Keefe, F.J., Ahles, T.A., Sutton, L., Dalton, J., Baucom, D., Pope, M.S., . . . Scipio, C. (2005). Partner-guided cancer pain management at the end of life: A preliminary study. Journal of Pain and Symptom Management, 29, 263–272.
Intervention goals were to
Three 45- to 60-minute face-to-face sessions with an RN educator for training in pain management strategies were delivered over one to two weeks. Educators were knowledgeable about cancer pain and skilled in coping skills training interventions. Four educators were used, and quality assurance plans were described.
For sessions 2 and 3, the educator guided participants through skills, partners were asked to serve as coach, and the educator provided feedback.
Following completion of the three sessions, the educator reviewed the coping skills found most useful and developed a maintenance plan.
Home setting
A properly randomized, controlled trial design was used (with small sample size). Power analysis was not reported.
A trend toward reporting lower levels of caregiver strain (p = 0.06) existed.
Partners receiving the intervention reported significantly higher levels of self-efficacy for helping patients control pain and significantly higher levels of self-efficacy for helping patients control other symptoms.
No significant difference was found in positive or negative mood.
Kee, B.K., Morris, J.S., Slack, R., Crocenzi, T., Wong, L., Esparaz, B., . . . Fisch, M.J. (2015). A phase II, randomized, double blind trial of calcium aluminosilicate clay versus placebo for the prevention of diarrhea in patients with metastatic colorectal cancer treated with irinotecan. Supportive Care in Cancer, 23, 661–670.
To determine whether the oral administration of calcium aluminosilicate clay (CASAD) reduces the rate of grade 3 diarrhea associated with irinotecan administration in patients with colorectal cancer
Patients were provided with CASAD or placebo capsules. The treatment arm received capsules containing 500 mg of the active compound taken as two tablets four times daily. Treatment lasted for six weeks or until treatment criteria were met. After six weeks, all patients were offered off-label CASAD for an additional six weeks. Patients who developed diarrhea were provided standard-of-care antidiarrheal medication. Patients completed baseline assessments of bowel statuses and additional assessments at three, five, and six weeks. Daily bowel logs were completed by patients and reviewed at the third, fifth, and sixth provider visits.
This was a phase II, randomized, double-blinded, multicenter study. Patients were randomized on a 1:1 ratio to receive CASAD or a placebo. Patients were stratified according to irinotecan therapy, no concurrent therapy, or concurrent therapy in addition to irinotecan.
There were no differences between groups. In the CASAD arm, seven out of 49 patients in the CASAD arm versus three out of 46 patients in the placebo arm developed grade 3 diarrhea during the first six weeks (PR = 0.10). The incidence of any grade of diarrhea was similar in both arms. There was no difference in gastrointestinal (GI) toxicities between the two groups.
CASAD was ineffective in preventing diarrhea in this patient population. There were no issues with GI toxicities, indicating that CASAD was clinically safe.
CASAD is not indicated as a preventive measure for diarrhea associated with irinotecan administration.
Kedge, E.M. (2009). A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients. Radiography, 15, 247–257.
To systematically review the currently available high-quality evidence evaluating treatments for moist desquamation in patients receiving radiotherapy
Databases used were AMED, BIOMED, BIOSIS, BNI, British Library Integrated Catalogue, CINAHL, Cochrane, Current Controlled Trials, DARE, Dissertation Abstracts, DoH Research Findings Register, EMBASE, HSRProj, IBSS, Index to Theses, ISI Wok, Medline, National Cancer Research Network, National Register of Cancer Trials, National Research Register, PROQUEST, and ZETOC. Keywords searched were radiotherapy, radiation therapy, deep x-ray therapy, irradiation, wounds, moist desquamation, desquamation burns, radiation burns, radiotherapy burns, broken skin, ulcers, wound healing, skin care, wound care, and epithelial. Studies were included if they
Studies were excluded if they
The search returned 166 articles. Of these, 20 were relevant. Only 10 were included in the review. Studies were evaluated for quality using the CASP guidelines for clinical trials. Of the 10 studies that met inclusion criteria, none were judged to be of very poor quality, so all were included in the review. Studies were not homogenous in interventions or variables examined, so no meta-analysis was undertaken. A qualitative overview of results is presented.
No convincing evidence for any intervention was found. Evidence was mixed concerning the use of hydrogel and hydrocolloid dressings; however, improved patient comfort was sometimes seen with these. Other dressings studied did not show positive results and comparison dry dressings may cause injury of granulating tissue with daily removal for treatment. A number of other types of dressings that might be useful were briefly identified, but there are no reports of research using these yet. Limited evidence supports other interventions. Most findings with topical agents were equivocal. In one study, hydrocortisone cream appeared to reduce healing time (abstract only).
Although the author states that the 10 studies included were all of sufficient quality for use according to the guidelines used, results reported per study indicate that one study may have reported information that was untrue, one study was identified as being poorly reported with insufficient information, and one study was identified as fairly low quality.
Well-designed research in this area is urgently needed.
Keat, C.H., Phua, G., Abdul Kassim, M.S., Poh, W.K., & Sriraman, M. (2013). Can granisetron injection used as primary prophylaxis improve the control of nausea and vomiting with low- emetogenic chemotherapy? Asian Pacific Journal of Cancer Prevention: APJCP, 14, 469–473.
To examine differences in incidence and risk of chemotherapy-induced nausea and vomiting (CINV) among patients receiving low emetogenic chemotherapy (LEC) with or without prophylactic granisetron
The first cohort of patients received 8 mg IV bolus dexamethasone or 10 mg metachloepramide. The second cohort also was given 3 mg IV bolus of granisetron. Both groups were given dexamethasone (2-4 mg twice daily) or metochlopramide (10 mg three times daily) tablets to be taken for three days after chemotherapy. CINV was evaluated for 120 hours, days 1–5 after chemotherapy.
The study was conducted at a single outpatient site in Malaysia.
All patients were in active, antitumor treatment.
This was a two-group cohort, observational trial.
Those who received granisetron had lower rates of acute and delayed nausea and emesis. The only significant difference between groups was in the prevalence of acute emesis; 3.9% of those who received granisetron experienced acute emesis versus 19% of those who did not receive granisetron (p = 0.017). No differences were found between groups in complete control rates in either the acute or delayed phases. With analysis controlling for covariates influencing CINV, those receiving granisetron had a lower risk of CINV (overall response [OR] = 0.1, 95% confidence interval [CI] = 0.02–0.85, p = 0.034).
Patients receiving granisetron in addition to antiemtic regimens recommended for LEC had a lower incidence of acute emesis, but no effect was found on delayed phase symptoms or acute nausea.
Common recommendations for CINV prophylaxis with LEC do not include the use of neurokinin 1 (NK1) or 5-HT3 medications but, rather, rely primarily on the use of increased dexamethasone dosage for control. This study examined the addition of a 5-HT3 to an LEC antiemetic regimen and demonstrated a significant improvement in acute emesis. Granisetron is more costly than a single-agent antiemetic regimen such as dexamethasone, so additional antiemetic use is seen as controversial or “overtreatment.” Nurses can advocate for consideration of aggressive prevention of CINV to minimize the adverse patient experience with chemotherapy, balanced with recognition of potential cost burdens to the patient. As shown in many other studies, control of nausea (rather than emesis) remains challenging. The strength of findings in this study are limited by the study design. Further well-designed research in this area is warranted.
Kearney, N., Miller, M., Maguire, R., Dolan, S., MacDonald, R., McLeod, J., . . . Wengström, Y. (2008). WISECARE+: results of a European study of a nursing intervention for the management of chemotherapy-related symptoms. European Journal of Oncology Nursing, 12, 443–448.
To evaluate the impact of a nursing intervention incorporating structured symptom assessment and management of the chemotherapy-related symptoms of nausea, vomiting, fatigue, and mucositis.
A consecutive sample of 249 patients, who were scheduled to receive first-line chemotherapy, received structured symptom assessment and management, facilitated by WISECARE+, an information technology–based program. Symptom data was self-report by patients using a paper questionnaire for 14 consecutive days following each cycle of chemotherapy, starting on the first day of treatment.
Patients were undergoing the active treatment phase of care.
The study used a pre- and postintervention design.
Patients experienced less nausea postintervention, but pre/post differences were only significant at days 0 to 4 (p = 0.025). Similarly, patients had less vomiting after the intervention but pre and post differences were only significant at days 0 to 4 (p < 0.001). Although changes in oral problems varied at different time points in the study, overall repeated measures analysis showed reduction in oral problems over the course of the study (p = 0.016). There was no effect of the intervention on fatigue.
Structured nursing symptom assessment and management of chemotherapy-related symptoms improved the symptoms of nausea, vomiting, and oral problems (mucositis) related to chemotherapy.
The study used patient-assessed symptom data that was collected in real time. The data measured the incidence, severity, and associated distress of the symptoms. Additional research is needed to evaluate the effectiveness of the structured symptom assessment and management of chemotherapy-related symptoms.
Kazemian, A., Kamian, S., Aghili, M., Hashemi, F. A., & Haddad, P. (2009). Benzydamine for prophylaxis of radiation-induced oral mucositis in head and neck cancers: A double-blind placebo-controlled randomized clinical trial. European Journal of Cancer Care, 18(2), 174–178.
To evaluate the efficacy of benzydamine oral rinse for prevention of radiation-induced mucositis
Patients rinsed for 2 minutes four times a day with 15 mL study medication (0.15% benzydamine oral rinse) or identical placebo (in appearance and taste) from the first day of radiation therapy (RT) to the end of treatment. Patients were encouraged to brush their teeth at least twice daily and rinse as necessary with normal saline or sodium bicarbonate. Commercial mouthwashes were prohibited.
The study was conducted at the Radiation Oncology Department of the Cancer Institute at Tehran University of Medical Sciences in 2004-2005.
This was a double-blind, randomized, placebo-controlled trial.
Benzydamine 0.15% oral rinse was safe and well tolerated. It significantly reduced RT-induced mucositis, which also decreased the interruption of treatment.
Nurses will need to know how to effectively teach patients to use the oral rinse. This study also highlights the importance of daily oral hygiene, which is another good teaching point.
Kawazoe, H., Motoki, Y., Takechi, Y., Shishino, Y., Ido, K., Suemaru, K., & Araki, H. (2010). Comparison of antiemetic efficacy between single and repeat treatment with dexamethasone in patients receiving carboplatin-based combination chemotherapy. Methods and Findings in Experimental and Clinical Pharmacology, 32(7), 499-505.
To assess the preventive effects of single and repeat treatment with dexamethasone on delayed nausea and vomiting in patients receiving carboplatin-based chemotherapy
This was a single-site study conducted at an inpatient setting in Ehime, Japan.
This was a retrospective, observational study.
Patients treated with carboplatin-based combination chemotherapy may benefit from a daily dose of dexamethasone for three days following initiation of chemotherapy.
Kawamura, I., Ohmagari, N., Noda, S., Sugiyama, T., & Kurai, H. (2013). Preventing the transmission of methicillin-resistant Staphylococcus aureus at a tertiary care cancer center in Japan: Quality improvement report. American Journal of Infection Control, 41, 1105–1106.
To evaluate the effectiveness of implementing the new methicillin-resistant Staphylococcus aureus (MRSA) control measures in a tertiary care unit in Japan
The study was conducted in Japan, where the rate of MRSA was the second highest in the Asia-Pacific region—69.5%—in 2002. Although Japan was following infection control practices, the rate was not going down because its survey for the incidence of MRSA was not standardized. In 2003, according to the Society for Healthcare Epidemiology of America (SHEA), Japan started to strictly follow the evidence-based infection control guidelines, which included wearing gowns, masks, and gloves, in addition to implementing contact isolation in a separate room and conducting nasal swab cultures for colonization before discontinuing isolation. Two basic metrics also have been included to conduct surveys on the basis of SHEA and the Infection Control Practices Advisory Committee. To conduct this study, the authors have reviewed patients' data from January 2003–December 2010.
The study showed a significant reduction in MRSA infection or colonization and MRSA BSI (p < .0001) after strongly implementing the new infection control practices in the tertiary setting.
This was the first study conducted at a tertiary level in Japan. It was based on the evidence based-practice showing a significant reduction in MRSA spread and MRSA infection burden, which was proved after strictly following the new practices of MRSA control, including isolating the patient. Through this study, the authors also standardized in discontinuing the isolation of MRSA patients based on SHEA and the Infection Control Practices Advisory Committee.
Nurses play an important role in implementing infection control practices, as nurses are the one who come into contact with patients first. Nurses can follow these guidelines and also advise other healthcare workers to do the same.
Kawabata, M., & Kaneishi, K. (2013). Continuous subcutaneous infusion of compound oxycodone for the relief of dyspnea in patients with terminally ill cancer: A retrospective study. The American Journal of Hospice & Palliative Care, 30, 305-311.
The objective of this study was to evaluate the efficacy of injectable form of oxycodone on pain and dyspnea in terminally ill patients with cancer.
This single-site study was conducted in an inpatient setting in Japan.
The study was a retrospective, descriptive trial.
A three-point symptom severity verbal rating was used.
Subcutaneous oxycodone administration was effective for reduction of pain and dyspnea in some patients.
Kaviani, A., Fateh, M., Yousefi Nooraie, R., Alinagi-Zadeh, M.R., & Ataie-Fashtami, L. (2006). Low-level laser therapy in management of postmastectomy lymphedema. Lasers in Medical Science, 21(2), 90-94.
To study the effects of low-level laser therapy (LLLT) in postmastectomy lymphedema
Patients were randomly assigned to either a laser or sham group. Patients in the laser group were treated with GA-As laser device wavelength 890 nm over the arm and axillary areas. Therapy was administered three times a week for three weeks. Then, after an eight-week interval, the same treatment protocol was repeated. Patients received a total of 18 treatments.
This was a double blind controlled trial.
Investigators measured changes in patients’ limb circumferences, pain scores, range of motion (ROM), heaviness of the affected limb, and desire to continue the treatment. Measurements were taken before and during the treatment at 3, 9, 12, 18, and 22 weeks.
The study reported that LLLT may be effective in reducing arm circumference and pain. Researchers encouraged further studies with larger samples and more therapy. The study used a good design and excellent blinding.