Damian, S., Celio, L., De Benedictis, E., Mariani, P., Agustoni, F., Ricchini, F., & De Braud, F. (2013). Is a dexamethasone-sparing strategy capable of preventing acute and delayed emesis caused by combined doxorubicin and paclitaxel for breast cancer? Analysis of a phase II trial. Oncology, 84(6), 371–377.
To evaluate the effectiveness of palonosetron without delayed dexamethasone in breast cancer patients receiving doxorubicin and paclitaxel (AT) for three cycles
Phase II, nonrandomized, single-arm feasible study
The Common Toxicity Criteria for Adverse Events (CTCAE) v3.0 was given as a card to patients in order to grade the severity of nausea experienced. Patients also were asked to record emetic episodes and any antiemetic use.
74% of the patients achieved CC in the first cycle, but there was a small reduction in CC as treatment continued to subsequent cycles. Authors even mentioned that delayed dexamethasone can be added in to the regimen if more optimal CINV control is needed. It is challenging to see the relevance of the proposed regimen if delayed dexamethasone would still be needed and steroids are still a part of the premeds, even if delayed dexamethasone is not required.
Data have shown that dexamethasone can be decreased to day 1 only in combination with palonosetron with comparable nausea control. Data also have shown that CINV control with dexamethasone/palonosetron is superior than palonosetron as a single agent. Further investigation is required to determine if dexamethasone can be successfully replaced by other steroids in a premedication regimen.
Damholdt, M.F., Mehlsen, M., O'Toole, M.S., Andreasen, R. ., Pedersen, A.D., & Zachariae, R. (2016). Web-based cognitive training for breast cancer survivors with cognitive complaints—A randomized controlled trial. Psycho-Oncology, 25, 1293–1300.
To investigate the use of a web-based cognitive training intervention for subjective and objective cognitive complaints in breast cancer survivors
HAPPYneuron Pro© (Scientific Brain Training, Villeurbanne Cedex, France) is a customized 12-task training program of 6 cognitive domains (attention, processing speed, learning, memory, working memory, problem solving) involving 10 levels of difficulty. The program required a minimum commitment of 30 minutes a day for 5 days a week for 6 weeks.
PHASE OF CARE: Late effects and survivorship
Randomized, waitlist controlled, pretest–post-test design
Web-based cognitive training did not improve function for the PASAT-measured domain of working memory or the CFQ-measured secondary outcome of perceived cognitive function. Improvement was demonstrated for cognitive function on two other neuropsychologic measures for verbal learning (RAVLT) (F [2, 272.1] = 3.2, p = 0.043) and working memory (digit span backward) (F [2, 272.6] = 3.3, p = 0.04).
Primary and secondary outcomes were not achieved, but web-based cognitive training was associated with improvement onone test of verbal learning and one test of working memory. Further study with instruments validated for phone administration may be warranted.
The web-based cognitive training intervention was well received by participants and not burdensome to administer in terms of costs. Small improvements were noted for some cognitive measures in the intervention group, and further study may be warranted.
Dalton, J. A., Keefe, F. J., Carlson, J. & Youngblood, R. (2004). Tailoring cognitive-behavioral treatment for cancer pain. Pain Management Nursing, 5, 3–18.
To determine whether a profile-tailored cognitive-behavioral therapy (CBT) treatment program was more effective than either standard CBT or usual care in changing outcomes for patients with cancer-related pain.
Patients received standard CBT, profile-tailored CBT, or usual care. Therapy group sessions ranged from 5 to 50 minutes.
Standard CBT is comprehensive CBT that evaluates thoughts, feelings, and behaviors. It uses six to eight treatment strategies to teach patients to understand the relationship among pain, suffering, and emotions; to use symptom-coping skills, problem solving, relaxation, and self control; and to modify cognitive distortions associated with emotional distress.
Profile-tailored CBT matches patients’ scores on the Biobehavioral Pain Profile (BPP) to specific CBT modules, environmental influences, loss of control, healthcare avoidance, past and current experience, physiologic responsivity, and thoughts of disease progression.
RNs received a two-day training course to deliver the intervention.
The study was conducted at one inpatient and three outpatient cancer centers in the southeastern United States.
Patients were undergoing the active treatment phase of care.
This was a randomized, controlled trial.
Short-term outcome: Based on the BPI, interference with sleep improved from baseline to immediately postintervention for the profile-tailored CBT group.
Between-group comparison of the treatment effect over the entire study found treatment effects for interference of pain with mood and sleep. Response to the intervention decreased with time.
Dalton, J. A., Keefe, F. J., Carlson, J., & Youngblood, R. (2004). Tailoring cognitive-behavioral treatment for cancer pain. Pain Management Nursing, 5, 3–18.
Participants received standard cognitive-based therapy, profile-tailored cognitive-based therapy, or usual care. Those in both therapy groups received 5- to 50-minute sessions. Standard cognitive-based therapy includes comprehensive cognitive and behavioral therapy that evaluates thoughts, feelings, and behaviors. It uses six to eight treatment strategies to teach patients to understand the relationship between pain, suffering, and emotions; to use symptom coping skills, problem-solving, relaxation, and self control; and to modify cognitive distortions associated with emotional distress. Profile-tailored cognitive-behavioral therapy (CBT) matched patient scores on the Biobehavioral Pain Profile (BPP) to specific CBT modules: environmental influences, loss of control, health care avoidance, past and current experience, physiological responsitivity, and thoughts of disease progression.
One inpatient and three outpatient cancer centers in the Southeastern United States
Participants were undergoing the active treatment phase of care.
The study was a randomized trial.
Profile of Mood States (POMS) Symptom Distress Scale
No significant effects on fatigue were found.
Dahlen, T., Kalin, M., Cederlund, K., Nordlander, A., Bjorkholm, M., Ljungman, P., & Blennow, O. (2016). Decreased invasive fungal disease but no impact on overall survival by posaconazole compared to fluconazole prophylaxis: A retrospective cohort study in patients receiving induction therapy for acute myeloid leukaemia/myelodysplastic syndromes. European Journal of Haematology, 96, 175–180.
To investigate the effects of changing from floconazole to posaconazole on the incidence of invasive fungal disease (IFD) and survival
Data were obtained from medical records for analysis. From 2008 to March 2011, primary antifungal prophylaxis was fluconazole 100–200 mg daily. In 2011, prophylaxis was changed to posaconazole 200 mg three times per day. Fungal prophylaxis in most cases was done only during neutropenia. Wards were not equipped with HEPA filters. Bacterial prophylaxis with ciprofloxacin was used during neutropenia in 80%–90% of patients. In 283 patients, comparison of results with posaconazole versus fluconazole was done.
PHASE OF CARE: Active antitumor treatment
Retrospective cohort comparison
IFD was defined according to the revised 2008 European Organization for Research and Treatment of Cancer (EORTC) definitions.
The incidence of IFD was signficantly lower at day 100 and at the end of patient follow-up (p < 0.01). The incidence of aspergillosis (p = 0.01) and invasive candidiasis (p < 0.05) were also lower in those given posaconazole. Antifungal therapy was more common in the fluconazole group (p < 0.01). There was no difference in overall survival at day 100 or at the end of follow-up.
The use of posaconazole for primary antifungal prophylaxis was more effective for reduction in IFD compared to fluconazole.
Posaconazole was shown to be more effective than fluconazole for the prevention of IFD in high-risk patients; however, the retrospective nature and other design factors limit the validity of this study. A variety of research is aimed at the determination of the most effective antifungal agents for prophlyaxis. Additional research is needed to determine if specific antifungals are more effective overall.
Daeninck, P., Gagnon, B., Gallagher, R., Henderson, J.D., Shir, Y., Zimmermann, C., & Lapointe, B. (2016). Canadian recommendations for the management of breakthrough cancer pain. Current Oncology, 23, 96–108.
RESOURCE TYPE: Evidence-based guideline
Not clearly listed in article. Article focused on the consensus points and education points. Prior to those sections, a general section regarding the literature was included.
Understanding BTCP is vital for nurses to adequately manage pain. Nurses need to be aware of the available guidelines since they are usually at the sharp end of managing pain. With this knowledge, nurses can educate patients and families regarding the proper use of medications to manage pain, specifically BTCP.
Dadu, R., Zobniw, C., & Diab, A. (2016). Managing adverse events with immune checkpoint agents. Cancer Journal, 22, 121–129.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
Expert opinion
Literature review of common checkpoint inhibitors adverse events. No quality review provided.
Further education needs to be available on the toxicity profile related to immune checkpoint inhibitors, and obtaining a detailed personal and family history of autoimmune diseases, other comorbidies, concurrent medications, PE, and medications of patients is important prior to starting therapy.
da Costa Miranda, V., Trufelli, D. C., Santos, J., Campos, M. P., Nobuo, M., da Costa Miranda, M., . . . del Giglio, A. (2009). Effectiveness of guaraná (Paullinia cupana) for postradiation fatigue and depression: results of a pilot double-blind randomized study. Journal of Alternative and Complementary Medicine, 15, 431–433.
To evaluate the effectiveness of guaraná in fatigue and depression in 36 patients with breast cancer undergoing adjuvant radiotherapy.
Patients were randomized to 75 mg guaraná daily or placebo for two weeks, and then switched to the opposite treatment for the last two weeks of radiotherapy. Randomization was centralized by a pharmacist.
Patients were recruited at Faculdade de Medicina da Fundação do ABC.
The study was a randomized, controlled crossover trial.
No significant differences existed between the two groups on any of the scales. In addition, no side effects were reported from the guaraná.
This study showed no effect from guaraná on fatigue for this population.
The study used patients who reported no fatigue at the beginning of the study.
A currently fatigued population may be worth exploring with guaraná. Patients using guaraná for fatigue should be educated about the research findings.
da Silva Leal, N.F., Carrara, H.H., Vieira, K.F., & Ferreira, C.H. (2009). Physiotherapy treatments for breast cancer-related lymphedema: A literature review. Revista Latino-Americana De Enfermagem, 17(5), 730–736.
To present physiotherapy modalities applied for lymphedema therapy through a systematic literature review
Databases searched were Latin American and Caribbean Literature (LILACS), PubMed, and SciELO, covering periods from 1981–2009, 1951–2009, and 2001–2004, respectively. Also, data from physiotherapy textbooks were surveyed. Search keywords were post mastectomy lymphedema, physiotherapy upper limb lymphedema, complex decongestive physiotherapy, and manual lymphatic drainage. Inclusion and exclusion criteria were not described.
No description was provided of the total number of studies reviewed initially, of how identified articles were assessed, or hwo studies were selected and evaluated.
Physiotherapy used for lymphedema treatment includes complex decongestive therapy (CDT), pneumatic compression (PC), high-voltage electrical stimulation (HVES), and laser therapy. Better results are obtained with combined techniques. CDT is the most used protocol, and its association with PC has demonstrated efficacy. The new techniques HVES and laser demonstrate satisfactory results.
CDT has the strongest scientific support. Its application together with PC has demonstrated efficacy, and new techniques with satisfactory results are being studied, such as HVES and laser therapy. Combined physiotherapy techniques produce the most beneficial effects.
Clinicians should select the best combination based on a detailed assessment of individual cases.
da Costa Miranda, V., Trufelli, D.C., Santos, J., Campos, M.P., Nobuo, M., da Costa Miranda, M., … del Giglio, A. (2009). Effectiveness of guarana (Paullinia cupana) for postradiation fatigue and depression: Results of a pilot double-blind randomized study. Journal of Alternative and Complementary Medicine, 15, 431–433.
To evaluate the effectiveness of guarana in the treatment of the fatigue and depression of patients with breast cancer who are undergoing adjuvant radiation therapy
Guarana, a plant native to the central Amazon, is known for its stimulant properties. The study involved three phases. Investigators randomized patients at the start of adjuvant radiation treatment (RT) to either guarana or placebo (phase 1). Halfway through RT, crossover occurred from placebo to guarana and vice versa (phase 2). Protocol terminated at end of the 28th RT (phase 3) for both groups. Assessments occurred three times, once at the start of each phase. The total time of the trial was 35 days. A dose of 75 mg/day guarana was administrated.
Active treatment
Double-blind randomized design with crossover
Findings did not support the use of guarana for the treatment of depression or fatigue in cancer patients.
Due to the limitations noted, this study does not support valid nursing conclusions.