Conn, V. S., Hafdahl, A. R., Porock, D. C., McDaniel, R., & Nielsen, P. J. (2006). A meta-analysis of exercise interventions among people treated for cancer. Supportive Care in Cancer, 14, 699–712.
Databases searched were MEDLINE, CANCERLIT, Cochrane Central Register of Controlled Trials (CENTRAL), Dissertation Abstracts, PsycINFO, SPORTDiscus, HealthSTAR, Clinical Evidence, and CINAHL through 2002. The authors also searched the National Institutes of Health (NIH) database of funded studies from 1986 through 2002 and conducted hand searches of selected journals.
Thirty primary study reports (24 in the published literature and the remainder in unpublished dissertations and presentation papers) contained sufficient information to be included in the quantitative analysis. Thirteen studies were designed as single-group pre/post research; the remainder compared at least two groups of patients. Only one two-group study did not randomly assign patients to study arms. Comparisons groups were most often described as having received usual care. Outcomes were quality of life, physical functional ability, fatigue, symptoms other than fatigue, mood, body composition, and exercise behavior.
Twenty-one of 30 studies tested supervised exercise interventions rather than home-based exercise. Supervised exercise was most often scheduled three times per week, and in 16 of the 21 studies of supervised exercise, the exercise program lasted longer than 10 weeks. Supervised exercise generally included aerobic activity (e.g., walking and cycling) and less often included resistance or flexibility exercise. Mixed types of aerobic exercise were used in several studies. The exercise intervention in most studies was of moderate intensity to achieve approximately 30% to 70% of maximum oxygen consumption.
The effect size estimate for the outcome of fatigue in the two-group comparisons was small and not statistically significant (standardized mean difference [SMD] = 0.11). However, the effect size estimate for the outcome of fatigue in the single group comparisons of pre- and posttest was larger (SMD = 0.27) and remained statistically significant under both the assumption that there was no correlation between participants’ pre- and posttest scores and that pre- and posttest scores were strongly correlated (r = 0.80).
Effect sizes among only control group participants were very small but negative; this observation may lend some support to the validity of meta-analytic findings from single-group designs.
The small, nonsignificant effect size for exercise on the outcome of fatigue may have occurred due to heterogeneity in the exercise characteristics and intervention dose, varied samples, diverse measures of outcomes, and variable outcome assessment timing.
Connors, S., Graham, S., & Peel, T. (2007). An evaluation of a physiotherapy led non-pharmacological breathlessness programme for patients with intrathoracic malignancy. Palliative Medicine, 21(4), 285–287.
This program was conducted for four years. The study was based on prior research conducted by Corner et al. (1996) and Bredin et al. (1999), also reported elsewhere in the table.
The study reported on a sample of 169 patients. All patients reported breathlessness as a symptom. Patients were referred from three sources to a physiotherapist-led breathlessness program for patients with intrathoracic malignancy. The three sources included an outpatient lung cancer clinic, the inpatient unit, or the community where they were referred by a specialist palliative care team. A screening questionnaire was used to identify the cause of breathlessness. If the cause was reversible, the patient received appropriate care. Only 14 of 169 completed the entire program.
The following tools were used at one, four, and eight weeks.
Only 14 of 169 completed the entire program. The following are characteristics of the 14 who completed the program.
Of the 14 who completed the program, pre- and post-assessment scores showed modest improvement, but it was not statistically significant. The majority did not complete the program. One hundred thirty-one patients (85%) were seen at least once and anecdotally had subjective benefit. Of those who did not complete the program, some had progressive disease and were too ill to participate or died before being seen. Median survival was 95 days.
Patients with intra-thoracic cancer may benefit from a formal nonpharmacologic program. Patients who are frail and/or on palliative care may need a more flexible program.
One hundred fifty-five patients did not complete the program because of progressive disease and associated shorter survival. The small subset who did complete the program did not show significant improvement in dyspnea measures. Dropout rate was 82% versus 41% in the Corner study and 43% in the the Bredin study. Interventions in the three studies were similar. The difference in dropout rate for this study compared to Bredin and Corner’s studies is explained by the fact that the patients in this study were older and were recruited from the totality of patients with lung cancer presenting to the cancer center.
Colson, J., Koyyalagunta, D., Falco, F.J., & Manchikanti, L. (2011). A systematic review of observational studies on the effectiveness of opioid therapy for cancer pain. Pain Physician, 14(2), E85–E102. Retrieved from http://www.painphysicianjournal.com/2011/march/2011;14;E85-E102.pdf
To assess current literature regarding the overall effectiveness of opioid therapy in cancer pain management
Studies involved a variety of opioid types and varied in terms of duration of follow-up, as the summaries that follow show.
This review identified evidence of moderate strength, from observational studies, regarding the effectiveness of opioids as a treatment for cancer pain. Authors strongly recommend opioids, by various routes, for the management of cancer-related pain.
Authors note that further evidence is needed in the areas of dose response and treatment for breakthrough pain.
Opioids by various routes remain the mainstay of cancer-pain management. Some evidence suggests that the addition of an NSAID can improve results and that use of fentanyl formulated for rapid onset and short duration is effective and well tolerated for breakthrough pain. Additional research in breakthrough pain is needed.
Colodny, L., Lynch, K., Farber, C., Papish, S., Phillips, K., Sanchez, M., . . . Block, J. (2000). Results of a study to evaluate the use of Propax to reduce adverse effects of chemotherapy. Journal of the American Nutraceutical Association, 3, 17–25.
In both studies, the dose of Propax was given to patients three times daily in a packet that contained four tablets and one softgel capsule. Supplements were administered with food to limit potential gastrointestinal upset. In the open-label study, patients received the Propax nutritional supplementation five to seven days prior to chemotherapy treatments and continued throughout the next 12 weeks of the chemotherapy regimen. After six weeks of chemotherapy, patients crossed over to the other product (placebo to Propax or Propax to placebo). Outcomes were evaluated at baseline, week 6 (mid-point), and week 12 (end of the intervention).
Outpatient chemotherapy centers in California, Florida, Maine, Massachusetts, New Jersey, and New York
Patients were undergoing the active treatment phase of care.
This was a crossover, placebo-controlled, randomized, controlled, trial and a pilot open-label study.
The article did not discuss which measurement instruments were used.
In the open-label trial, patients reported significant improvements in fatigue (>0.5 change in score). Patients who began with Propax in the crossover randomized, controlled trial reported improvement in fatigue during the 12-week study period. Patients who began with the placebo experienced improved quality of life; however, fatigue was not specifically mentioned.
Collins, K.B., & Thomas, D.J. (2004). Acupuncture and acupressure for the management of chemotherapy-induced nausea and vomiting. Journal of the American Association of Nurse Practitioners, 16(2), 80-84.
To review existing research on the use of acupuncture and acupressure in the management of nausea and vomiting in order to provide nurses the information required to assist their patients receiving chemotherapy and experiencing chemotherapy-induced nausea and vomiting (CINV)
Databases searched were described as scientific and internet sources, Institutes of Health Consensus statement, and federal regulations.
Search keywords included acupuncture and acupressure in combination with chemotherapy-induced nausea and vomiting.
Numerous studies tested the effectiveness of acupressure, acupuncture, and the combination. Few focused on acupressure alone for managing CINV.
A total of five studies were found, representing a total of 409 patients.
Very few studies were found, but, overall, results indicated improvement in nausea and vomiting, supporting the use of acupressure and acupuncture of the treatment of CINV. Acupuncture and acupressure were found to be safe and effective for the relief of CINV in combination with current antiemetic drugs.
The sample sizes were small in the studies; therefore, determining applicability to various practice settings and populations is difficult.
Collinge, W., Kahn, J., Walton, T., Kozak, L., Bauer-Wu, S., Fletcher, K., . . . Soltysik, R. (2013). Touch, caring, and cancer: Randomized controlled trial of a multimedia caregiver education program. Supportive Care in Cancer, 21, 1405–1414.
To evaluate the effect of family caregiver–provided massage, as instructed through a multimedia home-based training program, on patient symptom ratings, caregiver attitudes (confidence, self-esteem), and perceived stress
The experimental group received a DVD and written manual instructing caregivers on how to prepare for and safely practice providing massage and acupressure to patients with cancer in the home setting. Dyads were requested to practice at least three times per week for four weeks. Control group caregivers were asked to read to patients for the same frequency and duration. Caregiver/patient dyads were randomized to the intervention or control (reading) group for a four-week period, after which controls could opt to receive the intervention. An additional 16-week observation period followed.
A randomized controlled trial design was used.
Both control and intervention caregivers had good compliance with the protocol, and both experienced significant improvements in caregiver attitudes (ability to help patient feel better and worry about causing distress through touch). Intervention group caregivers reported increased self-efficacy in providing massage.
Patients in both groups reported significantly improved symptoms after each session. Over the four-week period, patients in the intervention group had significant mean decreases in symptom ratings for pain (p = 0.04), nausea (p = 0.02), and patient-specified symptoms (p = 0.02; these symptoms were not listed by the authors). There were some significant pre-/postsession symptom ratings improvements in the massage group when scores by week were compared, but no linear association of time and symptom trajectory was noted.
Both massage and reading interactions within patient/caregiver dyads appear to have a positive effect on caregiver attitudes and patient symptom ratings. Dyads utilizing massage based on the home instruction materials may receive more benefit regarding caregiver self-efficacy specific to that skill and greater symptom relief over time.
This study measured the benefits of massage on caregiver and patient outcomes as compared to a control (reading) and found both activities were potentially beneficial. The method by which the intervention group was instructed was innovative, multilingual, and widely reproducible, as it is offered through a DVD recording and written manual, and was tested in a sample that was very inclusive (open to all cancers and stages of adult patients who spoke three common languages, from three geographic sites in the United States). However, despite the study title, which leads the reader to believe that an aim of the study was to examine the effectiveness of the instruction method itself, this is not the case. A prior feasibility study was noted to pilot the included content, and a patient convenience sample (n = 18) was noted to have tested the multimedia program for usability, but no report of testing the effectiveness of teaching the content in this manner versus any other method was reported. There were no implementation challenges or adverse events reported in the study (these were assessed by biweekly phone calls), and an oncology massage therapist made one home visit to the dyads to ensure the intervention was delivered safely. It is implied that the multimedia tool was an effective instruction method, but this was not explicitly studied. Study findings suggest that providing carers with any specific concrete way to intervene to help patients may be what is actually beneficial.
Coleman, E. A., Coon, S., Hall-Barrow, J., Richards, K., Gaylor, D., & Stewart, B. (2003). Feasibility of exercise during treatment for multiple myeloma. Cancer Nursing, 26, 410–419.
A home-based exercise program was used that included aerobic and resistance training. The exercise group received an individualized exercise prescription, with strength levels and aerobic capacity at first testing. The control group received usual care. Outcomes were exercise, fatigue, mood, and sleep.
Patients were undergoing the active treatment phase of care.
The study was a pilot feasibility, randomized, controlled trial.
The feasibility of an individualized exercise program for patients receiving aggressive treatment for multiple myeloma was determined.
Coleman, E. A., Goodwin, J. A., Kennedy, R., Coon, S. K., Richards, K., Enderlin, C., . . . Anaissie, E. J. (2012). Effects of exercise on fatigue, sleep, and performance: a randomized trial. Oncology Nursing Forum, 39, 468–477.
To compare usual care with a home-based individualized exercise program (HBIEP) in patients receiving intensive treatment for multiple myeloma (MM) and epoetin alfa therapy.
This was a randomized trial with repeated measures of two groups (one experimental and one control) and an approximate 15-week experimental period for the HBIEP. The control group received a recommendation to walk 20 minutes three times per week. In the HBIEP, patients were given color-coded stretch bands and materials to illustrate exercises to be used, and they were to perform aerobic walking to reach 65% to 80% of the maximal heart rate. Patients mailed in weekly activity summaries. Assessments were performed at baseline, 10 to 12 weeks later prior to the second chemotherapy cycle, and three to four weeks later when finishing stem cell collection.
This was a randomized, controlled trial with repeated measures of two groups and a 15-week experimental period.
No statistically significant differences existed among the experimental and control groups for fatigue, sleep, or performance (aerobic capacity). Statistically significant differences (p < 0.05) were found in each of the study outcomes for all patients as treatment progressed, and patients experienced more fatigue and poorer nighttime sleep and performance.
The effect of exercise seemed to be minimal on decreasing fatigue, improving sleep, and improving performance. Exercise is safe and has physiologic benefits for patients undergoing MM treatment and, when combined with epoetin alfa, helped to alleviate anemia.
Although the results might indicate no derived benefit, patients became more fatigued, slept less, and experienced a decline in performance with more treatment. The HBIEP group required fewer red blood cell transfusions to maintain a similar hemoglobin level, less platelet transfusions, and fewer days to collect stem cells. When combined with epoetin alfa therapy, exercise had an effect in decreasing cancer-related anemia and improving cell count recovery after high-dose chemotherapy. These are benefits to patients and the healthcare economy. Cancer rehabilitation exercises may result in improved performance. Having fatigue prior to treatment might predict having fatigue after treatment. Energy conservation measures should be considered with endurance and resistance exercises. Rehabiltation therapy might be needed for deconditioned patients. Exercise should be tailored individually based on the patient's disease stage, presence of bone lesions, and values. The HBIEP may have helped to alleviate anemia, but there is no evidence that HBIEP combining muscle strengthening and aerobic walking exercises decreases fatigue.
Colella, G., Cannavale, R., Vicidomini, A., Rinaldi, G., Compilato, D., & Campisi, G. (2010). Efficacy of a spray compound containing a pool of collagen precursor synthetic aminoacids (l-proline, l-leucine, l-lysine and glycine) combined with sodium hyaluronate to manage chemo/radiotherapy-induced oral mucositis: Preliminary data of an open trial. International Journal of Immunopathology and Pharmacology, 23(1), 143-151.
Evaluate the efficacy of sodium hyaluronate to decrease pain and severity of oral mucositis
Patients affected by oral mucositis were consecutively recruited. Patients were instructed to apply the hylauronic based spray on oral lesions 3-4 times per day for 14 days after meals. All patients did mouth care, including oral rinses with 0.12% chlorhexidine gluconate based mouthwash 3 times daily. Patients were evaluated with oral examination and photo recording at baseline, at 24 hours, 72 hours, 7 days, and 14 days.
The study was comprised of 27 patients with a mean age of 61 (SD = 18.6 years) and a range of 18-96 years. There were 12 femailes and 15 males.
Diagnosis Information: Recent treatment for head and neck cancer, daily radiotherapy, or chemo for neoplasm
Other Key Characteristics: signs of at least grade 1 oral mucositis
Mutli-site: University of Naples and University Hospital of Palermo
Open label prospective clinical trial
Pain scores with VAS reduced over time and was significantly reduced after two hours from spray provision (p < 0.0001). Similar differences were shown at every other measurement time point as well (p < 0.0001). Patients treated showed improvement of lesion at 72 h (p = 0.0005) and progressive improvement in ability to swallow food and liquids.
Findings suggest that hylauronic acid/sodium hyaluronate may be helpful for management of oral mucositis.
Small sample <30. No appropriate control group; variety in treatment regimens (chemo versus non-chemo) may skew results. Patients already had mucositis at study entry and were using chlorhexidine, which is contrary to guideline recommendations. It is unclear if this may have affected findings.
May be effective but what are side effects? Does it lead to numbing? What does it taste like? Etc.
Colella, J., Scrofine, S., Galli, B., Knorr-Mulder, C., Gejerman, G., Scheuch, J., et al. (2006). Prostate HDR radiation therapy: A comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA. Urologic Nursing, 26, 57–61.