Hoff, A.C., & Haaga, D.A. (2005). Effects of an education program on radiation oncology patients and families. Journal of Psychosocial Oncology, 23, 61–75.
The intervention was a formal education/orientation program with oral and written information for patients and their significant others upon beginning radiation therapy. The control group of patients receiving radiation therapy and their significant others received information during their consultation visit via the physician, several pamphlets, and individual teaching by the nurse.
A randomized controlled trial design was used.
The information orientation session had no significant effect on anxiety, general distress, adherence to treatment, or knowledge about radiation. The program did increase satisfaction with care, use of psychological counseling, and outside support resources.
Hodgson, B. D., Margolis, D. M., Salzman, D. E., Eastwood, D., Tarima, S., Williams, L. D., et al. (2011). Amelioration of oral mucositis pain by NASA near-infrared light-emitting diodes in bone marrow transplant patients. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 20(7),1405-1415.
To investigate the use of extra-orally applied near infrared phototherapy for the reduction of oral pain secondary to chemotherapy and radiation therapy induced mucositis in adult and pediatric HSCT patients.
Eighty HSCT patients were divided into regular and low risk groups, and then into experimental and placebo groups. The experimental groups received gallium-aluminum-arsinide light emitting diode (LED) once daily, while the placebo group also received a similar appearing placebo treatment daily, beginning on day of HSCT (day 0) through day 14. The LED was applied extra-orally, by placing the light source in contact with the cheeks and anterior throat. The blinded evaluators examined the patients three times/week scoring their oral tissues, and patient reported pain assessments.
The sample was comprised of 80 patients age 3-74 years.
Males (%): 55 and Females (%): 45
Key Disease Characteristics: Aplastic anemia, neuroblastoma, AML, NHL, CLL, SLL, ALL, Hodkin’s disease, PNT, MES, Ewing's sarcoma, sickle cell anemia, CML, TC, HLH, WAS, MDS, osteoporosis, lymphoma, multiple myeloma, POEMS, amyloidosis
Other Key Sample Characteristics: All patients received conditioning therapy with melphalan.
Site: Multi-site
Setting Type: Not specified
Location: Children’s Hospital of Wisconsin, University of Alabama - Birmingham, The Children’s Hospital of Alabama
Phase of Care: Active treatment
Randomized, double-blinded, placebo-controlled
There were no significant differences in the WHO clinical examination scale between any of the groups. The other scales used also did not elicit significant differences.
Although it was not statistically significant, the data suggested a trend for the experimental groups to have general improvements in all of the scales.
Small sample <100
Groups were not split into children versus adults.
Inconclusive, would need much more research to demonstrate effectiveness. The positive note was that this treatment is applied extra-orally, making it more tolerable during periods of oral mucositis. This treatment would require education for the healthcare team as well as added cost for the use of the technology.
Hocking, C.M., & Kichenadasse, G. (2014). Olanzapine for chemotherapy-induced nausea and vomiting: A systematic review. Supportive Care in Cancer, 22(4), 1143–1151.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Palliative care
Per the authors, evidence exists to support olanzapine in highly emetogenic regimens. The Navari (2011) trial was the strongest study to support the use of olanzapine. Toxicity in all included trials demonstrated little side effects. Only one trial described sleepiness during chemotherapy. Olanzapine is a safe and more costly option to use instead of NK-1 antagonists. When used with other antiemetics such as metoclopramide there is a role in prevention, and as a single agent it shows efficacy in delayed CINV as well.
There were only three studies in each group. Only the Shumway trial was double-blinded, but it was a small trial. All the breakthrough trials were by the same investigator and included less than 110 patients.
Olanzapine may have a role in preventing CINV and delayed CINV but there is still limited research. The most recent trial for delayed CINV is a small trial but is double-blinded. Further research is indicated.
Hoang, B.X., Tran, D.M., Tran, H.Q., Nguyen, P.T., Pham, T.D., Dang, H.V., … Shaw, D.G. (2011). Dimethyl sulfoxide and sodium bicarbonate in the treatment of refractory cancer pain. Journal of Pain & Palliative Care Pharmacotherapy, 25, 19–24.
To evaluate efficacy and effective doses of a dimethyl sulfoxide (DMSO) sodium bicarbonate combination for refractory pain in patients with cancer
Participants received 8 infusion cycles of 20–60 ml of DMSO mixed with 1.4% of NaHCO3 daily for 10 days with 2 days off between cycles. Data were recorded at baseline, and at 3, 10, 20, 30, 60, and 96 days. Patients were allowed to take any medication, supplements, or herbal preparations as usual for them. The DMSO concentration was increased incrementally until pain was completely under control.
The study was conducted at a single-site, inpatient setting in Hanoi, Vietnam.
This was an open label, prospective trial.
Patients used a verbal pain scale ranging from 0 (no pain) to 4 (extreme pain).
After 2 cycles, 11 (43%) patients achieved 20% or more reduction in pain and were discharged from the hospital to outpatient therapy. After 3 cycles, an additional 23% achieved this level of pain control. All but 4 patients achieved pain control at this level by day 96. By day 96, 83% of patients used less pain medication. No major negative effects occurred related to the infusion solution. The most frequent side effects were headache and chills during and after treatment. These effects resolved within 2 hours. The proportion of patients with other symptoms also was reported to decline over the course of the study.
This preliminary information suggests that this DMSO and NaHCO3 infusion can have a positive benefit for patients in the relief of refractory pain and is not associated with severe adverse effects.
Findings suggest that this DMSO infusion may be a safe alternative for pain control in terminal patients with severe pain that is not otherwise well controlled. However, the study does not provide sufficient support for this intervention. The positive findings here suggest that further well-designed research on DMSO infusion is warranted.
Ho, R.T., Fong, T.C., Cheung, I.K., Yip, P.S., & Luk, M.Y. (2016). Effects of a short-term dance movement therapy program on symptoms and stress in patients with breast cancer undergoing radiotherapy: A randomized, controlled, single-blind trial. Journal of Pain and Symptom Management, 51, 824–831.
To investigate the effectiveness of dance movement therapy on treatment-related symptoms
The program consisted of six 1.5-hour sessions of dance movement therapy twice weekly for three weeks during radiotherapy. Therapy involved use of stretching, movement to exercise upper extremities, improvisational dance, and expressive movement. Participants were encouraged to share experience and communicate and to relate movement to personal experiences of breast cancer and treatment. Patients were randomized to the intervention or a wait-list control group.
All patients showed decline in fatigue scores over time with no difference between groups. Sleep disturbance declined in the study group and increased slightly in the control group, but differences were not significant. Anxiety and depression remained stable in both groups. Pain severity and pain interference declined in the dance group and increase in the control group (p < 0.05). The size of effect for pain was moderate (d = 0.35). Perceived stress declined in the dance group compared to controls (p < 0.05). The program had a high completion rate.
Participation in this group dance movement therapy was associated with decline in pain severity and interference.
The dance movement therapy program used here combined rhythmic and expressive movement with group sharing and support. The contribution of each of these components cannot be differentiated, but results showed positive benefits in terms of pain and perceived stress. There were a number of study limitations; however, the program completion rate was high, and there were no adverse effects, suggesting that this type of intervention can be practical to provide during active radiotherapy treatment.
Ho, C.L., Su, W.C., Hsieh, R.K., Lin, Z.Z., & Chao, T.Y. (2010). A randomized, double-blind, parallel, comparative study to evaluate the efficacy and safety of ramosetron plus dexamethasone injection for the prevention of acute chemotherapy-induced nausea and vomiting. Japanese Journal of Clinical Oncology, 40, 294–301.
To evaluate the efficacy of IV ramosetron plus dexamethasone compared to granisetron plus dexamethasone for the prevention of acute chemotherapy-induced nausea and vomiting (CINV)
Subjects were randomized to receive 0.3 mg ramosetron plus 20 mg dexamethasone or 3 mg granisetron plus 20 mg dexamethasone on day 1 prior to chemotherapy. Patients were evaluated over a 24-hour period. All vomiting episodes were recorded by the patient. Every 6 hours, the degree of nausea was evaluated.
The study was conducted at multiple sites in Taiwan.
All patients were in active treatment.
This was a randomized trial (double-blind), parallel group trial.
Complete response (CR) was defined as no vomiting and no rescue medication. The date, time, and number of episodes of vomiting or retching were recorded. Patients rated their levels of nausea using a 10-cm visual analog scale (VAS) tool. Total control was defined as no vomiting and nausea rating of less than 0.5 cm on the VAS tool. A proportion of subjects received rescue drugs.
Ramosetron plus dexamethasone regimen was found to be equivalent to granisetron plus dexamethasone in CR rate during the acute phase.
Ramosetron plus dexamethasone regimen was found to be as effective as granisetron plus dexamethasone in the management of CINV during the acute phase, suggesting that ramosetron could be used as an alternative to other 5-HT3 receptor antagonists in highly and moderately emetogenic chemotherapy.
Hiura, Y., Takiguchi, S., Yamamoto, K., Takahashi, T., Kurokawa, Y., Yamasaki, M., . . . Doki, Y. (2012). Effects of ghrelin administration during chemotherapy with advanced esophageal cancer patients: A prospective, randomized, placebo-controlled phase 2 study. Cancer, 118, 4785–4794.
To examine the effects of administration of synthetic ghrelin on appetite and oral intake in patients with advanced esophageal cancer during chemotherapy
Patients were randomized to receive either ghrelin at 3 µg/kg over 30 minutes twice daily or placebo for seven consecutive days (days 1–7 of therapy) intravenously. All patients also received the same protocol of IV fluid of 3 L/day from days 1–3 and 2 L/day from days 4–7. Appetite was scored prior to each meal. A registered dietitian determined caloric intake by measuring the weight of each dish before and after every meal.
Patients were undergoing active antitumor treatment.
The study was a placebo-controlled randomized controlled trial.
Dietary intake declined after cisplatin administration to the lowest levels on days 5–7. It took another 4–7 days for oral intake to recover and enable discharge from the hospital. The decline in dietary intake was less in the ghrelin group (p = 0.0027). On day 7, intake with ghrelin was 26.7 kcal/kg/day compared to 23.1 kcal/kg/day for those receiving placebo. Prealbumin was higher in those on ghrelin (p = 0.042), and transferrin was higher with ghrelin (p = 0.037) compared to those levels in the placebo group. The severity grades of anorexia and nausea were lower with ghrelin (< 0.02).
Findings suggest that administration of ghrelin during cisplatin-based chemotherapy was effective in reducing anorexia and maintaining caloric intake compared to placebo.
Findings suggest that ghrelin as administered in this study may be beneficial to preserve appetite and nutritional intake during chemotherapy. As done here, ghrelin and fluid administration would only be practical in an inpatient setting.
Hiramatsu, Y., Maeda, Y., Fujii, N., Saito, T., Nawa, Y., Hara, M., . . . West-Japan Hematology and Oncology Group. (2008). Use of micafungin versus fluconazole for antifungal prophylaxis in neutropenic patients receiving hematopoietic stem cell transplantation. International Journal of Hematology, 88, 588–595.
The hypothesis was that micafungin (150 mg) is a safe and effective alternative to fluconazole (400 mg) for the use of antifungal prophylaxis during neutropenia.
Patients were randomly assigned to receive either micafungin or fluconazole treatment using a 1:1 schedule. Randomization was stratified according to the risk or transplant-related mortality. High risk included acute leukemia in relapse or in complete remission for at least the third time, chronic myelogenous leukemia other than the first chronic phase, Hodgkin lymphoma or non-Hodgkin lymphoma in relapse or greater than or equal to the second complete or partial remission, myelodysplastic syndrome, or myeloproliferative syndrome. Low risk included all factors not classified as high risk and any type of transplant (i.e., autologous, allogeneic using peripheral blood stem cells or bone marrow, or allogeneic using cord blood). Groups received either 150 mg of micafungin or 400 mg of fluconazole daily by infusion until the earliest of: (1) absolute neutrophil count (ANC) of 500 cells/mm3 or greater, (2) 42 days after hematopoietic stem cell transplantation (HSCT), (3) development of proven, probable, or suspected invasive fungal infection, (4) development of unacceptable drug toxicity, or (5) other reason for withdrawal or discontinuation of treatment. Antifungals were given within 48 hours of initiation of the transplant conditioning treatment.
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized, open-label comparative trial.
Neutrophil recovery was seen in an average of 13.7 days in both arms. Graft-versus-host disease was present in 24% of patients in the micafungin arm and 30% in the fluconazole arm. Overall treatment success, defined as the absence of proven, probable, or suspected systemic fungal infection through the end of prophylaxis therapy and as the absence of a proven or probable systemic fungal infection through the end of the four-week posttreatment period, was comparable in both arms, with 94% in the micafungin arm and 88% in the fluconazole arm. This was not a significant difference.
The study showed that another class of medications, the echinocandins, can be effective in preventing fungal infections. Its effectiveness is comparable to that of fluconazole, which is considered the gold standard for antifungal prophylaxis. Neither drug had significant side effects, although the incidence was slightly higher with the use of micafungin.
This was an open-label study and was not powered to measure success rate differences.
Patients should be educated regarding the use, effectiveness, side effects of the medications, and need for continued antifungal prophylaxis based on risk.
Hiramatsu, T., Sugiyama, M., Kuwabara, S., Tachimori, Y., & Nishioka, M. (2014). Effectiveness of an outpatient preoperative care bundle in preventing postoperative pneumonia among esophageal cancer patients. American Journal of Infection Control, 42, 385–388.
To determine the effectiveness of a care bundle completed by patients with esophageal cancer before surgery to reduce the risk of postoperative pneumonia
Retrospective, case-controlled study comparing two groups of patients, each from a different time period in the past.
The definition of postoperative pneumonia was based on the Centers for Disease Control and Prevention criteria. The detection of postoperative pneumonia was based on bacteria collected from a bronchoscope within 30 days of surgery. An analysis between groups was completed using logistic regression.
Completing daily care bundle activities before surgery for esophageal cancer may lower the risk of postoperative pneumonia. The study design and underadherence to care bundle activities limit stronger conclusions. However, most care bundle activities were inexpensive with little risk to patients, so the use of this intervention may still be warranted.
Preoperative nursing interventions and patient education may influence postoperative health outcomes. Nurses can promote smoking cessation, deep breathing, breathing exercises, oral care, and adherence to nutritional guidelines before surgery for esophageal cancer as a potential strategy to decrease the risk of postoperative pneumonia.
Hirai, K., Motooka, H., Ito, N., Wada, N., Yoshizaki, A., Shiozaki, M., . . . Akechi, T. (2012). Problem-solving therapy for psychological distress in Japanese early-stage breast cancer patients. Japanese Journal of Clinical Oncology, 42, 1168–1174.
To examine the feasibility and effectiveness of problem-solving therapy for psychological distress among patients with early-stage breast cancer
The problem-solving therapy involved five weekly sessions aimed at assessing problems, setting goals, generating solutions, choosing a solution, and implementing the solution and evaluating results. The therapy included a manual and worksheet for patients to use. Authors collected self-report data prior to the intervention, after the final sessions, and three months after the final sessions.
Patients were undergoing active antitumor treatment.
A pre/post-test design was used.
Four patients dropped out of the study after starting treatment. Analysis showed a significant effect of time on anxiety and depression scores (p < 0.01). Over time scores for global health status, physical functioning, emotional functioning, and role functioning improved significantly.
The study shows that symptoms of anxiety and depression and some aspects of quality of life improved over time. The effect of the intervention cannot be evaluated from these study results. Though authors state that the intervention was feasible, the fact that 17% of the initial sample did not complete the study suggests that the intervention was not of interest to a substantial proportion of the patients.
Study results are insufficient to allow evaluation of the acceptability and efficacy of the problem-solving intervention.