Cowan, C.C., Hutchison, C., Cole, T., Barry, S.J., Paul, J., Reed, N.S., & Russell, J.M. (2011). A randomised double-blind placebo-controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract Infections in patients undergoing radiotherapy for cancer of the bladder or cervix. Clinical Oncology, 24, e31–e38.
The purpose of this study was to evaluate the effectiveness of cranberry juice on the incidence of urinary tract infections and urinary symptoms in patients undergoing pelvic radiotherapy for cancer of the bladder or cervix.
Participants were randomized to receive cranberry juice, twice a day (morning and night) for the duration of their radiotherapy treatment and for two weeks after treatment (six weeks in total) or a placebo beverage, for the same duration. The primary study end point was the percentage of patients who experienced an increase in the Common Toxicity Criteria (CTC) grade of their urinary symptoms or developed a urinary tract infection during the period of six weeks. The laboratory diagnosis of a urinary tract infection was based on a significant isolate of a single organism (i.e., 100,000 ml or heavy growth) in a non-catheterized patient and/or other abnormal findings, such as pus cells in the urine with or without subjective symptoms. Patients were required to provide weekly urine samples and to keep a daily diary to record their bladder symptoms and compliance with drinking the juice.
A single-site outpatient setting in Scotland
Acute treatment
Randomized, double-blind, placebo-controlled trial
The incidence of increased urinary symptoms or urinary tract infections was 82.5% in the cranberry juice group and 89.3% in the placebo group (p = 0.24, adjusted odds ratio [cranberry/placebo] 0.48, 95% CI [0.14, 1.63]).
This study did not provide support for effect of cranberry juice for prevention of urinary tract infections in this group of patients.
This study did not support effectiveness of drinking cranberry juice for prevention of urinary tract infections in patients receiving pelvic irradiation. The study had multiple limitations. No conclusions can be drawn from this study report due to limitations and small sample size.
Courneya, K.S., Segal, R.J., Gelmon, K., Reid, R.D., Mackey, J.R., Friedenreich, C.M., . . . McKenzie, D.C. (2007). Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology, Biomarkers and Prevention, 16, 2572–2578.
Primary aim: To determine if prior research findings of improvement in patient outcomes with exercise during adjuvant chemotherapy would be maintained at six-month follow-up
Secondary aim: To determine if patients who reported regular exercise during the follow-up period would report better outcomes at six-month follow-up
Participants who had initially been in a three-armed randomized controlled trial were recruited to participate in this study. Prior study groups were aerobic exercise, resistance exercise, and control. Exercise groups were supervised. Participants were mailed questionnaires to determine the frequency of exercise and to rate their quality of life, self-esteem, fatigue, anxiety, and depression. Participants were asked to recall their exercise of the past six months using a questionnaire, and were then categorized into meeting or not meeting current guidelines for aerobic exercise (>/= 60 minutes of vigorous or 150 minutes of moderate exercise per week).
Patients were undergoing the transition phase of care after initial treatment.
This was a descriptive study for follow-up from a previous randomized controlled trial.
Of the sample, 20.9% reported meeting both aerobic and resistance exercise guidelines, 8% reported meeting only resistance exercise guidelines, 28.9% reported meeting only aerobic guidelines, and 42.3% reported not meeting any exercise guidelines. Those who originally were in a group given supervised aerobic exercise training (AET) had fewer reporting that they met exercise guidelines during follow-up (p = 0.034). Those who had received resistance exercise training (RET) reported higher self-esteem at six months (p = 0.032). The AET group reported significantly lower anxiety at six months than either the control or RET group members (p = 0.049). All other changes in self-reported outcomes at six months favored the exercise groups, but were not statistically significant. Those who reported that they met exercise guidelines reported higher quality of life (p = 0.025) and less fatigue (p = 0.013). They also reported less anxiety, but this difference was not significant. At six months, those in the AET group reported that anxiety was lower by 4.7 points and depression was reduced by 2.7 points.
Exercise training during chemotherapy treatment may have longer-term effects on anxiety and self-esteem. Consistent exercise meeting recommended guidelines appears to benefit patients in terms of a positive effect on symptoms of fatigue and general quality of life.
Findings suggest that ongoing exercise according to guidelines appears to have positive effects on patients’ quality of life, fatigue, anxiety, and self-esteem. Nurses can educate patients about these potential benefits.
Courneya, K.S., Segal, R.J., Mackey, J.R., Gelmon, K., Friedenreich, C.M., Yasui, Y., . . . McKenzie, D.C. (2014). Effects of exercise dose and type on sleep quality in breast cancer patients receiving chemotherapy: A multicenter randomized trial. Breast Cancer Research and Treatment, 144, 361–369.
To compare the effects and doses of a three-arm exercise trial to improve sleep quality in patients with breast cancer receiving active chemotherapy
The three-group design of the CARE trial compared the standard dose of 25–30 minutes of aerobic exercise (STAN) to higher doses of activity that included 50–60 minutes of aerobic exercise (HIGH) and 50–60 minutes of combined-dose of aerobic and resistance exercise (aerobic and strength training three times per week) (COMB). COMB strength training was part of the 50–60 minute session and included two sets of 10–12 repetitions of nine different strength exercises at 60%–75% of the estimated one-repetition max (RM). All groups received three weekly treatments with outcomes measures to determine primary and secondary outcomes. Interventions continued for the duration of chemotherapy. Data were collected at baseline, midpoint 1, midpoint 2, and postintervention.
Blinded, randomized, controlled trial
296 patients completed the study with complete data. Baseline global sleep scores were M = 6.2 (SD = 4.1) with 52% of participants reporting poor sleep at baseline (PSQI > 5). The main effects of the study showed that the HIGH group had statistically better outcomes compared to the STAN group for primary sleep global scores (d = 0.22; p = 0.039), sleep quality (d = 0.26; p = 0.028), and sleep latency (d = 0.18; p = 0.049). The COMB group barely scored significantly higher than the STAN group for global sleep quality, sleep duration, and sleep efficiency (d = 0.24; p = 0.04) and percent of poor sleepers (d = 0.20; p = 0.045). The HIGH group was statistically better than COMB for sleep latency only (d = 0.20; p = 0.04) . Significant moderators included surgery, baseline aerobic fitness, baseline aerobic exercise guidelines, baseline strength guidelines, and number of comorbid conditions. The effect size for the HIGH group compared to the STAN group was larger for global sleep quality for lumpectomy patients with no comorbid conditions, those meeting aerobic exercise guidelines, and those who were fitter at baseline. Scores in the COMB group were higher than those of the STAN group for lumpectomy patients meeting strength exercise guidelines. The overall effect for each arm was small.
Higher doses of exercise and the combination of exercise and strength training were associated with better overall sleep quality compared to the standard dose of 50–60 minutes of aerobic exercise. Different sleep components appeared to be most affected by the type of exercise intervention, and no single intervention impacted all the sleep components measured.
Nurses often suggest maintaining activity during treatment, but there is little information about the effectiveness of this recommendation on sleep-wake disturbances. This study provided a large sample of patients with breast cancer that narrowed down the doses needed to affect sleep. The overall results of this study suggest that exercise can improve sleep during chemotherapy treatment. However, the limitations of this study need to be taken into consideration before recommending the actual interventions used.
Courneya, K.S., Sellar, C.M., Trinh, L., Forbes, C.C., Stevinson, C., McNeely, M.L., . . . Reiman, T. (2012). A randomized trial of aerobic exercise and sleep quality in lymphoma patients receiving chemotherapy or no treatments. Cancer Epidemiology Biomarkers & Prevention, 21, 887–894.
To test the hypothesis that aerobic exercise would be better than usual care for improving sleep quality, and to examine potential moderators of intervention effects
Patients were stratified by lymphoma type and whether the patient was receiving chemotherapy and then randomized to receive the exercise intervention or usual care. The intervention consisted of supervised aerobic sessions three days per week for 12 weeks. Prescriptions for unsupervised exercise were provided for patients who were unable or unwilling to attend supervised sessions, and these sessions were not counted in adherence evaluation. Usual care patients were asked to not change baseline exercise habits and were offered supervised exercise after final study assessments.
Aerobic exercise resulted in a small (d = -0.19) but not significant improvement in global sleep quality. In the intervention group, the exercise program improved global sleep quality in patients receiving chemotherapy (p = .013), but not for those who were off therapy. Exercise improved global sleep quality in those who were poor sleepers at baseline (p = .007), but not in those who were good sleepers at baseline. Analysis further showed that positive effects of exercise were seen in patients with shorter time since diagnosis, patients who were obese, and patients who had less aggressive disease.
Aerobic exercise did not significantly improve sleep quality in this study of patients with lymphoma. Exercise appeared to have some benefits for sleep quality in individuals who were in active treatment.
Findings show that overall, participation in aerobic exercise does not improve overall sleep quality in patients with lymphoma. Some benefit may exist for patients during chemotherapy treatment and for individuals who have baseline poor sleep quality. For these types of patients, nurses should consider suggesting aerobic exercise or providing exercise prescriptions.
Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncology, 12, 357–374.
Patients were randomized to receive either 10 weeks of group psychotherapy and exercise (home-based, moderate intensity, 20 to 30 minutes, three to five times per week, and tailored across the intervention to promote progression toward the goal of achieving a heart rate during exercise of 65% to 75% of the estimated heart rate maximum) or group psychotherapy only. The group psychotherapy intervention consisted of stress management and relaxation training or expressive supportive therapy. Both group psychotherapy interventions had a psychoeducational focus. Patients in the group psychotherapy only arm received a personalized exercise plan after study completion. To control for possible contamination between the experimental conditions, groups of patients who had registered for a group psychotherapy program at a large cancer center, rather than individual patients, were randomized.
Patients were undergoing the active treatment and long-term follow-up phases of care.
This was a randomized, controlled trial with a crossover for the control group receiving group psychotherapy alone.
Functional Assessment of Cancer Therapy–Fatigue (FACT-F)
No difference existed between expressive supportive therapy and stress management and relaxation therapy in group psychotherapy effect in either group. Group psychotherapy and exercise improved quality of life beyond group psychotherapy only in cancer survivors (active treatment and long-term follow-up). The group psychotherapy intervention did not significantly reduce fatigue; however, the addition of moderate-intensity exercise resulted in a statistically significant improvement in fatigue.
Courneya, K. S., & Friedenreich, C. M. (1999). Physical exercise and quality of life following cancer diagnosis: a literature review. Annals of Behavioral Medicine, 21, 171–179.
Databases searched were MEDLINE, CANCERLIT, CINAHL, HERACLES, PsycINFO, and SPORTDiscus through 1997. Studies restricted solely to movement therapy and/or stretching/flexibility exercises for rehabilitation of range of motion were excluded. Studies were also excluded if they presented insufficient detail to allow for critical review.
Eighteen intervention studies (10 quasiexperimental and eight experimental designs) of physical exercise designed to improve cardiovascular and/or muscular fitness were included.
Outcomes were fatigue, health-related quality of life, symptom distress, immune function, physical exercise capacity (maximal oxygen consumption), and other physical performance measures.
Treatment evaluated cycle ergometer (eight studies), walking either alone or in combination with some other exercise mode (six studies), resistance training (one study), and unspecified (three studies).
Length of the intervention was 12 weeks or less in 14 studies, between four and six months in three studies, and one year in one study. Exercise was supervised (13 studies), unsupervised home-based (three studies), and partially supervised (two studies).
The reviewed studies indicated promising effects on both physiological and psychological outcomes. Three studies reported a significant reduction in fatigue. Although effect sizes could not be summarized across studies due to the diversity of outcomes with small numbers of effect sizes, the effects appeared to be robust and clinically significant.
Additional studies are needed to examine the effect of exercise, specifically on the endpoint of fatigue.
Courneya, K.S., McKenzie, D.C., Gelmon, K., Mackey, J.R., Reid, R.D., Yasui, Y., . . . Segal, R.J. (2014). A multicenter randomized trial of the effects of exercise dose and type on psychosocial distress in breast cancer patients undergoing chemotherapy. Cancer Epidemiology, Biomarkers and Prevention, 23, 857–864.
To examine the effects of exercise dose and type on psychosocial distress in patients with breast cancer receiving chemotherapy
Patients were computer-stratified by center and protocol and randomly assigned in a 1:1:1 ratio to standard (STAN), combination (COMB), or high-volume (HIGH). Participants exercised for the duration of their chemotherapy schedules. STAN treatment followed the Physical Activity Guidelines for Americans. The guidelines recommend a minimum of 75 minutes per week of vigorous aerobic exercise over three days per week. HIGH followed double the minimum guidelines of 150 minutes per week, and COMB followed the STAN guideline with the addition of a standard strength training program for three days per week. Exercise was supervised, and attendance, duration, and the intensity of aerobic exercise, weight, sets, and repetitions of strength training were recorded.
Randomized trial
There were no significant differences in managing depressive symptoms with HIGH and COMB exercises compared to the STAN exercise. COMB and HIGH exercises were effective in managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline. There were no differences between the groups in anxiety scores.
Compared to standard exercise, higher volumes of exercise did not improve depressive symptoms, but it was effective in managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline.
Depression is the most common psychological symptom in patients with cancer. Oncology nurses should encourage patients to perform standard aerobic exercise to improve depressive symptoms. Exercise also has been shown to be beneficial for anxiety and fatigue.
Courneya, K.S., Segal, R.J., Mackey, J.R., Gelmon, K., Reid, R.D., Friedenreich, C.M., . . . McKenzie, D.C. (2007). Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. Journal of Clinical Oncology, 25, 4396–4404.
The three-armed study reported on an exercise intervention with supervised aerobic exercise (AET) and supervised resistance exercise (RET) versus usual care (UC). The exercise sessions were started one to two weeks after starting chemotherapy and ended three weeks after completion of chemotherapy. Exercise trainers administered the intervention.
Data were collected at three time points: baseline (one to two weeks after starting chemotherapy), midpoint (three to four weeks after starting chemotherapy), and at six-month follow-up.
The study reported on a sample of 242 women with breast cancer receiving adjuvant chemotherapy.
Multiple centers in Canada
A randomized controlled trial (RCT) design was used.
Mixed-model analysis measured at three time points compared the differences across groups in changes over time. Neither AET nor RET interventions significantly improved cancer-specific quality of life, fatigue, depression, or anxiety, although the trends favored the exercise groups. AET improved self-esteem, aerobic fitness, and percent of body fat. RET improved self-esteem, muscle strength, lean body mass, and chemotherapy completion rates.
The study is an RCT with an adequate sample size but null findings for anxiety levels.
The intervention required exercise trainers.
Cotter, J. (2009). Efficacy of crude marijuana and synthetic delta-9-tetrahydrocannabinol as treatment for chemotherapy-induced nausea and vomiting: A systematic literature review. Oncology Nursing Forum, 36, 345–352.
To determine if oral synthetic tetrahydrocannabinol (THC) and smoked marijuana are effective in the treatment of chemotherapy-induced nausea and vomiting (CINV), and to evaluate the side effects and patient preferences for treatment
Databases searched were MEDLINE (1966–present), CINAHL (1982–present), and the Cochrane Library. A search of article reference lists also was performed.
Search keywords were nausea, vomiting, cancer, chemotherapy, cannabis, marijuana, and dronabinol.
Studies were included in the review if they
The author retrieved 18 relevant citations, 10 of which were clinical trials and included in the review. The author evaluated the quality of the reference based on strength of evidence, study design, sample size, and purpose. Specific criteria were not described.
Nurses need to review potential sides effects. Individual patients can have differing concerns as a result of other problems or preferences. Oral THC may be the best option for use among patients with cancer.
Correa-Gonzalez, L., Arteaga de Murphy, C., Pichardo-Romero, P., Pedraza-Lopez, M., Moreno-Garcia, C., & Correa-Hernandez, L. (2014). (153)Sm-EDTMP for pain relief of bone metastases from prostate and breast cancer and other malignancies. Archives of Medical Research, 45, 301–308.
To evaluate the effect of 153Sm–ethylenediamine tetramethylene phosphonate (Sm-EDTMP) for relief of pain from bone metastases
Consecutive patients referred to nuclear medicine who met eligibility criteria (life expectancy greater than six months, no chemotherapy within the previous four weeks, and acceptable blood values) were entered into the study. Each patient was asked to evaluate his or her pain daily using a visual analog and a verbal rating scale. Pain palliation was assessed using the patient’s mean scores. Sm-EDTMP was given intravenously in a solution of 37 MBq per kilogram body weight. Patients had blood work daily, and a TcMDP bone scan was done on the fifth day.
Observational
Pain was reduced in patients with prostate cancer by 74%, in breast by 67%, in renal by 78%, in thyroid by 67%, in lung by 75%, in cervical by 80%, in colon and rectum by 73%, and by 100% in patients with osteosarcoma. There were no significant changes in blood work values of leukocyte counts, hemoglobin, or platelets at 3 or 12 weeks after treatment. Pain scores were significantly reduced at 3 and 12 weeks (p = .001). There was a relatively high variability in pain score differences.
Sm-EDTMP was effective in reducing pain from bone metastases from multiple tumor types over a 12-week period.
Radiopharmaceuticals such as Sm-EDTMP may be effective for the management of pain from bone metastases. Further research comparing various pain control approaches is warranted with longer follow-up.