This study evaluated the neuroprotective effect of vitamin E in patients with solid tumor malignancy treated with cisplatin chemotherapy.

Patients were randomly assigned to either group 1, which received vitamin E supplementation during cisplatin chemotherapy, or to group 2, which received cisplatin chemotherapy alone. Vitamin E 300 mg per day was administered orally before cisplatin chemotherapy and continued for three months after the suspension of treatment.

• A total sample of 47 patients was recruited. Twenty-seven completed the study.
• Patients had a variety of solid organ malignancies.
• Exclusion criteria included previous chemotherapy treatment or regimens including other neurotoxic drugs.

• Assessment of neuropathic symptoms, pinprick, vibratory sensations, strength, and deep tendon reflexes.
• A follow-up neurologic examination was performed by the same neurologists (not blinded to treatment status) after the three cycles of cisplatin treatment and after the cessation of chemotherapy. Neuropathic signs and symptoms were scored using a questionnaire designed for the detection of sensory disturbances (e.g., paresthesia, pain, and burning in feet or fingers) experienced by patients.
• Nerve conduction velocity and the amplitude of potentials of the sensory median and sural nerves were assessed at baseline and at the end of treatment with vitamin E.
• Plasma levels of vitamin E were measured by gas chromatography-mass spectrometry prior to chemotherapy.

Twenty patients dropped out of the study. Plasma levels of vitamin E were in the normal range and not significantly different between the two groups (8.06 and 7.17 mg/ml, respectively). Twelve of the 14 patients in the control group developed CIPN as compared to 4 of 13 patients who received vitamin E supplementation.

Vitamin E supplementation significantly protects against cisplatin-induced peripheral neuropathy and reduces incidence and intensity of neurologic signs and symptoms.

• The small sample size and differing tumor types included make comparisons difficult.
• The small sample size can also make finding statistically significant results more likely by chance alone.

STUDY PURPOSE: To review current research of free vascularized lymph node transfer (VLNT) for the treatment of lymphedema

TYPE OF STUDY: Systematic review

• FINAL NUMBER STUDIES INCLUDED = 18
• TOTAL PATIENTS INCLUDED IN REVIEW = 305 patients, 309 limbs and 316 flaps
• SAMPLE RANGE ACROSS STUDIES: Participants aged 13–80 years, 195 upper limbs and 114 lower. Secondary lymphedema was the leading cause of LE. Limb size determination varied. The duration of lymphedema varied from 3 months to 26 years. The average duration of lymphedema was greater than 24 years. Postoperative follow-up ranged from 2 to 132 months. 
• KEY SAMPLE CHARACTERISTICS: Level of evidence studies: 3 were level II, 13 were level III, and 2 were level IV. None of the studies were ranked I or high quality.

PHASE OF CARE: Pre- and postoperative VLNT
 
APPLICATIONS: Elder care

• Outcomes varied because evaluation of reduction was not consistent across studies.  
• Circumferential measurement reduction: Ninety-one percent showed postoperative improvement.  
• Lymphangioscintigraphy/lymphangiography: Sixty percent improved flow with moderate to significant improvement.  
• Patient satisfaction: All but seven patients stated improvement and surgery satisfaction.

The findings suggest that the use of VLNT may be helpful in reducing lymphedema. Larger studies with standardized measurements are needed to create a stronger body of research to fully evaluate this surgical procedure.

• Limited number of studies included
• Low sample sizes
• The need to evaluate same lymphedema types, primary versus secondary, radiation, and no radiation is needed.  
• All lymphedemas are not the same.

Limited evidence supports surgical interventions to manage lymphedema. However, the studies being conducted, although scant, do have potential, but outcomes vary presently.

To compare the clinical outcomes between allogeneic peripheral blood stem cell (PBSC) recipients who did and did not receive matched granulocyte transfusions.

Patients who did not have an ABO matched donor were assigned to a comparison control group, and those with a matched donor were assigned to receive granulocyte transfusions.  Patients received conditioning either with total body irradiation, etoposide and cyclophosphamide or busulfan and cyclophosphamide given over seven days, or the regimen of total body irradiation and cyclophosphamide administered over three days.  Posttransplant granulocyte colony-stimulating factor was given to all patients on day 1 until neutrophil recovery.  No prophylactic antibacterial or antifungal antibiotics were given.  Prophylactic acyclovir was given to prevent herpes simplex infection.  Empiric antibiotic therapy was given for an initial fever of 38.3°C or higher.  Empiric therapy of amphotericin B was given for persistent fever.

• One hundred fifty-one donor-recipient pairs were included.
• Mean age was 44.5 years (range 14–68).
• Of the patients included, 56.3% were male and 43.7% were female.
• The majority of patients had leukemia, myelodysplastic syndrome, myelofibrosis, or aplastic anemia.

• Single site  
• Inpatient  
• United States

Patients were undergoing the active antitumor treatment phase of care. 

This was a prospective two-group study.

• Onset of neutropenia (defined as absolute neutrophil count [ANC] decrease to 500/mm³)
• Recovery (defined as the first day after ANC nadir that ANC increased to 500/mm³ for three consecutive days)
• A febrile day (defined as any day during hospitalization with a temperature of 38.3°C or higher)
• Bacteremia included culture-proven systemic blood infections.

Patients receiving granulocyte transfusion had a mean of 13.2 days of hospitalization, compared to 29.6 days in the control group (p = 0.03).  Patients receiving transfusions had fewer days of severe neutropenia.  This difference was 1.5 days on average (p = 0.0005).  The percentage of patients who developed fever during hospital stay from the start of conditioning to discharge was 82.7% in patients who did not receive granulocytes versus 64.2% in those who received granulocyte transfusions (p = 0.03). There were no other differences between groups in bacteremia or overall survival.

Granulocyte transfusions in this group of patients may have a statistically significant but clinically mild beneficial effect on the duration of neutropenia and hospital stay.

• Risk of bias (no blinding and no random assignment)  
• Unintended interventions or applicable interventions not described that would influence results *

* There was no subgroup analysis between those who may have received empiric treatment for fever as described in the study methods; therefore, it is unclear if such treatment influenced the results.  Sample sizes with results reporting tend to vary throughout the report, so it is unclear if this is related to missing data from the retrospective method.

The findings suggested that granulocyte transfusions may have some benefits for allogeneic stem cell transplant recipients; however, this study did not provide strong support for this intervention due to study limitations.  Because these patients did not receive routine prophylactic antibiotic or antifungal treatment, it is not clear what the clinical role of granulocyte transfusion might be in the setting of more aggressive preventive clinical management.

To evaluate the effectiveness of topical lidocaine spray for pain relief during cervical punch biopsies and endocervical curettage (ECC)

Women with abnormal cervical cytology requiring colposcopy-directed cervical biopsy with or without ECC were randomly assigned to receive 10% lidocaine or normal saline spray to the ectocervix prior to colposcopy.

• N = 214   
• MEAN AGE = 24.25 years
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Turkey

• PHASE OF CARE: Diagnostic

• Double-blind, placebo-controlled, randomized, controlled trail

• Wong-Baker FACES Pain Rating Scale

No significant difference in pain scores between groups was reported.

The use of sprayed local anesthetic prior to colposcopic punch biopsy did not reduce procedure-related pain.

• Measurement/methods not well described
• Measurement validity/reliability questionable
• Exactly when pain was measured is unclear.
• No subgroup analysis between those who also had ECC and those who did not

The use of a topical anesthetic spray prior to colposcopic procedures as studied here did not demonstrate effectiveness in reducing postprocedure pain. Further research is needed to determine the best approaches to reduce or eliminate pain associated with this type of procedure.

The study was a randomized, controlled trial. The intervention was a “Bedside Wellness System” (BSW) that included:  a virtual world for 20 minutes, with three-dimensional sound, wide angle display screens, gentle breezes, aromatherapy, and synchronized foot movement devices. There were three scenes:  a lake, a forest, and a country town. The control group interviewed before chemotherapy and the end of the trial.

• The sample was comprised of 30 patients.
• Age ranged from 18 to 70 years. 
• Most patients were women.
• Patients had multiple types of cancer.

• Outpatient chemotherapy
• Tokyo, Japan

The study was a randomized, controlled trial with pre-/posttests and two trials; both groups were subdivided into depressed versus nondepressed.

• Cancer Fatigue Scale (developed by the institution) 
• Fatigue visual analog scale (VAS)

An insignificant effect on fatigue was found when comparing the pre-/posttests of the depressed and nondepressed subgroups in the control group, comparing between the trials, although the depressed control subgroup seemed to have greater fatigue after chemotherapy than the nondepressed subgroup. Statistical significance was found after the second test in the control group, and post second trial tests showed significance compared to the control; however, no significance was found when comparing the depressed versus nondepressed subgroups.

• Data/charts in the article do not support the conclusion of decreased fatigue, except for the control group.
• The study had a small sample size; it was limited to chemotherapy patients and was random but not diverse.
• The equipment was expensive and requires expertise in virtual reality distraction techniques.

The intervention consisted of a virtual reality immersion system and was a six- to seven-minute system trial that included:  a wide three-screen LCD with stereo sound, a walking system for bedridden patients, scent with gentle breeze, and a vital signs monitor. Three scenarios were used:  a typical park, a plateau, and a cherry blossom avenue in bloom.

• The sample was comprised of 22 female, bedridden patients.
• Age ranged from 33 to 75 years. 
• Patients had breast (n = 18) and ovarian (n = 4) cancers.
• Performance Status:  0–2. 

• Inpatient
• Japanese cancer center

This was a single-arm, pilot study.

The authors used their own fatigue scale (not described).

Of the patients, 16 were not fatigued, four were a little fatigued, one was fairly fatigued, and one had no answer.

Major

• Analyses were poorly described.

Minor

• How patients were chosen was not described.
• This was a pilot study.
• The equipment was very expensive.

To develop a new treatment using virtual reality technology as an intervention to decrease chemotherapy-related side effects in patients with cancer

Patients chose a preferred aromatic essential oil, sound system (headphone or speakers), and content. Three virtual worlds (lake, forest, and country town) were available, and each lasted about 20 minutes. The length of the intervention depended on the length of chemotherapy. If chemotherapy was long, patients could rest and restart the intervention.

• The study consisted of 30 patients (6 males and 24 females).
• The average age of participants was 53.5 years, with a range of 18–70 years.

The setting was an outpatient clinic at a national cancer center hospital in Japan.

The study had a randomized, controlled design.

The following scales were used.

• Hospital Anxiety and Depression Scale
• Cancer Fatigue Scale
• Face Visual Analogue Scale (VAS)

Emesis was measured using a VAS after the experience.

Fatigue and emesis scores showed a statistically significant decrease three to five days after chemotherapy (p < 0.05 for both symptoms). Carry-over effects were detected. Emesis was strongly related to psychological state. The intervention also was associated with decreased postinfusion emesis.

Virtual reality may be a new way to treat emesis.

• Nausea was not measured. Only the number of times a patient vomited was measured.
• The VAS was used postemesis as a measure of vomiting.
• The study did not use available tools to measure nausea, vomiting, and retching.
• The fatigue scale was developed by an institution.
• Motion sickness is a potential side effect when using virtual reality.
• The cost of the virtual reality system and setup must be considered.

To examine the efficacy of palonosetron, dexamethasone, and aprepitant to prevent chemotherapy-induced nausea and vomiting (CINV) in patients with gastric cancer receiving S-1 (oral 5-fluorouracil analog) and cisplatin

• Day 1: 125 mg aprepitant PO 60 minutes prior to chemotherapy, then 9.9 mg dexamethasone IV and 0.75 mg palonosetron IV 30 minutes prior to chemotherapy
• Days 2 and 3: 80 mg aprepitant PO QAM and 8 mg dexamethasone PO BID
• Day 4: 8 mg dexamethasone PO BID
• Throughout observation: Rescue antiemetic as needed
• Vomiting, retching, changes in dietary intake, and impact on quality of life were measured for 120 hours post administration of cisplatin.

• N = 72, 70 patients completed Functional Living Index-Emesis (FLIE) questionnaires   
• AGE = 50–81 years
• MEDIAN AGE = 65 years
• MALES: 80.6%, FEMALES: 19.4%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Gastric cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Sixty-five patients had received previous chemotherapy, and no patients had a history of CINV.

• SITE: Multi-site   
• SETTING TYPE: Multiple settings    
• LOCATION: Japan

• PHASE OF CARE: Active antitumor treatment

• This was a prospective, observational, noncomparative study.

Patients with gastric cancer who received S-1 and cisplatin tolerated palonosetron and dexamethasone. When compared to a previous study in a similar population who received aprepitant, granisetron, and dexamethasone, no significant differences existed in the CR rate, complete protection, dietary intake, or quality of life.

• Small sample (< 100)

The CR rate and complete protection were observed in the majority of patients with gastric cancer on S-1 and cisplatin who received antiemetic prophylaxis with palonosetron and dexamethasone. Although CINV did not significantly affect the quality of life in most patients, dietary intake decreased during the five-day observation time.

To evaluate the feasibility of a structured aerobic exercise intervention during treatment in a predominately Hispanic population of women.

A convenience sample of women who met the criteria at the time of their outpatient appointments were included. Patients were weighed and measured and completed tests regarding side effect burden and fatigue. Patients were given a sports outlet gift card for walking shoes and a six-month membership to the community health club. They were instructed to make an appointment with a physical therapist and a community health club for exercise. The research intervention was exercise three times a week for one hour with a goal to continue for six months. Exercises involved 10 minutes of warm-ups, 30 minutes of resistance training to improve muscle tone, 20 minutes of brisk walking to improve heart strength, and 10 minutes of cool-down. Assessments occurred at three and six months.

• Thirteen participants (all female) were included, although five did not go to a health club; only eight were available for a one-on-one interview.
• Age ranged from 40 to 63 years.
• Patients had first-time diagnoses of stage II breast cancer.
• Patients had undergone surgery and were either receiving chemotherapy or had completed chemotherapy in the past six months.
• Eight participants were on leave from work following surgery and during chemotherapy/radiation treatment.
• Of the participants, 73% experienced chemotherapy-induced menopause.
• All patients were Hispanic.

• Single site
• Cancer Center Therapy & Research Center, San Antonio, Texas

The study used a mixed qualitative and quantitative, repeated measure, quasiexperimental design.

• Side Effect Burden Scale
• Revised Piper Fatigue Scale (PFS)
• Five-minute walk test
• Strength and range of motion testing
• Penn Shoulder Score
• Hip and waist measurements
• Percent body fat and body mass index
• Pearson correlation coefficients (used in analysis)

Fatigue was significantly correlated with age (p = 0.05), fasting blood glucose (p = 0.05), and weight gain (p = 0.01). Mean weight gain was 15 lb. No changes were seen in fatigue. Qualitative analysis identified physical limitations, family responsibilities, lack of transportation, return to work, and lack of habit development as factors that influenced adherence to the exercise program. Sources of support for adherence included family, peers, employer, and health care providers. Several patients indicated that they preferred to exercise in an area that had only women. Self-report of exercise adherence was 66% at the first follow-up and 7% at the study conclusion.

Social, physical, and psychosocial factors influenced the women’s exercise adoptions. The provision of a gift card and recommendations did not have an effect on fatigue in these individuals.

• The study had a small sample size, with less than 30 participants.
• Observational data relied on recall.
• This was a Hispanic population, so specific qualitative findings may not be applicable to other cultural groups.

A structured exercise program appears to facilitate recovery from cancer. These Hispanic women had difficulty setting aside time to exercise. Support from health care providers was identified as a facilitator of adherence to exercise, suggesting that encouragement to exercise may be helpful. Concrete barriers, such as lack of transportation and dealing with family responsibilities, need to be addressed if patients are to be able to participate in exercise programs. Interventions need to fit lifestyle needs and preferences of the individual.

To determine if medical Qigong changed fatigue, depression, and sleep in patients with cancer and survivors

Participants were asked to review and complete a packet of information with instruments before their first class and after their last class. They were involved in a one and a half-hour class for five weeks that included the history of Qigong and movements for relaxation that they were encouraged to perform on their own.

• N = 22  
• MEAN AGE = 57.63 years (range = 36–75 years, SD = 11.3 years)
• MALES: Not provided, FEMALES: Mostly women
• KEY DISEASE CHARACTERISTICS: Patients with cancer and survivors undergoing active treatment or no treatment
• OTHER KEY SAMPLE CHARACTERISTICS: Aged greater than 18 years; spoke and read English

• SITE: Single site    
• SETTING TYPE: Outpatient  
• LOCATION: Ohio

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Palliative care 

Descriptive pre- and post-test design

• Brief Fatigue Inventory (BFI)
• Center for Epidemiologic Studies-Depression (CES-D)
• Pittsburgh Sleep Quality Index (PSQI)

Of the 38 participants, 38 completed the preintervention, 22 completed the postintervention, 16 did not attend the class, 15 completed the pre/post PSQI, and 19 completed the CES-D and BFI. There was a reduction in depression. The study found only CES-D scores to be improved postintervention, and all the scores were more favorable after the classes. Sleep scores were improved after classes.

This pilot study indicated a reduction in depression with the use of medical Qigong after five weeks. This is shorter than other studies in the literature that were performed over a 12-week period. The findings are limited by the small sample size.

• Small sample (< 30)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 
• Risk of bias (no appropriate attentional control condition)  
• Risk of bias (sample characteristics)
• Findings not generalizable
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Sample characteristics not well described; five-week intervention compared to 12 weeks in the literature; number subjects not completing various aspects of the program was high; specific training for this type of intervention might be impractical if you do not have someone who is an expert in Qigong; most participants were active, were motivated to learn, were not receiving cancer treatment, and reported a positive outlook and adequate social support; depression and fatigue interventions would likely not be a priority for this group

Complementary and alternative medicine therapies are an alternative to offer patients for symptom management, especially to potentially help with depression. Nurses can educate patients about these types of alternatives to alleviate the symptoms of cancer treatment and its aftereffects. The findings of this study were limited by the sample size and high rate of patients who did not participate and did not show the effects of the intervention.