Lewis, L., Carson, S., Bydder, S., Athifa, M., Williams, A.M., & Bremner, A. (2014). Evaluating the effects of aluminum-containing and non-aluminum containing deodorants on axillary skin toxicity during radiation therapy for breast cancer: A 3-armed randomized controlled trial. International Journal of Radiation Oncology, Biology, Physics, 90, 765–771.
To evaluate the effects of aluminum- and nonaluminum-containing deodorants
Patients were randomly assigned to use (a) just soap and water, (b) nonaluminum-containing deodorant and soap and water, or (c) aluminum-containing deodorant and soap and water. Low irritant soap was provided to study participants for use, as were both deodorants. The axilla of the breast or chest wall undergoing radiation was assessed weekly. One month after completion of treatment, patients were interviewed to assess their compliance with the treatment assignment.
PHASE OF CARE: Active antitumor treatment
Randomized, controlled, three-arm trial
There were no skin toxicities at two weeks, and at four weeks, less than 5% in all groups had at least grade 2 skin toxicity. At seven weeks, 66.7% of 12 remaining aluminum-containing users, 80% of the remaining 10 nonaluminum-containing deodorant users, and 58.8% of the 17 remaining controls had at least grade 2 toxicity. There was no statistically significant difference in axillary skin toxicity associated with study group, and there were no significant differences among groups in pain, itch, or burning sensation.
This study found no evidence that aluminum- or nonaluminum-containing deodorant use had an adverse effect on axillary skin toxicity during radiation therapy.
This study demonstrated that the use of deodorants, including aluminum-containing deodorant, did not adversely effect skin reactions during radiation therapy for breast cancer. Nurses can educate patients that they do not need to avoid using such deodorants during radiation therapy.
Lewis, F.M., Casey, S.M., Brandt, P.A., Shands, M.E., & Zahlis, E.H. (2006). The Enhancing Connections program: Pilot study of a cognitive-behavioral intervention for mothers and children affected by breast cancer. Psycho-Oncology, 15(6), 486–497.
The Enhancing Connections program is a five-session multicomponent cognitive behavioral educational counseling intervention delivered at two-week intervals. Each session is scripted and lasts one hour. Components include home-based interactive didactics for mothers, experiential exercises, skilled efficacy-enhancing rehearsals led by a patient educator, mother-child booklets about cancer, mother-child workbooks, and between-session telephone access to a patient educator.
13 mothers with stage 0, I, and II breast cancer and 13 school-age children
Pacific Northwest of the United States
Single-group pre- and post-test design
Maternal measures: Center for Epidemiological Studies Depression Scale, State-Trait Anxiety Inventory Form Y, and Cancer Self-Efficacy Scale.
Mother-child measures: Relatedness Scale and Family-Peer Relationship Scale.
Child measures: Illness-related Pressures Scale, Cancer-Worries Scale, Disenfranchised Grief Scale, Revised Child Manifest Anxiety Scale, Child’s Depression Inventory, and the Child Behavior Problem Checklist.
The program resulted in significant improvements between baseline and post-test in mother’s depressed mood, state anxiety, and self-efficacy in regard to caring for self and family and dealing with the impact of cancer. For children, the program resulted in significant improvements in behavior and emotional functioning, in anxiety or depressed mood, and in reduction of cancer worries.
Evidence suggests that the Enhancing Connections program helped mother and children improve functioning.
Lewis, F.M., Cochrane, B.B., Fletcher, K.A., Zahlis, E.H., Shands, M.E., Gralow, J.R., . . . Schmitz, K. (2008). Helping Her Heal: A pilot study of an educational counseling intervention for spouses of women with breast cancer. Psycho-Oncology, 17, 131–137.
To enhance spouses’ skills and confidence in communicating and interpersonally supporting their wives with breast cancer
To improve spouses’ self-care, depressed mood, anxiety, and marital adjustment
Baseline measures of the six study scales were obtained: depression, spouse skills, anxiety, self-efficacy of spouse, marital quality, and interpersonal sensitivity and mutuality. Five one-hour sessions were scheduled and delivered at two-week intervals. Details of the fully scripted educational counseling intervention session were described, and content was presented in a tabular format. Homework for each participant to complete with his wife was assigned to build skills and enhance efficacy. An exit interview with each participant and his wife was conducted. Post-test measures were taken.
A pre/post-test pilot study design was used.
Depressed mood and anxiety were significantly (p = 0.001 and p < 0.001, respectively) diminished; self-efficacy was significantly improved; spousal skills were significantly (p < 0.001) improved; and marital quality was significantly (p = 0.028) improved but only on one of the affectional expression subscales. There was no significant improvement on the other subscales of marital quality. There were no significant changes in the cancer-specific measure of marital quality. Spouses verbalized that the educational counseling intervention was helpful, specifically for listening skills.
A brief, structured, skill-focused, efficacy-enhancing educational counseling intervention has the potential to positively affect spouses’ adjustment (mood and anxiety), skills, self-efficacy, and self-care during the diagnosis and treatment phase of their wife’s breast cancer. The program focuses the intervention on the spouse to reduce tension and improve interpersonal communication regarding the wife’s diagnosis, treatment, feelings, and associated emotions.
The Helping Her Heal program offers promise to assist with building coping skills and support strategies for couples by educational counseling intervention among spouses of people with breast cancer and other chronic conditions.
Levine, M.E., Gillis, M.G., Koch, S.Y., Voss, A.C., Stern, R.M., & Koch, K.L. (2008). Protein and ginger for the treatment of chemotherapy-induced delayed nausea. Journal of Alternative and Complementary Medicine, 14, 545–551.
To determine the extent to which protein meals along with ginger, when used as adjuvant therapies for standard antiemetic treatment, reduce delayed nausea
Patients were assigned randomly to 1 of 3 experimental groups. The Protein (P) and High Protein (HP) Groups received test meals of varying protein content and dried powdered ginger root in addition to standard antiemetic medication; the Control Group received only standard antiemetic medication.
The P and HP Groups were asked to consume two test meals daily for three days beginning 24 hours after their first chemotherapy session. Patients in the Control Group consumed their normal diet.
Patients completed daily diaries during the three-day study. Investigators called patients daily to monitor for adverse events, answer questions, remind patients to eat the test meals, and remind them to complete diaries.
The setting was not reported.
All patients were in active treatment.
This was a randomized controlled trial, non-blinded study.
An Electrogastrogram Symptom Diary was used to report nausea symptoms incidence, frequency, and intensity. Patients also recorded use of as-needed antiemetics.
High-protein meals with ginger reduced delayed nausea associated with chemotherapy and use of antiemetic medications.
The limitations of this study limit the ability to draw conclusions for nursing practice.
Levesque, M., Savard, J., Simard, S., Gauthier, J.G., & Ivers, H. (2004). Efficacy of cognitive therapy for depression among women with metastatic cancer: A single-case experimental study. Journal of Behavior Therapy and Experimental Psychiatry, 35, 287–305.
A statistically significant improvement in fatigue level was seen.
Leung, H.W., & Chan, A.L. (2016). Glutamine in alleviation of radiation-induced severe oral mucositis: A meta-analysis. Nutrition and Cancer, 68, 734–742.
STUDY PURPOSE: To assess the effectiveness of glutamine to treat severe mucositis induced by radiation therapy in patients with head and neck cancer
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care
Glutamine treatment had statistically significant benefits: It (a) reduced the risk and severity of OM (grade IV) (RR = 0.17, 95% confidence interval [0.06, 0.47]) and (b) shortened the duration of OM by 2–3 days. The studies reviewed had a low risk of overall bias.
The protective effects of glutamine for radiation and chemotherapy-induced mucositis are promising. Glutamine or alanyl-glutamine accelerated the mucosal recovery through increasing mucosal tissue glutathione stores, reducing inflammatory parameters and speeding re-epithelization.
Large prospective, comprehensive clinical trials are needed to investigate the effectiveness of glutamine in the prevention of OM induced by radiation therapy or chemoradiotherapy.
Leung, N., Furniss, D., & Giele, H. (2015). Modern surgical management of breast cancer therapy related upper limb and breast lymphoedema. Maturitas, 80, 384–390.
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Palliative care
The most useful procedure out of those reviewed was lymphatic vessel anastomosis. The least recommended was lymph node transfer because of conflicting data and potential complications. The remaining reviewed options would be effective based on individual cases and needs.
The findings of this systematic review showed that initiatives to do primary research and data collection would be useful. This may be an area in which nurses can contribute.
Leung, E.Y., Tirlapur, S.A., & Meads, C. (2015). The management of secondary lower limb lymphoedema in cancer patients: A systematic review. Palliative Medicine, 29, 112–119.
STUDY PURPOSE: To evaluate the evidence for the treatment of lower limb lymphedema in patients with cancer
PHASE OF CARE: Late effects and survivorship
The treatments included in this study were compression stockings, coumarin, pneumatic compression devices, microsurgery, manual lymphatic drainage, and an herbal remedy combining coumarin ginkgo and melitoto. There was a high risk of bias among the studies. Various methods of measuring limb volume were used. All studies reported favorable outcomes with a reduction of limb excess volume from 6.8% to 20%. The largest effect was reported with complete decongestive therapy. Some studies included patients with lymphedema etiologies other than cancer. Only one study using each type of intervention was found.
The effectiveness of various treatments for lower limb lymphedema are unclear because of the very limited evidence in this area.
There is very little evidence regarding the efficacy of various interventions for lower limb lymphedema in patients with cancer. Lymphedema can be disabling, and effective interventions have not been identified. This is an area in which additional, well-designed research is needed.
Letellier, M., Towers, A., Shimony, A., & Tidhar, D. (2014). Breast cancer-related lymphedema: A randomized controlled pilot and feasibility study. American Journal of Physical Medicine & Rehabilitation, 93, 751–763.
To assess whether conducting a larger randomized, controlled trial of aqua lymphatic therapy (ALT) would be feasible and to estimate the extent to which ALT combined with home-based exercise compared with home-based exercise alone would reduce arm disability in patients with breast cancer-related lymphedema
Twenty-five women were randomly assigned to one of two groups, either ALT combined with home-based exercises or home-based exercises alone. Each woman was assessed before the intervention and after the 12-week intervention with pool-based therapy exercises. Arm volume, arm disability, pain, and quality of life were measured.
Single-blinded, randomized, controlled pilot study
No reductions were found in limb volume in either group. Participants in the ALT group showed significant beneficial changes after 12 weeks of treatment, specifically on the Palliative Prognostic Index (PPI) score when compared to the control group (p = 0.025). There were no other significant improvements between groups. Within groups, there were significant improvements pre- and postintervention in healthy arm grip strength (p = .001 for both groups), affected arm grip strength (p = .008 for both groups), DASH scores (p = .016 in ALT group), FACT-B scores (p = .021 in ALT group), and PPI scores (p = .025 in ALT group).
A larger randomized, controlled trial would be feasible. ALT showed significant improvement in grip strength and DASH, FACT, and PPI scores after 12 weeks of ALT treatment. The intervention did not make lymphedema volume worse, and therefore it may be a safe alternative to land-based treatments of breast cancer-related lymphedema.
In this study, ALT showed no benefit in arm volume reduction over the control group. ALT was, however, effective at reducing pain intensity scores in the experimental group. Nurses should be aware that ALT does not appear to worsen limb volume in women with breast cancer who have been diagnosed with lymphedema, but it also does not improve limb volume. Nurses should note that ALT may be one potential intervention to help reduce the intensity of pain in breast cancer survivors with lymphedema.
Lesser, G. J., Case, D., Stark, N., Williford, S., Giguere, J., Garino, L. A., . . . Wake Forest University Community Clinical Oncology Program Research Base. (2013). A randomized, double-blind, placebo-controlled study of oral coenzyme Q(10) to relieve self-reported treatment-related fatigue in newly diagnosed patients with breast cancer. Journal of Supportive Oncology, 11, 31–42.
To determine the effect of coenzyme Q10 (CoQ10) on self-reported fatigue, depression, and quality of life.
Patients were women with breast cancer and planned adjuvant chemotherapy randomized to oral supplements of 300 mg of CoQ10 or placebo, each combined with 300 IU of vitamin E in three daily doses. The intervention began within four days of starting chemotherapy and was continued for 24 weeks. All study assessments were conducted at baseline and 8,16, and 24 weeks. Serum CoQ10 and vitamin E levels were used to measure adherence to the study medications.
Patients' homes in South Carolina
Patients were undergoing the active antitumor treatment phase of care.
This was a randomized, placebo-controlled, double-blind trial.
The study used multiple instruments with the primary outcome of fatigue:
No significant differences existed between the CoQ10 and placebo arms at 24 weeks for scores on the outcome instruments measuring fatigue. In addition, no significant differences were found on secondary outcomes, such as quality of life measured by the FACT-Brease Cancer (BC) instrument or the Center for Epidemiologic Studies Depression (CESD) Scale measuring depression.
Supplementation with conventional doses of CoQ10 led to sustained increases in plasma CoQ10 levels but did not result in improved self-reported fatigue or quality of life after 24 weeks of treatment.
The study suggests that no evidence exists that using standard-dose CoQ10 supplementation to target fatigue in newly diagnosed women with breast cancer is effective in ameliorating treatment-related fatigue.