Mentes, S.D., Unsal, D., Baran, O., Argun, G., & Ertunc, F.N. (2005). Effect of sedation with midazolam or propofol on patient’s comfort during cancer chemotherapy: A prospective, randomized, double-blind study in breast cancer patients. Journal of Chemotherapy, 17, 327–333.
The trial had three arms: Group 1 – chemotherapy control, Group 2 – chemotherapy plus midazolam, and Group 3 – chemotherapy plus propofol.
The study reported on a sample of 45 patients with breast cancer (s/p mastectomy, second chemotherapy).
Turkey
A randomized controlled trial design was used.
Clinical Global Impression Scale (CGI) for anxiety
Midazolam and propofol significantly decreased anxiety, with propofol being better.
It is unclear which groups completed the CGI measure.
Meneses-Echavez, J.F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Effects of supervised multimodal exercise interventions on cancer-related fatigue: Systematic review and meta-analysis of randomized controlled trials. BioMed Research International, 2015, 328636.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Palliative care
Supervised multimodal exercise programs resulted in an overall reduction of fatigue in cancer survivors (SMD = –0.23, p = 0.001) with low statistical heterogeneity. Slight evidence of publication bias was noted. Length (weeks of training), frequency (sessions/week), and duration (minutes/session) were linearly associated with overall improvement in CRF (Tau squared = 0.04, p = 0.04). Aerobic exercise, resistance training, and stretching were implemented in seven of the nine studies, and the pooled effect estimate showed significant reductions in CRF (SMD = –0.35, p = 0.01). Two studies used resistance training, and the pooled effect estimate showed no significant reductions in CRF (SMD = –0.17, p = 0.3). Reported adverse events occurred infrequently (n = 7 events, one requiring hospitalization). Most studies were conducted during treatment (chemotherapy) and resulted in significant reductions of CRF (SMD = –0.23, p < 0.0001). No significant reductions in CRF were reported after anticancer treatment (p = 0.1).
Supervised multimodal exercise programs implemented during treatment are supported as an intervention for reducing CRF.
Supervised multimodal exercise programs are safe and beneficial for patients receiving anticancer therapy. Referrals to exercise professionals to plan a personalized exercise program for patients with cancer is recommended.
Meneses-Echavez, J.F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Supervised exercise reduces cancer-related fatigue: A systematic review. Journal of Physiotherapy, 61, 3–9.
PHASE OF CARE: Active
The interventions had a mean duration of 17 weeks (SD = 12) with an average of three sessions (SD = 1) per week. The mean session duration was 45 minutes (SD = 29). The interventions included aerobic exercise (i.e., walking, stationary cycling) in all trials, resistance training in six trials (55%), and stretching/flexibility exercises in four trials (36%). Training intensity varied considerably among studies, ranging from 50%–90% of maximum heart rates. All studies reported pre-exercise screening before high intensity physical training. The overall meta-analysis showed that supervised physical activity had a favorable effect on cancer-related fatigue when compared to conventional care. The final analysis of the results revealed that supervised physical activity interventions were effective in the management of cancer-related fatigue for all types of cancer. The favorable effect was no longer significant at the six-month follow-up. However, more participants in the intervention group continued to exercise.
This study provides additional support for exercise in management of cancer-related fatigue during active treatment, in this case supervised activity. It reinforces the role of physiotherapy in the management of cancer-related fatigue.
Publication bias may have been present, but it was not possible to test for it because of the small number of included studies. Heterogeneity was present in most of the meta-analyses. This may be because of the range of sample sizes, the diverse exercise regimens (in terms of length, duration, and intensity) evaluated, and the wide variety in outcome measurement tools used in the included studies
Nurses can continue to recommend exercise as an intervention for cancer-related fatigue. However, additional research is still needed on the type, frequency, intensity, and duration of exercise.
Meneses-Echavez, J.F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: A systematic review and meta-analysis. BMC Cancer, 15, 77-015-1069-4.
PHASE OF CARE: Multiple phases of care
All trials included aerobic training, and six included resistance training. The average duration of training was 21 weeks, and the average sessions per week was 2.5. Supervised aerobic exercise was more effective than usual care in improving fatigue (SMD = –0.51, 95% confidence interval [CI] [–0.81, –0.21]). SMD for resistance training was –0.41 (95% CI [–0.76, –0.05]). No dose response for training intensity was seen. Studies conducted during active treatment showed a significant benefit in reducing fatigue (SMD = –0.66, p < 0.05). In four studies conducted after cancer treatment, the effects of exercise on fatigue were not significant. Exercise improved physical well-being, but no significant effects were observed for social and emotional domains.
Supervised aerobic training during cancer treatment was associated with a significant improvement in fatigue.
Exercise during cancer treatment has been shown to reduce fatigue. This study suggests that the results may be best with aerobic exercise. The optimum intensity and “dosage” of exercise at various time points in cancer treatment remain unclear.
Melchart, D., Ihbe-Heffinger, A., Leps, B., von Schilling, C., & Linde, K. (2006). Acupuncture and acupressure for the prevention of chemotherapy-induced nausea: A randomised cross-over pilot study. Supportive Care in Cancer, 14, 878-882.
To study the effectiveness of acupuncture and acupressure in reducing chemotherapy-induced nausea
Patients were treated for one cycle of chemotherapy with acupuncture and acupressure at point P6 and for one cycle at a close sham point. Participants were randomized to acupuncture at P6 or at a close nonacupuncture point, and it was delivered by one of two physicians with training and experience in acupuncture. Participants wore acupressure bands for 72 hours at the same points on both arms and could wear them for an additional four days if needed. The bands were covered with a mull bandage to blind the staff. Participants completed diaries for seven days, documenting intensity (on a 0-6 rating scale), frequency, and duration of nausea and vomiting; additional antiemetics taken; and, on day 7, rate the effectiveness of side effects or impairment by acupuncture or acupressure. Patients completed the Morrow Assessment of Nausea and Emesis (MANE). Oncology staff checked that the diaries were completed accurately, standard antiemetics regimens were followed, and if any adverse reactions related to acupuncture occurred.
The study was conducted by the hematology and gastroenterology departments of a large university hospital in Germany.
This was a randomized, crossover pilot study.
Meissner, W., Leyendecker, P., Mueller-Lissner, S., Nadstawek, J., Hopp, M., Ruckes, C., . . . Reimer, K. (2009). A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. European Journal of Pain (London, England), 13, 56-64.
To assess the impact of orally administered prolonged-release (PR) naloxone on the analgesic effectiveness of PR oxycodone and on constipation in patients with severe chronic pain.
The study comprised three phases:
This was a prospective, placebo-controlled, randomized, double-blind, parallel-group, phase II study.
The study provided evidence that a combination of PR oxycodone/PR naloxone in a 2:1 ratio could enable patients with chronic pain to achieve both adequate pain control and bowel evacuation function.
The study only looked at oxycodone for pain control and did not include many patients with cancer.
An oral combination of PR oxycodone/PR naloxone in a 2:1 ratio seems to improve bowel function without compromising analgesia in patients with chronic pain. Additional study should include patients with cancer and a variety of other opioids.
Meissner, W., Schmidt, U., Hartmann, M., Kath, R., & Reinhart, K. (2000). Oral naloxone reverses opioid-associated constipation. Pain, 84, 105–109.
To evaluate the use of oral naloxone for the management of opiate-associated constipation in patients with cancer.
Patients were observed for six days without intervention. Afterward, oral naloxone was titrated as follows: 3 mg TID (day 1), 6 mg TID (day 2), 9 mg TID (day 3), 12 mg TID (day 4; maximum). Titration was stopped with laxation or increased peristalsis.
Hospital in Germany
This was a controlled study with a control period, but not a control group.
Starting with a low dose of naloxone and titrating up is recommended.
Meirow, D., Rabinovici, J., Katz, D., Or, R., & Ben-Yehuda, D. (2006). Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer, 107, 1634–1641.
Medical information was collected from a computer database. Patients received either DMPA or D- tryptophan -6-leutenizng hormone-releasing hormone agonist (GnRH-a) or no treatment before myelosuppressive chemotherapy.
Four patients were excluded because of gynecologic pathology. Average days of thrombocytopenia was 24.75 +/- 23.6 days. There was no statistical significant difference between groups regarding duration of thrombocytopenia. There was no difference in moderate to severe nonvaginal bleeding. There was no difference in platelet /packed red blood cells and fresh frozen plasma transfusions. Moderate/severe vaginal bleeding occurred in 16.8%—both treatment groups had lower rates of menorrhagia than untreated groups. None of the GnRH-a group had moderate/severe vaginal bleeding (p-0.002). There was a need for urgent gynecologic consult—untreated versus treated (P < 0.0001). Urgent treatment with estrogen was needed in the DMPA group but not the GnRh-a group (P = 0.004).
Meiri, N., Ankri, A., Hamad-Saied, M., Konopnicki, M., & Pillar, G. (2016). The effect of medical clowning on reducing pain, crying, and anxiety in children aged 2–10 years undergoing venous blood drawing—A randomized controlled study. European Journal of Pediatrics, 175, 373–379.
To compare the use of medical clowning with the use of local anesthetic cream or the use of no intervention on pain in children undergoing a procedure
The study authors evaluated the use of a trained medical clown with the application of an anesthetic cream or no intervention on the effect on children’s pain and anxiety associated with a procedure. The control group underwent a blood draw/venipuncture without any intervention. The medical clown group had the clown distract and entertain the child from 10 minutes before as well as during and after the procedure. The final group had children given a local anesthetic containing a mixture of lidocaine and prilocaine 50 minutes prior to the blood draw/venipuncture. Duration of crying was measured by an independent observer, pain level was assessed by the child using the visual analog scale (VAS) for pain, and pain and anxiety were also assessed from the parents' perspective using VAS for pain and anxiety during a follow-up phone call.
The duration of the child crying was significantly shorter with the clown group than in the control group (p = 0.01). The duration of crying prior to the procedure was significantly shorter in the clown group compared to the EMLA cream group (p < 0.05) and control group (p < 0.01). The child’s assessment of pain was significantly less in the EMLA group compared to the control group (p = 0.04), but no difference existed between the clown and control groups. The parent’s assessment of the child’s pain was lowest in the clown group (p < 0.05 between all groups). Parent’s assessment of future anxiety was significantly lower in the clown group than the EMLA group or control group (p < 0.05).
The use of the medical clown had a positive effect on parents’ anxiety for future venipuncture as well as anticipatory crying duration and perception of pain in children.
Nurses should be aware of alternative methods such as the use of a medical clown for distracting or controlling children’s pain. Although medicine is shown to have a significant effect on the child’s pain, these methods can assist with both children and parents’ anxiety and management of pain.
Meiri, E., Jhangiani, H., Vredenburgh, J.J., Barbato, L.M., Carter, F.J., Yang, H.M., Baranowski, V. (2007). Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Current Medical Research and Opinion, 23(3), 533-543.
To compare the effectiveness of dronabinol alone or in combination with ondansetron versus ondansetron alone for delayed, chemotherapy-induced nausea and vomiting (CINV) among patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in multiple cancer centers
The study was conducted at multiple cancer centers.
This was a randomized, double-blind, placebo-controlled, parallel-group study.
The following measurement instruments were used.
Difficulties in enrollment led to early termination of this study.