Meijer, A., Roseman, M., Milette, K., Coyne, J.C., Stefanek, M.E., Ziegelstein, R.C., . . . Thombs, B.D. (2011). Depression screening and patient outcomes in cancer: A systematic review. PloS One, 6(11), e27181.
To evaluate, by means of a systematic review, whether evidence supports systematic screening for depression as part of cancer care
Data from this analysis do not support the hypothesis that screening for depression improves depression-related outcomes.
More work is needed to determine how screening directly or indirectly affects depression-related outcomes. All patients should have access to depression care from a multidisciplinary team.
Mehnert, A., Veers, S., Howaldt, D., Braumann, K.M., Koch, U., & Schulz, K.H. (2011). Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie, 34, 248–253.
To investigate whether an exercise intervention reduces anxiety and depression, and improves quality of life, body image, and physical fitness in women with breast cancer
Patients were randomly assigned to the intervention or a wait list control group after a sports medicine assessment. The intervention group received structured group exercise training twice weekly for 10 weeks. Training sessions lasted 90 minutes, were done in small groups (five patients), and included two main components: (a) warm-up, dance and movement games, physiotherapeutic exercises, and relaxation, and (b) moderate walking and jogging outdoors. Patients wore heart monitors during exercise. Sessions were led by a physio- or sports medicine therapist. Outcome variables were measured at baseline and at the end of the 10-week study period.
A randomized controlled trial design was used.
Anxiety declined over time in all patients (p = 0.08), and ANOVA showed a significant interaction of the intervention (p = 0.03). The effect size in anxiety with the intervention was -0.54 (95% CI -1.06 to -0.02). Depression declined over time in all patients (p = 0.02), but there was no interaction effect with the intervention. Body image improved over time in all patients (p = 0.003), and there was a significant interaction effect of group assignment (p = 0.006); however, body image at baseline was also better in the intervention group. There were no differences between groups in symptom burden or quality of life.
Participation in this exercise intervention was associated with a significant decline in anxiety.
Study findings suggest that group exercise can be helpful in reducing anxiety in patients with breast cancer after completion of adjuvant treatment. These study results should be interpreted with caution given the high drop-out rate and study limitations.
Meghrajani, C.F., Co, H.S., Arcillas, J.G., Maano, C.C., & Cupino, N.A. (2015). A randomized, double-blind trial on the use of 1% hydrocortisone cream for the prevention of acute radiation dermatitis. Expert Review of Clinical Pharmacology, 9, 483–491.
To evaluate the efficacy of 1% hydrocortisone cream for the prevention of acute radiodermatitis
Patients were randomized to receive either 1% hydrocortisone or placebo cream. Patients were to apply the cream to the irradiated field twice daily beginning on the first day of radiation therapy until one week after the last radiation session. The cream was to be applied at least two hours prior to therapy. Patients were instructed not to use any other topical medications or deodorants during the study. In case of severe radiodermatitis, additional treatment was determined by the dermatologist. These patients were considered treatment failures and were included in the analysis. Patients were evaluated at one, two, three, four, and five weeks.
PHASE OF CARE: Active antitumor treatment
Four patients from each group developed moist desquamation by week 5. No difference existed between groups in preventing moist desquamation. At week 1, a higher incidence of grade 1 dermatitis was observed in the placebo group (p = 0.038), and at week 4, a higher occurrence of grade 2 dermatitis was observed in the placebo group (p = 0.017). Groups were comparable at weeks 3–5. The incidence of pruritus was less in the steroid group in weeks 4 and 5 (p < 0.04).
The findings suggest that the use of topical 1% hydrocortisone cream reduced pruritus and delayed the onset of radiation dermatitis. However, it did not prevent moist desquamation compared to the placebo.
Topical steroid cream was associated with less pruritus from radiodermatitis and may delay the onset of skin problems; however, it was not effective in preventing severe skin toxicity. Whether stronger formulations would be more beneficial is unclear. Patients can benefit from the use of topical steroids to reduce itching.
Mehdipour, M., Taghavi, Z., A., Asvadi, K., I., & Hosseinpour, A. (2011). A comparison between zinc sulfate and chlorhexidine gluconate mouthwashes in the prevention of chemotherapy-induced oral mucositis. Daru Journal of Faculty of Pharmacy Tehran University of Medical Sciences, 19(1), 71-73.
To evaluate the effectiveness of a zinc-containing mouthwash on chemotherapy-induced oral mucositis in comparison with chlorhexidine gluconate mouthwash as control.
Patients with acute myeloid leukemia under chemotherapy were allocated to an experimental and control groups of 15 patients each. The required dilution of 0.2% zinc sulphate and chlorhexidine gluconate mouthwashes. Subjects instructed to rinse with 10 ml of 0.2% zinc sulphate mouthwash twice a day for 14 days in the experimental group. The control group used 0.2% chlorhexidine mouthwash in the same manner. The mouthwashes were coded with A and B letters on the bottles, and the investigator, as well as the subjects were blinded to the type of the mouthwash, which was administered to the groups by a simple random method. All subjects were examined every other week for eight weeks.
The study was comprised of 30 patients, over 15 years of age.
MALES (%) Not specified, FEMALES (%) Not specified
KEY DISEASE CHARACTERISTICS: Acute myeloid leukemia
OTHER KEY SAMPLE CHARACTERISTICS: Subjects receiving an established treatment plan of Cytarabine in the induction phase and Novantrone in the consolidation phase were included in the study. Exclusion criteria included no subject <15 years of age. Allergy to zinc or chlorhexidine mouthwashes. Any systemic disease with other diagnosis of malignancies or chemotherapy-induced oral mucositis, any oral ulcers, or mucositis developed before starting chemotherapy.
SITE: Single site
LOCATION: The oncology ward of Shahid Gazi Hospital in Tabriz, Iran
PHASE OF CARE: Active treatment
APPLICATIONS: Acute myeloid leukemia
Randomized, double-blind, controlled
There were no significant differences between the case and control groups in the first week (p = 0.124). The trends of changes in the assessed oral mucositis index during the course of the study were similar in both groups. The mean a (alpha) index in both groups increased from the first week to the third week and then decreased in the fourth week. Although the mean a (alpha) index was generally lower in the test group compared to the control group at all four time intervals evaluated, repeated measure ANOVA revealed that the difference was statistically significant in weeks 2 and 3 (p = 0.025).
Zinc mouthwash used in conjunction with chemotherapy may reduce the severity of oral mucositis lesions in patients with leukemia.
The double-blind study is the most efficacious. Within the field of oncology, the occurrence of mucositis has always been associated as a side effect of chemo-radiation therapies. Mucositis is a result of radiotherapy and chemotherapy or a combination of the two. Thus, mucositis needs immediate and timely nursing interventions. The zinc mouthwash appears to be cost effective and easy to use. To this, clinical trials with randomized testing within the United States that support zinc mouthwash may be beneficial. Nurses who are in the oncology setting face challenges to plan and provide care that promotes the best possible health related outcomes for their patients.
Mego, M., Chovanec, J., Vochyanova-Andrezalova, I., Konkolovsky, P., Mikulova, M., Reckova, M., . . . Drgona, L. (2015). Prevention of irinotecan induced diarrhea by probiotics: A randomized double blind, placebo controlled pilot study. Complementary Therapies in Medicine, 23, 356–362.
To determine if the probiotic Colon Dophilus is able to prevent irinotecan-induced diarrhea in patients with metastatic colon cancer
Placebo versus probiotic Colon Dophilus. The probiotic was given three times per day for 12 weeks while the patient received irinotecan.
Probiotics reduced the incidence of grade 3 or 4 diarrhea compared with placebo (0% versus 17.4% for control group). Patients who used probiotics reported using fewer antidiarrheal medications.
Probiotics appear to be safe and may be of use in irinotecan-induced diarrhea.
More research on the use of probiotics and irinotecan-based chemotherapy is needed.
Meghrajani, C.F., Co, H.C., Ang-Tiu, C.M., & Roa, F.C. (2013). Topical corticosteroid therapy for the prevention of acute radiation dermatitis: A systematic review of randomized controlled trials. Expert Review of Clinical Pharmacology, 6, 641–649.
STUDY PURPOSE: To assess the efficacy of topical corticosteroids in the prevention of acute radiation dermatitis compared with placebo, other topical medication, or no treatment
PHASE OF CARE: Active antitumor treatment
Together, the studies showed that the prophylactic application of topical corticosteroids reduced the incidence of moist desquamation and lowered the mean acute radiation dermatitis scores.
The results of this systematic review and meta-analysis show that topical steroids may be likely to reduce the incidence of radiotherapy-induced moist desquamation of the breast. Additional well-constructed studies consistently implementing blinding and testing the same steroid formulation and route of administration are needed. Studies examining other radiation treatment sites are indicated.
Meegan, M.A., & Haycocks, T.R. (1997). An investigation into the management of acute skin reactions from tangential breast irradiation. Canadian Journal of Medical Radiation, 28, 169–173.
To determine if there is an adverse effect to irradiated skin when patients use their normal skin care regimens
Two consecutive groups of patients received tangential breast irradiation. The first group (group A) used the traditional skin care advice of using warm water only, avoiding the use of all lotion, soaps, and deodorants in the treatment field. The second group (group B) continued with their normal skin care regimen with no product restriction. Patients and therapists scored the skin reaction weekly and three weeks after treatment.
The study used a prospective trial design.
There were no significant differences found in skin assessment scores between groups. Reactions peaked at 7–10 days from completion of radiation. There was no difference in the skin scores between the two groups at that point. Patient self-scoring of the severity of the skin reaction revealed that group A consistently scored higher than group B, indicating greater level of problems.
There is no difference between the severity of skin reactions of patients using no products and those using their usual skin care products.
Mebel, D., Akagami, R., & Flexman, A.M. (2016). Use of tranexamic acid is associated with reduced blood product transfusion in complex skull base neurosurgical procedures: A retrospective cohort study. Anesthesia and Analgesia, 122, 503–508.
To determine the effect of tranexamic acid (TA) upon transfusion frequency and to explore the safety of TA in patients undergoing complex skull base neurosurgical procedures
The authors retrospectively examined records of patients undergoing complex skull base neurosurgical procedures. Patients were placed into one of two cohorts based upon administration of TA or not to determine the effect of TA on transfusion rates and TA-associated complications. Data were collected from patients undergoing the surgical procedure from 2001 to 2013.
PHASE OF CARE: Active antitumor treatment
Retrospective, observational cohort study
Multivariate regression was used to identify predictors of transfusion.
The administration of TA was associated with a decreased incidence of transfusions (95% confidence interval [CI] [0.15, 0.65], p = 0.002). No evidence of an adverse event profile (95% CI) existed for either thrombotic events (adjusted odds ratio (OR) = –0.09, 95% CI [–3.5, 1.8]) or seizure activity (OR = 1.1, 95% CI [–1.7, 3.9]) associated with TA.
In patients undergoing complex skull base neurosurgical procedures, this retrospective observational study compared transfusion frequency and TA-related adverse events between two cohorts based upon the administration of TA. A significantly decreased frequency of transfusions was associated with the administration of TA; no significant increase in TA-related adverse events was reported between the two cohorts.
Neurosurgical nurses caring for patients perioperatively may anticipate less need for transfusions in patients who receive TA perioperatively. However, the retrospective nature of this study needs confirmation of findings from future randomized, controlled trials.
Meattini, I., Francolini, G., Scotti, V., Cardillo, C.D.L., Cappelli, S., Meacci, F., . . . Mangoni, M. (2015). Aprepitant as prophylaxis of chemotherapy-induced nausea and vomiting in anthracyclines and cyclophosphamide-based regimen for adjuvant breast cancer. Medical Oncology, 32, 1–5.
To appraise the effectiveness and safety of a three-drug antiemetic prophylaxis treatment in patients with breast cancer receiving a regimen of 5-fluorouracil, epirubicin, and cyclophosphamide
All patients received the same antiemetic prophylaxis regimen consisting of aprepitant (oral 125 mg on day 1 and oral 80 mg on days 2 and 3), palonosetron (0.25 mg IV on day 1), and dexamethasone (12 mg IV on day 1). The acute phase was defined as the first 24 hours after chemotherapy, and the delayed phase was defined as days 2–5 following chemotherapy. Complete response (CR) was defined as no vomiting or rescue treatment, and complete protection was defined as no vomiting, no rescue treatment, and no significant nausea. Total control was defined as no vomiting, no rescue treatment, and no nausea. Data were collected for five days following the administration of chemotherapy.
Cross-sectional, descriptive, single-arm design (design was not specifically mentioned in the article)
Only cycle 1 data were used in this study. In the acute phase, 89.1% of patients achieved CR, and 81.5% achieved CR in the delayed phase. Complete protection was achieved in 67.4% of patients in the acute phase and 62.0% of patients in the delayed phase. Total control was achieved in 52.2% of patients in the acute phase and 48.9% of patients in the delayed phase.
Prophylaxis consisting of aprepitant, palonosetron, and dexamethasone was safe, effective, and highly recommended in patients receiving anthracycline-based regimens (although it is not classified as a highly emetogenic chemotherapy by all international guidelines). Additional controlled trials are strongly needed to better define the optimal approach in emesis prophylaxis.
The majority of patients in this study experienced CR in the acute and delayed phases after chemotherapy administration. Triple-drug therapy was an appropriate intervention for chemotherapy-induced nausea and vomiting prophylaxis in patients with breast cancer receiving anthracycline and cyclophosphamide treatment.
McQuade, J., Prinsloo, S., Chang, D.Z., Spelman, A., Wei, Q., Basen-Engquist, K., . . . Cohen, L. (2016). Qigong/tai chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: A randomized controlled trial. Psycho-Oncology. Advance online publication.
To examine the efficacy of qigong or tai chi to alleviate treatment-related fatigue and disturbed sleep in men who were undergoing radiotherapy for prostate cancer
PHASE OF CARE: Active antitumor treatment
Randomized, controlled trial
This study did not show improvements in fatigue scores reported in any group either during treatment or after. Improvements in sleep duration was reported by those in the qigong group when compared to the light exercise group and the wait-list control. Sleep disturbance remained higher than clinical cutoff for all groups. Adherence to attendance at intervention in all classes was 64%. Additional practice at home after radiotherapy ended was not assessed.
Men undergoing radiotherapy for prostate cancer are able and willing to participate in physical activity interventions, such as qigong and/or light exercise. Fatigue and sleep disturbance are common symptoms experienced by men undergoing radiotherapy for prostate cancer and may persist after treatment is complete. However, qigong improved sleep duration for participants during radiotherapy treatment. This study did not detect improvements in fatigue or sleep disturbance that were sustained over the three-month period of the study.
No side effects were reported in either intervention group (qigong or light exercise).