Gotzsche, P.C., & Johansen, H.K. (2002). Routine versus selective antifungal administration for control of fungal infections in patients with cancer. Cochrane Database of Systematic Reviews, 2, CD000026.
The purpose of this systematic review was to evaluate studies conducted with various antifungal agents to determine whether or not commonly used antifungals decrease mortality in patients with cancer.
The search strategy used databases such as the Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed, as well as the reference lists of articles attached to the publications identified. Also reviewed were the proceedings of the ICAAC (from 1990–2007), General Meeting of the ASM (from 1990–2007), and the European Congress of Clinical Microbiology and Infectious Diseases (1995–2007). The authors also contacted expert researchers in the field.
Key words included random, control, blind, nystatin, amphotericin, fluconazole, itraconazol, ketoconazole, miconazol, voriconazol, bone-marrow, cancer, fungemia, hematologic, fumalignan, neoplasm, neutropenia, granulocytopenia, leukemia, or lymphoma
Randomized trials of antifungal treatments that were experimental in nature for patients with cancer were included. Studies that applied to treatment or prevention of oral candidiasis were excluded, as well as any non-randomized trials or randomized trials with noncancer patients.
Forty-four articles were retrieved. The authors reviewed the identified studies for mortality, mortality associated with a fungal infection, invasive fungal infection, colonization, use of additional antifungal therapy, and harm to patients.
The final article sample size was 32, with total subjects numbering 4,287.
Active treatment
Amphotecerin B was the only antifungal studied that showed reduced mortality significantly and consistently, used either prophylactically or empirically. Ketaconozole, fluconazole, and amhotercerin B were shown to be significant in overall effect for prophylactic administration. Itraconozole, fluconazole, and amphotecerin B all showed effectiveness in treating invasive fungal infection.
Amphotecerin B is highly effective in reducing mortality associated with fungal infection in patients with cancer. More studies should be done with large sample sizes to effectively compare amphotecerin B to other anti-fungals.
Goerling, U., Foerg, A., Sander, S., Schramm, N., & Schlag, P.M. (2011). The impact of short-term psycho-oncological interventions on the psychological outcome of cancer patients of a surgical-oncology department—A randomised controlled study. European Journal of Cancer, 47, 2009–2014.
To examine the influence of psycho-oncologic intervention on the psychological condition of patients with cancer
Patients, who had self-assessed regarding anxiety and depression levels, were placed in high- or low-risk groups. Participants were then randomized to either a psycho-oncologic support group or a control group. Support involved talks with a certified psychologist, who addressed development of a therapeutic relationship, supported the patient’s personal autonomy and defense mechanisms, worked to increase hopefulness and confidence, and facilitated communication between patients and providers. Patients were randomized at the time of surgery. Study measures were obtained at hospital discharge and 12 months later. The number of support sessions varied according to the length of inpatient care. High-risk groups averaged four sessions lasting an average of 41 minutes each. Low-risk patients had two or three sessions lasting an average of 40 minutes each.
Active treatment
Randomized controlled trial
Hospital Anxiety and Depression Scale (HADS), German version
The study showed statistically significant reduction of anxiety and depression in high-risk patients who had undergone psycho-oncologic intervention at the end of inpatient care (p = 0.001). At 12 months, anxiety and depression scores increased in all patients. Depression scores increased in all low-risk patients at the time of discharge.
Patients with cancer who have anxiety may benefit from psycho-oncologic support.
Postsurgical patients with cancer who are anxious may benefit from psycho-oncologic support services. In the study, the effect of the intervention was significant in only those patients who had high anxiety scores at baseline. Study findings are similar to those produced by other research. This fact may suggest that interventions for anxiety are most beneficial for individuals who have meaningful levels of anxiety to begin with. Psycho-oncologic support did not appear to affect depression scores; however, these scores were not high at baseline.
Goerling, U., Jaeger, C., Walz, A., Stickel, A., Mangler, M., & van der Meer, E. (2014). The efficacy of short-term psycho-oncological interventions for women with gynaecological cancer: A randomized study. Oncology, 87, 114–124.
To study the effects of two different interventions on anxiety and depression postoperatively
The interventions that were studied included a single educational session and a single session of progressive muscle relaxation delivered between the third and sixth postoperative day to women who had surgery for gynecologic cancers. Women randomly were assigned to intervention groups. Study measures were obtained preoperatively prior to hospital discharge.
Randomized, noncontrolled trial
Anxiety scores declined significantly in both groups (p < .005), and depression declined significantly in those receiving the educational intervention (p < .001). There were no differences between groups in self-reported stress, and there were no significant changes in physiologic measures.
The findings of this study demonstrate that the interventions tested here may have some benefit; however, the strength of the results is low due to study limitations
This study does not provide strong evidence in support of educational and muscle relaxation interventions for the reduction of anxiety or depression.
Goedendorp, M. M., Peters, M. E., Gielissen, M. F., Witjes, J. A., Leer, J. W., Verhagen, C. A., & Bleijenberg, G. (2010). Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial. The Oncologist, 15, 1122–1132.
The primary aim was to demonstrate the efficacy of a brief nursing intervention (BNI) and cognitive-behavioral therapy (CBT) compared to usual care (UC). The secondary aim was to determine the role of physical activity in reducing fatigue during cancer treatment.
In total, 220 patients were randomly assigned to one of three groups: BNI, CBT, or UC.
The study was a multicenter, randomized, controlled trial.
The CBT group was significantly less fatigued than the UC group. Between the BNI and the UC groups, no significant difference in fatigue was found. Physical activity was found not to mediate the effect of CBT on fatigue.
CBT during curative cancer treatment resulted in less fatigue compared to the BNI and UC groups. The mediation hypothesis was rejected.
Further study is warranted to determine the effects of specific nursing interventions on the experience of fatigue in patients with cancer.
Goedendorp, M. M., Gielissen, M. F., Verhagen, C. A., & Bleijenberg, G. (2009). Psychosocial interventions for reducing fatigue
during cancer treatment in adults. Cochrane Database of Systematic Reviews, 1, CD006953.
To evaluate if psychosocial interventions are effective in reducing fatigue and to consider which interventions are the most effective.
Databases searched were Cochrane Central Register, PUBMED, MEDLINE, EMBASE, CINAHL, and PsycINFO to September 2008. Hand searching of reference lists was also performed.
Extensive keywords and specific search terms per database were provided.
Studies were included in the review if
Patients were excluded if they were breast cancer survivors receiving only hormonal therapy and were not considered in active treatment.
In total, 85 references were retrieved. The Jadad scale criteria were applied for quality rating, as well as additional criteria identified by vanTulder (1997).
In most studies, it was unclear at what stage of cancer the intervention ended. In most studies, the interventions were given by nurses. Formats varied and included intervention in groups; combination of face-to-face and telephonic support; and provision of additional written, videotape, or audiotape information. The number and duration of sessions varied across studies. In four studies, participants received an intervention of the same number and duration for the attention control. The number, type, and timing of outcome assessments also varied. Most studies used one instrument to measure fatigue, with the Profile of Mood States (POMS) used most often. Only five studies used a measure specifically defined to measure fatigue. Only three studies scored at least a three on the Jadad quality scale, and only one study had a good evaluation of quality scoring related to internal validity. Most had a moderate quality. Seven studies reported a significant effect on fatigue, with effect sizes ranging from 0.17 to 1.07 (p ≤ 0.05). In two of these, there was an immediate effect, but the results were not maintained at follow-up. Twenty studies were regarded as not effective. Interventions specifically aimed at fatigue, rather than multiple additional symptoms, tended to be more effective for fatigue.
Findings showed that there was no solid evidence that interventions not specifically focused on fatigue were effective in reducing fatigue. Overall, there was limited support and conflicting results for psychosocial interventions on fatigue during cancer treatment. Studies that showed an effect included education about fatigue and teaching in self-care or coping strategies and taught activity management, balancing activity, and rest.
Psychoeducational interventions, including education about fatigue, helping patients in self-care and coping, and teaching patients to balance activity and rest, may be helpful in alleviating fatigue among patients receiving cancer treatment. The degree and timing of fatigue can vary according to treatment type and the cancer trajectory. The most effective interventions based on treatment and phase of care were not clear, and further research in this area is warranted.
Goedendorp, M.M., Knoop, H., Gielissen, M.F., Verhagen, C.A., & Bleijenberg, G. (2014). The effects of cognitive behavioral therapy for postcancer fatigue on perceived cognitive disabilities and neuropsychological test performance. Journal of Pain and Symptom Management, 47, 35-44.
To determine whether cognitive behavioral therapy (CBT) for post-cancer fatigue has an effect on patients’ perceived cognitive functioning and/or neuropsychological test performance
Subjects were randomly assigned to intervention (CBT) or wait-list control (WLC) group. Participants were evaluated on six perpetuating factors of fatigue: inadequate coping with the cancer experience, fear of recurrence, dysfunctional beliefs concerning fatigue, sleep dysregulation, activity dysregulation, and low social support and negative social interactions. Results were used to customize the standardized modules for an individualized CBT intervention. Each hour-long CBT session was delivered by one of three trained therapists over a six-month interval. The number of sessions varied per participant since it was dependent upon when therapeutic goals were met. Participants were offered up to two booster sessions over an additional six months. Measurements were performed at baseline (T1) and at six months (T2).
PHASE OF CARE: Late effects and survivorship
Randomized clinical trial with waitlist control group
At baseline, most participants (78%) had clinically relevant difficulties with concentration as indicated by scores on the reaction time tasks; however, no differences existed between the intervention and control group. In contrast, the CBT group reported greater cognitive disability at baseline than WLC, as measured the CIS-concentration subscale (p = 0.04) and SIP-alertness subscale (p = 0.015). After intervention completion, there was a significant improvement in concentration and alertness behavior (p < 0.05) in participants who received CBT as compared to WLC. For CBT group, the improvements in self-reported concentration and alertness behavior were significantly associated with their decrease in fatigue severity (p < 0.001; p < 0.02); SDMT scores and computerized reaction time tests were slightly improved but not significant.
Individualized CBT may be an effective intervention in reducing self-reported fatigue. Although improvements in concentration and alertness behaviors were found, it is difficult to differentiate if they were related to reduced fatigue, CBT, or both. Improvements in perceived cognition were not associated with either depression or anxiety.
CBT decreased fatigue and improved perception of cognitive functioning over a six-month interval; however, the durability of those results are unknown. Further research is warranted to validate these findings and to determine whether this intervention can be adapted for general clinical use.
Godoy Mde, F., Pereira, M.R., Oliani, A.H., & de Godoy, J.M. (2012). Synergic effect of compression therapy and controlled active exercises using a facilitating device in the treatment of arm lymphedema. International Journal of Medical Sciences, 9(4), 280–284.
To evaluate the effects of active exercise using a facilitating apparatus with compression on arm lymphedema secondary to breast cancer
Patients received two sessions of four, 12-minute stints of exercise using an active apparatus pulley system. The device was a vertical iron wheel fixed to a 30-cm-high support on a metal bench. The patient revolved the wheel, thus elevating the shoulder and stretching the arm. A homemade short-stretch compression sleeve made of a cotton polyester material was used during one of the exercise sessions. Arm volume measurements were taken before and immediately after each exercise session.
The study took place at an outpatient setting in Brazil.
The study has clinical applicability for late effects and survivorship.
The study used an observational single group design.
Arm volume was measured by water displacement.
A mean reduction in arm volume of 24.6 ml was seen in the exercise session while wearing the compression garment (p < 0.0004). Without the compression garment, arm volume increased by a mean of 9.7 ml.
The apparatus used here was effective for provision of active exercise. Without the compression garment, exercise increased arm volume slightly. The low stretch, inelastic compression had a synergistic effect with exercise to reduce arm volume.
Findings demonstrated the importance of use of a compression mechanism during exercise in patients with lymphedema.
Pereira de Godoy, J.M., & Guerreiro Godoy, M.D. (2013). Evaluation of a new approach to the treatment of lymphedema resulting from breast cancer therapy. European Journal of Internal Medicine, 24(1), 59–62.
To evaluate the efficacy of a new combination therapy for the management of lymphedema
All patients had a three-to-four hour weekly session that included manual lymph drainage, mechanical lymph drainage, and exercises using facilitating apparatuses and a compression sleeve made from a cotton-polyester material. Exercise and daily life activities were adapted for home use, and psychological and nutritional supports were provided. Compression sleeves were adapted for home use. Activities were individually evaluated and adapted for each patient by an occupational therapist to ensure they could be adapted to fit the treatment program. The textile used for low-stretch compression sleeves exert pressure with muscle activity and rest, and lengthwise elasticity allows flexibility in the limb. Arm volume was measured monthly.
The study was conducted in a single-site, outpatient setting in Brazil.
A prospective study design was used.
Water displacement was used to measure volume.
The model of treatment appeared to be effective in management of lymphedema among women with breast cancer.
This approach for lymphedema management appears to be effective. Methods shown here are similar to complete decongestive therapy, with differences in the textile used for compression sleeves, use of an apparatus for arm exercises, and once weekly manual lymph drainage.
Godino, C., Jodar, L., Durán, A., Martínez, I., & Schiaffino, A. (2006). Nursing education as an intervention to decrease fatigue perception in oncology patients. European Journal of Oncology Nursing, 10, 150–155.
The patient education intervention was delivered in three sessions and consisted of: one-to-one education, training and counseling, and audio-visual computerized educational materials. In session one (first cycle of chemotherapy treatment), patients were introduced to the project and were given information about fatigue and how to manage it, as well as a diary to record their daily feelings related to fatigue. In session two (second cycle of chemotherapy treatment), the nurse and patient engaged in an open interview about treatment, side effects, and daily activities of the patient and discussed the diary notes. In session three (one month after the completion of treatment), the patient discussed with the nurse changes in fatigue perception throughout treatment using diary notes. A questionnaire was completed by both the intervention and control groups at sessions one and three. Only the intervention group completed the questionnaire at session two.
Patients were undergoing the active treatment phase of care.
The study used an experimental, randomized, stratified design.
Fatigue levels were lower for the intervention group after the second session in comparison to baseline and remained steady after one month posttreatment. Fatigue levels remained stable for the control group at baseline to one month posttreatment. These differences were not statistically significant.
Glover, M., Smerdon, G.R., Andreyev, H.J., Benton, B.E., Bothma, P., Firth, O., . . . Yarnold, J. (2016). Hyperbaric oxygen for patients with chronic bowel dysfunction after pelvic radiotherapy (HOT2): A randomised, double-blind, sham-controlled phase 3 trial. Lancet Oncology, 17, 224–233.
To determine the clinical benefit of hyperbaric oxygen therapy on the management of bowel dysfunction in patients who receive radiation therapy to the pelvis
Study of patients with chronic gastrointestinal problems for greater than 12 months post radiation therapy in spite of optimal medical management. Patients received either hyperbaric oxygen therapy or sham.
PHASE OF CARE: Late effects and survivorship
Double-blinded, sham-controlled, phase 3, randomized trial
No difference between treatment groups existed.
In this patient group, no improvement using hyperbaric oxygen versus sham occurred.
Large randomized, phase 3 studies are required before any conclusions can be made about the use of hyperbaric oxygen in patients with bowel dysfunction after radiation therapy.