Chan, R.J., Webster, J., Chung, B., Marquart, L., Ahmed, M., & Garantziotis, S. (2014). Prevention and treatment of acute radiation-induced skin reactions: A systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 14, 53-2407-14-53.
TOTAL REFERENCES RETRIEVED: 8,599
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Risk of bias was assessed according to the Cochrane handbook
PHASE OF CARE: Active antitumor treatment
Forty-seven studies on the six types of interventions for managing RISR were reviewed (oral systemic medications, skin care practice [washing and deodorant], steroidal topical ointment/cream, dressings, nonsteroidal cream/ointment, and LED vs sham treatment). The results of a meta-analysis of Wobe Mugos versus a control showed an odds ratio of 0.13 (p < 0.0004) in favor of Wobe Mugos. There was a mean difference of -09/92 (p < 0.0001) for Wobe Mugos treatment across two studies including 219 patients. Pentoxifylline was not shown to have an effect. Oral sucralfate and oral antioxidants did not show an effect. Various topical steroids showed mixed results. A meta-analysis of trolamine showed no significant benefit. Washing the skin and using deodorants did not affect skin toxicity scores. Evidence was restricted because of the variation of interventions as it was not easily detectable which products would be most effective. There was no strong evidence for any of the products included in the study. The study quality of most of the included RCTs was only fair, and there were few interventions that were examined in multiple studies.
Additional research studies establishing the effectiveness of multiple skin care products is needed. The findings of this meta-analysis in regard to Wobe Mugos were positive, suggesting that additional, well designed research is warranted.
Additional research on skin care products used to manage RISR is needed.
Chan, R. J., Larsen, E., & Chan, P. (2012). Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. International Journal of Radiation Oncology, Biology, Physics, 84, e357–e362.
To review the evidence for interventions to prevent and manage radiodermatitis.
Databases searched were MEDLINE, CIHANL, EMBASE, and Cochrane. Key journals were manually searched.
The primary aim was to review the efficacy of interventions for preventing and managing radiodermatitis. The article was published in a peer-reviewed publication.
The following were excluded from the review: unpublished work, abstracts, letters, and conference proceedings.
In total, 1,837 references were retrieved. Assessment of multiple systematic reviews (AMSTAR) was used.
There is insufficient evidence to support the use of any particular intervention for preventing or managing radiodermatitis. There were several shortfalls identified in these systematic reviews. It was noted that the outcomes of pain, itching, and quality of life should be incorporated into the research in this area.
There was high variability in the quality of the systematic reviews concerning management and prevention of radiodermatitis.
The study was limited to discussing systematic reviews.
The study points to the continuing issue of insufficient evidence regarding effective interventions to prevent or manage radiodermatitis, as well as design and reporting limitations of many of the studies in this area. Further research is needed in this area.
Chan, R.J., Mann, J., Tripcony, L., Keller, J., Cheuk, R., Blades, R., . . . Walsh, C. (2014). Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: A phase 3, double-blind, randomized, controlled trial. International Journal of Radiation Oncology, Biology, Physics, 90, 756–764.
To investigate the effects of a natural, oil-based emulsion containing allantoin versus aqueous cream for preventing and managing radiation-induced skin reactions
Patients received either cream 1 (the natural, oil-based emulsion containing allantoin [Moogoo Udder Cream]) or cream 2 (aqueous cream). The allantoin emulsion contained multiple other ingredients, including aloe. Patients were stratified by irradiated site, body mass index, and smoking status, and they randomly were assigned to the intervention. Patients applied the cream to irradiated skin twice daily or more as needed. If moist desquamation occurred, the treatment was discontinued until healing occurred. Study assessments were completed weekly. The creams for both arms had a similar appearance and were manufactured in a plain tube. The participants and researchers remained blinded until the end of the study when codes on the tubes revealed the study arm. Inter-rater reliability was measured and resulted in an intraclass correlation of 1.0 (perfect agreement). A sample size calculation was conducted; 81 participants were required for each arm, and ≥ 81 participants completed each arm.
Double-blinded, blocked, randomly assigned, controlled, phase III clinical trial
Patients who received cream 1 had a significantly lower average CTCAE score at week 3 (p < 0.05) but had statistically higher average levels of skin toxicity at weeks 7, 8, and 9 (all p < 0.001). Similar results were observed when skin toxicity was analyzed by grades. In regard to pain, patients in the cream 2 group had significantly higher average worst-pain scores (p < 0.05) and itching (p = 0.046) compared to the cream 1 group at week 3; however, these differences were not observed during other weeks. In addition, there was a strong trend for cream 2 to reduce the incidence of grade 2 or more skin toxicity in comparison with cream 1 (p = 0.056). Overall, more participants in the cream 1 group were required to use another topical treatment at weeks 8 (p = 0.049) and 9 (p = 0.01).
Overall, this was a well designed study. However, some participants used prescribed creams in addition to the assigned study cream, making it difficult to know the true effects of the study creams. The cream containing allantoin performed better during the first five weeks of treatment but worse thereafter.
Additional studies with improved “buy-in” from participant healthcare providers to reduce the use of non-study creams are needed. This study does not provide strong evidence for the effectiveness of this intervention as findings varied at different time points and there were several study limitations. Nurses' awareness of the importance of using the CTCAE for grading skin toxicities related to topical treatments is vital in standardizing assessments. Moogoo Udder Cream is available in the United States (http://moogoousa.com/udder-cream-skin-milk.html), but not in stores.
Chan, A.S., Cheung, M.C., Law, S.C., & Chan, J.H. (2004). Phase II study of alpha-tocopherol in improving the cognitive function of patients with temporal lobe radionecrosis. Cancer, 100(2), 398–401.
The study was conducted to determine if vitamin E (alpha-tocopherol) could improve cognitive function in patients with nasopharyngeal carcinoma and temporal lobe radionecrosis.
Participants were administered 1,000 IU of vitamin E twice daily for one year. Assessments were conducted prior to the initiation of vitamin E dispensal and after the completion of one year of treatment.
The study was a single-site project at the neurology clinic of Queen Elizabeth Hospital in Hong Kong.
The study employed a pre- and post-test design with a treatment and control group.
There was no significant difference in cognitive performance at baseline between the two groups. In the treatment group, there was significant improvement from baseline on
Improved executive function was also measured in the treatment group, as seen in average reaction times (p = 0.001) and scores on the Cognitive Flexibility Test (p = 0.04); these improvements were not found in the treatment group. No significant differences were found in sustained attention for either group. There was a slight, but not statistically significant, increase in participant ratings after one year of treatment for the treatment group. The control group reported a slight worsening of function on their subjective ratings (p = ns).
Vitamin E may be a promising complementary intervention for improvement in verbal and visual memory, global cognitive function, and cognitive flexibility.
Chan, R.J., McCarthy, A.L., Devenish, J., Sullivan, K.A., & Chan, A. (2015). Systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations after chemotherapy for breast cancer. European Journal of Cancer, 51, 437–450.
PHASE OF CARE: Late effects and survivorship
Risk of bias was high in 11 studies but unclear in two studies that evaluated psychostimulants.
Pharmacologic interventions: No improvements in cognitive function were found using psychostimulants (four studies) or ginkgo biloba. Patients reported better cognitive function using epoetin alfa with doses titrated for hemoglobin levels (p < 0.05). However, a death caused by a cerebrovascular accident was noted.
Nonpharmacologic interventions: Small-group memory training improved self-reported cognitive function, and both memory and speed of processing after small-group training improved immediate and delayed recall (p < 0.05). Home-based online executive function training improved verbal function and attention (p < 0.05). Speed-feedback therapy during biking improved executive and motor function (p < 0.05). Cognitive behavioral therapy-based interventions (two studies), Tibetan sound meditation, and hatha yoga did not improve cognitive function.
The pharmacologic studies reviewed did not support the use of psychostimulants or ginkgo biloba to improve cognitive function after chemotherapy for breast cancer. Epoetin alfa was not recommended for practice because of safety concerns. The nonpharmacologic studies reviewed provided some evidence that cognitive training and speed-feedback therapy might improve cognitive function for breast cancer survivors.
The risk of bias was high for most studies. Therefore, although positive results were found, well-designed, prospective RCTs need to be completed to confirm these findings. It is unclear how sustainable the positive results of the cognitive training and exercise interventions might be because follow-up was limited to less than three months.
This systematic review provided limited support for cognitive training and structured exercise to improve cognitive function after chemotherapy for breast cancer. Cognitive training is currently categorized as likely to be effective for cognitive impairment.
Chan, C.W., Lam, L.W., Li, C.K., Cheung, J.S., Cheng, K.K., Chik, K.W., . . . Tang, W.P. (2015). Feasibility of psychoeducational interventions in managing chemotherapy-associated nausea and vomiting (CANV) in pediatric oncology patients. European Journal of Oncology Nursing, 19, 182–190.
To determine the feasibility of using a combination of relaxation techniques and patient education (multidimensional psychoeducational intervention package) to alleviate (chemotherapy-induced nausea and vomiting (CINV) while estimating the effect size and assessing the research design feasibility and stability of the Morrow Assessment of Nausea and Emesis (MANE) and the Chinese version of the State-Trait Anxiety Inventory (STAI) in children
Two intervention groups and two matching control groups were followed for 60 days. Patients randomly were assigned to the relaxation (progressive muscle relaxation [PMR] and guided imagery [GI]) or the education group. Patients in the relaxation group received six sessions of daily PMR and GI training (days 0–5, 30 minutes per session) and daily self-practice for two months with a PMR and GI audiotape. Patients in the education group received two 30-minute sessions of patient and parent education on days 1 and 2 (risk assessment, antiemetic use, and meal planning). The usual care also was given to participating patients, which included antiemetic ondansetron intravenously as needed and diet advice (i.e., avoid spicy and greasy food, eat easily swallowed and digested food).
Exploratory pre- and post-test control group pilot study
Because of the small sample size, the findings were not confirmatory. A significant reduction in vomiting as a possible result of the relaxation exercise was reported on day 3 (the day most patients in the study experienced CINV and a lowered performance status and satisfaction with care). From days 2–7, fewer patients in both intervention groups vomited compared with the control groups. Anticipatory nausea and vomiting was experienced by 40% of patients prior to chemotherapy. The study was feasible, but it took 18 months to recruit 20 patients. Patients and parents prefered relaxation to the education intervention. MANE and STAI scales were easy to understand in Chinese, and there were no difficulties with completion.
Relaxation and education could reduce vomiting. Anticipatory nausea and vomiting also may be alleviated with relaxation techniques. The early intake of antiemetics controlled and decreased patients' experience of CINV.
Relaxation and patient education (major components of a combined psychoeducational interventions) are potential helpful for CINV and are accepted techniques. However, preventive measures provided before the commencement of chemotherapy are more helpful. Patients preferred relaxation for anxiety reduction over education.
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. Retrieved from http://www.hkmj.org/article_pdfs/hkm0810sp5p32.pdf
To assess the feasibility of using relaxation and patient education
Patients were placed in group 1 or 2 (no randomization information). Group 1 received training of progressive muscle relaxation (PMR) and guided imagery (GI) with audiotapes daily on days 0–5, then practiced daily for two months. Group 2 received two 30-minute patient/parent education sessions on day 0 and day 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. At one and two months after the intervention, anxiety, compliance with PMR and GI (group 1 only), satisfaction with care, and quality of life were assessed. Pulse and blood pressure were reported in the findings but not listed in the procedure.
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 differences of antiemetic use existed between the intervention and control groups. No significant differences existed in body weight, chemotherapy-induced nausea and vomiting (CINV), antiemetic use, quality of life, and caloric intake between groups. The health diaries indicated that the patients practiced PMR 3–4 times weekly at home with no significant changes in blood pressure or pulse. Patient and parents reported that the interventions were moderately useful.
This study is poorly designed, and the findings should be used cautiously. The authors reported that PMR and education can reduce CINV; however, no conclusions should be made except that further research is warranted.
The study is of too poor a quality to provide any implications for nurses. Well-designed research in this area is needed.
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
A 40-minute educational intervention consisted of preparatory information; discussion of symptom experience; exploration of means of, and goals associated with, symptoms; advice on self-care strategies; and training and practice in progressive muscle relaxation. The educational package consisted of an audiotape and leaflets as well as discussion on the selected symptoms and their self-care management.
Patients were undergoing the active treatment phase of care.
A pre/post-test randomized controlled trial design was used.
Univariate tests on anxiety showed a significant difference (p = 0.001) in the pattern of change over the course of time, with a very small effect size (partial eta² = 0.051).
Findings suggest that interventions such as those tested in the current study, including progressive muscle relaxation, education, and counseling, have significant effects on patterns of symptom change over time.
Progressive muscle relaxation and education may be helpful in managing anxiety, fatigue, and breathlessness in patients with cancer, but effects may be small.
Chan, R.J., Webster, J., & Marquart, L. (2011). Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews, 12, CD008273.
To assess effects of interventions that orient patients and carers to a cancer care facility and to the services provided
Initial searching identified 14,319 records. Investigators assessed 21 full-text articles for eligibility, and the systemaic review included a sample of four. Two studies were included in meta-analysis. Study quality was assessed using guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.
Effects of Interventions
This review shows that orientation programs may reduce distress in patients with cancer at the beginning of their involvement with a cancer care facility, but the quality of the evidence is low. Orientation programs may have some effect on general distress and symptoms of depression; however, findings do not show significant effects on anxiety.
These findings are limited by the small number of trials included, low quality of studies, and high heterogeneity found related to some outcomes.
Orientation of the patient, the patient's family, and those who care for the patient may help to reduce a patient's symptoms of depression and level of distress; however, this study does not reveal strong support for these outcomes. The most effective format and timing of orientation approaches are unclear.
Chambers, S.T., Sanders, J., Patton, W.N., Ganly, P., Birch, M., Crump, J.A., & Spearing, R.L. (2005). Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: Results from a prospective randomized controlled trial. Journal of Hospital Infection, 61, 53–61.
The purpose of the study was to evaluate the efficacy of sustained-release chlorhexidine (CHX) dressings versus standard dressings.
All adult patients admitted under the hematology service that were to receive chemotherapy and had a tunneled cuffed central intravascular catheter inserted were eligible for inclusion. After insertion, all tunneled intravascular catheters were randomized, but they were treated in the same manner with a sterile gauze and porous adhesive dressings until the exit site was dry and free from ooze. Those randomized to standard catheter exit-site treatment (control group) received no dressing in accordance with BCHS guidelines. The CHX group (intervention group) were treated with CHX dressings consisting of a 2.5 cm hydrophilic polyurethane foam disk containing CHX gluconate in a sustained-release formulation. These were applied to the exit site as soon the oozing had stopped following intravascular catheter insertion, and changed as needed or weekly until the catheter was removed. The same treatment was continued for the life of the catheter but if an intravascular catheter was removed and replaced, the new catheter was randomized. Exit site and tunnels were routinely examined on a weekly basis.
The primary endpoint of this study was the development of exit-site and/or tunnel infection. The secondary endpoint was removal of the catheter for infection. In total, 114 tunneled intravascular catheters in 95 patients were randomized from August 1998 to December 2001.
A single-site inpatient hematology unit
Prospective, randomized
All patients received a 10F vascular catheter with a surecuff tissue ingrowth, vitacuff antimicrobial cuff inserted percutaneously by a radiologist using the Seldinger technique.
Definitions used:
This study has shown that the use of CHX dressings was associated with less exit site infections (OR = 0.13, 95% CI [0.04, 0.37], p < 0.001). The rate of premature catheter removal for these infections was reduced approximately three fold in the CHX group (OR = 0.23, 95% CI [0.07, 0.77]). The failures of the CHX dressing group were associated either with a very early occurrence after insertion of the catheter, suggesting that the infecting organisms were implanted at the time of catheter insertion, or with delays in application of the CHX dressing. Positive blood cultures occurred in fewer patients in the control group (p < 0.01) with less isolates of gram-positive organisms in the control group (p < 0.05).
This study demonstrated that use of the sustained-release CHX dressing was associated with reduced extralumenal catheter infections; however, it was not associated with fewer blood stream infections.
Sustained-release CHX dressings may help to reduce some central line-associated infections in patients with cancer who are at risk and in whom other aspects of catheter insertion and care are in place. Further well-designed research in this area is warranted.