Hershman, D.L., Unger, J.M., Crew, K.D., Awad, D., Dakhil, S. R., Gralow, J., . . . Moinpour, C.M. (2015). Randomized multicenter placebo-controlled trial of omega-3 fatty acids for the control of aromatase inhibitor-induced musculoskeletal pain: SWOG S0927. Journal of Clinical Oncology, 33, 1910–1917.
To determine if omega 3 fatty acids can be effective in decreasing arthralgia resulting from aromatase inhibitor (AI) treatment
Patients were randomized to receive either a placebo or 3.3 g of omega 3 fatty acids daily for 24 weeks. Random assignment was stratified by prior history of arthritis and prior taxane use. Study assessments were done at baseline and at six, 12, and 24 weeks.
Double-blinded, placebo-controlled, randomized trial
There were no significant differences between the groups in worst pain scores or stiffness at any study time point. The mean observed changes in other study measures showed somewhat reduced symptoms in the omega 3 arm, but these changes were not statistically significant. There were no significant changes in serum measures over time other than decreased triglycerides in those receiving the fatty acids. Over time, symptoms improved in both study groups.
This study did not show any improvements in arthralgia symptoms induced by AIs with the use of omega 3 fatty acids compared to a placebo.
There are no effective therapies for the prevention or treatment of AI-associated arthralgia. Ongoing research to determine optimal approaches to prevent or manage this symptom is necessary. These symptoms' mechanism of development is not clear, but they may have inflammatory and autoimmune components.
Herschbach, P., Berg, P., Waadt, S., Duran, G., Engst-Hastreiter, U., Henrich, G., … Dinkel, A. (2010). Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychotherapy and Psychosomatics, 79, 31–38.
To examine the effects of generic psychotherapeutic interventions on dysfunctional fear of progression (FoP)
Randomization was stratified by diagnosis, and participants were blinded with regard to group assignment. The intervention group received four sessions of group psychotherapy, each 90 minutes. The first group received cognitive behavioral group therapy (CBT) and a manual that was structured with content, topics, and interventions. The supportive experiential group therapy (SET) had a manual with regard to structure, but it was less prescriptive in content than was the CBT manual. The groups were led by psychotherapists who had had three years or more of clinical experience or were in the final phase of training. Sessions were recorded, to monitor integrity. Measures were taken at the initial session, before discharge, at three months, at 12 months, and after discharge. The control group provided data at the initial, before-discharge, and after-discharge points only. The intervention groups received booster telephone calls at six and nine months after discharge. The control group was sampled in the same clinics as were other patients and at one year after the completion of the intervention, using the same eligibility criteria.
Active treatment and transition phase
Single-blind partially longitudinal randomized controlled study
Both interventions were associated with a decrease in FoP over time, but only among cancer patients. The two interventions did not differ in reducing FoP. A significant interaction between time and illness group emerged for anxiety, depression, and the mental component of health-related quality of life, indicating an improvement in cancer patients. The intervention had no effect on any of the secondary outcomes.
Dysfunctional FoP can be identified and targeted with brief group interactions. These interventions may reduce FoP, especially in populations with cancer. The intervention used here did not appear to have a long term benefit related to symptoms of depression.
Dealing with FoP is important in the care of cancer survivors. Findings of this study suggest that dysfunctional fear can be identified and that interventions can be appropriately targeted. While the intervention in this study did not show a lasting benefit related to depression, the study does provide potential approaches to identifying patients who may benefit from interventions to address fear.
Herrstedt, J. (2008). Antiemetics: An update and the MASCC guidelines applied in clinical practice. Nature Clinical Practice.Oncology, 5, 32–43.
To review the pathophysiology of cancer-related nausea and vomiting and the research regarding various medications for management of this symptom, as well as similarities and differences among guidelines of various professional groups
Multinational Association of Supportive Care in Cancer (MASCC) guidelines are based on consensus via surveys and a consensus conference.
High emetic risk (e.g., cisplatin, dacarbazine, high-dose cyclophosphamide)
Moderate emetic risk (e.g., cyclophosphamide at more than 100 mg/m2, anthracyclines, oxaliplatin, carboplatin)
Low emetic risk (e.g., topotecan, gemcitabine, taxanes, capecitabine, trastuzumab)
Minimal emetic risk (e.g., bleomycin, vinca-alkaloids, bevacizumab): No routine prophylaxis
No approach to anticipatory nausea was provided.
New medications are highly effective in prophylaxis of emesis, but prevention of nausea remains challenging.
Herrstedt, J., Roila, F., & ESMO Guidelines Working Group (2009). Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis. Annals of Oncology, 20(Suppl. 4), 156–158.
To provide guidance to clinicians for the prevention and management of chemotherapy-induced nausea and vomiting in patients receiving cancer chemotherapy of varying emetogenic potential
The evidence-based process was not fully described. Specific research was not stated. Literature cited were the antiemetic resource center at www.mascc.org and the Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer 2004 consensus conference, cited in Annals of Oncology 2006, 17, 20–28.
Levels of evidence and grades of recommendation as used by the American Society of Clinical Oncology (ASCO) were applied to specific recommendations and considered by the authors and European Society for Medical Oncology (ESMO) faculty. This was approved by the ESMO guidelines working group.
This reference provides definitions of nausea and vomiting; relative emetogenic potential of oral and IV drugs; recommended drugs, dosing, and schedules for antiemetic drugs; and recommendations for management of nausea and vomiting based on emetogenic potential.
Specific regimens are outlined below. Stated level (I–V) and grade of evidence assessed are shown in parentheses.
Herrstedt, J., Sigsgaard, T.C., Nielsen, H.A., Handberg, J., Langer, S.W., Ottesen, S. & Dombernowsky, P. (2007). Randomized, double-blind trial comparing the antiemetic effect of tropisetron plys metopimazine with tropisetron plus placebo in patients receiving multiple cycles of multiple-day cisplatin-based chemotherapy. Supportive Care in Cancer, 15, 417-426.
To compare tropisetron plus metopimazine versus tropisetron plus placebo for the prevention of chemotherapy-induced nausea and vomiting (CINV)
This study reported on 82 patients with germ cell tumors scheduled to receive four cycles of cisplatin, given as a five-day treatment every three weeks.
This was a randomized, double-blind trial.
Patients used diaries to record the number of vomiting and retching episodes, nausea severity (on a four-point Likert-type scale), and appetite evaluation (on a four-point Likert-type scale).
Satisfaction with antiemetic treatment was collected via a categorical question (satisfied versus not satisfied). Those who were not satisfied with the antiemetic treatment were withdrawn from the study, as they were requesting additional or other treatments.
Tropisetron plus metopimazine was reported to be superior to tropisetron plus placebo in the overall period (days 1-9) in terms of complete protection from vomiting as well as decreased nausea. The treatment arm also was superior over multiple cycles, providing cumulative emetic protection.
This study addressed an appropriate and effective antiemetic prophylaxis for multiple-day chemotherapy regimens (usually cisplatin-based). However, antiemetic control in both treatment arms was poor.
Since this study was conducted, newer agents (i.e., palonosetron and aprepitant) have been proven to have greater efficacy than the treatments used in this study. Furthermore, the treatments described in this study are known to be inferior to treatments that include a corticosteroid. Finally, the rates of protection from CINV associated with the agents studied are not good.
Herrstedt, J., Roila, F., Warr, D., Celio, L., Navari, R., Hesketh, P., . . . Aapro, M.S. (2017). 2016 updated MASCC/ESMO consensus recommendations: Prevention of nausea and vomiting following high emetic risk chemotherapy. Supportive Care in Cancer, 25, 277–288.
RESOURCE TYPE: Evidence-based guideline
PHASE OF CARE: Active antitumor treatment
One thousand three hundred and thirty articles were initially retrieved, and a final set of 22 were used for the update.
Very few studies examining olanzapine were included. More evidence is available.
This review provides guidelines regarding prophylaxis for acute and delayed CINV for patients receiving HEC or AC-based chemotherapy. Recommendations are consistent with those of other professional groups. This review does not include the consideration of dexamethasone-sparing regimens and does not include the full range of olanzapine-based regimen evidence.
Herrstedt, J., & Roila, F. (2008). Chemotherapy-induced nausea and vomiting: ESMO clinical recommendations for prophylaxis. Annals of Oncology, 19(Suppl. 2), ii110–ii112.
PURPOSE: To provide guidance to clinicians for the prevention and management of chemotherapy-induced nausea and vomiting
PATIENT POPULATION: Patients receiving cancer chemotherapy of varying emetogenic potential
PROCESS OF DEVELOPMENT: The process was not fully described. The references cited were the antiemetic resource center on the Multinational Association of Supportive Care in Cancer's (MASCC's) website and the Antiemetic Subcommittee of MASCC's 2004 consensus conference, cited in Annals of Oncology 2006, volume 17, pages 20–28. The levels of evidence and grades of recommendation used by the American Society of Clinical Oncology were applied to specific recommendations and considered by the authors and ESMO faculty.
This reference provides definitions of nausea and vomiting; the relative emetogenic potential of oral and IV drugs; recommendations of drugs, dosing, and schedules for antiemetic drugs; and recommendations for the management of nausea and vomiting based on emetogenic potential.
Herrington, J.D., Jaskiewicz, A.D., & Song, J. (2008). Randomized, placebo-controlled, pilot study evaluating aprepitant single dose plus palonosetron and dexamethasone for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. Cancer, 112, 2080–2087.
To evaluate the efficacy of one-day versus three-day administration of aprepitant in combination with palonosetron and dexamethasone for the prevention of acute and delayed nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC)
The study was conducted in a single site.
All patients were in active treatment.
This was a randomized, double-blind, placebo-controlled, comparative pilot study.
This study suggested that a single, 125-mg dose of aprepitant provides similar effectiveness compared to the 3-day regimen. The addition of palonosetron and dexamethasone provided protection against emesis in more than 90% of patients during the 5-day study period.
The use of aprepitant has shown to be effective in preventing acute and delayed emesis in patients who are receiving cisplatin- and anthracycline-containing therapies.
Herr, K., Titler, M., Fine, P.G., Sanders, S., Cavanaugh, J.E., Swegle, J., . . . Forcucci, C. (2012). The effect of a translating research into practice (TRIP)-cancer intervention on cancer pain management in older adults in hospice. Pain Medicine, 13, 1004–1017.
To promote the adoption of evidence-based pain practices for older adults with cancer
No significant differences existed between the E and C groups in regards to improvement in the CPPI. A decrease in pain severity was found from baseline to post-intervention in the E group, but this was not statistically significant.
Numerous factors influence a multicomponent intervention. Culture, competing priorities, intervention complexity, and other factors may have a role. Future studies should focus on more specific factors in need of change. Although the patient sample was large, only eight hospices comprised each group for the study.
Translating research into practice is a primary goal of nursing, and pain guideline translation is essential to improving pain outcomes. Translation, however, takes time and may not translate immediately to improved patient outcomes.
Hernandez-Reif, M., Ironson, G., Field, T., Hurley, J., Katz, G., Diego, M., . . . Burman, I. (2004). Breast cancer patients have improved immune and neuroendocrine functions following massage therapy. Journal of Psychosomatic Research, 57, 45–52.
Patients were randomized to receive massage therapy or standard treatment. The massage therapy group received 15 massages that were 3–30 minutes long per week by a trained massage therapist for four weeks. The control group received standard medical care alone.
Massage did show some benefit in patient mood scale assessment tools and immune system function. Specifically, reduced anxiety was found on the STAI after the first and last sessions. Reduced depression was found on the POMS depression score after the first and last sessions and from the first to the last day of the study. The SCL-90-R confirmed a reduction in depression from the first to the last day. Wilcoxon’s matched-pairs signed-ranks tests revealed an increase in dopamine and serotonin levels in the massage group; the control group showed a significant increase in norepinephrine. Natural killer cell cytotoxicity did not attain significance.