Chan, A., Leng, X.Z., Chiang, J.Y., Tao, M., Quek, R., Tay, K., & Lim, S.T. (2011). Comparison of daily filgrastim and pegfilgrastim to prevent febrile neutropenia in Asian lymphoma patients. Asia-Pacific Journal of Clinical Oncology, 7, 75–81.
The study aim was to compare the effectiveness of primary prophylaxis with filgrastim and pegfilgrastim to prevent the incidence of febrile neutropenia in Asian patients with cancer undergoing chemotherapy.
Data analyzed on intent-to-treat basis from January 2008 and August 2009 identified from the pharmacy prescription database. The G-CSF must have been administered at least 24 hours after chemotherapy administration for primary prophylaxis against febrile neutropenia. Crossover between the two G-CSFs was allowed and the patient was assigned to the treatment group according to the G-CSF used with the first cycle.
Active treatment
Single-center, retrospective study
During the first cycle of chemotherapy, six (7.4%) and 11 (8.9%) patients developed FN in the filgrastim and pegfilgrastim arms, respectively (p = 0.8). Across all cycles of chemotherapy treatments, the overall incidence of FN in both arms was much higher than in the first cycle. However, the incidence of FN between the filgrastim group and the pegfilgrastim group remained similar (13.6% in the filgrastim arm versus 16.3% in the pegfilgrastim arm; p = 0.69) across all cycles. More patients in the filgrastim arm experienced treatment delays (8.6%) and chemotherapy dose reductions (4.9%) compared to those who were administered pegfilgrastim (incidence of dose delay = 5.7%, p = 0.25; incidence of dose reduction = 3.3%, p = 0.45) during the first cycle. However, these differences were not statistically significant. The cumulative occurrences of dose delays or dose reductions in all cycles were higher among patients who received pegfilgrastim (absolute difference of dose delay = 2.7%, p = 0.71; absolute difference of dose reduction = 0.7%, p = 1.00). Across all cycles, for regimens that possess a FN risk below 20%, a lower incidence of FN was observed in patients who received filgrastim than those who received pegfilgrastim (12.2 versus 21.4%, respectively; p = 0.31). Similar trends also were observed with the cumulative incidence of treatment delay and chemotherapy dose reduction: patients receiving pegfilgrastim were more likely to suffer from the complications of FN. With regards to the chemotherapy regimens that possess FN risk of 20% or greater, the incidence of FN, treatment delays, and dose reductions all were similar in both treatment arms (absolute difference in the incidence of FN = 5.6%, p = 0.52; absolute difference in the incidence of dose delays = 0.5%, p = 1.00; absolute difference in the incidence of dose reductions = 4.3%, p = 0.46).
There was no statistically significant difference between filgrastim and pegfilgrastim for the primary prophylaxis of febrile neutropenia in Asian patients undergoing chemotherapy. There was no statistically significant difference between filgrastim and pegfilgrastim with regard to the incidence of dose delays or dose reductions.
Retrospective study that relied on the accuracy of the medical records reviewed.
Filgrastim and pegfilgrastim are equally effective to prevent chemotherapy-induced febrile neutropenia and to prevent dose delays and dose reductions in subsequent cycles.
Chan, D.N., Lui, L.Y., & So, W.K. (2010). Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: Systematic review. Journal of Advanced Nursing, 66(9), 1902–1914.
To review the effectiveness of exercise programs on shoulder mobility and lymphoedema in patients with breast cancer after having axillary lymph node dissection as revealed by randomized controlled trials
Databases searched were CINAHL, Ovid Medline, the BritishNursing Index, Proquest, Science Direct, PubMed, Scopus, and the Cochrane Library. Search keywords were breast; cancer, malignancy, neoplasm, or tumour; modified radical mastectomy, radical mastectomy, breast conservation surgery, wide local excision, axillary lymph node dissection, or adjuvant therapy; exercise, training, weight training, stretching exercise, physical activity, rehabilitation or resistance training, aerobic training, strength training, or lifestyle or range of motion exercises; lymphoedema, arm circumference, arm swelling, oedema, range of motion or shoulder mobility, joint movement, or shoulder function. Studies were included in the study if they
Studies were excluded if they
The total number of studies initially reviewed was 325. A quantitative effectiveness review was used with levels of evidence defined by the Joanna Briggs Institute.
Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion.
Nurses have an important role in educating and encouraging patients to practice these exercises to speed up recovery.
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.
The objective of the study is to examine the effectiveness of a psychoeducational intervention (PEI) that combines patient education with progressive muscle relaxation (PMR) in the relief of a symptom cluster of anxiety, breathlessness, and fatigue in patients with advanced lung cancer receiving palliative radiotherapy (RT).
A total of 140 participants were randomized by lucky draw method to either an intervention group or a control group. Participants in the intervention group received a 40-minute educational package consisting of leaflets and discussion on the symptom cluster (breathlessness, anxiety, and fatigue) and self-care management. Coaching of PMR was delivered within one week prior to the beginning of the course of RT and reinforced three weeks after RT commencement. The intervention was delivered by RNs with two years of clinical experience who went through a two-day training session on the materials in the educational package and the practice of PMR. An audiotape in Chinese and educational leaflets were also given, and patients were encouraged to practice PMR daily and as required. Patients in the intervention group were given a telephone reminder at the end of the second week to enhance participation in the week three sessions. Those in the control group only received “usual care,” which was offered to patients in both the intervention and control groups and consisted of a mandatory individual briefing of RT procedures and a five- to seven-minute discussion of side effects focusing on skin care by a therapy radiographer. An optional group talk by an RN and a medical social worker about general care before and/or after the start of RT was also offered. Data were collected by a research assistant (RA) who was blinded to group allocation. Data collection on symptoms was obtained at four time points: prior to intervention (T0), week 3 (T1), week 6 (T2), and week 12 (T3). Patients were also asked to record adherence to the relaxation exercise in a simple health diary (calendar) for 12 consecutive weeks.
A randomized, controlled trial design was used.
At baseline, all patients had a low intensity for breathlessness (mean: 15.81; range: 0–100), but low-to-moderate fatigue (mean: 3.41; range: 0–100) and anxiety (mean: 42.04; range: 20–80) intensity scores, and an overall low-to-moderate functional score (mean: 25.14–66.41; range: 0–100). Patients in the control group, however, were noted to have significantly more advanced-stage lung cancer (p < 0.05) than the intervention group. In the intervention group, 94% of participants completed the intervention in full (based on the intervention log), the majority of whom demonstrated high attention and interest. Participants practiced about four to five sessions of PMR per week, and more than 60% both read the leaflets and listened to the audiotape. At all four time periods (T0–T4), significant and moderate positive intercorrelations among breathlessness, fatigue, and anxiety were observed (p < 0.01), thus suggesting a prominent relational effect of the three symptoms when considered as a cluster. Over time (T0–T2), a significant difference in the pattern of change in “composite” outcome (i.e., breathlessness, anxiety, and fatigue considered as a cluster) between the two study groups was observed (p = 0.003). When considered individually, univariate tests also confirmed a significant difference in pattern of symptom changes over time (T0–T2) for breathlessness (p = 0.002), fatigue (p = 0.011), and anxiety (p = 0.001), as well as functional ability (p = 0.000). Due to high attrition rates from death after T3, long-term effect of PEI at week 12 (T4) was not found to have significant difference in the pattern of change in fatigue (p = 0.034).
PEI is effective in the simultaneous relief of breathlessness, fatigue, and anxiety as a symptom cluster. The authors suggest that the total difference in symptom intensity between the intervention and control groups would have otherwise gone unrecognized if each were to be examined separately.
One limitation of the study was the higher attrition rate (due to patient mortality) experienced by the control group (42%) than the intervention group (11%) at T3 and overall attrition (27%) at the end of the 12 weeks. More patients in the control group had more advanced-stage cancer and distant metastasis than in the intervention group, thus indicating a failed randomization process. Also, due to high attrition, the authors advise that findings should be viewed with caution because of missing data. Additionally, information is lacking regarding participants’ perceptions and feelings toward the intervention process and outcomes. Other limitations related to possible confounding population characteristics that could influence symptom management include prior lung cancer treatments (especially if known pulmonary toxins), preexisting interstitial lung disease, tumor locations, and patient ages.
PEI with primarily PMR seems promising as a resource for the relief of low-intensity breathlessness in light of low-to-moderate intensity anxiety and fatigue up to at least six weeks after palliative RT. Long-term effect of PEI on this symptom cluster at 12 weeks is inconclusive. Similarly, more studies are warranted to establish if PEI is effective for higher baseline intensity of breathlessness and/or anxiety and fatigue. Cost-effectiveness of PEI (i.e., cost of material and training of personnel to deliver the intervention) should be weighed against the cost of poor symptom management (i.e., frequency of hospitalization, length of stay, and pharmacologic treatments).
Chanwimalueang, N., Ekataksin, W., Piyaman, P., Pattanapen, G., & Hanboon, B.K. (2015). Twisting Tourniquet® technique: Introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities. Cancer Medicine, 4, 1514–1524.
To describe the clinical effectiveness of a particular device in decongestive therapy
The Schnogh device consists of fabric and other parts that enable a spiral twisting that delivers sequential compression for 15 minutes followed by decompression for five minutes over the course of an hour. Patients analyzed in this study completed five days of treatment over one week.
Prospective, descriptive study
The average percent limb volume reduction was 50.2% for upper extremities and 55.6% for lower extremities.
Decompression therapy as provided with the device described here was effective in reducing lymphedema volume.
Complete decongestive therapy is effective for lymphedema reduction with most evidence describing its use in upper extremities. The findings in this study suggested that this device can provide similar results with no manual decongestive component. Additional well-designed studies are needed to confirm that this approach yields comparable or better results than current treatments.
Chanthawong, S., Subongkot, S., & Sookprasert, A. (2014). Effectiveness of olanzapine for the treatment of breakthrough chemotherapy induced nausea and vomiting. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 97, 349–355.
To evaluate the safety and efficacy of olanzapine for breakthrough emesis in addition to standard antiemetic regimen in patients with cancer receiving highly emetogenic chemotherapy
All patients were treated with the institutional standard for HEC: ondansetron 24 mg IV BID and dexamethasone 10 mg IV BID on day 1. Oral metoclopramide 10 mg TID plus dexamethasone 10 mg po BID were given on days 2 and 3. Oral olanzapine 5 mg was given after the first vomiting episode. Twelve hours later, the second dose was given concurrently with the standard prevention regimen.
Complete response of breakthrough emesis was 60.9%, retching was 71.7%, and nausea was 50.0%. Adverse events were mild, including dizziness, fatigue, and dyspepsia.
The study demonstrated the effectiveness and safety of olanzapine in the treatment of nausea and vomiting in HEC patients. Olanzapine could be considered for treatment of patients at high risk for breakthrough emesis despite standard prevention. Olanzapine 5 mg every 12 hours for at least 24 hours could be recommended per the study.
Olanzapine is a drug that could be extremely helpful in treatment of CINV. Studies have shown olanzapine to be a safe and effective medication in acute and delayed CINV. The reviewed study attempted to show effectiveness in the breakthrough setting but many limitations were reported and are listed above. The researchers should not conduct CINV studies for “breakthrough” if the patient is given suboptimal treatment upfront.
Chang, J.T., Lin, C.Y., Lin, J.C., Lee, M.S., Chen, Y.J., & Wang, H.M. (2010). Transdermal fentanyl for pain caused by radiotherapy in head and neck cancer patients treated in an outpatient setting: A multicenter trial in Taiwan. Japanese Journal of Clinical Oncology, 40(4), 307–312.
To evaluate the effectiveness of transdermal fentanyl (TF) for pain management in patients with head and neck cancer receiving radiotherapy; to evaluate the effectiveness, safety, and long-term tolerability of TF after initial administration
Patients entered in the trial were instructed in the use of TF. Initial TF dose was 25 mcg/hour, and patches were replaced every three days. Dose was titrated upward as needed, in 25 mcg/hour increments. Patients requiring more than 50 mcg/hour were allowed to use multiple patches to achieve the required dose. Doses greater than 100 mcg/hour were used in exceptional circumstances only. As a treatment for breakthrough pain, patients received immediate-release morphine to be administered as needed, every 2–4 hours. Use of all rescue medications was recorded. Pain was measured by means of a questionnaire that was administered at study entry and after 7, 14, 28, 35, and 42 days. Amount of rescue analgesics and data about constipation, diarrhea, and use of laxatives and antidiarrheals were recorded by patients daily. Investigators summarized the data at each study visit.
Prospective trial
Data suggest that TF can be effective and relatively easy to use, in an outpatient setting, for patients receiving radiotherapy; however, TF was accompanied by a high rate of severe side effects.
Additional research regarding various approaches to pain management, in the cited population, is needed.
Chang, C.J., & Cormier, J.N. (2013). Lymphedema interventions: Exercise, surgery, and compression devices. Seminars in Oncology Nursing, 29, 28–40.
STUDY PURPOSE: To review the current literature regarding the treatment of lymphedema, providing applications of the evidence to the care of patients with cancer, with or at risk for, lymphedema
PHASE OF CARE: Multiple phases of care
The PAL trial provides the strongest evidence to date that progressive resistive exercises may reduce the risk of, and not exacerbate pre-existing, BCRL. However, no clear evidence-based recommendation regarding compression garment use during exercise can be made. Surgical treatment is associated with risk, and should not be considered a first line treatment. IPC devices may play a role in a multi-modality approach. There are no clear evidence-based guidelines for pressure setting use in lymphedema management.
CDT remains the standard in LE therapy, but there is some limited evidence supporting consideration of adjunctive therapies, such as exercise, surgery, and IPC. More RCTs looking at exercise and LE in populations other than those with breast cancer are needed, especially studies with LE of other areas of body, and role of compression garments during exercise. Surgical treatments are promising in LE not responsive to standard therapy. IPC in low to moderate pressure ranges appear to be a safe adjunctive treatment option for appropriate, selective patients, in conjunction with CDT.
Patients with LE need education regarding the benefits of exercise in general health and cancer prevention, tailored to their individual needs and comorbidities. Surgery for LE should not be considered a first-line treatment. Microvascular procedures should be treated by experienced surgeons offering ongoing care with support from certified lymphedema providers. IPC is potentially a valuable adjunctive therapy, and should be prescribed only by practitioners trained at a specialist level. With no clear guidelines for use, the authors recommend the current NLN recommendations for pump pressures from 30-60 mmHG. Additional research is essential in these categories to provide evidence based guidelines and safe, effective patient care for patients with lymphedema.
Chang, C.W., Mu, P.F., Jou, S.T., Wong, T.T., & Chen, Y.C. (2013). Systematic review and meta-analysis of nonpharmacological interventions for fatigue in children and adolescents with cancer. Worldviews on Evidence-Based Nursing/Sigma Theta Tau International, Honor Society of Nursing, 10, 208–217.
STUDY PURPOSE: To review the published evidence on non-pharmacologic interventions for fatigue in children and adolescents with cancer
TYPE OF STUDY: Meta-analysis and systematic review
DATABASES USED: Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, CINAHL, PsycINFO, Ovid, MEDLINE, ProQuest Dissertations and Theses, the Electronic Theses and Dissertations System, the Index to Taiwan Periodical Literature, Electronic Thesis and Dissertation System (Chinese)
KEYWORDS: experimental study, random study, quasi-experimental study, children, adolescents, pediatric, cancer, oncology, nonpharmacological interventions, massage, exercise, fitness, physical activity, cognitive-behavioral, stress management, energy conservation, sleep therapy, relaxation, distraction, psychoeducation, fatigue, cancer-related fatigue, loss of energy, levels of tiredness, tired, side effect, symptoms
INCLUSION CRITERIA: RCT or quasi-experimental studies; 1–18 years of age, experiencing cancer-related fatigue; maintenance stage or survivor stage; hospitalized or home; acute lymphoblastic leukemia (ALL)/acute myeloid leukemia (AML)/lymphoma/solid tumor; interventions with descriptions of length, frequency setting, and provider, and including activity enhancement, psychosocial interventions, cognitive behavioral therapy, stress management, relaxation, nutrition consultation, massage, or educational interventions; use of validated scales for cancer-related fatigue in outcomes
EXCLUSION CRITERIA: Written in languages other than English or Chinese
TOTAL REFERENCES RETRIEVED = 76
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Retrieved papers reviewed by two independent reviewers with a third for disagreements about methodologic validity
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics
Two studies showed no significance in decreasing total fatigue with exercise. Two studies suggested exercise reduced general fatigue (p < .01). No significance was found for sleep/rest fatigue or cognitive fatigue. Study of massage showed no effect on fatigue. Final study used nurse education session on fatigue versus UC with reports that interventions were “effective.”
No study reduced total fatigue in any population. General fatigue was the only fatigue measure with significant improvement in some studies.
The phases of care, tumor type, and age varied. Children may not have had an ability to differentiate fatigue and relaxation, making fatigue perhaps difficult to measure.
Exercise may be a safe intervention for improving general fatigue in children and adolescents experiencing cancer-related fatigue.
Chang, J., Couture, F.A., Young, S.D., Lau, C.Y., & McWatters, K.L. (2004). Weekly administration of epoetin alfa improves cognition and quality of life in patients with breast cancer receiving chemotherapy. Supportive Cancer Therapy, 2, 52–58.
The study's primary aim was to evaluate the effect of epoetin alfa on changes in quality of life and utility scale scores at week 12. Its secondary aim was to evaluate transfusion reduction and hemoglobulin level increase.
Participants were screened at the initiation of chemotherapy with hemoglobin (Hgb) levels ≤ 15.0 grams per deciliter (g/dL). Randomization occurred when the Hgb level was decreased to 12.0 g/dL. They received 40,000 IU of erythropoietin subcutaneously each week for 16 weeks or for 4 weeks after the completion of chemotherapy, whichever was longer (the maximum amount of time participants could receive erythropoietin was 28 weeks).
This multi-site study was conducted in Canada.
The study was a phrase III, randomized, open-label, multi-center trial.
Based on the subscale HUI survey, significant improvement in cognition (p = 0.02) was found in participants who received erythropoietin.
No objective measure for cognitive function was used.
Chandwani, K.D., Perkins, G., Nagendra, H.R., Raghuram, N.V., Spelman, A., Nagarathna, R., . . . Cohen, L. (2014). Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. Journal of Clinical Oncology, 32, 1058–1065.
To test whether participation in yoga during radiation therapy would have long-term effects on fatigue, depression, and sleep disturbances
Patients were randomly assigned to one of three groups: a yoga group, an exercise group, and a wait list control group. Yoga and exercise groups attended up to three 60-minute sessions per week during six weeks of radiation therapy. These were given one-on-one or in groups according to the patient’s convenience and schedule. Each received a CD and written program manual to encourage at-home practice. The yoga program included warm-up breathing, postures, deep relaxation, alternate nostril breathing, and meditation. The exercise program included exercises specifically recommended for women recovering from breast cancer treatment involving multiple positions and stretching. Study assessments were done at baseline, during the last week of treatment, and at one, three, and six months after treatment.
Greater increases in physical component scores of the SF-36 were seen in the yoga group compared to both other groups at one and three months (p = .01). The yoga group (p = .04) and exercise group (p = .02) had greater reduction in fatigue compared to wait list controls at the end of treatment. These differences were not significant at other time points. Fatigue consistently declined over time in all patient groups. Sleep quality improved in all groups over time with no significant differences between groups.
Both yoga and exercise were associated with reduced fatigue by the end of radiation treatment; however, these effects were not maintained over the following six months.
Findings showed that both yoga and exercise programs during radiation therapy were beneficial in reducing fatigue. Fatigue declined over time in all patients, and effects seen by the end of treatment did not appear to last. The follow-up information here is limited by the high number lost to follow-up, showing the difficulty of conducting longitudinal examination of intervention effects. Nurses can recommend that patients participate in programs such as yoga and exercise during active cancer therapy.