Lipov, E. G., Joshi, J. R., Sanders, S., Wilcox, K., Lipov, S., Xie, H., … Slavin, K. (2008). Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncology, 9, 523–532.
To investigate the hypothesis that stellate ganglion block (SGB) can be a safe and effective treatment for hot flushes (HF) and sleep dysfunction in patients with breast cancer.
Thirteen women with breast cancer (in remission) experiencing severe HF and night awakenings were treated with SGB at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy. Patients recorded HF in a daily diary by use of the Hot Flash Score and night awakenings by use of the Pittsburgh Sleep Quality Index (PSQI). Both instruments were used one week before the procedure and then weekly after the procedure for 12 weeks. The generalized-estimating-equations method was used to analyze the longitudinal measurements of the number of HF and night awakenings over time.
This pilot study used a prospective, single-arm, pre/post design.
No adverse events resulted from the SGB, although patients had temporary Horner's syndrome, indicating the effectiveness of the block. Five patients had only one SGB, and eight had two SGBs. The total number of HF decreased from a mean of 79.4 (standard deviation [SD] = 37.4) per week before the procedure to a mean of 49.9 (SD = 39.9) per week during the first two weeks after the procedure (p = 0.0002). The total number of HF continued to decrease over the remaining follow-up period (weeks 3–12) and stabilized at a mean of 8.1 (SD = 5.6) per week (p < 0.0001). The number of very severe HF was decreased to near zero by the end of the follow-up period (week 12; p < 0.0001). Night awakenings decreased from a mean of 19.5 (SD = 14.8) per week before the procedure to a mean of 7.3 (SD = 7.1) per week during the first two weeks after the procedure (p < 0.0001). The total number of night awakenings continued to decrease over the remaining follow-up period (weeks 3–12) and stabilized at a mean of 1.4 (SD = 1.2) per week (p < 0.0001).
The findings suggest that SGB can provide survivors of breast cancer with relief from HF and sleep dysfunction, with few or no side effects. Long-term symptom relief has the potential to improve overall quality of life (QOL) and increase compliance with antiestrogen medications for breast cancer.
The findings suggest that SGB can provide breast cancer survivors with relief from HF and sleep disturbances, with potential to improve overall QOL.
Lipov, E.G., Joshi, J.R., Sanders, S., Wilcox, K., Lipov, S., Xie, H., … Slavin, K. (2008). Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: A pilot study. Lancet Oncology, 9, 523–532.
Researchers employed a pilot study to investigate the safety and effectiveness of a stellate-ganglion block to ameliorate hot flashes in women with breast cancer .
Anesthetic was injected at the anterolateral aspect of the C6 vertebra on the right side under fluoroscopy.
The study treated 13 breast cancer survivors who were experiencing severe hot flashes, night awakenings.
Participants recorded hot flashes in a daily diary by use of the Hot-Flash Score. Scores were recorded 1 week before the procedure and then weekly after the procedure for 12 weeks.
The total number of hot flashes decreased from 79.4 mean episodes to 49.9 in the first two weeks, and continued to decrease during the follow-up period to 8.1 per week. Night awakenings decreased from 19.5 mean episodes per week to 7.3 during treatment then to 1.4 per week during follow up. Very severe hot flash episodes decreased to near zero at follow up.
No adverse events resulting from the stellate-ganglion block were reported, although patients had temporary Horner’s syndrome indicating the effectiveness of the block.
This was a limited pilot study with a very small sample size.
Lipman, A.G., Karver, S., Cooney, G.A., Stambler, N., & Israel, R.J. (2011). Methylnaltrexone for opioid-induced constipation in patients with advanced illness: A 3-month open-label treatment extension study. Journal of Pain and Palliative Care Pharmacotherapy, 25, 136-145.
To provide access to methylnaltrexone for patients who participated in a prior study of the agent, and to continue to evaluate the safety and efficacy of methylnaltrexone in patients with opioid-induced constipation.
This open-label drug extension study recruited participants from both the control and active treatment groups of a prior methylnaltrexone study. All patients were at the end of life, were not pregnant, and were using birth control. Patient received methylnaltrexone 0.15 mg/kg subcutaneously as needed once per day. The dose was increased to 0.3 mg/kg if the agent was not effective in four hours. The dose was reduced to 0.075 mg/kg if the patient had adverse events.
This was a nonrandomized, single-arm, drug continuation study.
All patients (control group and active treatment group, as defined in the prior study) received a minimum of one drug dose. Patient laxation effect was similar between the active treatment (45.3%) and control (48.3%) groups. Most patients had an effect in less than one hour. Side effects included abdominal pain, nausea, and vomiting. Serious adverse events considered drug related were muscle spasms, abdominal pain, and pain exacerbation. The effect on patient pain levels was minimal. Opioid withdrawal symptoms ranged from none to mild.
Patients obtained benefit from methylnaltrexone for up to three months, and the agent was well tolerated.
Patients at the end of life who have an ongoing need for methylnaltrexone may continue to receive an effect from the drug for up to three months when it is used as needed.
Liossi, C., White, P., & Hatira, P. (2009). A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain, 142(3), 255–263.
To compare the efficacy of EMLA cream to EMLA plus hypnosis in the relief of venipuncture-induced pain and anxiety; to determine whether the intervention has a beneficial effect on parents’ anxiety levels during their child’s venipuncture
Patients arriving at the unit had 2.5 g EMLA cream 5% applied over a prominent vein. Those who agreed to the study were randomized to one of three groups: EMLA alone, EMLA plus hypnosis, or EMLA plus attention. Hypnosis included a 15-minute session with a therapist in a private room. The therapist provided analgesic suggestions and led the patient in relaxation. The attention group received a 15-minute session with the therapist and engaged in conversation unrelated to the procedure. Investigators collected measures of pain and anxiety immediately after the intervention and during two follow-up venipunctures. EMLA was removed after 60 minutes.
Randomized blinded, controlled trial
The study showed that hypnosis, used in conjunction with the local anesthetic EMLA, helped to decrease procedure-related pain anxiety, and distress in pediatric cancer patients. In addition, the intervention helped to decrease parental anxiety.
Oncology nurses in the pediatric setting may want to advocate for the use of hypnosis, along with local anesthetic, to decrease the pain and anxiety of venipuncture.
Lin, Y., Lin, L., Lin, S., & Chang, C. (2010). Discrepancy of the effects of zinc supplementation on the prevention of radiotherapy-induced mucositis between patients with nasopharyngeal carcinoma and those with oral cancers: subgroup analysis of a double-blind, randomized study. Nutrition & Cancer, 62(5), 682-691.
The purpose of this study was to determine the effect of zinc supplementation on radiation-induced mucositis in patients with nasopharyngeal carcinoma (NPC) and those with oral cancers (OC).
Patients were randomly assigned to experimental or control groups. The experimental group received 75 mg zine 4 times/day for three months during radiation therapy. Control group patients received soy bean capsules. Patients were evaluated if mucositis was detected, weekly. Patients were followed at 3 and 12 months post-radiation therapy completion. Side effects were evaluated by a blinded physician observer.
The study was comprised of 83 patients, age >18 years of age.
MALES 85.5%, FEMALES 14.5%
KEY DISEASE CHARACTERISTICS: 40 were patients with nasopharyngeal cancers (NPC) and 43 were patients with oral cavity cancers (OC).
OTHER KEY SAMPLE CHARACTERISTICS: zinc supplementation
SITE: Single site
PHASE OF CARE: Active treatment
Randomized double blind study
Serum zinc, cell count, blood urea nitrogen (BUN), creatinine, glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), transferrin, and body weight were checked one week prior to radiotherapy and were repeated biweekly until radiotherapy was completed. The serum zinc level was checked using the atomic absorption method.
The study found that there is a discrepancy in the effects of zinc supplementation in preventing mucositis between patients with NPC and those with OC, as there were significant effects of zinc supplementation in improving mucositis in patients with OC. Grade 2-3 mucositis occurred earlier in patients receiving placebo.
Further studies need to be done to investigate the effect of zinc supplementation in preventing the severity of mucositis in relation to the different radiation fields between those associated with patients diagnosed with oral cancer and nasopharyngeal cancer. This study was focused on subgroup analysis of a previous report.
Small sample <100
Zinc supplementation may be of benefit in the prevention of oral mucositis. It appears that efficacy may differ according to the specific type and location of the tumor.
Ling, C.C., Lui, L.Y., & So, W.K. (2012). Do educational interventions improve cancer patients' quality of life and reduce pain intensity? Quantitative systematic review. Journal of Advanced Nursing, 68(3), 511–520.
To complete a systematic review to evaluate the effect of patient education on the pain intensity, pain interference, and quality of life of patients with cancer
The search retrieved 68 references. Authors considered 23 references. Authors evaluated studies on the basis of methodological quality assessment; two independent reviewers assessed all studies by using the Jadad scoring system. In the event of a discrepancy, a third reviewer evaluated the study. Data were obtained by means of the PICO (participants, interventions, comparison, and outcomes) approach. The study employed six different instruments to measure quality of life across four studies; two instruments were used to evaluate pain (three studies used the Brief Pain Inventory).
Clinical applications: late effects and survivorship, palliative care
Pain scores decreased as a result of the educational interventions in each study, but effects of education on quality of life were not statistically significant.
A limited number of studies evaluating effects of education on cancer pain and quality of life are available. Based on available studies, education about pain has little effect on quality of life in the specified patient population.
Ling, W., Lui, L.Y.Y., So, W.K.W., & Chan, K. (2014). Effects of acupuncture and acupressure on cancer-related fatigue: A systematic review. Oncology Nursing Forum, 41, 581–592.
PHASE OF CARE: All phases
Seven out of eight acupuncture studies showed improvement in CRF, but only four reached statistic significance. All four acupressure studies showed significant improvement. The four studies that showed improvement during initial treatment determined that results could be maintained for as many as 12 weeks. However, the maintenance study did not determine any extra benefit. Three studies reported no side effects. In other studies, adverse events were identified as minor and transient. Four studies used acupressure. These showed positive results. However, three studies were underpowered, and the comparability of study groups was questionable.
Acupuncture and acupressure may be helpful in reducing fatigue. However, because of multiple methodologic flaws in studies reviewed, no firm conclusions can be made regarding the effectiveness of these interventions.
Acupuncture and acupressure appear to be safe and may be effective. Therefore, this intervention may be suggested for patients with CRF. Additional research is needed to confirm their effectiveness.
Lindquist, H., Enblom, A., Dunberger, G., Nyberg, T., & Bergmark, K. (2015). Water exercise compared to land exercise or standard care in female cancer survivors with secondary lymphedema. Lymphology, 48, 64–79. Retrieved from https://journals.uair.arizona.edu/index.php/lymph/article/view/18783
To determine if water exercise was more effective than land exercise and the current standard of care to reduce limb volume, body mass index (BMI), and perceptions of swelling in female cancer survivors with secondary lymphedema
Physical exercise does not worsen lymphedema and, based on the results from this study, female cancer survivors with secondary arm lymphedema experience decreased volume, BMI, and self-reported frequency of swelling after water exercise compared to land exercise. Conclusions about the value of land or water exercise as an intervention for female cancer survivors with secondary leg lymphedema cannot be drawn from this study because of the small number of subjects in that group.
Water exercise can be beneficial to female cancer survivors with secondary arm lymphedema. Further interdisciplinary research is needed to design studies that will lead to the development of guidelines/protocols specific to exercise for cancer survivors with secondary arm and leg lymphedema.
Lindemalm, C., Mozaffari, F., Choudhury, A., Granstam-Björneklett, H., Lekander, M., Nilsson, B., . . . Mellstedt, H. (2008). Immune response, depression and fatigue in relation to support intervention in mammary cancer patients. Supportive Care in Cancer, 16, 57–65.
To examine the effect of a support intervention on immune function and levels of depression, anxiety, and fatigue in patients with breast cancer after completion of surgery and adjuvant treatment
A total of 41 women were chosen from an ongoing prospective randomized study. The first patients in each stratum of treatment were chosen for current study. Twenty-one women received adjuvant combined radio-chemotherapy (CT-RT), and 20 women received radiotherapy (RT). Eleven CT-RT patients and 10 RT patients were randomized to the support group, while 10 CT-RT and 10 RT patients served as controls. The support intervention consisted of educational lectures about cancer etiology, risk factors, treatment, psychological and physical effects, and coping. Exercise, relaxation training, qigong, and art therapy were also included. The intervention was provided for one week and then for another four days two months later. Study measures were obtained at baseline, 2 months, 6 months, and 12 months.
Patients were in the transition phase after initial treatment.
A randomized controlled trial design was used.
There was no significant immune effect from the support intervention. More patients in the support group had higher anxiety scores at the start of the intervention compared to the nonsupport group. The mean value anxiety score in the support group was also higher compared to the nonsupport group and improved significantly over time. Low levels of depression were reported in both groups, with no significant difference in depression scores. There was no significant difference in fatigue, but fatigue significantly improved over time in all patients. There were no significant differences in study measures between groups.
The support intervention had no effect on depression or immune parameters. There was no difference in improvement of anxiety and fatigue over time associated with the intervention.
Findings do not support effectiveness of the intervention tested here. Results show that depression, anxiety, and fatigue improved significantly over time.
Lindemalm, C., Mozaffari, F., Choudhury, A., Granstam-Björneklett, H., Lekander, M., Nilsson, B., . . . Mellstedt, H. (2008). Immune response, depression and fatigue in relation to support intervention in mammary cancer patients. Supportive Care in Cancer, 16(1), 57-65.
To examine the effect of a support intervention on immune function and levels of depression, anxiety, and fatigue in breast cancer patients after completion of surgery and adjuvant treatment
Authors chose 41 women from an ongoing prospective randomized study. The first patients in each stratum of treatment were chosen for the current study. Of the 41 women, 21 received adjuvant combined radiochemotherapy (CT-RT) and 20 women received radiotherapy (RT). Eleven women (CT-RT) were randomized to the support group, and 10 women (RT) were randomized to the support group. Ten CT-RT and 10 RT patients served as controls. The support intervention consisted of educational lectures about cancer etiology risk factors, treatment, psychological and physical effects, and coping. Exercise, relaxation training, qigong, and art therapy were also included. The intervention was provided for one week and, two months later, for another four days. Study measures were obtained at baseline, 2 months, 6 months, and 12 months.
Phase of care: transition phase after initial treatment
Randomized controlled trial
The support intervention had no effect on depression or immune parameters. The intervention did not appear to cause any difference in improvement of anxiety and fatigue over time.
Findings do not support effectiveness of the intervention tested here. Results show that levels of depression, anxiety, and fatigue reduced significantly over time.