Galbraith, S., Fagan, P., Perkins, P., Lynch, A., & Booth, S. (2010). Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. Journal of Pain and Symptom Management, 39(5), 831-838.
The objective of this study was to investigate whether a handheld fan reduces the sensation of breathlessness in patients with dyspnea.
Room temperature and humidity were controlled, and the fan was directed to either face or leg for five minutes. This was followed by a 10-minute washout followed by repeat intervention, as crossover dyspnea scores were collected at baseline, at completion of each 5-minute intervention, and after 10-minute washout of each intervention. Additional data collected included pulse rate and oxygen saturation after each 5-minute use of the fan and each 10-minute washout.
The study was conducted in an inpatient medical center and a hospice setting in the United Kingdom.
The study had a randomized, controlled, crossover design.
Visual analogue scale (VAS) 10 cm for dyspnea was used. Anchors were no shortness of breath to worst shortness of breath. VAS calculations were performed by a noninvestigator.
Only eight participants perceived benefits of the fan to the face at the conclusion of 5 minutes, but 19 participants perceived benefit at the end of the 10-minute washout. The eight who initially perceived benefit did register reduction in benefit during the washout period. A significant difference in VAS scores was seen between the two treatment arms with reduction in breathlessness when the fan was directed to the face (p = 0.003).
Use of a fan pointed at the face may reduce the sensation of breathlessness in a controlled temperature and humidity environment.
Handheld fans are inexpensive and easy and permit empowerment of patient initiation of symptom management. This study suggests that this intervention, in a controlled temperature and humidity condition, will decrease the sensation of dyspnea. Patients may continue to experience benefit from the intervention even after its discontinuation, so it may be extremely helpful as bridge management when awaiting onset of an intervention such as a pharmacologic agent.
Galantino, M.L., Desai, K., Greene, L., Demichele, A., Stricker, C.T., & Mao, J.J. (2012). Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor–associated arthralgias. Integrative Cancer Therapies, 11, 313–320.
To establish feasibility of studying the effects of yoga on function, pain, and quality of life in women with aromatase inhibitor–associated arthralgias
Women who had joint pain attributed to aromatase inhibitor treatment were studied. Patients met two times per week for eight weeks for yoga sessions taught by certified instructors. The protocol used was inspired by Iyengar yoga involving precise postures, and meditation using relaxation and combinations of static and active stretching and isometric and dyunamic strengthening. Sessions were done among groups of 5–10 women, and an abbreviated version was given for home practice during week 2. Patients were asked to perform home practice for 15 minutes three times per week on days when sessions did not take place. Study assessments were done at baseline and at the end of the program.
Patients were undergoing active antitumor treatment.
This was a quasi-experimental feasibility study.
Of the sample, 80% reported adherence to home practice as recommended. Participants had significant improvement in functional reach (p = 0.048) and sit and reach (p = 0.009). Participants experienced significant reduction in pain severity (3.9–2.79, p = 0.016).
The yoga protocol used here was associated with improvement in flexibility and pain associated with aromatase inhibitor–induced arthralgia.
There is limited evidence regarding interventions to reduce arthralgia pain in patients undergoing cancer treatment. This study shows that a yoga intervention is feasible and may provide some promising results. Further research in this area is warranted.
Galantino, M.L., Callens, M.L., Cardena, G.J., Piela, N.L., & Mao, J.J. (2013). Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: A feasibility study. Alternative Therapies in Health and Medicine, 19(6), 38-44.
To evaluate the feasibility of tai chi to improve well-being for women with breast cancer treatment-associated arthralgia
Women met twice weekly for eight weeks for group tai chi under supervision. The program was a gentle, low-impact form of tai chi focusing on body awareness, deep breathing, and weight bearing. Women were provided written information for home practice. Participants were asked to complete journal entries after each tai chi session and home exercise, encouraged to maintain usual activities, and asked to refrain from other exercise during the study. Study measures were obtained at baseline and at the end of 8 weeks.
PHASE OF CARE: Late effects and survivorship
Single-group observational, mixed-method, feasibility
There was a reduction in anxiety from 8.0 to 5.7 (p = .003) and in depression from 5.17 to 2.42 (p = .02). A positive, but non significant, reduction in fatigue and pain occurred. Themes from analysis of qualitative results were improved relaxation and reduced stress, an increase in undisturbed sleep, and perceived value from the group and instructor support. There were no adverse events.
Tai chi participation appears to be feasible for breast cancer survivors and may have positive effects on anxiety and other symptoms.
Tai chi sessions are feasible for cancer survivors and may be of benefit. This combination of relaxation and exercise disciplines may be helpful and acceptable to some patients. Study findings here suggest that the supportive nature of instructor-led group sessions contributed to the positive results.
Gagnon, B., Low, G., & Schreier, G. (2005). Methylphenidate hydrochloride improves cognitive function in patients with advanced cancer and hypoactive delirium: A prospective clinical study. Journal of Psychiatry Neuroscience, 30, 100–107. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC551162/?tool=pubmed
The study was conducted to investigate the clinical improvement observed in patients with advanced cancer and hypoactive delirium after the administration of methylphenidate hydrochloride (MPH).
First, a 10 mg test dose of MPH was given orally to all participants. If there were no distressing side effects, participants were given 10 mg of MPH twice daily at 8 am and 12 pm. Follow-up was daily for hospital inpatients and every three to four days for patients in the community. Doses of MPH were increased in 5 mg increments to reach the maximum tolerable dose for the patient’s satisfaction and the resolution of delirium.
Measurements were taken before delirium and delusions (T0), at baseline prior to the MPH treatment (T1), one hour after after the MPH dose (T2), and when a stable dose was achieved (T3).
The Mini-Mental State Examination was used as an assessment tool on a daily basis for inpatients and every three to four days for outpatients.
The study utilized a case series design for patients with advanced cancer and hypoactive delirium.
All participants had a positive response to MPH that included increased alertness, partial-to-complete resolution of psychomotor retardation, normalization of slurred speech, and a marked increase in energy levels.
All 14 participants showed improvement in their cognitive function as documented by the MMSE. In 13 patients, the median MMSE score improved to 28 (mean = 27.8, standard deviation = 2.4, p = 0.02) compared with the median score one hour after the first dose of MPH. One patient died before reaching a stable dose of MPH.
The pretreatment MMSE median score was 21 (mean = 20.9, standard deviation = 4.9), which improved to a median of 27 (mean = 24.9, standard deviation = 4.7) after the first dose of MPH (p < 0.001).
MPH improved alertness and general cognitive function in a small sample of patients with advanced cancer. However, due to confounding issues with disease and treatment responses, more research is warranted to determine its effectiveness.
Gagnon, B., Murphy, J., Eades, M., Lemoignan, J., Jelowicki, M., Carney, S., . . . Macdonald, N. (2013). A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer. Current Oncology, 20, 310-318.
To evaluate the degree to which a multi-component rehabilitation program improves symptom control and quality of life in patients with advanced cancer
The intervention was a 10-12 week program offered by a multidisciplinary team, consisting of nutritional counseling, a collaborative care plan based on patient goals, a palliative care physician specialist focused on symptom-related medical interventions, a pivot nurse for care coordination and case management, and an exercise component with semi-weekly exercise sessions with a physical therapist and a home exercise plan. Occupational therapy was provided and focused on self care, leisure, and productivity. Patients were assessed at baseline and during their final clinic visit at the end of the study.
SITE: Single site
SETTING TYPE: Outpatient
LOCATION: McGill University Cancer Center, Montreal, Canada
Quasi-experimental
Change in symptom severity was analyzed and Cohen’s d was used to calculate effect size. Severity of depression from ESAS declined (p <. 0001, d = 0.7); anorexia declined (p < .0001, d = .4); pain declined (p < .0001, d = .4); physical and general fatigue declined (p < .0001, d = .7); mental fatigue declined (p < .0005, d = .4); and level of distress and difficulty coping declined (p < .0001).
The multi-component rehabilitation program provided here resulted in a significant improvement in multiple symptoms and a reduction in distress and difficulty coping.
A multi-component, multi-disciplinary rehabilitation and palliative care program can provide effective improvement of multiple symptoms in patients with advanced disease.
Gafter-Gvili, A., Paul, M., Fraser, A., & Leibovici, L. (2007). Effect of quinolone prophylaxis in afebrile neutropenic patients on microbial resistance: Systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy, 59, 522.
To compare antibiotic prophylaxis with placebo or no intervention or another antibiotic in patients with afebrile neutropenia
DATABASES USED: Cochrane Cancer Network Register of Trials (December 2004), Cochrane Library (Issue 4, 2004), EMBASE (January 1980–December 2004), and MEDLINE (January 1966–December 2004); the reference lists of all the articles also were searched.
FINAL NUMBER STUDIES INCLUDED = 95 RCTs
TOTAL PATIENTS INCLUDED IN REVIEW = 9,283 patients comparing prophylactic antibiotics with placebo, no intervention, or other prophylactic antibiotics
KEY SAMPLE CHARACTERISTICS: Sixty-four trials included only patients with hematologic malignancies, and nine trials consisted of more than 80% of patients with solid tumors. Twenty-seven studies included patients undergoing bone marrow transplantation (BMT).
Prophylactic antibiotics significantly decreased
Fluoroquinolones, when compared with placebo or no intervention, decreased the risk of
The relative risk for adverse events was not statistically significant (relative risk 1.30 [confidence interval 0.61–2.76]). Comparatively, in trials comparing trimethoprim/sulfamethoxazole with placebo or no intervention, the corresponding estimates were statistically significant (relative risk 2.42 [confidence interval 1.35–4.36] and 3.63 [confidence interval 1.32–9.98], respectively). Moreover, in trials that compared fluoroquinolones with trimethoprim/sulfamethoxazole, less resistance developed to fluoroquinolones in the fluoroquinolone group than that developed to trimethoprim/sulfamethoxazole in the trimethoprim/sulfamethoxazole group (relative risk 0.45 [confidence interval 0.27–0.74]). When fluoroquinolones were compared with placebo, the number of fungal infection episodes did not statistically or significantly differ (relative risk 0.83 [confidence interval 0.56–1.22]).
Fluoroquinolone prophylaxis increased the risk of fluoroquinolone-resistant infections, but the increased risk was not statistically significant (relative risk 1.69 [confidence interval 0.73–3.92]).
Gafter-Gvili, A., Fraser, A., Paul, M., Vidal, L., Lawrie, T.A., van de Wetering, M.D., . . . Leibovici, L. (2012) Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database of Systematic Reviews, 1, CD004386.
The purpose of this meta analysis and sytematic review was to evaluate the effect of antibiotic prophylaxis on mortality and infection in neutropenic patients. In addition, subgroups of patients who may benefit the most were identified, and whether or not the effectiveness of different antibiotic regimens were similar was evaluated, as were the adverse effects of different regimens and the emergence of quinolone-resistant bacteria.
119 total references were retrieved. Cochrane Handbook for Systematic Reviews methods were used to evaluate and commend on the literature used.
Active antitumor treatment
Antibiotic prophylaxis resulted in significant reduction in risk of mortality across 46 trials analyzed (RR = 0.66, 95% confidence interval [CI] [0.55, 0.79], p < 0.00001). The greatest effect was with quinolones, although differences between regimens was not statistically significant. The effect was larger for trials in which prophylaxis was begun at the onset of neutropenia. An advantage was seen for all quinolones except for norfloxacin. Antibiotic prophylaxis significantly reduced infection-related mortality (RR = 0.61, 95% CI [0.48, 0.77], p = 0.04), decreased occurrence of fever, documented infection, and occurrence of bacteremia. Quinolones and TMP-SMZ were both associated with side effects that were mostly diarrhea and nausea. TMP-SMZ was associated with drug resistant bacteria cultures (RR = 2.42, 95% CI [1.35, 4.36]). With quinolones, no significant differences were noted between study groups compared to placebo or other interventions. Addition of gram-positive coverage did not show any apparent benefits in terms of mortality.
Findings support use of quinolones as prophylaxis of choice since they reduced risk of death compared to placebo or not intervention and were generally associated with fewer side effects and less resistant bacterial cultures in treated patients. Levofloxacin or ciprofloxacin are recommended.
Prophylactic quinolone antibiotic therapy is recommended for patients with hematologic cancers and those who are likely to develop neutropenia. Additional research is needed to better define patients with solid tumors that may benefit from antibiotic prophylaxis. In most studies, prophylaxis was begun when chemotherapy was initiated, rather than when neutropenia occurred. Prophylaxis should be accompanied by surveillance to monitor quinolone-resistant gram-negative bacteria and other resistant organisms.
Gafter-Gvili, A., Fraser, A., Paul, M., & Leibovici, L. (2005). Meta-analysis: Antibiotic prophylaxis reduces mortality in neutropenic patients. Annals of Internal Medicine, 142(12, Pt. 1), 979995.
To compare antibiotic prophylaxis with placebo, no intervention, or another antibiotic to prevent bacterial infections in patients with afebrile neutropenia
DATABASES USED: Electronic searches on the Cochrane Cancer Network Register of Trials (2005), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2005), MEDLINE (1966–2005), EMBASE (1980–2005), and abstracts of conference proceedings; references of identified studies; the first author of each included trial was contacted.
FINAL NUMBER STUDIES INCLUDED = 101
TOTAL PATIENTS INCLUDED IN REVIEW: 12,599
KEY SAMPLE CHARACTERISTICS: RCTs or quasi-RCTs performed from 1973–2005; patients with cancer and neutropenia as a result of chemotherapy or bone marrow transplantation
Antibiotic prophylaxis significantly decreased the risk of death when compared with placebo or no intervention (RR 0.66 [95%CI 0.55 to 0.79]). The authors estimated the number needed to treat in order to prevent one death from all causes as 50 (95% CI 34 to 268). Prophylaxis with any antibiotic resulted in a significant decrease in the risk of infection-related death (RR 0.59 [95% CI 0.47 to 0.75]) and in the occurrence of fever (RR 0.77 [95% CI 0.74 to 0.81]). Quinolone prophylaxis reduced the risk for all-cause mortality (RR 0.52 [95% CI, 0.37 to 0.74] and the risk of infection-related mortality (RR 0.49 [95% CI 0.31 to 0.77]).
Antibiotic prophylaxis resulted in a significant decrease in the occurrence of clinically documented infection (RR 0.66 [95% CI 0.61 to 0.73]), microbiologically documented infection (RR 0.53 [95% CI 0.48 to 0.58]), microbiologically documented gram-negative infection (RR 0.38 [95% CI 0.32 to 0.45]), microbiologically documented gram-positive infection (RR 0.44 [95% CI 0.38 to 0.51]), and bacteremia (RR 0.52 [95% CI 0.47 to 0.59]. Quinolone prophylaxis reduced the risk of bacteremia (RR 0.58 [95% CI 0.50 to 0.68]. When compared to placebo or no intervention, all prophylactic antibiotics caused more side effects (RR 1.59 [95% CI 1.37 to 1.85]. There was no statistically significant difference in the number of episodes of fungal infection when prophylactic antibiotics were compared to placebo (RR 1.07 [95% CI 0.83 to 1.37, 38 studies, 2,682 participants]).
When compared to placebo, patients given quinolones and sulfamethoxazole/trimethoprim (SMZ-TMP) were found to be at increased risk of harboring bacilli resistant to the specific drug than patients receiving placebo (RR 1.47 [95% CI 1.08 to 2.01]). For quinolones, the RR was 1.18 (95% CI 0.81 to 1.70) and for SMZ-TMP, 2.42 (95% CI 1.35 to 4.36). When quinolones were compared to SMZ-TMP, the following were significantly reduced: microbiologically documented infections (RR 0.72 [95%CI 0.6 to 0.86]) (comparison 5.2), gram-negative infections (RR 0.21 [95% CI 0.13 to 0.36]) (comparison 6.2), gram-negative bacteremia (RR 0.35 [95% CI 0.21 to 0.59]), and side effects (RR 0.74 [95%CI 0.63 to 0.87]). The addition of antibiotic against gram-positive infection to quinolones resulted in a significant decrease in the number of bacteremic episodes (RR 0.72 [95%CI 0.57 to 0.92], gram-positive infections (RR 0.49 [95% CI 0.37 to 0.64], and gram-positive bacteremia (RR 0.61 [95% CI 0.45 to 0.83]), and also in more side effects.
Gadsby, J. G., Franks, A., Jarvis, P., & Dewhurst, F. (1997). Acupuncture-like transcutaneous electrical nerve stimulation within palliative care: a pilot study. Complementary Therapies in Medicine, 5, 13–18.
Acupuncture-like transelectrical nerve stimulation (AL-TENS) with low-frequency, high-intensity stimulation using acupuncture points for emesis and analgesia was delivered by a nurse practitioner in five consecutive daily treatments. The study was divided into three groups: AL-TENS, standard care, and standard care plus placebo.
The study was a pilot study and a double-blind, randomized, controlled trial.
No significant differences were observed, but the study was underpowered and groups were not equivalent in symptoms at baseline.
Nurses should be trained in the use of AL-TENS and identification of acupuncture points. Future trials focused on fatigue are recommended.
Gabrail, N., Yanagihara, R., Spaczynski, M., Cooper, W., O'Boyle, E., Smith, C., & Boccia, R. (2015). Pharmacokinetics, safety, and efficacy of APF530 (extended-release granisetron) in patients receiving moderately or highly emetogenic chemotherapy: Results of two phase II trials. Cancer Management and Research, 7, 83-92.
To determine the pharmacokinetics, safety, and efficacy of two dosing regimens of APF530
There were two separate studies reported in this paper. The first study included 45 patients and used three escalating dosing schedules of 250 mg, 500 mg, or 750 mg. The second study included 35 patients with two dosing schedules of 250 or 500 mg. Safety and efficacy were reported. Drug levels were measured from predose to 168 hours after administration. Doses were given via subcutaneous injection in the abdomen prior to chemotherapy. All patients also received dexamethasone.
Prospective
Both studies met the primary objective by defining pharmacokinetics. Adverse events did not appear to be dose-related. Most were mild to moderate and were unrelated to the study drug. Injection site reactions were low and were not associated with dosing, and 17.7% of erythema was reported in the 250 mg arm. No erythema was reported in the 750 mg arm. The plasma concentrations of granisetron were maintained for seven days with a single dose of the drug. Preliminary data demonstrated another option for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. Patients treated with APF530 at 250 or 500 mg obtained complete response 83% of the time in the acute-onset and delayed-onset phases. Complete control was obtained in 76%. Nausea was controlled almost as well as emesis. Nausea reports were mostly mild.
Granisetron exposure was maintained for seven days with a single dose of subcutaneous AFP530. Mild injection site irritation was noted. Nausea was mild, and nausea and vomiting were controlled in the acute and delayed phases.
This could be another option for treating chemotherapy-induced nausea and vomiting, but it is possible that this treatment causes unnecessary discomfort when oral and transdermal approaches are available. This is very preliminary data, and the study did not compare this treatment to standard care. Additional research to determine the usefulness of this drug for chemotherapy-induced nausea and vomiting is needed.