Freedman, G.M., Li, T., Nicolaou, N., Chen, Y., Ma, C.C.-M., & Anderson, P.R. (2009). Breast intensity-modulated radiation therapy reduces time spent with acute dermatitis for women of all breast sizes during radiation. International Journal of Radiation Oncology, Biology, Physics, 74, 689–694.
To determine differences in toxicity and time spent with radiation-induced dermatitis during a course of conventional radiation therapy (RT) or intensity modulated RT (IMRT)
At the time of treatment, a physician and nurse prospectively evaluated the skin and recorded the maximum skin toxicity each week. Chi-square and Wilcoxon analysis was used to find differences between groups from retrospective data. Multivariate analysis determined significant predictors of grade 2 or higher radiation dermatitis
The study included cases treated at Fox Chase Cancer Center in Philadelphia, PA.
The study used a retrospective analysis design, using cases from 2001–2006.
In all breast size groupings, a significantly lower percentage of patients in the IMRT group developed grade 2 or higher radiation dermatitis (p ≤ 0.0004). Per group, volumes that developed a maximum toxicity of grade 2 or higher were 52% for IMRT and 75% for CRT. The time spent per week of radiation with grade 2 or 3 dermatitis was lower in the IMRT group. In the IMRT group, 18% of weeks were at grade 2 or 3, and in the conventional group, 71% of weeks were at grade 2 or 3. Weeks 2–6 for those receiving IMRT had significantly less toxicity (p < 0.00001). Predictors of grade 2 or greater dermatitis found to be significant (p < 0.021) were technique (e.g., use of IMRT), large bra size, treatment week, and chemotherapy or tamoxifen administered prior to or during radiation.
IMRT is associated with less skin toxicity than conventional RT.
Freedman, G.M., Anderson, P.R., Li, J., Jinsheng. L., Eisenberg, D.F., Hanlon, A.L., . . . Nicolaou, N. (2006). Intensity modulated radiation therapy (IMRT) decreases acute skin toxicity for women receiving radiation for breast cancer. American Journal of Clinical Oncology, 29, 66–70.
To determine the incidence and severity of acute skin toxicity with IMRT compared to conventional RT
Women treated with breast conserving surgery and IMRT were matched one to one with historical controls based on bra size and chest wall separation. Maximum recorded skin toxicity during six weeks of RT was compared between the two groups using Chi-squared analysis or Fisher-exact tests. Cases were grouped for analysis by bra size.
The study took place at Fox Chase Cancer Center.
The study used a prospective comparison with matched historical controls design.
Acute skin toxicity was scored using the National Cancer Institute (NCI) common terminology criteria (CTC) for acute radiation dermatitis by the physician or nurse weekly during treatment. Scores given to evaluate erythema were grade 1 for mild and grade two for moderate. Scores given for desquamation were grade 1 for dry and grade 2 or 3 for moist. Additional variables included in analysis were chest wall separation, total energy megavoltage, use and timing of chemotherapy, use and timing of tamoxifen, and tumor stage.
The degree of desquamation was greater for conventional patients (p = 0.0001). In the IMRT group, 21% had grade 2, compared to 38% in the RT group. Grade 1 desquamation was higher in the IMRT group (37% IMRT, 10% RT). No patient had grade 3 desquamation. There were no differences between the two groups in CTC or erythema scores. Subgroup analysis showed that the incidence and severity of desquamation by bra size was significantly lower in the IMRT group for small and large breast sizes (p < 0.04) but not for medium sizes. Use of IMRT (p = 0.0011) and breast size (p < 0.0001) were the only significant predictors for having moist desquamation.
IMRT was associated with reduced incidence and severity of desquamation.
Although CTV was found to be a significant predictive variable, it was not included in the stepwise regression analysis.
Franco, P., Migliaccio, F., Angelini, V., Cante, D., Sciacero, P., Peruzzo Cornetto, A., . . . Ricardi, U. (2014). Palliative radiotherapy for painful bone metastases from solid tumors delivered with static ports of tomotherapy (TomoDirect): Feasibility and clinical results. Cancer Investigation, 32, 458–463.
To evaluate the feasibility and efficacy of palliative radiation therapy given via static ports of tomotherapy
Tomotherapy is a treatment modality that delivers a series of highly modulated linear beam paths for hypofractionated palliative radiation therapy (RT). Doses given were 3 Gy in 10 fractions, 4 Gy in five fractions, or 8 Gy in one fraction. The selection of a schedule was individualized to patients. Pain was evaluated by physicians immediately before RT for current, worst within the past 24 hours, least, and average pain. Opioid consumption in the previous 24 hours was evaluated.
Prospective, observational study
At two weeks, response rates ranged from 49%–55% with no significant difference between the fractionation groups. Among all patients, opioid consumption decreased (p < 0.001). At two months, response rates decreased to 40%. The rate of no response was highest in the 8 Gy single fraction group. This group also had increased opioid use and more frequent retreatment.
RT is effective for pain relief in patients with painful bone metastases. This study suggested that the TomoDirect™ delivery of RT can be feasible and effective.
RT was effective for pain reduction in patients with painful bone metastases; however, the duration of palliation may be brief. Studies have suggested that multiple fractionation for RT delivery may be more effective.
Francis, M., & Williams, S. (2013). Effectiveness of Indian turmeric powder with honey as complementary therapy on oral mucositis: A nursing perspective among cancer patients in Mysore. Nursing Journal of India, 105, 258–260.
To test the effectiveness of the application of a mixture of turmeric and honey on treatment-induced oral mucositis in patients receiving chemotherapy and radiation therapy
Patients were randomly assigned to receive the mixture of turmeric and honey or to a control group that did not receive the intervention. The mixture was applied for five minutes before treatment and again five minutes after treatment. Study measures were obtained on days 2, 4, and 6 of treatment.
The mucositis score was significantly lower at all post measurements in the experimental group (p < 0.05). Scores were similar between groups at baseline, but subsequent measures were lower in the experimental group.
The combination of turmeric and honey may provide some protection against the development of oral mucositis and may provide benefit for treatment.
The results of this study suggest that turmeric and honey may have some promise in the management of oral mucositis, but this study has several substantial limitations. Further well-designed research is needed. One of the basic needs for preventing and managing oral mucositis is regular mouth care, the foundation of any intervention.
Frame, D.G. (2010). Best practice management of CINV in oncology patients: I. Physiology and treatment of CINV. Multiple neurotransmitters and receptors and the need for combination therapeutic approaches. Journal of Supportive Oncology, 8(2, Suppl. 1), 5–9.
This article demonstrated the importance of combination therapy for prevention and management of CINV. The author provides a good overview of relevant physiology, mechanism of action of current agents, and current regimens used. The article points to the need for additional research with the use of olanzapine for CINV.
Foster, C., Grimmett, C., May, C.M., Ewings, S., Myall, M., Hulme, C., . . . Richardson, A. (2016). A web-based intervention (RESTORE) to support self-management of cancer-related fatigue following primary cancer treatment: A multi-centre proof of concept randomised controlled trial. Supportive Care in Cancer, 24, 2445–2453.
To test the proof of concept for a web-based intervention for fatigue designed to enhance self-efficacy in the management of cancer-related fatigue to inform the design of an effectiveness trial
This study was a multi-center, parallel-group, two-armed (1:1), exploratory, randomized (RESTORE or written leaflet), controlled trial with qualitative process evaluation. Patients were randomly assigned to receive an informational leaflet or participate in the use of a web-based program. The web-based program consisted of five sessions, including mandatory sessions on fatigue and goal setting and four other sessions that patients could choose from, that were presented to the patient at weekly intervals. The program also included videos of patient stories and automated tailored feedback components.
FEASIBILITY: Forty-one percent of eligible patients consented to the study (16% of screened patients). The randomization process resulted in generally balanced groups with the exception of “not working” and “days since last cytotoxic treatment.” ACCEPTABILITY: Fifty percent indicated that the timing of program delivery was “about right”; others would have preferred earlier. Participants reported feeling supported and reassured that someone was interested in their fatigue. The attrition rate from consent to T2 was 36%. Seventy-one percent of participants determined to have adhered to intervention (completed sessions 1 and 2 and one of the remaining three sessions). No significant differences in symptoms or self-efficacy existed between groups.
Web-based resource (RESTORE) for the enhancement of self-efficacy in the management of cancer-related fatigue, pending recommended revisions, may be feasible and acceptable for use in research studies. Further study is needed to determine effectiveness.
Nursing implications include the cautious use of feasibility, acceptability, and adherence data for the completion of a web-based program to enhance self-efficacy in the management of cancer-related fatigue based on responses from multi-site participants in the United Kingdom.
Forner-Cordero, I., Munoz-Langa, J., Forner-Cordero, A., & DeMiguel-Jimeno, J.M. (2010). Predictive factors of response to decongestive therapy in patients with breast-cancer-related lymphedema. Annals of Surgical Oncology, 17(3), 744–751.
To identify predictive factors of response to decongestant treatment through univariate and multivariate analysis
Patients received complex decongestive treatment with manual lymphatic drainage (45 minutes) and pressotherapy with pneumatic multichambered device between 50 and 80 mm Hg (30 minutes). Treatment also included wearing a multilayered bandage until the next day. Sessions were performed consecutive days until a plateau in reduction was reached, which was normally between 10–20 sessions. Compliance with bandages was measured.
The study took place across multiple sites in Spain.
The study used a prospective, multicenter controlled cohort design.
Eleven variables were retained after initial screening. Venous insufficiency, treatment in autumn, and compliance were associated with better outcome while higher baseline excess volume and percentage reduction, heaviness, numbness, chemotherapy, axillary radiation, total dose of radiation, and treatment in winter were associated with poorer outcome.
The most important predictor of response to treatment was compliance. Early intervention is key.
Patient education and support to promote early intervention and patient compliance with treatment may have a positive effect in response to lymphedema treatment
Forastiere, E., Sofra, M., Giannarelli, D., Fabrizi, L., & Simone, G. (2008). Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. British Journal of Anaesthesia, 101(6), 841–847.
To compare, after open nephrectomy, the efficacy of continuous wound site infusion with ropivacaine with that of saline; to examine morphine consumption, side effects, bowel function, and hospital length of stay in two study arms
Patients received continuous surgical wound site infusion of either 0.5% ropivacaine or 0.9% saline. For breakthrough pain, all patients received standard care with PCA morphine and ketorolac.
Prospective randomized, double-blinded, placebo-controlled study
Continuous wound infusion with ropivacaine improved pain relief and accelerated recovery and discharge.
A single surgeon peformed all procedures and placed all catheters. Because of the various locations of nociceptive receptors, this makes generalizing study findings questionable; placement of catheters for local infusion relates to results.
Multimodal pain management that includes continuous wound infusion of anesthetic and systemic opioid can reduce postoperative pain, thereby reducing length of stay and hospitalization costs.
Fong, S.S., Ng, S.S., Luk, W.S., Chung, J.W., Ho, J.S., Ying, M., & Ma, A.W. (2014). Effects of qigong exercise on upper limb lymphedema and blood flow in survivors of breast cancer: A pilot study. Integrative Cancer Therapies, 13, 54–61.
To investigate the effects of qigong exercises on upper extremity lymphedema, arterial resistance, and blood flow velocity in breast cancer survivors
Experimental group performed approximately six minutes of the 18 forms tai chi qigong exercises, and the control group rested.
There was an immediate circumferential decrease and blood flow resistance decrease, with increase in blood flow velocity in the experimental group. However, no girth changes between groups may indicate only temporary effects.
More rigorous randomized, controlled studies are needed to confirm the effects of this exercise.
Nurses should encourage limb movement and range of motion exercises for breast cancer survivors.
Fong, D.Y., Ho, J.W., Hui, B.P., Lee, A.M., Macfarlane, D.J., Leung, S.S., . . . Cheng, K.K. (2012). Physical activity for cancer survivors: Meta-analysis of randomised controlled trials. BMJ, 344, e70.
STUDY PURPOSE: To evaluate the evidence regarding the effects of physical activity in cancer survivors
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Late effects and survivorship
The median duration of the exercise intervention was 13 weeks (range = 3–60). A meta-analysis of results for body mass index, body weight, and other physiologic measures was reported. A meta-analysis was completed for three studies regarding effect on fatigue, and slightly reduced fatigue was demonstrated using the Piper Fatigue Scale (p = 0.03). However, sample sizes were small in these studies. A meta-analysis of effects on depression included four studies and showed reduced depression using the Beck Depression Inventory (p < 0.01). Three of the four studies had relatively small sample sizes. Quality of life outcomes showed improved Short Form-36 physical functioning scores (p = 0.01) and mental health scores (p = 0.01). The authors noted substantially different results based on the measurement scales used in the included studies.
This analysis supports the effectiveness of exercise in general on cancer-related fatigue and depression.
It was suggested that the intensity of the exercise could affect results, and intensity was not consistently reported in the studies included. The mean duration of the intervention was as high as 13 weeks and as low as three weeks. The relatively short duration limits the ability to assess long-term outcomes. Most studies were completed in patients with breast cancer. There were very few studies in the analysis, and it was surprising that more studies were not found for inclusion. The studies of fatigue and depression included in this meta-analysis had relatively small sample sizes.
This report adds to the already large body of evidence demonstrating that exercise can improve fatigue and depression outcomes in cancer survivors. Current evidence, however, involves relatively short-term interventions and assessments. For long-term benefits, it is generally believed that physical activity needs to be incorporated into everyday life. Nursing interventions and future research should consider the examination of approaches to address this need for ongoing behavior change. Most exercise studies continue to involve women with breast cancer. Although there is some evidence in other groups, it is limited. Continued research to examine exercise's effects in more varied patients would be beneficial.