Hao, J., Wang, K., Shao, Y., Cheng, X., & Yan, Z. (2013). Intravenous flurbiprofen axetil to relieve cancer-related multiple breakthrough pain: A clinical study. Journal of Palliative Medicine, 16, 190–192.
To compare the effects of immediate-release morphine to those of flurbiprofen axetil in the treatment of cancer-related breakthrough pain
For the treatment of cancer-related breakthrough pain, patients in the flurbiprofen group received 50–100 mg flurbiprofen axetil IV and patients in the control group received a proportional dose of immediate-release morphine. Incidents of breakthrough pain were assessed for three days.
Two-group observational study
Average time to meaningful pain relief following administration of the rescue medication was 16 minutes in the flurbiprofen group and 27.3 minutes in the morphine group (p < 0.01). Patients in the flurbiprofen group and the morphine group received significant reduction in pain, from an average of 7 to 2.2 or 3.0, respectively, on the VAS. The number of breakthrough episodes was significantly lower in the fluribprofen group than in the morphine group (p = 0.000). Most patients needed 50 mg flurbiprofen; only five patients required a dose increase. No serious complications were observed. The prevalence of side effects was similar in both groups
IV flurbiprofen may be an effective intervention for cancer-related breakthrough pain.
Flurbiprofen appears to be a promising agent for the management of cancer-related breakthrough pain. This study has several limitations. Further research regarding flurbiprofen is warranted.
Hanssens, S., Luyten, R., Watthy, C., Fontaine, C., Decoster, L., Baillon, C., . . . De Grève, J. (2011). Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer. Oncology Nursing Forum, 38, E418–E424.
To evaluate the effects of a rehabilitation program on quality of life (QOL), fatigue, fear of movement (kinesiophobia), distress, anxiety, depression, and physical condition.
The intervention consisted of a 12-week comprehensive rehabilitation program based on Herstel and Balans’s 12-week program. The program combined physical exercise, psychoeducation, and individual counseling. Each component consisted of
The intervention was provided at no cost to patients.
The study used a prospective, one-group pre-/posttest design.
The rehabilitation program was associated with a positive effect on depression, fatigue, and QOL; however, weaknesses in study design may preclude making a definitive conclusion based on the study. Prospective randomized studies must determine the long-term impact and the relative contribution of the program versus spontaneous recovery. Future research should also consider the cost-effectiveness of the rehabilitation program.
Multidisciplinary rehabilitation can be one way to manage depression and fatigue in patients with cancer.
Hansen, M.V., Andersen, L.T., Madsen, M.T., Hageman, I., Rasmussen, L.S., Bokmand, S., . . . Gogenur, I. (2014). Effect of melatonin on depressive symptoms and anxiety in patients undergoing breast cancer surgery: A randomized, double-blind, placebo-controlled trial. Breast Cancer Research and Treatment, 145, 683–695.
To investigate whether melatonin could lower the risk of depressive symptoms in women with breast cancer in a three-month period after surgery with a secondary aim of assessing the effect of melatonin on anxiety, sleep, general well-being, fatigue, pain, and sleepiness in the immediate and long-term postoperative period
This study compared 6 mg oral melatonin versus a placebo daily one hour before bedtime for one week preoperatively and 12 weeks postoperatively (or a placebo administered on the same schedule).
Randomized, double-blinded, placebo-controlled trial
The incidence of depressive symptoms (MDI = 21) at one point in the study period was significantly different between groups, as 45% (9/20) of patients had depressive symptoms in the placebo group versus 11% (3/27) in the melatonin group (p = 0.008); relative risk 0.25 (95%, CI: 0.076–0.80). The area under the curve for VAS data on anxiety, sleep, general well-being, fatigue, and pain and KSS for sleepiness in the short-term perioperative period showed no significant differences between the two groups.
This study demonstrated no effects of melatonin on fatigue; it may be useful for the prevention of depression in women with breast cancer.
Melatonin is not effective in treating cancer-related fatigue; it may be useful in preventing depression.
Hansen, M.V., Madsen, M.T., Andersen, L.T., Hageman, I., Rasmussen, L.S., Bokmand, S., . . . Gogenur, I. (2014). Effect of melatonin on cognitive function and sleep in relation to breast cancer surgery: A randomized, double-blind, placebo-controlled trial. International Journal of Breast Cancer, 2014, 416531.
To determine the effectiveness of melatonin on postoperative cognitive function and sleep quality in women who underwent breast cancer surgery
The intervention group received 6 mg of melatonin orally one hour before bedtime one week prior to surgery through 12 weeks postoperatively. The control group received a placebo medication packaged by the hospital pharmacy with the same instructions. Both the placebo and melatonin were labeled and administered identically. Neuropsychological testing was conducted within one week preoperatively and after two and 12 weeks postoperatively. Sleep assessments were collected three days preoperatively to eight days postoperatively (short-term) and 2–12 weeks postoperatively (long-term).
Double-blinded, randomized, controlled study
There were no statistically significant differences between group characteristics. There was no evidence of cognitive impairment two weeks postoperatively in either group; however, there was a decline in cognitive performance (as a composite z-score) in the placebo group, 6.3%, compared to no decline in the intervention group (p = .38). Perioperative sleep efficiency was significantly greater for the intervention group (p = .02). Postoperative total sleep time was greater in the intervention group (p = .03). Side-effect frequency was similar for both groups; however, there was a difference in types of effects reported. Intervention side effects included dizziness (14%), headache (10%), and paresthesias (10%), and the placebo group experienced headache (27%), difficulty falling asleep (13%), and nausea (13%).
Although cognitive impairment was not found to be a significant problem in this sample, subjects who received melatonin had greater sleep efficiency and total sleep time postoperatively than those in the placebo group. In addition, subjects who received melatonin tended to have less cognitive decline although it was not statistically significant.
Melatonin may be useful as an intervention to reduce cognitive difficulties and improve sleep, but further study is warranted.
Hanna, L. R., Avila, P. F., Meteer, J. D., Nicholas, D. R., & Kaminsky, L. A. (2008). The effects of a comprehensive exercise program on physical function, fatigue, and mood in patients with various types of cancer. Oncology Nursing Forum, 35, 461–469.
To evaluate the effectiveness of a comprehensive exercise program consisting of low-to-moderate intensity aerobic and resistance exercise twice a week for 16 sessions to assess improvements in physical function, fatigue, and mood.
Patients received low-to-moderate aerobic and resistance exercise, education, and support twice weekly. At the start of each session, a specialist obtained blood pressure, oxygen saturation, and heart rate for each patient. Patients performed aerobic exercise on a seated machine or treadmill. Progression was obtained through increased exercise duration by adding small increments of three to five minutes per session as tolerated. All patients were able to progress to 40 minutes of aerobic exercise before the end of 16 sessions. Education included various topics focused on symptom management, coping, and wellness, including support groups, survivorship, resources, spirituality, stress management, chemotherapy, radiation, nutrition, energy conservation, relaxation and imagery, drugs and herbs, fatigue and pain, humor therapy, exercise safety and benefits, diagnostic testing, communication issues, financial issues, complementary therapy, and infection control. Average attendance per month was 12 sessions. Support included peer support, exercise environment conducive to discussion within the group, and facilitation of relationships of sharing and encouragement. The specialist inquired about how patients were coping with their disease, side effects, and treatments.
The study was a retrospective analysis of archived data. Patients were eligible if they had a diagnosis of cancer; type and age of diagnosis were not factors.
A comprehensive exercise program consisting of low-to-moderate intensity aerobic and resistance exercise, education, and support twice a week for eight weeks resulted in significant improvements in physical function, fatigue, and mood in patients in active treatment and in cancer survivors beyond treatment.
Further studies may need to be conducted comparing the degree of benefit achieved by patients in a comprehensive program versus a single-component exercise or support group program. The study encouraged the use of low-to-moderate intensity exercise to benefit people with all types of cancer. Further studies need to be completed to determine the best mode, duration, and intensity of exercise for survivors. The authors can say with some certainty that low-to moderate intensity exercise produces significant benefits for people with cancer without causing participant overload or drop-out.
Hanna, L.R., Avila, P.F., Meteer, J.D., Nicholas, D.R. & Kaminsky, L.A. (2008). The effects of a comprehensive exercise program on physical function, fatigue, and mood in patients with various types of cancer. Oncology Nursing Forum, 35(3), 461–469.
The Cancer Exercise Program (CEP) is based on exercise, education, and support. Patients attended CEP sessions twice a week as able until they completed 16 sessions. Exercise mode was based on patients’ fitness level; individualized heart rate target ranges were supplied. The education component focused on symptom management, coping, survivorship, resources, spirituality, stress management, treatment, and other topics. Education was an optional but encouraged component of the CEP. Peer support was encouraged. The exercise specialist also provided support.
Nonrandomized retrospective analysis of archived data
Hanebutt, F.L., Rolf, N., Loesel, A., Kuhlisch, E., Siegert, G. & Knoefler, R. (2008). Evaluation of desmospressin effects on haemostasis in children with congenital bleeding disorder. Haemophilia, 14, 524–530.
Desmopressin (DDAVP) was administered 0.3 mcg/kg IV over 30 minutes. Blood levels of coagulation factor FVIII activity, von Willebrand Factor Antigen, collagen-binding activity, and PFA-100® closure times were measured before and at 60, 120, and 240 minutes after DDAVP administration.
Twenty-four of 26 patients in the von Willebrand group (92%) had an overall positive response rate. Fourteen of 15 patients in the PFD group (93%) had a positive response. One patient in the von Willebrand group and two patients in the PFD group were nonresponders. Mild side effects of flushing or headache occurred in some patients. Side effects were not recorded exactly in the chart. Hemostatic effects differed between individuals and were dependent on coagulation disorder.
DDAVP “challenge” testing is recommended before its first therapeutic use in bleeding episodes or surgical procedures.
Handrup, M.M., Moller, J.K., & Schroder, H. (2013). Central venous catheters and catheter locks in children with cancer: A prospective randomized trial of taurolidine versus heparin. Pediatric Blood and Cancer, 60, 1292–1298.
To determine if a taurolidine catheter lock can reduce catheter-related bloodstream infection (CRBSI) in children with tunneled central venous catheters (CVCs)
Patients were randomized to receive either locks with 250 IE heparin in 2.5 ml normal saline or with 2.5 ml taurolidine 1.35%/sodium citrate 4%/heparin 100 IE/ml. Catheters were flushed once weekly. Catheter insertion was done according to standards in all patients, and bio-occlusive dressings were changed weekly after the skin was cleansed with chlorhexidine every three days. Tunneled lines and total implantable devices were included.
There were 33 episodes of CRBSI. The rate of total bloodstream infections per CVC days was seen in those with taurolidine locks (1.2 per 1,000 CVC days) compared to those with heparin locks (2.5 per 1,000 CVC days) (IRR = 0.49. p =.004). The rate of CRBSI in the experimental group was 0.4/1,000 CVC days compared to 1.4/1,000 CVC days (IRR = 0.26, p = .001). CVC survival was similar in both groups, with a median of 256 days in the heparin group and 300 days in the taurolidine group. Power analysis showed that the sample size was sufficient to detect a relative risk of 0.25 with the intervention.
Use of taurolidine citrate catheter locks was effective in preventing CRBSI in pediatric patients with long-term CVCs. The majority of these were totally implantable devices.
CRBSI is a major concern for patients with cancer who are immunocompromised. Results of this study provide an intervention that appears to prevent CVC-related infections with long term CVCs. Because the majority of catheters in this study were totally implantable devices, it is not clear if this will apply to other long- or short-term CVCs, but further study in these areas is warranted.
Handrup, M.M., Fuursted, K., Funch, P., Moller, J.K., & Schroder, H. (2012). Biofilm formation in long-term central venous catheters in children with cancer: A randomized controlled open-labelled trial of taurolidine versus heparin. Acta Pathologica, Microbiologica, Et Immunologica Scandinavica, 120, 794–801.
The purpose of the study was to compare the effect of catheter locking with taurolidine versus heparin in biofilm formation in central venous catheters.
In the standard arm, catheters were locked with 250 IU heparin in 2.5 ml normal saline while in the experimental arm they were locked with taurolidine 2.5 ml in a sodium citrate and heparin solution. All catheters were either tunneled or totally implanted devices and chosen at the physician’s discretion. Biocclusive dressings were changed every three days and the skin was cleansed with chlorhexidine with dressing changes.
A single-site inpatient setting in Denmark
Prospective, randomized, controlled, open-labeled study
There was no significant difference in the formation of biofilm between the two groups (p = 0.13). A reduction in catheter-related blood stream infections (CRBSIs) was demonstrated in the taurolidine arm (p = 0.03). CVCs locked with heparin were removed after a median of 246 days (range = 40–1,081) and after a median of 301 days (range = 51–590) in those with the experimental lock solution.
The trial confirmed that use of taurolidine as catheter-lock compared with heparin reduced the rate of CRBSIs. This reduction was not related to a reduction in the biofilm formation.
No difference in CVC survival was noted, requiring that they will be changed at the same rate as before. Findings suggest that taurolidine used as a catheter lock was associated with lower incidence of CRBSI.
Han, C.H., Khwaounjoo, P., Kilfoyle, D.H., Hill, A., & McKeage, M.J. (2013). Phase I drug-interaction study of effects of calcium and magnesium infusions on oxaliplatin pharmacokinetics and acute neurotoxicity in colorectal cancer patients. BMC Cancer, 13, 495.
To investigate the effects of calcium and magnesium infusions on oxaliplatin pharmacokinetics and neurotoxicity
Patients were randomized to receive either 1 g calcium and 1 g magnesium IV or placebo 15 minutes before and after a two-hour oxaliplatin infusion on cycle 1, then crossed over to the other intervention on cycle 2. Blood samples were obtained at multiple time points during and after the oxaliplatin infusion for pharmacokinetic analysis. Other study measures were obtained on day 2 and at the end of treatment cycles 1 and 2.
No evidence existed of a pharmacokinetic interaction between calcium and magnesium infusions and oxaliplatin. Most patients demonstrated EMG changes about 24 hours after oxaliplatin. No differences were seen between the experimental and control conditions.
Findings did not show a benefit of calcium and magnesium infusions for prevention of neurotoxicity symptoms from oxaliplatin.
Findings demonstrate that calcium and magnesium infusions did not have a preventive effect on the development of neuropathy symptoms in patients receiving oxaliplatin. Findings also showed that EMG changes happened within 24 hours of treatment. Nurses need to be aware that neuropathic symptoms can develop very quickly and need to assess for such changes early and on a routine basis to identify patients who may need dose reduction or other interventions.