Newton, P.J., Davidson, P.M., Macdonald, P., Ollerton, R., & Krum H. (2008). Nebulized furosemide for the management of dyspnea: Does the evidence support its use? Journal of Pain & Symptom Management, 36(4), 424-441.
The objective of the study is to synthesize information regarding the effect of nebulized furosemide in managing dyspnea.
The final sample included 42 articles, including 39 randomized controlled trials; 2 studies in cancer, 35 in asthma, 8 studies in health volunteers, and 1 in chronic obstructive pulmonary disease.
Dyspnea was only measured in five studies reviewed.
This review demonstrates a lack of strong evidence in the area of nebulized furosemide for dyspnea and little evidence was found in the management of dyspnea in patients with cancer.
Newell, S.A., Sanson-Fisher, R.W., & Savolainen, N.J. (2002). Systematic review of psychological therapies for cancer patients: Overview and recommendations for future research. Journal of the National Cancer Institute, 94, 558–584.
The study involved searches of the MEDLINE, Healthplan, PsychLIT, and Allied and Complementary Medicine databases. The articles included were published prior to December 1998.
The study consisted of a critical review of psychological therapies used by patients with cancer. Authors identified 627 relevant articles reporting 329 intervention trials. Authors identified 11 papers discussing 15 trials of fair quality and exploring interventions aimed at reducing depression.
Despite increased use of RCT designs, the methodological quality was generally suboptimal.
No intervention can be recommended for depression reduction, but interventions involving group therapy, education, structured counseling, cognitive-behavioral therapy (CBT), communication-skills training, and self-esteem building warrant further exploration before recommendations can be made.
Newby, T.A., Graff, J.N., Ganzini, L.K., & McDonagh, M.S. (2015). Interventions that may reduce depressive symptoms among prostate cancer patients: A systematic review and meta-analysis. Psycho-Oncology. Advance online publication.
PHASE OF CARE: Multiple phases of care
The meta-analysis across all studies with all types of interventions showed a positive effect of intervention (p = 0.002). In four studies using exercise, there was no significant effect. Across three studies of psychosocial interventions, including psychotherapy and peer support, the was an overall significant effect (point estimate –0.961, p = 0.003). In two studies of educational interventions, there was no statistically significant effect.
The findings of this study suggest that psychosocial interventions can be effective in reducing depressive symptoms among patients with prostate cancer.
The majority of studies included were of low quality. The authors stated that in multiple-arm studies, outcomes were only used in certain selected study arms. For each subanalysis, there were few individual studies. There were some discrepancies in the report regarding the number of studies included. Samples were mixed in terms of inclusion of patients who did or did not have clinically relevant depressive symptoms. Most studies were brief, and the long-term benefits of the interventions were not clear.
Although this analysis provides relatively limited evidence regarding the effectiveness of individual types of interventions, its findings do suggest that some intervention is more effective than doing nothing. Nurses need to identify patients with symptoms of depression and those at risk for depression and take action.
Nes, A.G., & Posso, M.B. (2005). Patients with moderate chemotherapy-induced mucositis: Pain therapy using low intensity lasers. International Nursing Review, 52(1), 68–72.
Laser energy 35 J/cm2 once a day for five days after the development of chemotherapy-induced \"moderate\" mucositis.
Laser has an 830 nm wavelength with a potency of 250 mW.
Each patient was informed of the oral hygiene protocol:
Avoid spicy food acid fruits, alcohol, and food and drinks with high temperature.
Use a soft toothbrush and avoid dental floss.
Only use mouth solution provided by health personnel (3% bicarbonate).
Do not smoke.
The study was conducted March-August 2002.
Thirteen individuals were treated. Convenience sample for chemo-induced mucositis-related pain.
Mucositis was determined using the Brown methodology. Patients determined to have moderate mucositis (score 13-18) were included in the study.
Non-parametric study
VAS pain scale
Brown methodology for classification of mucositis.
Significantly lower pain (p = 0.007) after each treatment. Average pain reduction was 67%. Pain reduction across the five days of treatment was also significant (p = 0.000).
Authors note that after five days, pain is usually reduced to such an extent not to require further treatment.
Limited sample size, short study – no control
Other factors may have contributed to pain reduction, including normal healing and placebo effect.
Optimal energy level is not determined.
Cost is high, and treatment is not available at most centers.
Main focus of study was on pain .
Nelson, N.L. (2016). Breast cancer-related lymphedema and resistance exercise: A systematic review. Journal of Strength and Conditioning Research. Advance online publication.
PHASE OF CARE: Late effects and survivorship
Performing structured RET is safe and effective in increasing muscle strength in patients with breast cancer.
Nelson, K.A., Walsh, D., & Hussein, M. (2002). A phase II study of low-dose megestrol acetate using twice-daily dosing for anorexia in nonhormonally dependent cancer. American Journal of Hospice and Palliative Care, 19, 206–210.
To evaluate the efficacy of a low dose of megestrol acetate (MA) in debilitated patients with cancer experiencing cachexia
Participants received 80 mg of MA twice daily after meals. After a two-week treatment period, participants were evaluated for efficacy, side effects, and satisfaction.
Consecutive patients (convenience sample)
Patients with advanced cancer and any degree of weight loss were eligible for the study. Of the 20 patients who were evaluable,
Excluded from the study were patients with
This single-site study took place in a large midwestern city at a large academic medical center with a cancer center.
The study was a phase II trial with a nonrandomized design and a descriptive, observational setup.
Outcomes included appetite, satisfaction, and side effects. Appetite and satisfaction were evaluated using a questionnaire that included one question for appetite (0 = absent, 4 = better than normal) and one yes/no question on satisfaction (Are you satisfied with the way the medication affected your appetite?). This empirical indicator appears to have been developed by the research team, although this is not clearly explicated. Side effects were measured using a “Side Effect Profile” (a list of MA side effects developed from a number of previous studies using varying doses of MA).
Fifteen out of 20 patients were deemed “responders.” Most responders had an appetite change of one degree in the categorical question, and 16 answered that they were “satisfied” with the way the medication affected their appetite. There were no significant differences in results based on gender, age, or performance status. The third outcome, side effects, was not specifically reported according to the Side Effect Profile. Researchers reported that five patients developed symptoms not present before the study; in three patients, these were considered drug-related.
The researchers concluded that a low dose of MA given twice daily was an effective appetite stimulant in patients with advanced cancer.
Nejad, Z.K., Aghdam, A.M., Hassankhani, H., & Sanaat, Z. (2016). The effects of a patient-caregiver education and follow-up program on the breast cancer caregiver strain index. Iranian Red Crescent Medical Journal, 18(3), e21627.
To assess the benefit of an intervention of two face-to-face education sessions at the bedside and four interventions for patients with breast cancer and their caregivers
Sixty patients with breast cancer and their caregivers (60 pairs) were randomized to either the usual care group or the intervention group. Both groups received a comprehensive medication review and education after the pretest. The intervention group received two face-to-face education sessions reviewing a booklet that discussed patient needs; informational needs, such as nutrition, medication, rest, and activity; and chemotherapy side effect management, as well as four telephone calls assessing educational needs, followed by a post-test three weeks later.
The mean caregiver strain score of the intervention dropped from 8.3 (SD = 2) to 2.3 after the intervention. The paired t-test results indicated that both the intervention and control groups were statistically different after the intervention in terms of caregiver strain scores (p < 0.001).
The caregiver group that received the intervention showed a statistical improvement in the pretest/post-test caregiver scores. The results showed an impressive improvement in the reduction of caregiver strain.
The authors described a benefit from an oncology nurse-focused intervention to decrease caregiver strain and burden. This intervention lacked specificity. Further areas of exploration should be depression, anxiety, and future use of additional tools to assess the effectiveness. Future studies should obtain larger sample sizes.
Neary, N.M., Small, C.J., Wren, A.M., Lee, J.L., Druce, M.R., Palmieri, C., . . . Bloom, S.R. (2004). Ghrelin increases energy intake in cancer patients with impaired appetite: Acute, randomized, placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism, 89, 2832–2836.
To determine whether ghrelin stimulates appetite in patients with cancer who have anorexia. Ghrelin is an appetite-stimulating hormone.
Patients received ghrelin (5 pmol/kg/min) or saline; four patients received ghrelin then saline (n = 4) or saline followed by ghrelin (n = 3).
Patients were recruited from oncology clinics at Charing Cross Hospital (United Kingdom).
The study was a prospective, randomized, placebo-controlled, crossover clinical trial.
Energy intake from a buffet meal during saline or ghrelin infusion indicated there was a 31% increase in energy intake in patients during the ghrelin infusion, and greater meal appreciation (by 28 +/- 8%). No side effects of the ghrelin therapy were observed. No changes were reported in levels of insulin, glucose, or triglycerides. Patients recorded greater food consumption on the days they received the ghrelin.
Further investigations are needed before conclusions can be drawn.
National Comprehensive Cancer Network. (2015). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Adult cancer pain [v.2.2015]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/pain.pdf
The results of literature search were not provided, and the only database cited was PubMed.
These guidelines provided dosing recommendations for the use of nonsteroidal anti-inflammatory drugs, opioids, etc. for various levels of pain. It recommended many types of adjuvant pharmacologic and nonharmacologic interventions, from energy conservation to cognitive behavioral therapy. It specifically suggested opioids for breakthrough pain at a standard percentage of basal opioid dose, education, and anxiolytics for acute pain.
Many of the guidelines were based on consensus and did not provide specific information about the evidence for each recommendation. The scope of the guideline was holistic in nature but less clear in terms of the actual evidence base
These guidelines provided useful information about dosing, equivalents across multiple medication types, and strategies for opioid rotation but did not provide clarity in terms of the actual strength of recommendations based on evidence.
National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology: Myeloid growth factors [V.2.2016]. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/myeloid_growth.pdf
RESOURCE TYPE: Consensus-based guideline
PHASE OF CARE: Active antitumor treatment
Limited database to PubMed, no full evidence evaluation provided. Although they suggest prophylaxis based on a percentage risk and suggest chemotherapy dosages accordingly, it does not match current practice in which dosages and regimens may not always be standard, causing a lack of clarity for clinical implementation of these standards.
Both chemotherapy regimens as well as patient-specific risk factors need to be considered to determine patients’ level of risk for developing FN. CSFs have been shown to reduce the incidence of FN and some infection events; however, evidence suggests that relevant guidelines and recommendations regarding the use of CSFs are not routinely followed in clinical practice. Nurses can advocate for adherence to CSF prophylaxis in at-risk patients.