Cheville, A.L., Sloan, J.A., Northfelt, D.W., Jillella, A.P., Wong, G.Y., Bearden III, J.D., . . . Loprinzi, C.L. (2009). Use of a lidocaine patch in the management of postsurgical neuropathic pain in patients with cancer: A phase III double-blind crossover study (N01CB). Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 17(4), 451–460.
To investigate the efficacy of one or more lidocaine patches in reducing incisional pain
In the initial four-week treatment phase, patients received either lidocaine patches or placebo to apply to postsurgical incisional sites. After four weeks, the lidocaine group received placebo and vice versa. Pain was rated at baseline and at four and eight weeks.
Double-blind, randomized, two-period crossover trial
Pain interference scores were significantly lower in the group that received lidocaine patch first. Significant differences in postsurgical pain intensity, with the lidocaine patch applied to incisional areas, were lacking overall.
Further research is needed to determine whether lidocaine patches augment the analgesic regimen for incisional pain.
Cheville, A.L., Kollasch, J., Vandenberg, J., Shen, T., Grothey, A., Gamble, G., & Basford, J.R. (2013). A home-based exercise program to improve function, fatigue, and sleep quality in patients with stage IV lung and colorectal cancer: A randomized controlled trial. Journal of Pain and Symptom Management, 45, 811–821.
To report the effects of a strength training and walking program in patients with stage IV lung and colorectal cancer.
Patients were given usual care or 1.5 hours of training by a physical therapist on rapid, easy, strength training exercises (REST) and pedometer-based walking using an instruction manual, resistance bands, an exertion rating scale, and a study log. They were then followed bimonthly by telephone for eight weeks.
Patients were undergoing the end of life phase of care.
The study was a single-blinded, randomized, controlled trial.
Mobility, fatigue, and sleep measures were statistically significant between the intervention and control groups from baseline to week 8 (p = 0.002, p = 0.03, and p = 0.002, respectively), in favor of exercise. Other measures did not show significance. The number of REST sessions and weeks logged with step counts were associated with changes in the mobility score. Survival and withdrawals did not differ significantly between the groups.
A home-based intervention using walking and strength exercises may improve mobility, fatigue, and sleep quality in patients with stage IV colorectal or lung cancer.
The teaching of walking exercises and strength routines may improve functioning in this patient population in terms of mobility, sleep quality, and fatigue. The one-time education session may be appealing to nurses looking for a timely intervention to help improve these symptoms.
Cheville, A. L., Girardi, J., Clark, M. M., Rummans, T. A., Pittelkow, T., Brown, P., . . . Gamble, G. (2010). Therapeutic exercise during outpatient radiation therapy for advanced cancer: feasibility and impact on physical well-being. American Journal of Physical Medicine & Rehabilitation, 89, 611–619.
To describe the feasibility of delivering a structured physical therapy (PT) program as part of a multidisciplinary intervention to patients undergoing outpatient radiotherapy for advanced cancer.
Patients were randomly assigned to receive the structured intervention or standard care using a stratified approach based on Eastern Cooperative Oncology Group (ECOG) performance status, age, sex, and tumor type. The structured multidisciplinary intervention consisted of eight sessions delivered by a PT and a psychiatrist or a psychologist with facilitation provided by an advanced practice nurse, licensed social worker, or certified hospital chaplain depending on the theme. Cognitive, emotional, social, and spiritual dimensions of the intervention centered on specific topics and coping strategies related to patients' goal setting, challenging negative thoughts, communication, and hope. PT sessions incorporated education and provision of printed material, truncal and upper-limb strengthening exercises, and lower-limb strengthening alternating between standing and seated exercises. These were performed with resistance provided by elastic bands. Aerobic conditioning was not included, although patients were encouraged to engage in regular physical activity. Standard care consisted of regular assessment of treatment toxicities. Patients were not counseled regarding the potential benefits of exercise.
This report focused on the PT and interdisciplinary structured intervention aspects of a previously reported study (Rummans et al. 2006).
The study was a single-blind, randomized, controlled trial.
The structured intervention appeared to provide short-term improvement in overall perception of well-being; however, this effect was not sustained over the duration of the trial.
Cheung, Y.L., Molassiotis, A., & Chang, A.M. (2003). The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology, 12, 254–266.
To examine progressive muscle relaxation training (PMRT) in reducing anxiety and improving quality of life in patients with colorectal cancer after stoma surgery
PMRT was provided for 20 minutes along with deep breathing (10 major muscle groups were used, but not valsalva response). Participants received two teaching sessions and practiced at home for 10 weeks. Measurements were taken during hospitalization and 5 and 10 weeks after surgery and intervention.
The study reported on a sample of 59 participants.
The sample was recruited from the department of surgery of two public hospitals in Hong Kong.
A longitudinal randomized controlled trial design was used.
R-ANOVA indicated there was a significant difference in state-anxiety over the 10 weeks between the two groups (p < 0.01), with the experimental group reporting a significantly lower state-anxiety level than the control group. Also, scores significantly decreased over time (10 weeks) in both groups (p < 0.001), indicating a 43% decrease.
Cheuk, D.K., Chiang, A.K., Lee, T.L., Chan, G.C., & Ha, S.Y. (2011). Vaccines for prophylaxis of viral infections in patients with hematological malignancies. Cochrane Database of Systematic Reviews, 3, CD006505.
To determine the effectiveness and safety of viral vaccines in patients with hematologic malignancies. The primary outcome was the incidence of infection. Secondary outcomes were mortality, incidence of complications, severe viral infection, hospitalization, immune response, and adverse effects.
Databases searched were the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL (June 2010). In addition, reference lists of relevant articles, abstracts from scientific meetings, and contacted vaccine manufacturers were used.
Randomized, controlled trials (RCTs) evaluating viral vaccines in patients with hematologic malignancies were included. No exclusion criteria were stated.
A total of 565 references were retrieved.
Relative risk (RR) was used for binary data, and mean difference (MD) was used for continuous data. The fixed-effect model was used in meta-analyses. Two authors (first and second authors) independently reviewed titles and abstracts of references retrieved from the searches and selected all potentially relevant studies. Copies of these articles were obtained and reviewed independently by the same authors against predefined inclusion criteria. The authors were not blinded to the names of the trial authors, institutions, or journal of publication. All disagreements about the selection of studies were resolved by consensus.
Interventions evaluated included heat-inactivated varicella-zoster virus (VZV) vaccine (two trials), influenza vaccines (five trials), and inactivated poliovirus vaccine (IPV) (one trial).
Patients were undergoing the active treatment phase of care.
The VZV vaccine might reduce herpes zoster compared with no vaccine (relative risk [RR] = 0.54; 95% confidence interval [CI] [0.3, 1.0]; p = 0.05). Vaccination also demonstrated efficacy in immune response but frequently caused local adverse effects. One trial reported a severity score of zoster that favored vaccination (MD = 2.6; 95% CI [0.94, 4.26]; p = 0.002). Two RCTs compared inactivated influenza vaccine with no vaccine and reported a lower risk of lower respiratory infections (RR = 0.39; 95% CI [0.19, 0.78]; p = 0.008) and hospitalization (RR = 0.17; 95% CI [0.09, 0.31]; p < 0.00001) in vaccine recipients. However, vaccine recipients more frequently experienced irritability and local adverse effects. There was no significant difference in seroconversion between one and two doses of influenza vaccine (one trial), or between recombinant and standard influenza vaccine (one trial), or influenza vaccine given with or without reinduction chemotherapy (one trial). The IPV trial comparing vaccination starting at 6 versus 18 months after stem cell transplantation (SCT) found no significant difference in seroconversion.
Inactivated VZV vaccine might reduce zoster severity in adult SCT recipients. Inactivated influenza vaccine might reduce respiratory infections and hospitalization in adults with multiple myeloma or children with leukemia or lymphoma. Local adverse effects occur frequently.
The quality of evidence is low.
Further high-quality RCTs are needed.
Cherrier, M.M., Anderson, K., David, D., Higano, C.S., Gray, H., Church, A., & Willis, S.L. (2013). A randomized trial of cognitive rehabilitation in cancer survivors. Life Sciences, 93, 617–622.
Test the effects of a group cognitive rehabilitation program on memory and attention in cancer survivors
Patients randomly were assigned to the treatment or a wait-list control group. The intervention consisted of hourly trainings that incorporated didactic teaching methods, focusing primarily on memory aids and skills, as well as mindfulness meditation. A portion of each session was dedicated to reviewing and practicing skills. The intervention was offered weekly over seven consecutive weeks, delivered in a group format. Homework was assigned to the participants with the expectation that they practice the intervention independently at home. Objective measures were evaluated twice at baseline (in an attempt to eliminate potential practice effects) and one month after completion of the intervention. Subjective measures were evaluated at baseline and one month after completion of the intervention. Control group participants underwent subsequent testing seven to eight weeks after their initial evaluation.
Randomized clinical trial
Patients who received the cognitive rehabilitation intervention had improvements in perceived cognitive function (p < 0.01), perceived cognitive abilities (p < 0.01), and cognitive quality of life (p < 0.01) as measured by the FACT-Cog and in one measure of attention, digit span backward (p < 0.01). In contrast, differences were not found between the treatment and control groups in other objective measures of cognition. No significant differences between groups over time were found for anxiety, depression, or fatigue.
Findings from this study suggest that cognitive rehabilitation may improve attention and perceived cognitive functioning, but not memory, in patients with cancer. The fact that significant differences were not found in anxiety, depression, or fatigue suggests that they were not related to the any improved cognitive functioning.
Although this study found improvements in perceived cognitive function and one objective measure of attention, it was underpowered and patient compliance was inconsistent. Further research with larger sample sizes is warranted to determine effectiveness. In addition, longer follow-up is required to determine the sustainability of any improvements in cognitive functioning.
Chermetz, M., Gobbo, M., Ronfani, L., Ottaviani, G., Zanazzo, G.A., Verzegnassi, F., . . . Zacchigna, S. (2013). Class IV laser therapy as treatment for chemotherapy-induced oral mucositis in onco-haematological paediatric patients: A prospective study. International Journal of Paediatric Dentistry.
To evaluate the efficacy of class IV laser therapy in pediatric patients affected by severe oral mucositis (OM)
Laser treatments were performed twice daily for four consecutive days, all over the oral cavity in ulcerated and erythematous areas. Treatment was started on average 7.5 days after the end of chemotherapy.
The use of class IV laser therapy (high-power laser therapy [HPLT]) was effective and induced better healing, reduced inflammation, and limited thermal damage along with maintained tissue integrity as compared to traditional low-power laser therapy (LPLT). All patients experienced a statistically significant decrease in pain sensation the day after the first laser application, with lesions healing by day 11.
The innovative protocol used, HPLT, employs high power and high wavelength as compared to traditional protocols and was effective, safe, and non-invasive for the treatment of OM. It accelerates healing time and causes reduction of pain and inflammation of OM. The efficacy of LPLT in pediatric patients with cancer has been established. Thus, laser light therapy has proved to be successful in the prevention and treatment of chemotherapy-induced OM. In the present study, all patients perceived a great improvement in all lesions and functional capacity.
A gap indicates a lack of knowledge regarding dosing levels of laser therapy (low versus high, adult versus pediatric), so additional research is needed. More double-blind, randomized, controlled studies are needed, as well as laser protocols.
Cheon, S., Zhang, X., Lee, I.S., Cho, S.H., Chae, Y., & Lee, H. (2014). Pharmacopuncture for cancer care: A systematic review. Evidence-Based Complementary and Alternative Medicine, 2014, 804746.
PHASE OF CARE: Active antitumor treatment (for CINV trials)
All studies favored pharmacopuncture over the control group, but outcome measures varied. Five out of six studies reported response rates as an outcome measure. Two studies calculated response rate using emesis episodes. One study (26) used two outcome measures, the total number of emesis episodes in 21 days and the proportion of emesis-free days in the same period.
The level of evidence was not strong enough to draw any conclusions. There was a careful suggestion that pharmacopuncture may help alleviate cancer-related pain, CINV, and other symptoms such as ileus, hiccups, fever, quality of life, and gastrointestinal disturbances.
The findings of this meta-analysis should be interpreted with consideration of its limitations. Additional rigorously designed and conducted studies are required.
Chen, S.Y., Chen, T.M., Dai, N.T., Fu, J.P., Chang, S.C., Deng, S.C., & Chen, S.G. (2011). Do antibacterial-coated sutures reduce wound infection in head and neck cancer reconstruction? European Journal of Surgical Oncology, 37, 300–304.
The primary aim of this study was to evaluate the effect of triclosan-coated sutures on cervical surgical wound infection rates. A secondary aim was to analyze the risk factors for wound infections in patients undergoing surgery for head and neck cancer.
The study sample was comprised of patients who were admitted to the Tri-Service General Hospital, National Defense Medical Center, in Taipei, Taiwan, from January 2007 to December 2009. The patients were admitted for tumor ablation after a diagnosis of head and neck cancer and they received reconstructive surgery after wide excision of the tumor. The patients also had an exploration of the cervical area for radical neck lymph node disection or vascular examination for microsurgical anastomoses.
Patients were randomized into the triclosan group or a control group by a flip of a coin.
All surgical procedures were the same. All patients received IV prophylactic antibiotics (1 g cephazolin every eight hours for three days and 80 mg of gentamycin every 12 hours for three days). Dressings were changed daily for wound care and evaluation. The closed suction neck drain was removed when there was less than 10 ml per day of drainage. Infections were inspected for and defined as local erythematous change in the sutured wound with purulent discharge, cervical wound dehiscence, or neck skin necrosis. Surgical wound and intra-oral flap sutures were removed two weeks post-surgery and evaluated for delayed healing defined as intra-oral wound dehiscence and surgical complications, such as flap necrosis, intra-oral flap dehiscence, oral-cervical fistula, and neck wound infection.
The total sample was 241 participants.
Mean age in the triclosan group was 53.6 years (SD = 9.8); the mean age in the control group was 51.1 years (SD = 11.3).
Males made up 93.4% of the sample; females made up 6.6%.
138 patients were stage T1 or T2 (58 in the triclosan group; 80 in the control group) and 103 were stage T3 or T4 (54 in the triclosan group; 49 in the control group)
67 patients had prior head and neck reconstruction (29 in the triclosan group; 38 in the control group), 91 had preoperative radiotherapy (46 in the triclosan group; 45 in the control group), 55 had diabetes (30 in the triclosan group; 25 in the control group), 219 underwent free flap transfer (102 in the triclosan group; 117 in the control group), flap sizes in the triclosan group were an average of 81 cm2 (+ 57.9) and 72.7 cm2 (+ 56.4) in the control group, and the length of stay for participants in the triclosan group was 35.3 days (+ 14.3) and 35.9 days (+ 21) in the control group.
A single-site inpatient setting in Taipei, Taiwan
Active treatment
Randomized, controlled trial
Thirty-six patients incurred infections, 17 in the triclosan group and 19 in the control group (p = 1.0). Risk factors for postoperative cervical wound infection included stages T3 and T4 (OR = 3.09, 95% CI [1.39, 6.87], p = 0.006); diabetes (OR = 2.01, 95% CI [0.88, 4.58], p = 0.098); delayed healing of intra-oral wound (OR = 5.82, 95% CI [2.66, 12.77], p < 0.001). Patients with infections had a statistically significantly longer length of stay (56.4 + 27.2 days) compared to no infection (32 + 13 days).
There was no statistically significant difference in infection rates between patients who received triclosan-coated sutures and controls. Advanced tumor stage, delayed intra-oral flap healing, and oral cavity contamination by normal flora were risk factors for infection.
Keeping the surgical site clean and clear from contamination is essential for infection prevention of surgical sites in patients with head and neck tumors. Study findings did not show a benefit with use of triclosan coated sutures in the surgical procedure.
Chen, H.L., Cheng, H.C., Wu, W.T., Liu, Y.J., & Liu, S.Y. (2008). Supplementation of konjac glucomannan into a low-fiber Chinese diet promoted bowel movement and improved colonic ecology in constipated adults: A placebo-controlled, diet-controlled trial. Journal of the American College of Nutrition, 27, 102–108.
To examine the effects of konjac glucomannan (KGM) supplementation on bowel habits and colonic environment in adults with constipation, and to examine the method by which KGM modulates bowel habits.
Patients who self-reported having constipation for more than six months were recruited from an outpatient clinic. The study comprised a three-week placebo (gelatin capsules containing corn starch) period, a one-week adaptation period in which KGM was gradually increased from 1.5 to 3 g per day, and a three-week KGM period (1.5 g KGM per meal or 4.5 g per day). Capsules were taken with 150 ml of water. Patients followed a typical low-fiber Chinese diet and were instructed to maintain their usual physical activity, lifestyle, and sleeping habits. Capsule consumption (compliance) was verified daily.
Taiwan
This was a single-blind, placebo-controlled, crossover study.
Adding KGM (4.5 g per day) to a low-fiber diet may increase frequency of bowel movements and improve colonic ecology.
KGM (4.5 g per day) may increase frequency of bowel movements in adults with mild constipation (participants did not use laxatives or enemas). The ecology of the colon may improve with KGM supplementation because the proportion of fecal clostridia and fecal pH decreased. Additional studies are warranted that include an oncology population and a larger sample size.