Jham, B.C., Chen, H., Carvalho, A.L., & Freire, A.R. (2009). A randomized phase III prospective trial of bethanechol to prevent mucositis, candidiasis, and taste loss in patients with head and neck cancer undergoing radiotherapy: A secondary analysis. Journal of Oral Science, 51, 565–572.
To determine the impact of bethanechol administration concomitant to radiotherapy on oral mucositis, candidiasis, and taste loss
Patients were randomly assigned to one of two treatment groups. Group 1 received 25 mg oral bethanechol, 3 times a day; group 2 received artificial saliva (OralBalance). Patients who experienced severe mucositis were subject to daily laser applications until remission of the lesions.
This was an outpatient radiation study conducted in Brazil.
Secondary analysis, stratified, open-label, random allocation to one of two groups.
No significant differences in frequency and severity of mucositis, candidiasis, or taste loss were found.
Bethanechol did not appear to reduce the incidence of mucositis, candidiasis, or taste loss when administered during RT.
Larger, randomized, double-blind, placebo-controlled studies are needed possibly to further test the hypothesis that bethanechol could minimize RT-induced mucositis incidence or severity.
Jepson, C., McCorkle, R., Adler, D., Nuamah, I., & Lusk, E. (1999). Effects of home care on caregivers’ psychosocial status. Journal of Nursing Scholarship, 31, 115–120.
The intervention was directed at patients and caregivers (primarily at patients). The standardized nursing intervention protocol included three home visits and six telephone calls over four weeks from an oncology clinical nurse specialist. Intervention activities included
Home setting
A controlled trial design was used, with a major limitation.
No significant differences existed on any outcome measure. No effect on caregiver esteem was found. Among caregivers with physical problems, those in the treatment group had an increase in lack of family support between interviews 1 and 2 followed by a decrease between interviews 2 and 3. Control group subjects displayed the opposite pattern. Caregivers with physical problems had greater decreases in difficulty with finances than those with no physical problems. Caregivers in the control group had a decrease, whereas those in treatment group did not. No significant effect on depression was found. Caregivers in the control group had a decrease in the effect of providing care on physical health between interviews 1 and 2 and then remained constant between interviews 2 and 3. Caregivers in the treatment group displayed the opposite pattern. The analyses are based on some caregivers who had received nonprotocol home care and were dropped from analyses.
Little information is presented on the details of the intervention. The control group had some contamination (32.4% of the control group and 32.2% of the intervention group received referrals for home care that were not connected with the study). Findings were difficult to interpret.
Jeppesen, E., Pedersen, C.M., Larsen, K.R., Rehl, A., Bartholdy, K., Walsted, E.S., & Backer, V. (2016). Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy: A randomised controlled trial. European Clinical Respiratory Journal, 3, 33472.
To measure the effect of a music intervention on anxiety related to bronchoscopy
Patients undergoing bronchoscopy were randomly assigned to listen to music via earbuds during the procedures or use earplugs with no sound. On admission to the hospital, patients completed a study questionnaire, and blood cortisol samples were obtained. On admission to the operating area, baseline vital signs were taken, and actigraph sensors were applied to the patients' wrists, ankles, head, and hips. After 10 minutes, study measures were obtained again. About 60 minutes after bronchoscopy, the study measures were repeated.
PHASE OF CARE: Diagnostic
Single-blind, randomized, controlled trial
Prior to bronchoscopy, the music group had lower STAI scores. After the bronchoscopy, anxiety was lower in both groups, with no difference between groups. No differences in duration of the procedure, sedatives, or amount of patient movement during the procedure were reported.
Music was not shown to reduce anxiety associated with bronchoscopy.
Music during bronchoscopy was not shown to affect patients' level of anxiety. Measurement of anxiety immediately prior to or during a procedure to perform this type of research is difficult and questionable.
Jeong, J.H., & Yoo, W.G. (2015). Effects of pulmonary rehabilitation education for caregivers on pulmonary function and pain in patients with lung cancer following lung resection. Journal of Physical Therapy Science, 27, 489–490.
To evaluate the effects of a pulmonary rehabilitation education program for caregivers on pain and pulmonary function in patients after lung resection
Patients were assigned to experiment and control groups. The control group received usual care including education on pain management, general postoperative care, incentive spirometer use, trunk and limb mobilization, and nebulizer instructions. In addition, caregivers in the experimental group received 30 minutes per week of instruction in splint coughing, airway clearance techniques, diaphragmatic breathing, and various exercises. Assessments were done at baseline (two weeks after surgery) and at four weeks after surgery.
Prospective trial
Forced expiratory volume in one second was higher in the experimental group at baseline and at four weeks (p < 0.01). There was no difference between the groups in pain scores after the intervention.
Pulmonary rehabilitation education may improve pulmonary function in patients after lung resection.
Pulmonary rehabilitation education provided to caregivers was not shown to reduce postoperative pain scores, but it may have been beneficial in terms of pulmonary function testing results.
Jeong, Y.J., Park, Y.S., Kwon, H.J., Shin, I.H., Bong, J.G., & Park, S.H. (2013). Acupuncture for the treatment of hot flashes in patients with breast cancer receiving antiestrogen therapy: A pilot study in Korean women. Journal of Alternative and Complementary Medicine, 19, 690–696.
To determine if acupuncture administered to Korean women receiving tamoxifen or anastrozole for breast cancer can be safe and feasible in controlling their hot flashes during eight weeks of intervention
Each intervention session lasted 40 minutes and consisted of 20 ± 5 minutes of acupuncture. Patients received three sessions per week for four weeks for a total of 12 sessions. The following acupuncture points were selected for the intervention: GV 20, M-HN-3, HT 8, KI 10, and LV 2. Acupuncture was administered by a physician with three years of experience. After appropriate skin preparation, eight needles were inserted 10-20 mm deep into the skin and were manipulated to obtain De Qi. Needles were rotated after 10 minutes. Data were recorded at baseline, weekly during the intervention (visits 5, 8, 11, and 13), and four weeks post study.
Interventional study in a nonrandomized series of cases enrolled prospectively
Data was self-reported using a hot-flash diary to record number and severity of hot flashes. A visual analogue scale was used to record severity of hot flashes. A total score was calculated by multiplying the severity and frequency of hot flashes.
Findings are limited in explaining completely the efficacy of acupuncture to decrease hot flashes in women receiving tamoxifen or anastrozole to treat breast cancer. Although safety and statistical significance result from the study, the sample size, the lack of a random design, and the lack of a control group limit the generalization of data.
Implications for cancer nurses are limited since applying this intervention requires professional training. However, oncology nurses are vital in providing information to patients about complementary treatments that are safe and feasible in controlling hot flashes related to hormone cancer treatments. No related adverse events were described.
Jeong, J. S., Ryu, B. H., Kim, J. S., Park, J. W., Choi, W. C., & Yoon, S. W. (2010). Bojungikki-tang for cancer-related fatigue: a pilot randomized clinical trial. Integrative Cancer Therapies, 9, 331–338.
To evaluate whether Bojungikki-tang has beneficial effects on fatigue and overall quality of life in patients with cancer.
Patients were randomized to the experimental group or the wait-list control group. The experimental group received Bojungikki-tang for two weeks. Bojungikki-tang was administered as granules containing a mixture of 10 medicinal plants given three times daily. Patients were randomized through computer generation. Patients were recruited through newspaper and hospital advertisements.
Unknown
The study was a randomized, controlled trial.
The experimental group had statistically significant improvements in VAS-F scores, as well as FACT-G, FACT-F, and TOI-F (p < 0.05) at week 2.
The study had a possible effect from the study drug, although p-values were on the edge of significance. The benefit shown suggests additional study is required in a larger, placebo-controlled trial.
Patients pursuing this treatment should be educated on the current need for additional research.
Jeon, Y.S., Lee, J.A., Choi, J.W., Kang, E.G., Jung, H.S., Kim, H. K., … Joo, J.D. (2012). Efficacy of epidural analgesia in patients with cancer pain: A retrospective observational study. Yonsei Medical Journal, 53, 649–653.
To evaluate the efficacy and complications of continuous epidural analgesia to improve its efficacy for control of cancer-related pain
Most patients received morphine, bupivacaine, and ketamine via continuous epidural infusion. Dosing was determined by converting the daily total opioid dose to an IV morphine equivalent. The epidural morphine was delivered at 25%–17% of the IV morphine dose. Bupivacaine 12.5–25 mg per day and ketamine 10–20 mg per day were administered at 2 mL/h and varied according to pain location, severity, and type, as well as progression of disease. Additional adjuvant therapies were used and included antiepileptic drugs, antidepressants, anti-inflammatory drugs, and steroids. Pain levels were evaluated at baseline and at two weeks postepidural.
The study was conducted at a single site in Korea. The setting type was not specified.
The study design was a retrospective chart analysis.
The MEDD decreased from 213.4 mg (SD = 221.7 mg) per day to 94.1 mg (SD = 145.0 mg) per day at two weeks follow up. Prior to receiving the epidural, 78.1% of patients reported severe pain; at the two-week follow up, only 19.6% reported severe pain (p < 0.05). Mild catheter complications occurred in 15.6% of patients. Moderate complications occurred in 14.6% of patients, including infection that had to be controlled with antibiotics or removal of the catheter.
Continuous epidural anesthesia is an effective pain control method for patients with cancer at the end of life. However, risk of infection and complications exist because of catheter placement.
For patients seeking more pain control, continuous epidural infusions may be an option for pain relief. The charts reviewed cited inappropriate pain control (78.1%) and intolerable side effects (21.9%) as the reasons for placing the epidural, which are key factors in working to improve comfort in patients with terminal cancer. Risks of complications include infection, occlusion, catheter removal, risk of respiratory depression, motor block, hypotension, sensory deficits, and gastrointestinal and genitourinary function that must be evaluated while the catheter is in place. In patients with terminal cancer, patient and caregiver education is important.
Jensen, J.M., Gau, T., Schultze, J., Lemmnitz, G., Folster-Holst, R., May, T., . . . Proksch, E. (2011). Treatment of acute radiodermatitis with an oil-in-water emulsion following radiation therapy for breast cancer: A controlled, randomized trial. Strahlentherapie Und Onkologie, 187(6), 378–384.
To test the hypothesis that treatment with an oil-in-water emulsion (WO1932) leads to more rapid skin hydration, improves skin barrier function, and reduces pruritus in patients after radiation therapy
Patients were randomized to a treatment group or control group. In the treatment group, the oil-in-water emulsion was applied twice a day over six to eight weeks, starting after radiation therapy was completed. Sauna, swimming, and use of any other skin care product were not allowed. Clinical assessment was done after week one and at the end of the study.
Pruritus decreased in all patients but more in the treatment group in weeks one, two, three, and five (p < .04). There was no significant difference between groups in skin scores overall. There was no difference between groups in transepidermal water loss.
This study does not provide strong evidence in favor of the oil-in-water emulsion tested here. Findings suggest the emulsion was helpful in reducing pruritus compared to no treatment at all.
This study does not provide strong evidence for evaluation of effectiveness of the oil-in-water emulsion tested here.
Jensen, S.B., Jarvis, V., Zadik, Y., Barasch, A., Ariyawardana, A., Hovan, A., . . . Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). (2013). Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients. Supportive Care in Cancer, 21(11), 3223–3232.
To analyze the available literature and define clinical practice guidelines for the use of the following agents for the prevention and treatment of oral mucositis (OM): allopurinol, midline mucosa-sparing radiation blocks, payayor, pentoxifylline, timing of radiation therapy (morning versus afternoon), pilocarpine, bethanechol, chewing gum, propantheline, and tetrachlorodecaoxide
A total of 99 references were retrieved. Of these, 18 were excluded based on the inclusion/exclusion criteria (which was not stated in the article). Of the remaining 81 papers, 49 pertained to agents of natural origin and the results on those agents were reported separately. This manuscript reported the results of the review of the remaining 32 papers that tested interventions that did not fit in any of the other categories and were classified as miscellaneous agents.
Studies were evaluated based on the list of major and minor flaws published by Hadorn. Level of evidence was assigned for each intervention based on the Somerfield criteria. A well-designed study was defined as a study with no major flaws per the Hadorn criteria. Findings from the reviewed studies were integrated into guidelines based on the overall level of evidence for each intervention.
PHASE OF CARE: Active treatment
Suggestions were made against the use of systemic pilocarpine administered orally for prevention of OM during RT in patients with head and neck cancer and in patients receiving high-dose chemotherapy with or without total body irradiation, prior to hematopoietic stem cell transplantation as well as against the use of systemic pentoxifylline administered orally for the prevention of OM in patients undergoing bone marrow transplantation. No guideline was possible for any other agent reviewed because of inadequate or conflicting evidence.
None of the agents reviewed was determined to be effective for the prevention or treatment of OM. This review was inadequate and difficult for the reader to understand. The methods section was missing needed information to assess the interventions and the associated recommendations.
Many products on the market claim to prevent or treat OM. Nurses need to be well informed before recommending any products or interventions to patients. Further research is needed.
Jensen, B.T., Jensen, J.B., Laustsen, S., Petersen, A.K., Søndergaard, I., & Borre, M. (2014). Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: Secondary reported outcome of a randomized controlled trial. Journal of Multidisciplinary Healthcare, 7, 301.
To evaluate whether pre- and postoperative physical exercise affect quality of life and symptoms in patients undergoing radical cystectomy
Patients were randomized to a standard care or intervention group. Standard care included preoperative nutritional screening counseling and the use of oral supplements as needed, patient education, and standard mobilization postoperatively by walking during each shift with supervision once daily. The intervention included all aspects of standard care plus a preoperative exercise program and a more comprehensive postoperative exercise program with related patient education 14 days prior to surgery. Prior to surgery, a phone call after one week was done to promote adherence to the program. Postsurgery, the intervention group had physical therapy sessions two times per day including progressive muscle strength and endurance training. The difference between groups at four months after the intervention were reported.
Randomized, controlled trial
Those in the intervention group reported reduced symptoms of constipation and flatulence. Compared to the intervention group, those in the standard care group reported reduced insomnia (p = 0.04) and a clinically relevant, but not statistically significant, reduction in fatigue. There were no other differences between groups in symptoms.
The perioperative multicomponent rehabilitation program studied here did not result in reduced fatigue or improvement in overall quality of life compared to those who received standard care.
A more intensive exercise and educational counseling program provided perioperatively did not result in better patient outcomes related to fatigue four months after surgery for this group of patients. The lack of information about patients’ adherence to both pre- and postoperative exercise recommendations is a limitation of this report. Additional research on the impact of perioperative rehabilitation therapies in various patient groups would be of benefit.