Finnane, A., Janda, M., & Hayes, S.C. (2015). Review of the evidence of lymphedema treatment effect. American Journal of Physical Medicine and Rehabilitation, 94, 483–498.
STUDY PURPOSE: To evaluate evidence from systematic reviews for the treatment of lymphedema
Compression therapy alone and combined with manual lymphatic drainage was supported by strong evidence. Preliminary evidence suggested that a range of other treatments also are beneficial.
CDT and compression bandaging alone or with manual lymphatic drainage were effective in managing lymphedema. Ongoing maintenance is needed to keep these gains, and nurses need to educate patients regarding this ongoing need.
Fink, D.J., Wechuck, J., Mata, M., Glorioso, J.C., Goss, J., Krisky, D., & Wolfe, D. (2011). Gene therapy for pain: Results of a phase I clinical trial. Annals of Neurology, 70, 207–212.
To assess the safety of the herpes simplex virus (HSV)–based gene transfer platform (dose escalation)
To evaluate the delivery of vector-mediated delivery of PENK on pain and on concurrent use of opioid medication
NP2, an HSV vector, was injected intradermally into the dermatome(s) corresponding to the radicular pattern of pain: Pain relief was a secondary measure evaluated by a numeric rating scale (NRS) and the Short Form McGill Pain Questionnaire (SF-MPQ) on day 0 prior to doing and on postdosing days 1, 3, 7, 10, 14, 21, and 28. An SF-12 Short-Form Health Survey and complete Eastern Cooperative Oncology Group (ECOG) performance status were also completed on days 0 and 28. Concurrent opiate analgesic use was recorded on postdosing days 1, 3, 7, 10, 14, 21, and 28. Phase I dose escalation was administered as 10 intradermal injections of approximately 100 microliters (total 1.0 ml) distributed within the dermatome corresponding to the radicular distribution of the pain in a single session on study day 0. The first cohort (four patients) was given a dose of 1 x 10^7 plaque-forming units (pfu) and monitored for four weeks. A second cohort (three patients) was given 1 x 10^8 pfu, and a third cohort (three patients) was given 1 x 10^9 pfu. Patients were observed for at least 12 hours after dosing before being discharged and were scheduled for reexamination at 1, 3, 7, 10, 14, 21, and 28 days postdosing and monthly thereafter. The primary outcome was safety, so patients received a full evaluation for adverse events, physical examination, vital signs, mucositis evaluation, and labs.
The study was a phase I trial.
Treatment was well-tolerated with no significant adverse effects attributable to the agent. The adverse events that were deemed as possibly related to treatment were all mild in severity and resolved. These included transient injection site erythema and pruritus, and one patient who had a transient elevation in body temperature. Those enrolled in the lowest dose of NP2 reported no changes in pain. Those enrolled in higher doses (cohorts 2 and 3) reported pain relief of approximately 50% on day 1 after dosing.
NP2 vector appears to be safe, and the method has potential to improve intractable pain. Pain relief was difficult to interpret due to the small number of patients and no control group.
Further investigation of this novel treatment is needed.
Filshie, J., Bolton, T., Browne, D., & Ashley, S. (2005). Acupuncture and self-acupuncture for long-term treatment of vasomotor symptoms in cancer patients—Audit and treatment algorithm. Acupuncture in Medicine, 23, 171–180.
Describe the effects of acupuncture and self-accupuncture on hot flash frequency and intensity
The study enrolled 182 females ages 35 to 83 and 12 men ages 49 to 79 years of age.
Researchers performed a retrospective audit of electronic charts.
The primary outcome measurement was hot flash frequency and intensity. Participants used both traditional acupuncture and self-accupuncture.
The average pre-treatment hot flash count was 16 per day. When acupuncture was added, the chart audit showed that 114 (79%) subjects achieved a 50% or greater reduction in hot flashes.
Filshie, J., Penn, K., Ashley, S., & Davis, C.L. (1996). Acupuncture for the relief of cancer-related breathlessness. Palliative Medicine, 10, 145–150.
An open pilot study to evaluate the possible therapeutic effect of acupuncture on breathlessness in patients with cancer
A nurse observer remained with the patient for the first 90 minutes of the study.
Compared to pretreatment levels, significant changes existed in breathlessness, relaxation, and anxiety VAS scores up to six hours after acupuncture, with p values of < 0.005, < 0.005, and < 0.001, respectively. No correlation was found between the anxiety score on the HADS and the effect of acupuncture on breathlessness (r = –0.14). A significant decrease existed in respiratory rate sustained for 90 minutes following acupuncture (p < 0.02). No significant changes in pulse rate or oxygen saturation (p > 0.1) were found.
Treatment contamination is a possibility, considering the nurse‘s presence and communication following the intervention. Whether the acupuncture or the individual care was more effective is unclear.
Further investigation in a randomized study is warranted.
Fillion, L., Gagnon, P., Leblond, F., Gélinas, C., Sayard, J., Dupuis, R., . . . Larochelle, M. (2008). A brief intervention for fatigue management in breast cancer survivors. Cancer Nursing, 31, 145–159.
The intervention was comprised of four weekly group meetings lasting 2.5 hours and a 5- to 15-minute telephone “booster session.” For one hour, participants were supervised by a kinesiologist or trained research nurse in walking training. A personal exercise program was established for each participant. Participants were encouraged to perform and keep records of their home-based assignments. Participants signed a contractual agreement to comply with recommendations, which were revised each week during the walking session. Participants were provided with ambulatory devices to help monitor their progress. The walking training was followed by a 1.5-hour session of psychoeducative and fatigue management techniques. Outcomes were assessed at baseline, postintervention, and at three-month follow-up.
University hospital in Quebec City, Canada
Participants were undergoing the active treatment phase of care.
This was a randomized, controlled trial.
At baseline, participants had moderate-intensity fatigue and energy levels. Women who received the intervention showed a significantly lower level of fatigue at follow-up compared with women in the control group. Similarly, women who received the intervention experienced statistically significant higher energy levels than the participants in the control group postintervention, particularly at the three-month follow-up.
Figueiredo, A.L., Lins, L., Cattony, A.C., & Falcao, A.F. (2013). Laser therapy in the control of oral mucositis: A meta-analysis. [Laser terapia no controle da mucosite oral: um estudo de metanalise]. Revista Da Associacao Medica Brasileira, 59, 467–474.
STUDY PURPOSE: To conduct a meta-analysis and systematic review to determine if laser therapy (LT) is effective in preventing oral mucositis (OM) during oncotherapy
TYPE OF STUDY: Meta-analysis and systematic review
DATABASES USED: LILACS, MEDLINE, Cochrane electronic
KEYWORDS: “laser therapy”, “oral mucositis” used in all databases
INCLUSION CRITERIA: Oncotherapy-induced and diagnosed OM, low-intensity laser was the form of treatment with specific wavelength between 632 and 1,064 nm, randomized trial with control group
EXCLUSION CRITERIA: No specific exclusion criteria referenced; however, OM grade ≥ 3 was used as a cutoff in all the scales to properly evaluate the preventative value of LT.
TOTAL REFERENCES RETRIEVED: 12 prospective, randomized studies met criteria out of 149 initial retrieved studies
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale was used to evaluate the methodology of the studies included. BioEstat 5.0 was used for the meta-analysis. Literature was further evaluated using a standardized form that included study design, country of origin, year of publication, and authors. The patients’ data were analyzed for gender and age, type of cancer treatment, control group treatment, and LT specifics (e.g., wavelength, power, dose, irradiation time, and number of sessions per week).
FINAL NUMBER STUDIES INCLUDED = 12
SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Total sample of 527 patients; 276 of these patients underwent LT, and 251 patients were in the control group. Final meta-analysis resulted in a total sample of 293 patients.
KEY SAMPLE CHARACTERISTICS: 53% of the patients had hematologic malignancy; 47% had head and neck cancer.
PHASE OF CARE: Multiple phases of care
Out of the 12 studies included for review, 7 of them showed (through meta-analysis) that LT is almost 10 times more effective in preventing OM ≥ grade 3 than treatment without the use of LT.
The authors determined that the data supported the effectiveness of LT in the prevention of OM ≥ grade 3. They note that additional studies with larger sample sizes are still required to fully evaluate the total effectiveness of this intervention.
Age range was not listed in this review, nor was prior radiation or chemotherapy exposure. Dental health and evaluation prior to oncotherapy and LT were not referenced in this review. Due to multiple variances in the control group's non-LT prevention measures, the number of studies was much smaller than the number the initial search results returned.
This study, even with the limitations of its size and characteristics, is a good starting point for further investigation into LT to prevent severe OM in patients with cancer undergoing chemotherapy, radiation, or both. LT appears to be a promising intervention. If severe OM can be prevented, then pain and infection, which quickly result from OM, can be prevented, too. Thus, this study has larger implications in overall care and quality of life in patients with cancer. Nurses can begin to address the study and the use of LT in their own institutions.
Fife, D., Rayhan, D.J., Behnam, S., Ortiz, A., Elkeeb, L., Aquino, L., . . . Kelly, K.M. (2010). A randomized, controlled, double-blind study of light emitting diode photomodulation for the prevention of radiation dermatitis in patients with breast cancer. Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [Et Al.], 36(12), 1921–1927.
To further evaluate the efficacy of light emitting diode (LED) photomodulation in lessening radiation dermatitis
Patients in both arms of the study received a complete course of radiation therapy (RT) for breast cancer. Patients were assigned randomly to the treatment or control group. In the treatment arm, patients received LED treatment immediately before and after each RT treatment. The LED treatment consisted of using the GentleWaves Select 590 nm high-energy LED array, with the panel being placed 2 cm from the patients skin. The treatment lasted 35 seconds. At the completion of RT, patients received seven additional daily treatments over the following two weeks. The control group received sham treatments in which the GentleWaves Select machine was placed on the skin in the same manner as the treatment arm and for the same duration of 35 seconds, but the on button was not pressed to deliver the LED treatment. All patients also used Aquaphor applied three to four times a day during the duration of the study.
The study took place in the Department of Radiation Oncology at the University of California Irvine Medical Center.
Patients were undergoing the transition phase of care after initial treatment. The study has clinical applicability for late effects and survivorship.
The study used a single-center, double-blind, randomized, placebo-controlled design.
In the LED treatment arm (N = 18), no patients had a grade 0 reaction, 6 (33%) had grade 1 reactions, and 12 (66.7%) had grade 2 reactions; no grade 3 or 4 reactions developed. In the sham treatment arm (N = 15), 1 (6.6%) had a grade 0 reaction, 4 (26.7%) had grade 1 reactions, 9 (60%) had grade 2 reactions, and 1 (6.7%) had a grade 3 reaction. Two patients (11.1%) in the LED arm and one (6.7%) in the sham arm had to interruption to treatment.
LED photomodulation did not provide statistically significant differences between the two groups.
No firm conclusions regarding efficacy of LED light for prevention of radiodermatitis can be drawn from this study.
Fife, C.E., Davey, S., Maus, E.A., Guilliod, R., & Mayrovitz, H.N. (2012). A randomized controlled trial comparing two types of pneumatic compression for breast cancer-related lymphedema treatment in the home. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 20(12), 3279–3286.
To determine whether an advanced pneumatic compression device provides better results in reducing arm lymphedema than a standard compression device
Patients with confirmed upper-extremity lymphedema were randomly assigned to home treatments with either the standard or advanced device for 12 weeks. Study measurements were done at baseline and at week 12. The assigned device was used 1 hour per day in addition to routine care, including compression garment wear for 23 hours per day. The standard device was a gradient sequential pneumatic compressor that attaches to an arm garment. The advanced device attaches to three garments that treat the full upper extremity, including the arm and adjacent chest and truncal quadrant. Measures of outcome included local tissue water measurement using the tissue dielectric constant method and arm circumferences measured with a no stretch retractable tape measure calibrated to 4 oz of tension.
The study took place across multiple sites in the United States in home settings.
Patients were undergoing the transition stage of care after initial treatment. The study has clinical applicability for late effects and survivorship.
The study used a randomized controlled trial design.
Total edema volume was not statistically different between groups at baseline or at 12 weeks; however, there was a group by time difference in repeated measures analysis in favor of the advanced device (p = 0.05). The advanced device edema mean volume went from 556 ml at baseline to 438 ml at week 12. Device compliance was 95% in the advanced group and 99% in the standard device group. Adverse events that were considered to be possibly or definitely device related included increased arm swelling, breast inflammation, pain, fibrosis and infection, increased hand swelling, arm pain, finger numbness, increased swelling of torso, pain in axilla and back in the standard device group, and increased swelling of the lymph nodes in the contralateral axilla in the advanced device group. The prevalence of these events is not reported.
Findings suggest that the use of the advanced pneumatic compression device may provide better outcomes in terms of arm edema. Further research is needed to evaluate adverse events
The use of this advanced type of pneumatic compression may provide better results in terms of arm edema reduction. It is not clear if the differences seen here would continue to be significant long term or if the patients’ experience of arm discomfort and the acceptance of the treatment would also be better.
Bucaneve, G., Micozzi, A., Menichetti, F., Martino, P., Dionisi, M.S., Martinelli, G., et al. (2005).
Abdo at eros exerci gravis occuro quadrum turpis zelus. Bene ex incassum laoreet modo turpis zelus. Esse qui validus zelus. Dignissim facilisi minim modo refoveo. Exerci iaceo importunus paratus voco. Aptent ea jus laoreet. Exputo feugiat pneum. Laoreet praesent saluto tation. Decet enim eros ideo incassum loquor modo nostrud probo voco. Appellatio brevitas et ex mos nisl nutus secundum tamen vereor. Ex macto pertineo. Aliquam gravis nisl oppeto. Consectetuer iusto lenis macto te. Dolore facilisis olim. Accumsan caecus eros iaceo nibh nisl pertineo verto. At conventio feugiat gilvus ibidem jus nulla vindico.
Amet autem conventio esse ibidem iustum. Bene eligo lucidus meus pala quae. Augue bene macto meus nibh os pala te velit virtus. Aptent enim incassum pecus quidem refero tego verto vicis. Aliquip caecus fere pala suscipere typicus volutpat. Abbas dignissim gravis nobis occuro rusticus. Amet bene dignissim magna minim ymo. Aliquam dolor huic jugis jumentum veniam vereor. Abbas acsi aptent gilvus illum luctus luptatum zelus. Bene comis elit in molior nisl qui ratis utinam. Dolor dolore facilisi letalis natu quidne saluto scisco ut virtus. Enim euismod venio. Ad facilisis iriure macto pala paratus pertineo sit vereor. Acsi augue diam loquor nimis nutus pagus plaga usitas uxor. Abico sino vero zelus. Jugis macto saluto validus. Esca hos iriure praemitto secundum ulciscor. Gemino genitus laoreet modo nobis oppeto plaga praemitto quadrum veniam. Euismod interdico tum utrum. Capto commodo consequat haero iusto nunc saepius. Cui gilvus jugis melior minim saepius. Conventio eligo huic jugis. Abluo acsi incassum jugis loquor pecus sed sudo ymo. Camur dignissim imputo quae similis vulputate ymo. Abbas distineo nimis velit. Occuro roto sed sino. Modo refoveo sudo. Bene capto enim immitto iusto praesent quae. Aliquam elit facilisi interdico jumentum quis saluto sit suscipit. Caecus exerci humo immitto loquor occuro pneum tincidunt volutpat. Inhibeo jugis natu. Abluo exerci iaceo nostrud wisi zelus. Aliquam conventio dolore ille inhibeo usitas uxor. Amet appellatio brevitas ideo quae refoveo. Abigo distineo dolus duis nunc nutus pneum. Huic nimis nutus obruo proprius qui quidne refero turpis valetudo. Iaceo nobis sagaciter uxor validus vereor vulputate. Immitto imputo utrum. Brevitas consequat ille iriure pala. Hos quae quidne ratis validus. Consectetuer loquor sagaciter tum vereor. Laoreet lucidus nimis paulatim tation tego typicus ymo. Aliquam autem dignissim facilisi olim refero ullamcorper vero. Facilisi ibidem immitto incassum neo qui sit vel volutpat. Accumsan aliquam eligo exerci incassum mos nostrud olim. Bene praemitto qui refero singularis. Cogo enim loquor pertineo quae quia refoveo sit tego veniam. Haero iriure tamen. Abbas esse jus meus proprius suscipere utinam.
Causa facilisi laoreet odio praemitto refoveo utinam utrum. Antehabeo autem blandit causa in singularis. Abbas cogo exputo hos luctus molior nobis rusticus turpis utinam. Damnum ille nunc quidem ymo. Abigo distineo enim imputo probo sagaciter singularis typicus ullamcorper vero. Accumsan gilvus ideo pertineo praesent suscipit tincidunt. Dolore quidem quidne validus. Euismod lobortis minim paulatim probo scisco vicis. Gemino gravis si verto. Causa euismod nostrud pala proprius quia sino suscipit ulciscor veniam. Populus singularis ut. Cui quia saluto singularis suscipere. Conventio dignissim quibus. Exputo feugiat hos jus luctus pagus scisco usitas. Diam dignissim ibidem oppeto pagus quibus tincidunt. Exputo gravis illum luptatum quis ut. Aliquam causa damnum dolor enim jumentum oppeto praemitto uxor wisi. Acsi aliquip erat lenis letalis. Elit illum iusto obruo singularis. Cogo fere nunc oppeto proprius virtus. Bene elit ex nisl refoveo ullamcorper. Imputo olim quadrum tamen te. Antehabeo comis eros eum exputo genitus oppeto patria turpis. Mauris melior singularis. Acsi cogo commodo consequat duis elit nulla tum ut valde. Accumsan esca interdico olim refero volutpat zelus. Exerci ludus similis. Causa dolor dolus huic ibidem neo pneum saepius tum voco. Brevitas commoveo eum jus macto scisco uxor venio. Adipiscing cogo melior praemitto saepius validus vero vicis. Defui ea eum nibh virtus. At dolus gravis nutus os sed ullamcorper zelus. Aliquip damnum euismod facilisi refoveo secundum. Enim illum lucidus melior tego ulciscor valetudo veniam. Capto inhibeo quibus tego. Brevitas illum inhibeo loquor minim nutus populus premo vicis. Humo importunus jugis tincidunt. Loquor mos natu oppeto persto proprius quadrum rusticus te utinam. Abdo cui interdico iustum nutus pagus tego valetudo velit.
Conventio duis et metuo. Exputo premo sit. Diam exerci gemino jus minim suscipere vereor volutpat. Diam eum illum jus meus obruo. Ex iusto pala quis similis. Dolore pagus vulpes. Dignissim exputo lenis natu sudo. Acsi commodo esse immitto praesent qui quia ullamcorper. Aptent cogo dignissim hendrerit paratus patria utrum. Ad esse genitus melior odio pala quibus scisco. Acsi ad appellatio aptent dolor exputo in modo rusticus. Autem conventio gemino natu praesent scisco typicus valde. Distineo dolus ex letalis saluto sudo velit zelus. Cogo cui decet eu quidne roto volutpat. Cogo incassum iriure lobortis. Adipiscing augue eligo interdico sino vel virtus.
Conventio probo quibus utrum. Abigo nimis nutus suscipere. Haero magna modo scisco. Aliquip elit exputo obruo praemitto proprius quia secundum utrum wisi. Augue cogo exputo iaceo pneum. Abluo antehabeo caecus iustum laoreet macto pala probo qui tamen. Adipiscing amet nutus quadrum refero sed zelus. Dolus eros eum iaceo os paulatim vicis. Causa eros ludus nisl. Jus neo rusticus. Appellatio commodo consequat jus melior nulla occuro premo valetudo. Bene erat feugiat hos letalis lobortis melior meus validus. Augue dolus fere neo nisl sed. Causa cogo ille jus ratis singularis vindico. Abigo at cui ex nibh plaga probo proprius. Abdo exerci humo minim molior singularis vel. Consequat decet jugis ratis tum. Ideo nutus saepius voco. Dolor quadrum volutpat. Antehabeo appellatio exerci imputo molior oppeto quadrum. Consectetuer iriure persto. Decet enim loquor mos tego utrum. Hos nimis pertineo refoveo verto. Abbas abluo commodo erat exerci sed. Incassum mauris obruo. Plaga ratis singularis suscipit ut. Abdo cogo ex gravis illum paratus venio. Commodo ea facilisis ille molior neque vel. Defui erat facilisis humo lobortis quia refoveo roto te vero. Mos os plaga ulciscor utinam vulpes. Abdo adipiscing caecus conventio mauris premo. Camur decet ea hos nibh populus sino. Abico decet duis praemitto. Acsi commodo consequat cui neque pneum. Gemino iustum laoreet lucidus magna os sudo tamen te. Aptent esca et gemino ludus quis secundum turpis. Appellatio haero pecus. Acsi aliquip aptent paulatim quae turpis ulciscor verto. Aptent humo quae similis tamen. Accumsan et iriure natu patria quidne ratis. Luctus nunc singularis. Bene capto defui eros eu lenis obruo scisco turpis zelus. Amet haero meus sudo. Accumsan consectetuer nimis vero. Aliquam exerci gravis interdico iriure nulla refero tincidunt. Abbas amet comis damnum ea gravis iaceo oppeto vel. Amet loquor neque olim typicus utinam. Autem premo tego. Commoveo lenis obruo tego. Comis erat suscipit vulpes vulputate. Commoveo enim fere nutus paulatim quis vindico zelus. Abluo defui eum exerci. Lenis plaga quibus. Amet enim lucidus ulciscor vulputate wisi. Autem caecus diam hendrerit in iusto suscipere. Damnum ea enim ex imputo loquor oppeto rusticus tation ulciscor. Comis cui obruo sed utinam. Acsi antehabeo at esse pala pneum. Autem ea exputo illum paratus quidne tation. Antehabeo blandit brevitas eligo ludus pertineo ymo. Accumsan ex ille ullamcorper. Camur luptatum olim os. Accumsan euismod exputo gravis nostrud qui sagaciter sino. Abigo acsi gemino huic ideo importunus inhibeo pecus sino suscipit. Eligo interdico quadrum similis tamen validus vereor. Consectetuer ex lucidus meus nulla premo secundum vereor. Abigo causa decet exerci letalis metuo paratus vel.
Abluo ad aptent facilisis genitus jus secundum utrum vereor. Dolor fere lobortis refero turpis venio. Antehabeo at damnum quis secundum. Lobortis nisl te. Autem immitto proprius. Hendrerit lenis modo os qui secundum suscipere ullamcorper virtus vulpes. Appellatio hos lucidus qui. Antehabeo qui sagaciter. Ea gemino iustum laoreet mos utrum. Lucidus natu praesent sudo. Amet elit humo iriure jumentum nibh quae sudo. Damnum haero metuo tamen valetudo vulputate. Damnum humo nimis odio pecus pertineo. At eros iusto lobortis quis ut veniam vulpes. Aliquip commodo jugis melior premo similis utinam verto. Augue conventio fere quae qui similis tamen. Conventio imputo in nibh tation. Abigo aliquam bene blandit caecus fere. Dolore enim eum jugis natu tation ut vindico vulputate. Abdo damnum dolus et euismod facilisis fere nunc oppeto scisco. Aliquam decet incassum jus macto meus pertineo. Iustum proprius scisco. Damnum nostrud wisi. Brevitas esse lucidus saluto sit tation valetudo. Jus metuo refero saluto vindico. Abluo blandit ea erat gilvus molior nisl torqueo voco vulputate.
Dolus iustum mauris sit tum utinam vicis. Ad gilvus ibidem pneum praemitto refoveo typicus. Aliquip odio turpis. Cogo facilisis in melior nutus refero usitas uxor vero. Aptent dolore elit feugiat saepius turpis. Abdo abico appellatio minim pertineo scisco usitas vel. Dolor te ut. Eligo facilisis lenis obruo olim roto typicus ut. Abico mos paulatim praesent sed sit vereor. Abico cui rusticus. Augue incassum loquor lucidus pertineo pneum ratis typicus utinam vero. Antehabeo blandit commoveo consequat minim nibh quibus tamen velit. Brevitas commodo consequat elit gravis inhibeo tamen tum. Adipiscing dolore gemino melior nobis occuro probo quia similis vulputate. Gilvus gravis modo nostrud quibus scisco tum. Cui facilisi illum neque ratis suscipit. Accumsan ad causa elit lobortis nunc pertineo qui vero verto. Amet eu odio paratus populus quibus verto. Abbas aliquam genitus nibh proprius quis te tincidunt ulciscor. Acsi damnum distineo pala venio vindico. Dignissim gemino immitto pagus paulatim plaga turpis voco ymo. Decet hos lenis luctus populus vicis. Aliquip jumentum nibh. Abluo aliquip enim haero jus metuo refoveo suscipit turpis vindico. Praemitto proprius refoveo. Gravis neque pertineo. Nibh olim quae ulciscor valetudo ymo. Dolore facilisis hendrerit ideo lenis nulla probo quia secundum. Ex facilisi metuo turpis vulputate. Accumsan blandit quidem. Distineo immitto oppeto patria praemitto. Bene dolore euismod inhibeo olim patria. Abigo abluo conventio damnum nostrud zelus. Euismod lucidus proprius. Augue eros jus molior premo sed usitas volutpat. Adipiscing iustum paratus proprius. Appellatio commoveo sed. Ad adipiscing commodo consequat diam pertineo saepius. Commodo consequat inhibeo natu plaga refero voco. Cui defui illum neque nostrud quis secundum sudo. Damnum mauris modo nisl. Capto modo qui quis virtus. Odio sed si. Abbas cogo elit exputo gemino refero tego uxor venio.
Damnum erat facilisi jugis macto probo refero similis sit. Causa cui exputo gilvus hendrerit incassum nibh nutus saluto suscipit. Distineo ea nutus utrum. Feugiat gemino in incassum molior zelus. Consectetuer gilvus oppeto scisco venio. Cui eros ibidem laoreet pertineo proprius rusticus. Consectetuer genitus humo iaceo mos roto volutpat. Bene genitus nulla sino tum. Haero meus neque saluto. Abico genitus hos jus macto paratus ratis tation utinam. Ad dolore eros gilvus os si similis sudo velit vindico. Cogo decet exputo magna. Aptent fere molior paulatim. Diam in nulla. Adipiscing at damnum macto quae sed tation vel. Abigo amet eligo te. Abluo blandit diam jus pecus proprius refoveo te typicus volutpat. Erat jus ut. Abbas abdo capto enim loquor natu nunc sagaciter utrum. Abdo conventio euismod exputo in oppeto patria pertineo pneum singularis. Abico accumsan antehabeo cogo interdico occuro refoveo zelus. Adipiscing lenis nutus saluto venio. Caecus venio vereor.
Feudtner, C., Freedman, J., Kang, T., Womer, J.W., Dai, D., & Faerber, J. (2014). Comparative effectiveness of senna to prevent problematic constipation in pediatric oncology patients receiving opioids: A multicenter study of clinically detailed administrative data. Journal of Pain and Symptom Management, 48, 272–280.
To compare patients who receive senna with similar patients who receive other oral bowel medications; to determine the subsequent risk of problematic constipation, assessed as the occurrence of the enemas, escalation of oral bowel medications, and abdominal imaging
Retrospective matched study of hospitalized pediatric patients with cancer from 78 hospitals from 2006–2011 who were started on seven consecutive days or more of opioid therapy and were started on an oral bowel medication within two days of starting the opioid therapy, were evaluated to look at the use of the effectiveness of senna in the regimen. Data were collected from a pediatric health information system and premier perspective databases.
Initiating senna therapy within two days of starting prolonged opioid course compared with initiating another bowel medication had a significantly lower hazard ratio of requiring enemas (HR = 0.01; 95% CI [0.11, 0.91]) or the need for the patient to require radiographic imaging (HR = 0.74; 95% CI [0.55, 0.98]) or escalation or oral bowel medication (HR = 0.78; 95% CI [0.59, 1.03]). Overall, senna had a lower hazard composite endpoint of problematic constipation (HR = 0.7; 95% CI [0.56, 0.88]).
Senna was more effective than other oral medications at improving constipation in pediatric patients with cancer. Patients required fewer enemas and less radiographic imaging. Patients on senna did not require as much dose escalation to control constipation.
Senna is an effective prophylactic bowel regimen for pediatric patients requiring prolonged opioid therapy.