Cheema, B.S., Kilbreath, S.L., Fahey, P.P., Delaney, G.P., & Atlantis, E. (2014). Safety and efficacy of progressive resistance training in breast cancer: A systematic review and meta-analysis. Breast Cancer Research and Treatment, 148, 249–268.
STUDY PURPOSE: To assess the safety and efficacy of progressive resistance training in patients with breast cancer with attention to effects on lymphedema
PHASE OF CARE: Multiple phases of care
For the five studies included in the meta-analysis (654 patients), the odds ratio for the incidence or exacerbation of lymphedema was 0.53 (95%, CI = 0.31–0.9). PRT did not change arm volume or patient-reported severity as shown by an analysis of standard mean differences. Five studies reported no adverse events, and other studies reported temporary muscle soreness or minor musculoskeletal injuries. There was no significant heterogeneity. PRT produced a small, nonsignificant improvement in quality of life (SMD = 0.17). Overall, PRT improved upper and lower body muscle strength. Ten studies used machines or free weights for training.
Progressive resistance training did not induce or exacerbate arm lymphedema in women with breast cancer, and it was not associated with any severe adverse events.
Some included studies were done in women without lymphedema, and the risk of development was not clear from data in this review.
The findings of this meta-analysis suggested that progressive resistance training is safe in women with breast cancer and does not induce or exacerbate arm lymphedema. Women do not need to avoid lifting weight to prevent the exacerbation of lymphedema.
Chay, WY., Tan, SH., Lo, YL, Ong, S.Y., Ng., H.C., Gao, F., . . . Choo, S.P. (2010). Use of calcium and magnesium infusions in prevention of oxaliplatin induced sensory neuropathy. Asia Pacific Journal of Clinical Oncology, 6, 270–277.
The purpose of the study was to evaluate the neuropathy-protective effects of calcium and magnesium infusions in patients receiving oxaliplatin.
Patients were randomized to a treatment group with calcium gluconate 1 g plus 1 g of magnesium sulfate in 100 ml normal saline infused before and after oxaliplatin, or a placebo group with infusions of normal saline.
The study was conducted in a single-site location in Singapore.
The study was a blinded, placebo-controlled, randomized phase II design.
Measurements included the National Cancer Institute Common Terminology Criteria for Adverse Events [version 3.0] and oxaliplatin-specific toxicity scale nerve conduction studies.
Incidence of grade 1 and 2 neurotoxicity was higher in the placebo group, but there was a higher proportion of grade 3 cumulative numbness in the treatment group. No differences were noted between groups for tingling and cold sensitivity. In addition, no difference was noted in time to onset of symptoms. Conduction studies showed lower median score at the end of the study in the treatment arm (p = 0.02). Of note, the study was ended prematurely.
This study does not provide strong evidence regarding the efficacy of calcium and magnesium infusion for the reduction of chemotherapy-associated peripheral neuropathy.
Because of a small sample size, this current study does not provide strong evidence regarding use of calcium and magnesium infusions. Neuropathic symptom effects appear to be mixed, with higher prevalence of grade 3 with treatment, but overall prevalence lower with treatment. Some symptoms appear to be affected and some do not, and the relationship between nerve conduction findings and symptoms are unclear. Additional research in this area is needed to clarify the actual impact of calcium and magnesium for protective effects with neurotoxic treatment.
Chasen, M., Urban, L., Schnadig, I., Rapoport, B., Powers, D., Arora, S., . . . Gridelli, C. (2017). Rolapitant improves quality of life of patients receiving highly or moderately emetogenic chemotherapy. Supportive Care in Cancer, 25, 85–92.
To assess the impact of adding rolapitant to standard antiemetics (5-HT3 receptor antagonists and dexamethasone) on the daily lives of patients receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC)
This is a secondary analysis study of three clinical trials (phase III experimental studies). Patients were stratified by sex and randomly assigned (1:1) to either single oral dose rolapitant 180 mg or placebo 1–2 hours prior to chemotherapy. All patients received 5-HT3 receptor antagonists and dexamethasone. Quality of life was assessed by patients by completing the 18-item Functional Living Index-Emesis (FLI-E) questionnaire on day 6 of cycle 1.
Three double-blind, phase III, randomized, controlled longitudinal trials (specified analyses [MEC/AC study]), and pooled post hoc analyses (HEC studies)
Treatment comparisons were performed between the FLI-E questionnaire total score and nausea and vomiting domain scores, in addition to the end point of no impact on daily life.
Data were analyzed for all randomized patients in the modified intent-to-treat population. Patients in the rolapitant group reported a significantly higher FLI-E total score than patients in the control group in the pooled HEC studies (confidence interval [CI] [2.6, 7.9], p < 0.001) and in the MEC/AC study (CI [1.7, 6.5], p < 0.001). A significant improvement in the nausea domain score was observed with rolapitant versus control in the pooled HEC studies (CI [0.2, 3.4], p = 0.02) and the MEC/AC study (CI [0.3, 3.3], p = 0.019), as well as the vomiting domain score in the pooled HEC studies (CI [2.1, 4.7], p < 0.001) and the MEC/AC study (CI [1.1, 3.4], p < 0.001).
This secondary analysis study demonstrated the efficacy of adding rolapitant to standard antiemetics in reducing the negative delayed impact of CINV on the daily lives of patients receiving HEC or MEC.
Nurses should be aware of the additional benefit of adding an NK1 receptor antagonist to the treatment of patients with cancer receiving HEC and MEC.
Chasen, M., Hirschman, S.Z., & Bhargava, R. (2011). Phase II study of the novel peptide-nucleic acid OHR118 in the management of cancer-related anorexia/cachexia. Journal of the American Medical Directors Association, 12, 62–67.
To determine the effect of OHR118 on appetite, early satiety, and nutritional intake in patients with advanced cancer experiencing anorexia or anorexia-cachexia syndrome
Patients received 4.0 ml of OHR118 via subcutaneous injection daily for 28 days. Patients who benefited were offered the option to continue for a total of 56 days.
Eleven patients completed the first 28 days of the study, and 6 completed the second 28 days. Results from the first 28 days demonstrated a statistically significant improvement of appetite (p = 0.01) and depression (p = 0.05) on the ESAS. All other ESAS items did not show a statistically significant improvement. The overall PG-SGA score measuring nutrition (weight loss, nutrition impact symptoms, intake, and functional capacity) was significantly reduced (p = 0.01). The DSSI showed statistically significant results for the items of frequent burping or belching (p = 0.02), feeling full after meals (p = 0.04), and abdominal distention (p = 0.03). The sit-to-stand item on the SFA was statistically significant (p = 0.01) for deterioration of ability.
The authors concluded that OHR118 showed improvements consistent with previous work done in a \"very positive\" larger study in the AIDS population, and that this translates to \"improved patient comfort and quality of life.\"
Of the many values measured with the multiple measurement tools, only the general PG-SGA score, appetite, frequent belching, feeling full after meals, and abdominal distention showed statistically significant improvement. The study did not meet the secondary endpoints of changes in performance status, lean muscle mass, or quality of life.
This study should be interpreted with caution because it was small, with limited statistically significant results to support the research objective.
Charles, M. A., Reymond, L., & Israel, F. (2008). Relief of incident dyspnea in palliative cancer patients: a pilot, randomized, controlled trial comparing nebulized hydromorphone, systemic hydromorphone, and nebulized saline. Journal of Pain and Symptom Management, 36, 29–38.
To compare the efficacy of nebulized hydromorphone, systemic hydromorphone, and nebulized saline for incident dyspnea in patients with advanced cancer.
On three occasions when patients requested treatment for incident breathlessness, they randomly received one of the following:
If patients felt the intervention was not effective, they could ask for additional pharmaceutical interventions. Patients scored breathlessness at 10, 20, 30, and 60 minutes from completion of treatment. Treatment order was randomized.
Patients were undergoing the palliative and end of life phases of care.
The study was a pilot, double-blind, randomized, crossover, controlled trial.
There were no differences between treatments in improvement scores. Improvement in breathlessness at 10 minutes post intervention completion was seen in each of the treatment conditions. Improvement considered to be clinically significant (≥1 cm on the VAS) was only seen with the nebulized hydromorphone. Respiratory rate improved over time from 10 to 60 minutes (p < 0.05), with no difference between treatments. There were no clear, consistent preferences among patients for any particular intervention.
The results suggest that nebulized saline provides relief of incident breathlessness; its effect is ongoing and does not differ significantly from the effects of nebulized opioid treatments.
Charalambous, A., Giannakopoulou, M., Bozas, E., & Paikousis, L. (2015). A randomized controlled trial for the effectiveness of progressive muscle relaxation and guided imagery as anxiety reducing interventions in breast and prostate cancer patients undergoing chemotherapy. Evidence-Based Complementary and Alternative Medicine, 2015, 270876.
To test the effectiveness of progressive muscle relaxation (PMR) and guided imagery as stress-reducing interventions
Patients randomized to usual care had weekly meetings with psychologists. Those randomized to PMR and guided imagery had four supervised sessions and daily self-practice for three weeks. To stimulate imagery, the guided imagery component included auditory, tactile, and olfactory images. The imagery script was accompanied by music. The intervention was tested and measured with biofeedback prior to study use. Both groups were assessed at baseline and at the end of three weeks. Daily text message reminders were sent to the intervention group to remind them to practice PMR.
The group had a decrease in mean anxiety score whereas the control group had an increase in anxiety at three weeks compared to baseline. The difference between groups of this change was significant (p < 0.001). The same pattern of change between groups was shown for depression (p < 0.001). Salivary amylase and cortisol levels were directly related to anxiety and depression scores (p < 0.001).
PMR and guided imagery were associated with reduced anxiety and depression among patients with breast and prostate cancer during chemotherapy.
Findings here showed that progressive muscle relaxation and guided imagery were effective in reducing anxiety and depression during chemotherapy treatment. These are very low-risk interventions that can be helpful and can be readily incorporated into standard patient care.
Chapell, R., & Aapro, M.S. (2013). Efficacy of aprepitant among patients aged 65 and over receiving moderately to highly emetogenic chemotherapy: A meta-analysis of unpublished data from previously published studies. Journal of Geriatric Oncology, 4(1), 78–83.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care
The relative risk of complete response for patients under 65 is 1.30 (95% CI: 1.19–1.42; p < 0.0001). It is not significantly different from patients over 65 (Q = 0.281, p = 0.596). The relative risk for a complete response for patients over 75 is 1.42 (95% CI: 1.07–1.89; p = 0.02). It is not significantly different from the relative risk for patients under the age of 75 (1.28, 95% CI: 1.19–1.37; Q = 0.49, p = 0.78). The relative risk of a complete response to regimens including aprepitant for patients over 75 is not different for patients under 65 (Q = 0.42, p = 0.81). There was no statistically significant difference in heterogeneity among studies.
Aprepitant is beneficial for patients both over and under age 65.
The addition of aprepitant should be considered in patients, regardless of age, for the management of chemotherapy-induced nausea and vomiting associated with moderate and highly emetogenic chemotherapy.
Chao, L.F., Zhang, A.L., Liu, H.E., Cheng, M.H., Lam, H.B., & Lo, S.K. (2009). The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: A systematic review. Breast Cancer Research and Treatment, 118, 255–267.
To scrutinize the evidence of using acupoint stimulation (APS) by any modality on managing adverse events related to anticancer therapies in patients with breast cancer
English databases searched were PubMed, Cochrane library, Embase, the Cumulative Index to Nursing and Allied Health, and PsycINFO.
Chinese databases searched were CNKI, CEPS, and WanFang as well as manual searching.
Search keywords were medical terms of breast cancer (e.g., breast neoplasm, breast carcinoma, breast tumor) combined separately with at least one of the following: acupuncture, acupressure, auricular acupuncture, ear acupuncture, acupuncture points, electroacupuncture, acupoint, transcutaneous electric nerve stimulation, moxibustion.
Studies were included if they
Studies were excluded if they were
Initial review involved 843 titles and abstracts and 51 full-text articles. Of those, 26 studies were included in the report.
Study evaluation began with two independent reviewers using a modified Jadad scale, assessing 3 aspects: randomization procedure (2 points); dropout and withdrawal discussion (1 point); and blinding (2 points). Studies were classified as high quality if they attained a score of 3 or higher.
Evaluated literature included 18 randomized controlled trials (RCTs) and eight controlled clinical trials published between 1999 and 2008. Nine trials included conventional acupuncture, 6 included electroacupuncture, 5 included drug injection in acupoints, 3 included self-acupressure, and 3 included acupoint stimulation by wristbands or acumagnet. Eighteen were in English, and 8 were in Chinese.
Nine of the 26 studies were rated as high quality. Adverse effects (outcomes) of the APS included vasomotor syndrome, chemotherapy-induced nausea and vomiting (CINV), post-mastectomy pain, joint symptoms, lymphedema, leukopenia, and adverse events.
Eleven studies investigated CINV and APS with acupoints P6 and ST36. Ten of the CINV studies reported APS significantly improved emesis caused by breast cancer therapy.
The most common outcome evaluated by APS in the studies was CINV. APS was noted to be effective in reducing acute emesis caused by breast cancer therapy. Authors reported that APS is beneficial in the management of CINV, especially in the acute phase.
Healthcare providers should consider using APS as an option for the management of CINV.
Chan, C. W., Richardson, A., & Richardson, J. (2011). Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. Journal of Pain and Symptom Management, 41, 347–357.
To examine the effectiveness of a psychoeducational intervention (PEI) on the symptom cluster of anxiety, breathlessness, and fatigue compared with usual care.
Education on symptom management and coaching on the use of progressive muscle relaxation was delivered to patients one week prior to the start of radiotherapy (RT) and repeated three weeks after beginning RT. Symptom data were collected at four times points: prior to the intervention and at three, six, and 12 weeks postintervention.
The study was a randomized, controlled trial using a pre-/posttest design with two groups.
A significant difference (p = 0.003) was seen over time on the pattern of change of the symptom cluster between the PEI intervention and the usual care control group. Significant effects on patterns of changes in breathlessness (p = 0.002), fatigue (p = 0.011), anxiety (p = 0.001), and functional ability (p = 0.000) were found.
PEI is an effective treatment for relieving the symptom cluster of anxiety, breathlessness, and fatigue and each of the individually assessed symptoms.
The study provided evidence to support the symptom cluster of anxiety, breathlessness, and fatigue as interrelated, with assessment and management of those three symptoms as a cluster. Clarification of the nature of their interrelatedness is a potential area of further study. Education and counseling patients through nurses can be helpful in the management of these symptoms.
Chan, C.W., Cheng, K.K., Lam, L.W., Li, C.K., Chik, K.W., & Cheung, J.S. (2008). Psycho-educational intervention for chemotherapy-associated nausea and vomiting in paediatric oncology patients: A pilot study. Hong Kong Medical Journal, 14(5 Suppl.), 32–35.
To assess the feasibility of using relaxation and patient education
Patients were placed in group 1 or 2 (no randomization information provided). Group 1 received training in progressive muscle relaxation (PMR) and guided imagery (GI) using audiotapes daily. Training was provided daily on days 0-5, then patients practiced the techniques daily for two months. Group 2 received two 30-minute patient/parent education sessions on days 0 and 2, focusing on risk assessment, antiemetic use, and meal planning. All subjects completed instruments at baseline (prior to chemotherapy) then daily for seven more days. One and two months after the intervention, anxiety, compliance with PMR and GI (group 1 only), satisfaction with care, and quality of life was assessed. Pulse and blood pressure were reported in the findings but not listed in the procedure. A third group was comprised of 10 historical control cases who matched the characteristics of group 1.
The study was conducted at a single site hospital in Hong Kong.
All patients were pediatric and in active treatment.
This was a clinical trial with pre- and post-test design.
At baseline, group 1 had significantly lower anxiety than group 2 (p = 0.032). Group 1 had less vomiting on day 3 compared to the control group (p = 0.036). No significant difference was found in antiemetic use between the intervention and control groups. No significant difference was found in body weight, CINV, antiemetic use, quality of life, or caloric intake between groups 1 and 2. Health diaries indicated that patients practiced PMR three to four times weekly at home with no significant changes in blood pressure or pulse. Patients and parents reported the interventions as moderately useful.
This study was poorly designed, and findings should be used cautiously. Although the authors reported that PMR and education can reduce CINV, no conclusions should be made except that further research is warranted.
The quality of this study is too poor to provide any implications for nurses. Well-designed research in this area is needed.