Jordan, K., Kinitz, I., Voigt, W., Behlendorf, T., Wolf, H., & Schmoll, H. (2009). Safety and efficacy of a triple antiemetic combination with the NK-1 antagonist aprepitant in highly and moderately emetogenic multiple-day chemotherapy. European Journal of Cancer, 45, 1184–1187.
To determine the role of an neurokinin 1 (NK1) antagonist in multiple-day chemotherapy, in addition to standard of a 5-HT3 receptor antagonists and dexamethasone
Oral aprepitant 125 mg was given 1 hour before chemotherapy on day 1 and 80 mg oral aprepitant was given daily during chemotherapy and for 2 days after completion of the treatment course. Patients also received 1 mg IV granisetron and 8 mg IV dexamethasone daily prior to chemotherapy. Use and choice of rescue medication was at the discretion of the physician.
The setting was a single site in Germany.
Patients were in active treatment.
The study design was a prospective trial.
Aprepitant appears to be well-tolerated. CR rates were only slightly above those commonly seen with 5-HT3 receptor antagonists and dexamethasone.
Further well-defined research to fully evaluate multiple drug chemotherapy-induced nausea and vomiting regimens is warranted.
Jordan, B., Jahn, F., Beckmann, J., Unverzagt, S., Muller-Tidow, C., & Jordan, K. (2016). Calcium and magnesium infusions for the prevention of oxaliplatin-induced peripheral neurotoxicity: A systematic review. Oncology, 90, 299–306.
STUDY PURPOSE: To summarize the evidence regarding the effects of calcium and magnesium infusion to prevent peripheral neuropathy associated with oxaliplatin
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
Across four studies (640 patients), the relative risk of grade 2 or higher chemotherapy-induced peripheral neuropathy was 0.81; however, the z test for overall effect showed no statistical significance. The largest trial showed no difference between groups.
The findings did not show any benefit of calcium and magnesium infusions for the prevention of oxaliplatin-induced peripheral neuropathy.
The findings do not support the use of calcium and magnesium infusions to prevent chemotherapy-induced peripheral neuropathy.
Jordan, K., Jahn, F., Jahn, P., Behlendorf, T., Stein, A., Ruessel, J., … Schmoll, H. J. (2011). The NK-1 receptor-antagonist aprepitant in high-dose chemotherapy (high-dose melphalan and high-dose T-ICE: Paclitaxel, ifosfamide, carboplatin, etoposide): Efficacy and safety of a triple antiemetic combination. Bone Marrow Transplantation, 46(6), 784–789.
To assess the role of an neurokinin 1 (NK1) antagonist in antimetic protection in combination with granisetron and dexamethasone in patients receiving high-dose chemotherapy (HDC)
This study was conducted at a single site at a university hospital in Halle, Germany.
This was a nonrandomized, single-center, observational trial.
The study demonstrated a good toxicity profile with the addition of aprepitant to the standard antiemetic regimen, with improvement in the prevention of chemotherapy-induced nausea and vomiting (CINV) during multiday, high-dose regimens.
Jonsson, C., & Johansson, K. (2009). Pole walking for patients with breast cancer-related arm lymphedema. Physiotherapy Theory and Practice, 25(3), 165–173.
To investigate the influence of pole walking on arm lymphedema following breast cancer treatment when using a compression sleeve
Pole walking is a walking exercise with the addition of walking poles that simulates the arm motion of cross-country skiing during walking. Subjects participated in pole walking on one occasion for one hour outdoors in a park and on sidewalks for approximately 4 km. Each session was performed similarly and was supervised by the same person. Measurements were made before, immediately after, and 24 hours later.
The study took place at a single site in Sweden.
The study used a pre-post design.
The patients showed no significant difference in total arm volume in the edema arm immediately after pole walking or 24 hours later compared to before walking. Immediately after pole walking, a significant decrease in lymphedema absolute volume and in lymphedema relative volume was found compared to before pole walking. Twenty-four hours later, no differences were found compared to before walking. There were no significant differences in rating of heaviness and tightness on the visual analog scale immediately after pole walking or after 24 hours compared to the rating before pole walking.
A controlled, short-duration pole-walking program can be performed by patients with arm lymphedema using a compression sleeve without deterioration of the arm lymphedema.
Nurses and clinicians should be aware and encourage women with lymphedema to perform exercises, such as pole walking, which seems not to deteriorate arm lymphedema.
Jonsson, C., & Johansson, K. (2013). The effects of pole walking on arm lymphedema and cardiovascular fitness in women treated for breast cancer: A pilot and feasibility study. Physiotherapy Theory and Practice, 30, 236–242.
To investigate the effects on intensive pole walking on cardiovascular fitness, subjective assessment, and arm lymphedema in women who were treated for breast cancer
Eight-week exercise period preceded by a two-week control period where subjects were asked not to change anything in daily living. Exercise was self directed 3–5 times/week for 30–60 minutes. Subject pace had to correspond to 70%–80% of estimated maximum heart rate (220-age). Warm up period of 10 minutes included pole walking and light arm exercises. Subjects wore compression garments during exercise and various measurements prestudy, at various intervals, and at the conclusion of the study.
SITE: Multi-site
SETTING TYPE: Outpatient
LOCATION: Lymphedema unit at Skane University Hospital in Lund and Malmo, Sweden
Quasiexperimental
Statistically significant reduction in total arm volume (p = 0.001), lymphedema absolute volume (p = 0.014), and lymphedema relative volume (p = 0.015), as well as decreased heart rate and rating of tightness in the arms. Both positive and negative influences on well-being were reported.
Moderately intense exercise, such as pole walking, is feasible for patients with breast cancer with lymphedema. Standard precautions and use of compression garments during exercise is advisable. The effects of exercise on cardiovascular health and well-being are consistent with general public. Reduction in arm volume measurements post intervention should be further studied.
Patient education
Jongen, J.L., Huijsman, M.L., Jessurun, J., Ogenio, K., Schipper, D., Verkouteren, D.R., . . . Vissers, K.C. (2013). The evidence for pharmacologic treatment of neuropathic cancer pain: Beneficial and adverse effects. Journal of Pain and Symptom Management, 46, 581–590.e1.
STUDY PURPOSE: To evaluate the evidence regarding beneficial and adverse effects of pharmacologic treatment of neuropathic cancer pain
TYPE OF STUDY: Systematic review
DATABASES USED: PubMed and EMBASE before August 2012; additional studies were identified from study reference lists.
KEYWORDS: Complete search terms are provided.
INCLUSION CRITERIA: Studies involving adult patients with cancer receiving oral analgesics
EXCLUSION CRITERIA: Not specified
TOTAL REFERENCES RETRIEVED = 653
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: American Academy of Neurology evidence classification was used. Authors calculated the absolute risk benefit as the number of patients who received 30%–50% improvement divided by the total number of patients in the treatment group. The fraction of patients who dropped out because of adverse events also was determined. Pain reduction scores were calculated as the percentage of pain reduction from baseline in the study.
APPLICATIONS: Palliative care
The proportion of patients who obtained improvement of pain with antidepressants was 0.55 (95% CI 0.40–0.69), with anticonvulsants was 0.57 (95% CI 0.44–0.69), with opioids was 0.95 (95% CI 0.93–0.96), and with other adjuvant medications was 0.45 (95% CI 0.33–0.57). Effects for patients with mixed pain were similar. The proportion of patients who withdrew because of adverse effects was 12.6% with antidepressants, 5% with anticonvulsants, 6% with opioids, and 6% with other adjuvant medications.
A substantial proportion of patients achieved pain reduction with adjuvant pain medications, and the proportion of patients who had benefit was higher than those who had to withdraw from studies because of adverse effects. The highest benefit was seen with opioids.
Numerous limitations in this review make it difficult to evaluate the relative benefits of various approaches evaluated for management of neuropathic pain. Findings do suggest that results with all types of coanalgesics used appear to have benefits that outweigh the prevalence of adverse effects. Findings continue to support the effect and benefits of opioids as a mainstay of pain management for mixed and neuropathic pain.
Jones, J.M., Qin, R., Bardia, A., Linquist, B., Wolf, S., & Loprinzi, C.L. (2011). Antiemetics for chemotherapy-induced nausea and vomiting occurring despite prophylactic antiemetic therapy. Journal of Palliative Medicine, 14, 810-814.
To provide preliminary prospective evidence of the efficacy of individual agents prescribed for the treatment of breakthrough chemotherapy-induced nausea and vomiting (CINV)
Patients receiving moderately or highly emetogenic chemotherapy received prophylactic antiemetic treatment based on guidelines. If patients experienced breakthrough CINV, their treating oncologist prescribed antiemetics with discretion and the patients were instructed to complete a questionnaire starting at the point in which they took the antiemetic (baseline) and then every 30 minutes for four hours.
The study was conducted at a single site at the Mayo Clinic in Minnesota, United States.
All patients were in active treatment.
The study has applications for late effects and survivorship.
This was a prospective, exploratory observation study.
Of the total patients enrolled, 28% experienced breakthrough CINV and completed the questionnaire.
The breakthrough medications given were 10-mg oral prochlorperazine (88%) or a 5-HT3 receptor antagonist (RA) (12%) (specifically, 1 mg granisetron, 8-mg IV ondansetron, 8-mg sublingual ondansetron).
Patients receiving the prochlorperazine experienced a 75% median reduction in nausea after four hours, and vomiting was reduced from 21% to 4%. Of these, 96% reported they would recommend prochlorperazine to other patients (median satisfaction as 8 out of 10).
Patients who received the 5-HT3 receptor antagonists experienced a 75% median reduction in nausea over the four-hour study period. No vomiting from baseline was reported (satisfaction as 0, 4, and 8 out of 10). The patient who rated satisfaction at 0 recorded complete resolution of nausea by 30 minutes and said would recommend the medication to others, so investigators posited that this patient may have misunderstood the high satisfaction score of 0 rather than 10.
In the patients treated with prochlorperazine, the median drowsiness of 3 at baseline decreased to 2 after four hours. Headache was reported in 20% of patients and decreased to 0% after four hours. Agitation was reported in 20% of patients and decreased to 4% after four hours. Abdominal cramping, dry mouth, tachycardia, blurry vision were also recorded.
In the patients treated with 5-HT3 RAs, baseline drowsiness of 5 remained unchanged after four hours. One patient did not have drowsiness at baseline but reported drowsiness of 1 after taking the medication. No patients reported headache, agitation, or other toxicities.
Prochlorperazine and 5-HT3 RAs appeared to be effective breakthrough antiemetic therapies with favorable outcomes. Prochlorperazine is a good choice base on this study as it acts on a different pathway than prophylactic antiemetics. Further randomized, controlled trials would elucidate more effective antiemetic approaches for treating nausea.
Prochlorperazine has been used for a long time as a rescue medication. This study supports the choice of antiemetic for breakthrough CINV with minimal side effects. Further randomized controlled trials comparing different side effects are clearly recommended.
Jones, E., Isom, S., Kemper, K.J., & McLean, T.W. (2008). Acupressure for chemotherapy-associated nausea and vomiting in children. Journal of the Society for Integrative Oncology, 6, 141–145.
To assess the feasibility, safety, and effectiveness of acupressure therapy for preventing or reducing chemotherapy-induced nausea and vomiting (CINV) in children receiving chemotherapy
The study was conducted in a single inpatient site at a children’s hospital in North Carolina.
All participants were pediatric patients in active treatment.
This was a pilot study. It was a prospective, randomized, crossover clinical trial.
The study used modified methods of Morrow questionnaires. It did not state how the tool was modified. No reliability or validity information was provided.
Questionnaires quantified nausea on an 11-point Likert scale, collected demographics and diagnoses, and measured the following.
Although acupressure bands did not show a reduction in nausea or vomiting, patients perceived the bands as moderately effective, planned to use them in the future, and indicated they would recommend them.
The acupressure bands did not demonstrate a significant change in actual incidence of nausea and vomiting; however, this therapy may be helpful in reducing expectations of CINV.
Jones, E., Koyama, T., Ho, R.H., Kuttesch, J., Shankar, S., Whitlock, J.A., . . . Frangoul, H. (2007). Safety and efficacy of a continuous infusion, patient-controlled antiemetic pump for children receiving emetogenic chemotherapy. Pediatric Blood and Cancer, 48, 330–332.
To evaluate the safety and efficacy of antiemetic medication administration via patient-controlled infusion pump
Patients who failed a standard antiemetic regimen (including a scheduled 5HT3 and one or more additional breakthrough medication of a different class) were placed on a patient-controlled pump containing diphenhydramine 4 mg/ml, lorazepam 0.16 mg/ml, and dexamethasone 0.27 mg/ml mixed in 30 ml of normal saline. The pump ran with a basal rate of 0.1–0.2 ml per hour with a demand dose of 1–2 ml every 30 minutes. The infusion pump was used along with a scheduled 5HT3 agent.
This was a quasi-experimental trial with no comparison group. Data were from a retrospective chart review of all patients who used an antiemetic pump to control chemotherapy-induced nausea and vomiting (CINV) between March 1999 and April 2004.
Complete response (CR) was defined as no emesis and no rescue medications. If emesis occurred but no rescue medications were used, it was considered a partial response (PR). Failure was defined as the use of rescue medications. Total patient days in CR, PR, and failure were counted for cycles with and without the antiemetic pump. The total number of rescue medications used and the total number of hospital days also were compared.
Patients with an antiemetic infusion pump had more days in CR than without (45 versus 21 days). A larger number of rescue medications were required to control breakthrough nausea and emesis for the conventional prophylaxis versus the antiemetic pump (108 versus 24). Patients with an antiemetic pump had significantly shorter hospital stays.
Using an antiemetic continuous-infusion pump with demand dosing may reduce the total daily dose of each antiemetic medication used individually. Adverse events occurred in 4% of courses, and all side effects resolved with a decreased rate of infusion. No patients required the discontinuation of an infusion pump.
Preliminary data showed that using an antiemetic infusion pump with basal and demand dosing may be an effective way to manage CINV in pediatric patients who fail standard antiemetic therapy. Additional research is needed.
Jones, J.M., Lewis, F.M., Griffith, K., Cheng, T., Secord, S., Walton, T., . . . Catton, P. (2013). Helping Her Heal-Group: A pilot study to evaluate a group delivered educational intervention for male spouses of women with breast cancer. Psycho-Oncology, 22, 2102–2109.
To determine the acceptability and feasibility of HHH-G and the study methods to evaluate its impact on participating men’s skill, self confidence, and self care and to assess the impact of intervention on the participating husbands' ratings of marital quality and depressed mood
HHH-G is a group intervention program with five sessions. Intervention was delivered by two trained educational counselors over five separate 1.5-hour sessions delivered at one week intervals. The five sessions included
Each session included a short group presentation by the education counselors and skill building and efficacy enhancing group exercises. Participants were also provided with spouses' workbooks with session specific activities at home and home assignments that focused on enhancing behavioral capabilities including knowledge and skill. Data were collected at baseline, immediately after the last session, and three months later.
Phase of care: active antitumor treatment
A mixed method (one-arm, qualitative, pre-post intervention design) was used.
A moderate to favorable increase in skills was noted as measured by the spouse skill checklist (p < 0.001), including the self care and support subscale (p < 0.001) and the wife support scale (p < 0.003). A significant time effect on self efficacy was measured by CASE-S. No significant changes in depressed mood or marital functioning was noted for the husbands, but a significant reduction in depressed mood (p < 0.003) was noted for the wives.
The feasibility and acceptability of HHH-G were supported. No significant reduction in depression scores were noted for male spouses, which might have been caused by the floor effect because baseline CES-D scores were low in male spouses. A large sample size with a control group woul dneed to be studied to truly examine the effectiveness of this intervention program.
Study demonstrated promising findings on feasibility and reduction in depressed mood for the women with breast cancer. This sounds like a cost-effective approach that could be used by nurses and social workers to improve patient and caregiver outcomes, such as increasing self efficacy and marital functioning.