Huang, T.W., Tseng, S.H., Lin, C.C., Bai, C.H., Chen, C.S., Hung, C.S., … Tam, K.W. (2013). Effects of manual lymphatic drainage on breast cancer-related lymphedema: A systematic review and meta-analysis of randomized controlled trials. World Journal of Surgical Oncology, 11, 1–8.
To examine the evidence on manual lymphatic drainage (MLD) in the prevention or management of limb edema in postsurgical women with breast cancer
The literature search retrieved 170 references. Authors independently evaluated methodological quality in terms of blinding, attrition, and use of intention-to-treat analysis. No specific tool for evaluation was described.
Patients were undergoing multiple phases of care.
Some trials focused on prevention and others involved treatment of lymphedema. Nine studies were included in meta-analysis. Findings showed a risk ratio of 0.063 (95% CI 0.14, 2.83, p = 0.54). High heterogeneity existed. Standard mean difference (SMD) findings showed no benefit of MLD, with SMD = 75.12 (95% CI -9.34, 159.58). Findings showed that the addition of MLD to other individual components of complete rehabilitation such as compression bandaging does not show a significant benefit in reducing arm volume. Overall published reports of MLD show conflicting results. No significant differences were found in the incidence of lymphedema between patients treated with MLD or not.
MLD does not add significant benefit for prevention or management of lymphedema in patients with breast cancer.
Findings suggest that MLD as an adjunctive treatment is not effective in preventing or managing arm lymphedema in women with breast cancer who have had axillary lymph node excision.
Huang, J., Wang, X.J., Yu, D., Jin, Y.N., Zhen, L.Z., Xu, N., ... He, J. (2013). The effect of palonosetron hydrochloride in the prevention of chemotherapy-induced moderate and severe nausea and vomiting. Experimental and Therapeutic Medicine, 5, 1418–1426.
To determine the effectiveness of palonosetron hydrochloride in preventing nausea and vomiting in patients receiving chemotherapy agents known to cause moderate to severe nausea and vomiting
The study involved administering 0.25 mg palonosetron and a placebo to the experimental group and 3 mg granisetron and a placebo to the control group 30 minutes prior to the administration of moderate to severe emetogenic chemotherapy.
Randomized, multi-centered, double-blind, double-dummy, parallel-group, positive-controlled clinical trial
Palonosetron hydrochloride demonstrated better control of delayed vomiting and has a positive preventative effect on delayed nausea and vomiting. There was no difference between granisetron and palonosetron in preventing acute vomiting CR rates, full-course vomiting CR rates, vomiting control time, treatment failure, acute nausea CR rate, or adverse effects.
Palonosetron hydrochloride is an effective 5-HT3 antagonist in preventing delayed nausea and vomiting related to high to moderate emetogenic chemotherapy as compared to another 5-HT3 antagonist, granisetron.
Hu, W., Fang, J., Nie, J., Dai, L., Chen, X., Zhang, J., . . . Han, J. (2014). Addition of aprepitant improves protection against cisplatin-induced emesis when a conventional anti-emetic regimen fails. Cancer Chemotherapy and Pharmacology, 73, 1129–1136.
To study the effectiveness of aprepitant as a secondary agent to prevent chemotherapy-induced nausea and vomiting (CINV) in patients with lung cancer for whom cisplatin-induced nausea and vomiting was poorly controlled by a conventional antiemetic regimen of granisetron and dexamethasone
Stage 1 of the study recruited patients receiving cisplatin-based chemotherapy being actively treated for lung cancer. Patients who experienced vomiting of grade 2 or higher and needed rescue antiemetics during their first cycle of chemotherapy (stage 1) were enrolled in stage 2 of the study. During stage 2, patients had oral aprepitant added on day 1 at 125 mg and on days 2 and 3 at 80 mg daily of subsequent chemotherapy cycles. Patients were asked to keep diaries during the first two chemotherapy cycles.
Two-stage, prospective observation study
Patients who advanced to stage 2 of the study and who had aprepitant added to subsequent chemotherapy regimens reported significantly less acute and delayed nausea and vomiting compared to their first chemotherapy cycle. During the first cycle of chemotherapy, 18.7% of the 132 patients initially recruited required rescue antiemetics, and 52% required intravenous hydration. Of the 25 patients continuing to stage 2 of the study, none required rescue antiemetics or required intravenous hydration. 64% met the criteria for CR, and 28% met the criteria for CC after round two of chemotherapy.
The findings of this study show that aprepitant was effective in preventing acute and delayed nausea after high-dose, cisplatin-based chemotherapy for patients with lung cancer at a high risk of emesis, anticipatory vomiting, and poor CINV control.
Nursing care would benefit from improved strategies to manage CINV for patients with lung cancer receiving chemotherapy. However, the authors of this study acknowledged that larger randomized, controlled studies are needed before recommendations can be made. The assessment of CINV risk during all cycles of chemotherapy is an important aspect of nursing care and patient advocacy. Outcomes for CINV improve when standardized antiemetic guidelines are followed.
Hu, Z., Cheng, Y., Zhang, H., Zhou, C., Han, B., Zhang, Y., ... Zhang, L. (2014). Aprepitant triple therapy for the prevention of chemotherapy-induced nausea and vomiting following high-dose cisplatin in Chinese patients: A randomized, double-blind, placebo-controlled phase III trial. Supportive Care in Cancer, 22(4), 979–987.
To determine the efficacy of aprepitant on patients in Asian countries receiving highly emetogenic chemotherapy (HEC)
Patients receiving HEC were stratified by gender and randomized to receive either aprepitant or a standard therapy with a placebo. Placebo medications were matched to aprepitant capsules. Data were collected from the time of chemotherapy (0 hours) to six days (120 hours). Patients recorded vomiting episodes, daily nausea, and rescue medications.
A phase III, randomized, double-blind, placebo-controlled, parallel-group trial
Patients self-reported the times and dates of vomiting or retching episode(s), use of rescue therapy, and daily nausea assessments during the first chemotherapy cycle along with Visual Analog Scale (VAS) overall nausea ratings. Patients were contacted on the mornings of days 2–6 to ensure compliance. Functional Living Index-Emesis (FLIE) questionnaire scoring was self-administered early on day 6 directly following completion of final self-reports.
The addition of aprepitant to standard antiemetic treatment regimens for Chinese patients undergoing HEC provided superior chemotherapy-induced nausea and vomiting prevention and was very well tolerated.
The efficacy and tolerability of aprepitant were studied only for one or two cycles of chemotherapy; further study will be required for multi-cycle treatment. 56.4% of patients in the aprepitant arm used Chinese medicine versus 49% in the control arm.
Aprepitant is well-tolerated and effective in the treatment of CINV in Chinese patients receiving HEC. This is the first study in Chinese chemotherapy patients. Based on nursing knowledge of drug metabolism, this is an important study to assess that aprepitant provides efficacy in this group of chemotherapy patients.
Hsiung, W.T., Chang, Y.C., Yeh, M.L., & Chang, Y.H. (2015). Acupressure improves the postoperative comfort of gastric cancer patients: A randomised controlled trial. Complementary Therapies in Medicine, 23, 339–346.
To determine if acupressure affects the postoperative comfort of patients following subtotal gastrectomy
Patients were randomized to acupressure care and control groups. Control patients received usual care. The acupressure group received the intervention for three days. Pressure to the P6 and ST36 acupoints on both sides was applied for 12 minutes using the thumb to apply pressure followed by release, kneading of the area, and release again for each site. The intervention was provided by a trained researcher. Data were obtained at baseline and after the intervention, which began the second day after surgery. Experimental and control patients were placed in different wards in the hospital.
Randomized, controlled trial
There were no significant differences in the trends for pain or postoperative nausea and vomiting between groups.
This study did not show a significant benefit from acupressure for the management of acute pain.
This study did not demonstrate evidence for the efficacy of acupressure for the management of postoperative pain. Additional research would be useful to determine beneficial adjunctive interventions for acute pain management.
Hsieh, C. C., Sprod, L. K., Hydock, D. S., Carter, S. D., Hayward, R., & Schneider, C. M. (2008). Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Oncology Nursing Forum, 35, 909–915.
To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments.
Patients were divided into four groups based on specific type of treatment: surgery alone (n = 22); surgery and chemotherapy (n = 30); surgery and radiation (n = 17); and surgery, chemotherapy, and radiation (n = 27). Following comprehensive screening and medical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed. Individualized exercise prescriptions and six-month exercise interventions were developed. Participants attended supervised exercise sessions two to three days per week for six months.
This was a pre-/posttest quasiexperimental study.
Cardiopulmonary function (predicted maximal oxygen consumption and time on treadmill) significantly increased in all groups after exercise training. In addition, resting heart rate and forced vital capacity significantly improved in those undergoing surgery, chemotherapy, and radiation. Psychologically, the exercise intervention resulted in significant reductions in behavioral, affective, sensory, cognitive, mood, and total fatigue scale scores in all three groups who received treatment with surgery. The breast cancer survivors in the surgery alone group showed significant reductions in behavioral, affective, and total fatigue scale scores but not in sensory, cognitive, and mood fatigue scale scores.
The results suggested that moderate-intensity individualized exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue, regardless of treatment type. Moreover, cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention.
Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum, and the importance of participating in a cancer rehabilitation exercise program should be emphasized.
Howell, M., Lee, R., Bowyer, S., Fusi, A., & Lorigan, P. (2015). Optimal management of immune-related toxicities associated with checkpoint inhibitors in lung cancer. Lung Cancer, 88, 117–123.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Briefly reviews the management of diarrhea related to checkpoint inhibitor adverse reactions.
Brief literature review of common checkpoint inhibitor adverse and serious adverse events. No evidence quality review was provided.
Patient education is crucial to the early reporting of adverse events that develop in patients after treatment with checkpoint inhibitors. Closely monitor patients with evidence of adverse events. Hospitalization and aggressive patient support may be required for serious adverse events.
Howell, D., Oliver, T.K., Keller-Olaman, S., Davidson, J., Garland, S., Samuels, C., . . . Taylor, C. (2013). A Pan-Canadian practice guideline: Prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer. Supportive Care in Cancer, 10, 2695–2706.
The AGREE II and Cochrane Risk of Bias tool were used for evaluation of articles. Three practice guidelines and 12 RCTs were evaluated, and 27 supplemental supportive documents were reviewed (e.g., reviews, information summaries, consensus statements, best practice advice), which were not always cancer-focused. Results are summarized briefly with modest overall quality found in the practice guidelines and RCTs. Considerations were made for small samples, short follow-up in effectiveness trials, and lack of details on methods. Formal assessments were not conducted on supplemental articles to fill in missing gaps of knowledge.
The guideline recommends, at minimum, a brief and focused assessment for sleep disturbances in patients with cancer and cancer survivors and provides options for screening tools and self-report assessments. Strategies, algorithms for screening, assessment, and management are provided based on literature, but they also are consensus-driven. The screening should include a short two-step process using standardized tools. The focused assessment then should identify chronicity and severity of the sleep problems (parameters of symptoms of poor sleep included). This includes key questions and a sleep diary for full evaluation. Referrals for noninsomnia-related disorders (e.g., apnea, restless legs syndrome) are prompted within the algorithm. Based on the initial evaluation, nonpharmacologic and pharmacologic interventions are recommended in a step process with care pathways that match the severity of the sleep disturbance (i.e., mild, transient, insomnia syndrome) with three corresponding care pathways. Preventative and supportive educational information is provided for all patients with cancer and cancer survivors that focuses on sleep hygiene and other sleep-promoting strategies. Rationale is provided for each strategy of treatment within this algorithm.
A basic and focused screening for sleep problems in patients with cancer is needed, with corresponding treatment and education as pertained to the scope of practice.
Howell, D., Keller-Olaman, S., Oliver, T.K., Hack, T.F., Broadfield, L., Biggs, K., . . . Olson, K. (2013). A pan-Canadian practice guideline and algorithm: Screening, assessment, and supportive care of adults with cancer-related fatigue. Current Oncology, 20, e233–e246.
Guidelines and algorithm developed
Guidelines developed for clinical practice.
Hovey, E., de Souza, P., Marx, G., Parente, P., Rapke, T., Hill, A., . . . Lloyd, A. (2014). Phase III, randomized, double-blind, placebo-controlled study of modafinil for fatigue in patients treated with docetaxel-based chemotherapy. Supportive Care in Cancer, 22, 1233-1242.
To determine whether modafinil could reduce fatigue related to docetaxel chemotherapy
Patients with metastatic breast or prostate cancer receiving docetaxel chemotherapy and experiencing significant fatigue were randomized to receive modafinil or placebo for 15 days beginning with their third cycle of treatment and repeated for 2–4 subsequent chemotherapy cycles.
The goal was a 10% or greater relative difference between the two treatment groups.
The primary endpoint of reduced fatigue during docetaxel chemotherapy was not statistically different between the two treatment arms.
Features a trend in docetaxel-related fatigue. Effectiveness was not established for the broader cancer-related fatigue treatment.