the intervention group had a higher rate of complete response for delayed CINV (p = 0.02), less delayed nausea (p = 0.004), lower nausea scores (p < 0.001), and fewer doses of additional ondansetron (p = 0.002). Fewer patients reported adverse side effects when receiving acupuncture. Forty patients reported that they preferred acupuncture to ondansetron.
Acupuncture was effective in the prevention of delayed CINV and nausea. Patients receiving acupuncture also required fewer doses of ondansetron during the delayed phase of CINV.
Although additional research with a larger and more diverse sample is needed, the use of acupuncture to manage CINV could represent an effective nursing intervention for patients receiving platinum-based chemotherapy.
Rissanen, R., Arving, C., Ahlgren, J., & Nordin, K. (2014). Group versus individual stress management intervention in breast cancer patients for fatigue and emotional reactivity: A randomised intervention study. Acta Oncologica, 53, 1221–1229.
To evaluate if stress management delivered in group or individual settings improved fatigue and emotional reactivity among newly diagnosed patients with breast cancer
Group stress management (GSM) consisted of 10 two-hour sessions over three months. Homework was assigned between sessions and discussed in the group. Sessions were cognitive behavioral (CBT) therapy-based with specific subjects: introduction to stress and stress response, negative thoughts and stress behavior, irritability and anger, quality of life, expectations of life, reactions to a cancer diagnosis, sexuality, and recapturing. Individual stress management (ISM) consisted of four to eight one-hour sessions over four and a half months using the same subjects from thee GSM group. Subjects were offered additional sessions as needed. Subjects also were given homework assignments between sessions. Both groups were led by a nurse trained in the intervention, which was also manual-based.
Nonblinded, randomized, controlled trial that was randomized at three-month timepoints after enrollment if cutoff scores on the Hospital Anxiety and Depression Scale or the Impact of Events Scale were met or were higher
At the three-month evaluation, 304 women met eligibility requirements for randomization and 149 declined. Forty-two of 77 (52%) women who were randomized to the GSM group attended group sessions and completed an average nine of 10 sessions. Seventy-one of 78 women who were randomized to the ISM group completed an average of five of eight sessions. Those who declined participation in both groups reported significantly less activity. Results were compared at 12 months to three months. There were no significant changes over time and no significant changes between the GSM and ISM groups on fatigue or emotional reactivity. There was no significant difference over time in MFI-20 or ELSS scores. Thirty-one percent of participants who refused participation cited a lack of distress as the reason.
This study demonstrated no significant improvement in fatigue for patients breast cancer who participated in a CBT-based group or an individual intervention.
The willingness of patients to participate in group interventions should be considered when developing such programs.
Ripamonti, C.I., Santini, D., Maranzano, E., Berti, M., Roila, F., & European Society for Medical Oncology (ESMO) Guidelines Working Group. (2012). Management of cancer pain: ESMO Clinical Practice Guidelines. Annals of Oncology, 23(Suppl. 7), vii139–vii154.
To provide clinical guidance regarding the assessment and management of pain in patients with cancer
The development process for these evidence-based guidelines was not described.
These guidelines are for use in patients undergoing multiple phases of care.
The search and full body of evidence were not described. Evidence and recommendation level relating to each management guideline was included.
This resource provides general clinical practice guidelines regarding the management of pain of cancer. The authors note that cancer-related pain is generally undertreated. Nurses should be aware of the potential for the undertreatment of pain and advocate for effective pain management.
Rinke, M. L., Chen, A. R., Bundy, D. G., Colantuoni, E., Fratino, L., Drucis, K. M., . . . Miller, M. R. (2012). Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. Pediatrics, 130, e996–e1004.
To investigate whether a multidisciplinary, best practice central line maintenance care bundle reduces central line-associated blood stream infection (CLABSI) rates in hospitalized pediatric oncology patients and to further delineate the epidemiology of CLABSIs in this population.
The organization joined an effort to improve quality, focusing on CLABSI elimination through the implementation of best practice central line care bundles. The care bundle used was based on relevant Centers for Disease Control and Prevention (CDC) guidelines, including daily site assessment and dressings based on CDC recommendations; procedures for cap, tubing, dressing, and needle changes; catheter site care; and catheter hub, cap, and tubing care. Education on the Children’s Hospital Association (CHA) central line care bundle of reduction of line entries, aseptic entries into the line, and aseptic procedures when changing line components was performed. Nursing self-practice audits were performed prospectively, with a one day per week random nursing shift sampling for all patients with central lines. Targeted interventions were performed to improve compliance, including staff feedback of CLABSI rates, discussion in daily rounds, and mini root cause analysis in cases of CLABSI development. Ongoing individual and group education was performed based on the findings.
This study was a prospective, interupted time series.
The unit experienced a 20% decrease in CLABSI rates after the implementation of the intervention (p = 0.58). Secondary analyses indicated that the second year of the intervention had a 64% decline in CLABSI rates below baseline (p = 0.091), suggesting that a long ramp-up period may be necessary to achieve effective change. At the end of 24 months of continuous improvement efforts, 35% of patients were not receiving all bundle elements.
Although the implementation of best practices for central line care to decrease CLABSIs is a viable intervention, the long time to significant results should be seriously considered ongoing education, and monitoring would be required, potentially increasing costs and decreasing staff interest in the intervention.
CLABSI prevention efforts focusing on central line maintenance are difficult, rely directly on front-line staff participation, and require patience for culture change but also have a profound effect on each nurse who has worked to prevent an infection from occurring. Nurses need to be aware of the evidence regarding effective approaches to improve guideline adherence and performance of evidence-based practice and use known effective strategies. Causes of nonadherence to guidelines need to be identified in order for ongoing improvement. With bundle approaches, it might be useful to analyze which bundle items are truly critical to the outcome.
Ring, A., Marx, G., Steer, C., & Harper, P. (2002). Influenza vaccination and chemotherapy: A shot in the dark? Supportive Care in Cancer, 10, 462–465.
To evaluate influenza vaccination in patients with cancer
DATABASES USED: PubMed from 1992–2002, using influenza, vaccination, immunization, cancer, and malignancy as search terms; no restrictions were placed on the language of the publications. Additional data were acquired by direct communication with vaccine manufacturers.
FINAL NUMBER STUDIES INCLUDED = 11 studies measuring seroconversion after influenza vaccination
KEY SAMPLE CHARACTERISTICS: No comments existed regarding the research design of the studies, but five studies included a control group.
Seroconversion rates following influenza vaccination ranged from 10%–78% in patients with cancer as compared with 56%–94% in healthy controls. Seroconversion rates following influenza vaccination ranged from 37%–52% in patients with cancer on chemotherapy as compared with 76%–92% of patients with cancer not receiving chemotherapy. One study of 42 adult patients with hematologic or oncologic disorders found that the seroconversion rate following influenza vaccination was 50% if the vaccine was given at the time of chemotherapy, compared with 93% if the vaccine was given between cycles.
Riley, P., Glenny, A.M., Worthington, H.V., Littlewood, A., Clarkson, J.E., & McCabe, M.G. (2015). Interventions for preventing oral mucositis in patients with cancer receiving treatment: Oral cryotherapy. Cochrane Database of Systematic Reviews, 12, CD011552.
STUDY PURPOSE: To evaluate the evidence to assess the effects of oral cryotherapy for the prevention of oral mucositis (OM)
PHASE OF CARE: Active antitumor treatment
Insufficient evidence exists to evaluate the effect of cryotherapy in patients receiving radiation therapy alone for head and neck cancer. Five studies in which 5-fluorouracil (5-FU) was administered showed that oral cryotherapy reduced the risk of OM development (RR = 0.61; 95% CI [0.52, 0.72]; p < 0.00001). Five studies involving treatment with high-dose melphalan risk of OM was also reduced (RR = 0.59; 95% CI [0.35, 1.01]; p = 0.05). OM risk was reduced in mild, moderate, and severe OM cases. Insufficient evidence existed to determine whether 30 minutes or 60 minutes of cryotherapy was more effective. One study with a high risk of bias showed no difference between oral cryotherapy and the use of prophylactic chlorhexidine.
Oral cryotherapy is effective in reducing OM in patients receiving 5-FU and high-dose melphalan.
Studies were of moderate quality based on the risk of bias assessment.
Strong evidence existed in support of effectiveness of oral cryotherapy to reduce the OM risk in patients receiving 5-FU treatment and moderately strong evidence of efficacy in patients given high-dose melphalan. Very limited evidence existed in children. This intervention is very low risk, so nurses can advocate for the use of oral cryotherapy for patients receiving chemotherapeutic agents with a short half-life. Ice chips could create a potential choking hazard for children; therefore, the use of iced drinks or popsicles may be better approaches to use in this population. Future research of head and neck trials of cryotherapy versus other effective interventions would be useful to further inform clinical practice.
Rifkin, R., Spitzer, G., Orloff, G., Mandanas, R., McGaughey, D., Zhan, F., . . . Beveridge, R. (2010). Pegfilgrastim appears equivalent to daily dosing of filgrastim to treat neutropenia after autologous peripheral blood stem cell transplantation in patients with non-Hodgkin lymphoma. Clinical Lymphoma, Myeloma & Leukemia, 10, 186–191.
To compare time to absolute neutrophil count (ANC) recovery for patients treated with filgrastim versus pegfilgrastim.
Patients were randomized to Arm A, pegfilgrastim 6 mg subcutaneously on day 1 after autologous peripheral blood stem cell transplant (PBSCT), or Arm B, weight-based dose of filgrastim subcutaneously from day 1 until either the third consecutive day of ANC greater than 5,000/mm3 or one day of ANC greater than 10,000/mm3 after PBSCT. Duration of treatment was not to be more than 21 days.
Multi-site
Patients were undergoing the active treatment phase of care.
This was a randomized, phase II study.
In the posttransplant setting, pegfilgrastim is preferred over filgrastim based on faster neutrophil recovery, less patient discomfort, and comparable cost.
Small sample size
Pegfilgrastim is favored over filgrastim in patiens undergong NHL posttransplantation due to faster ANC recovery with less patient discomfort at cost that is comparable.
Rietjens, J.A., van Zuylen, L., van Veluw, H., van der Wijk, L., van der Heide, A., & van der Rijt, C.C. (2008). Palliative sedation in a specialized unit for acute palliative care in a cancer hospital: Comparing patients dying with and without palliative sedation. Journal of Pain and Symptom Management, 36(3), 228-234.
The primary aim of the study was to describe the practice of palliative sedation for patients with cancer and compare patients who were sedated prior to death with patients who were not sedated. The secondary aim was to explore clinical implications of palliative sedation for symptom management at the end of life.
The single-site study was conducted on an inpatient PCU in the Netherlands.
Patients were undergoing end-of-life and palliative care.
Retrospective, descriptive study
Checklist for data retrieval from medical records
Sixty-eight patients (43%) had received palliative sedation. Palliative sedation for the majority of patients (68%) started on the last day before death, with an average duration of 19 hours (range of 1–125 hours). No difference was seen between sedated and nonsedated patients with regards to sex or survival after admission to the acute PCU (mean of 8 and 7 days respectively, P = 0.12). Within 48–25 hours prior to death, sedation was initiated in 13 patients, while 45 patients received sedation 24–0 hours before death. The experience of pain, dyspnea, and delirium during the interval 48–25 hours before death in both sedated and nonsedated groups had decreased during the interval 24–0 hours before death (P = 0.54). Midazolam, sometimes combined with propofol, was the most commonly used sedating drug.
Ridner, S.H., Fu, M.R., Wanchai, A., Stewart, B.R., Armer, J.M., & Cormier, J.N. (2012). Self-management of lymphedema: A systematic review of the literature from 2004 to 2011. Nursing Research, 61(4), 291–299.
To evaluate evidence of lymphedema self-care through a systematic review
Databases searched were PubMed, CINAHL, Cochrane Collaboration, PapersFirst, ProceedingsFirst, Worldcat, PEDro, National Guidelines Clearing House, ACP Journal Club, and Database of Abstracts of Reviews of Effects. Best Practice for the Management of Lymphoedema (Lymphedema Framework, 2006) terms were used as well as additional terms that were not stated. Inclusion criteria were not specified. Qualitats, grey literature, dissertations, live studies, and case reports were excluded.
The total references received was 47. Literature was evaluated and commented on using categories of PEP levels of evidence.
Reviewed findings related to self-care interventions. No interventions met criteria for Recommended for Practice. Interventions that were Likely to Be Effective included full-body exercise and phase 2 complete decongestive therapy (CDT). Pneumatic compression devices, compression garments, infection management, self-monitoring, skin care, simple manual decongestive therapy, and weight reduction were categorized as Effectiveness Not Established. Aromatherapy was categorized as Effectiveness Unlikely.
Strongest evidence for effect is found for exercise and phase 2 CDT.
There were relatively few studies in the area of self-care interventions.
Findings suggested that self-care using exercise and CDT are likely to be effective for lymphedema self-management. Further research in other potential self-care interventions are needed.
Ridner, S.H., Murphy, B., Deng, J., Kidd, N., Galford, E., Bonner, C., … Dietrich, M. S. (2011). A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm treatment only in self-care of arm lymphedema. Breast Cancer Research and Treatment, 131, 147–158.
To compare advanced pneumatic truncal, chest, and arm treatment to arm only treatment to determine which therapy provides a larger reduction in lymphedema in post-operative patients with breast cancer
Participants were randomly assigned to receive truncal, chest, and arm compression or arm compression only. The compression was performed for one-hour, once per day for 30 days.
The study was conducted in Nashville, TN. The site and setting were not stated.
Patients were undergoing active lymphedema treatment.
This was a randomized control trial.
Demographic and medical data was collected via nurse interviews. The participants completed a Lymphedema Symptom Intensity and Distress Survey—Arm (LSIDS-A) and a functional assessment screening questionnaire (FASQ).
A statistically significant reduction was found in the number of symptoms and overall burden from the symptoms in both groups (p < 0.01). However, no statistical significance was found in the number of symptoms between groups (p = 0.145). No statistically significant change was found in functioning from baseline to the end of the study for either group, and no difference was found between the control and intervention group. The physical arm measurements indicated a significant reduction in bioelectrical impedance within both groups at the end of the study compared to baseline (p = 0.004 for arm only and p = 0.023 for truncal, chest, and arm). The combined groups were found to have a significant reduction at p = 0.018.
Both groups experienced a significant improvement but no difference was found based on treatment of arm alone or of truncal, chest, and arm. Some differences were noted between the intervention and control group that may have led to these conclusions. For example, the participants in the experimental group had more symptoms at baseline than the control group; whether these patients would have benefited equally from the arm-only treatment was not clear. Another variable that may have affected results is that the experimental group developed lymphedema more quickly after surgery and at a younger age. Researchers have hypothesized that opening truncal lymph channels is necessary to promote volume reduction, but this study suggested that the procedure may not play as a big of a role as originally thought. Repeating this study with a larger sample size, while holding these possible confounding variables constant, would be worthwhile.
This study suggested that truncal, chest, and arm pneumatic compression therapy is not significantly better than arm pneumatic compression alone. Differences between the control group and the experimental group could have contributed to these findings. Repeating the study with more rigorous inclusion and exclusion criteria is needed to ensure that these variables did not affect the results of the study.