Capuron, L., Gumnick, J. F., Musselman, D. L., Lawson, D. H., Reemsnyder, A., Nemeroff, C. B., . . . Miller, A. H. (2002). Neurobehavioral effects of interferon-alpha in cancer patients: phenomenology and paroxetine responsiveness of symptom dimensions. Neuropsychopharmacology, 26, 643–652.
Patients were given oral paroxetine/placebo 10 mg for one week pre-interferon treatment, paroxetine/placebo 20 mg during the first week of interferon treatment, and then paroxetine/placebo 20 to 40 mg for all subsequent weeks of interferon therapy. Total length of treatment with paroxetine was 12 weeks. The study was based on the hypothesis that, as a selective serotonin reuptake inhibitor (SSRI), paroxetine may improve the neuropsychiatric and neurovegetative symptoms associated with interferon-alpha treatment.
Patients were undergoing the active treatment phase of care.
The study was a randomized, double-blind, placebo-controlled trial.
Neurotoxicity Rating Scale (NRS) was used to measure various depressive symptoms, cognitive disturbances, and vegetative symptoms, including fatigue.
When compared with the control group, pretreatment with paroxetine was effective in preventing interferon-induced mood and cognitive symptoms, as well improving pain. Paroxetine had less effect on the development of interferon-alpha–related neurovegetative symptoms, including fatigue, as measured by the NRS. Fatigue and somatic symptoms increased in both depressed and nondepressed patients.
Across the twelve weeks of the study, seven patients from the placebo group and one patient from the paroxetine group withdrew due to severe depression or neurotoxicity.
No special training is required. There are costs related to drug acquisition.
Cappelli, C., Ragni, G., De Pasquale, M.D., Gonfiantini, M., Russo, D., & Clerico, A. (2005). Tropisetron: Optimal dosage for children in prevention of chemotherapy-induced vomiting. Pediatric Blood and Cancer, 45, 48–53.
To evaluate the efficacy of tropisetron in treating acute vomiting among children with solid tumors receiving chemotherapy
Tropisetron (5 mg for patients < 20 kg and 10 mg for patients > 20 kg) was given intravenously daily over 15 minutes 30 minutes before chemotherapy administration. No other antiemetics were given except for steroids in three patients with Hodgkin lymphoma and two patients with non-Hodgkin lymphoma. Data were collected hourly in the first 24 hours following chemotherapy.
Descriptive
Overall frequency: TC was obtained in 154 out of 189 chemotherapy courses (85%), MC in 7.5% of courses, and NC in 7.5% of courses.
Dosage: Patients who received greater than 8 mg/m2 of tropisetron achieved TC significantly more often (92%) than patients receiving 6–8 mg/m2 of tropisetron (78%) or 6 mg/m2 (69%) (p = 0.0072).
Emetic potential: TC was achieved in 85% of patients receiving highly emetic chemotherapy, 81% of patients receiving moderately emetic chemotherapy, and 100% of patients receiving slightly emetic chemotherapy. NC was achieved in 6% of patients receiving highly emetic chemotherapy and 12% of patients receiving moderately emetic chemotherapy.
Time of administration: TC was achieved in 91% of patients with initial chemotherapy while TC was achieved in 81% of patients who received an antiemetic medication for earlier chemotherapy (p > 0.05).
Age: The youngest age group (aged 0–5 years) achieved TC and MC 98% of the time while children aged 6–10 years achieved TC and MC 90.5% of the time and children aged greater than 10 years achieved TC and MC 84% of the time (p = 0.0235). Side effects of acute vomiting occurred immediately at the start of chemotherapy among one patient receiving tropisetron at 13.5 mg/m2.
Tropisetron was an effective antiemetic medication for pediatric patients receiving highly emetic chemotherapy. It was mostly effective for patients receiving moderately emetic chemotherapy. The medication was more effective in younger children (aged 0–5 years). The dosage should range from 8–12 mg/m2 and be used with the initial chemotherapy course.
Tropisetron was an effective antiemetic medication that should be administered prior to the initial chemotherapy course.
Capozzi, L.C., McNeely, M.L., Lau, H.Y., Reimer, R.A., Giese-Davis, J., Fung, T.S., & Culos-Reed, S.N. (2016). Patient-reported outcomes, body composition, and nutrition status in patients with head and neck cancer: Results from an exploratory randomized controlled exercise trial. Cancer, 122, 1185–1200.
To detect the optimal timing for the initiation of an exercise training intervention
This was a 12-week lifestyle intervention consisting of five components: physician referral and clinic support, health education, behavior change support, social support through group-based settings, and an individualized exercise program based on patient need. Patients were asked to attend exercise sessions twice a week with additional at-home implementation of the exercise regimen twice more per week. The individualized exercise programs consisted of progressive resistance-training programs with a short, moderate intensity warm-up followed by two sets of 8 repetitions for 10 exercises. Progression of the regimen occurred at weeks 4, 6, and 9, as appropriate. In addition to attending the exercise sessions, participants were required to attend six education sessions after their exercise sessions.
PHASE OF CARE: Multiple phases of care
The study design is a randomized, controlled exercise trial in which patients were randomly assigned to either the immediate lifestyle intervention (ILI) group or the delayed lifestyle intervention (DLI) group.
No significant differences were reported for lean body mass or percentage body fat during the 24 weeks. A main effect of time for lean body mass, body mass index, and percentage body fat was detected (lean body mass: F[2,74.5] = 54.141, p < 0.001; BMI: F[2,74.5] = 67.955, p < 0.001; percent body fat: F[2,74.5] = 29.679, p < 0.001). No between group statistical difference was detected for fitness outcomes, the six-minute walk test (6MWT), or the sit-to-stand test (SST), which may be because of the small sample size. No statistical differences were observed between the two groups’ quality of life during the 24-week period. A significant effect was observed on depression, but no associated difference was observed between study groups.
The intervention did not demonstrate an effect on patient outcomes.
This study did not show efficacy of an intervention involving exercise and supportive interventions. The findings are limited by study design aspects and sample size.
Caplinger, J., Royse, M, & Martens, J. (2010). Implementation of an oral care protocol to promote early detection and management of stomatitis. Clinical Journal of Oncology Nursing, 14, 799–802.
To observe the benefits of implementing an oral care protocol in the identification and treatment of stomatitis in patients with head and neck cancer receiving radiation and chemotherapy
Databases searched were CINAHL, the Cochrane Central Register of Controlled Trials, and Medline.
Search keywords were stomatitis, mucositis, mucous membrane, treatment protocols, clinical practice guidelines, radiation therapy, and chemotherapy.
A protocol was developed based on the literature. Nursing education was conducted regarding grading stomatitis based on World Health Organizaiton (WHO) guidelines and interventions for each grade. Patient education was developed regarding the key components of oral hygiene, along with creation of a stomatitis brochure. Chart audits were evaluated for a 20-day period pre- and post-intervention.
After protocol implementation, more cases of stomatitis were identified and stomatitis was identified at an earlier stage of severity.
Protocol use gives nurses the tools to identify high-risk patients and provide treatment.
Daily oral assessment and protocol use reduces the severity of stomatitis resulting in improved patient outcomes. This project could have been expanded and carried one step further by looking at both patients' and nurses' satisfaction and perceived effectiveness of the program.
Cantarero-Villanueva, I., Fernández-Lao, C., Cuesta-Vargas, A. I., Del Moral-Avila, R., Fernández-de-Las-Peñas, C., & Arroyo-Morales, M. (2013). The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 94, 221–230.
To examine the effectiveness of an eight-week aquatic exercise program on cancer-related fatigue and physical and psychological outcomes in patients with breast cancer.
Patients were randomly assigned to exercise groups or usual care control groups. The intervention consisted of an eight-week program of water-based exercises, three times per week, in a heated deep swimming pool. Sessions lasted 60 minutes each and included a warm-up and cool-down. Exercise intensity was maintained according to recommendations for moderate exercise as stated by the American College of Sports Medicine and American Heart Association. Groups of 10 to 12 women participated in the exercise program. Data were collected at baseline, eight weeks, and six months.
Patients were undergoing the transition phase after active treatment.
This was a single-blind, randomized, controlled trial.
Deep-water exercise reduced fatigue, provided a short-term improvement in leg and abdominal muscle endurance, and resulted in some short-term reduction in depression. Effects on muscle endurance and depression declined after the eight-week program. Apparent effects on fatigue lasted six months.
The study adds to the large body of evidence showing the effectiveness of various types of exercise in the treatment of fatigue in patients with breast cancer. Nurses can recommend various types of exercise for their patients.
Cannici, J., Malcolm, R., & Peek, L. A. (1983). Treatment of insomnia in cancer patients using muscle relaxation training. Journal of Behavioral Therapy and Experimental Psychiatry, 14, 251–256.
The intervention consisted of individual muscle relaxation training over three sessions plus instructions for home practice twice daily. Patients were either in the relaxation (n = 15) or usual care (n = 15) group. The outcome was sleep.
Patients were undergoing the active treatment and long-term follow-up phases of care.
The study was a randomized, controlled trial.
Daily diary and questionnaire pertaining to sleep behavior the previous night, for a total of nine nights
Sleep-onset latency was reduced in the relaxation group compared with the usual care group; differences in sleep latency were maintained at the three-month follow-up. No differences were found in other sleep variables.
No cost issues existed.
Cankurtaran, E. S., Ozalp, E., Soygur, H., Akbiyik, D. I., Turhan, L., & Alkis, N. (2008). Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine. Supportive Care in Cancer, 16, 1291–1298.
To compare the effectiveness of two psychotropic medications, mirtazapine and imipramine, on distressing somatic symptoms (i.e., pain, nausea, vomiting, decreased appetite, and sleep disturbance) of cancer as well as symptoms of depression and anxiety.
Patients self-selected to receive psychotropic medication and supportive psychotherapy (intervention group) or supportive psychotherapy only. Those who elected to take medication were randomly enrolled to receive mirtazapine or imipramine. Mean dosage of mirtazapine ranged from 5 to 30 mg/day, depending on the visit. Mean dosage of imipramine ranged from 5 to 100 mg/day, depending on the visit. Each group was then assessed at three visits: baseline and three and six weeks after therapy had begun.
Patients were undergoing the active treatment phase of care.
The study used a prospective, repeated measures design.
Mirtazapine is effective in resolving insomnia and in reducing the symptoms of anxiety and depression in patients with cancer who have depression, anxiety, or adjustment disorders.
Mirtazapine may be useful in treating anxiety, depression, and insomnia in patients undergoing chemotherapy for cancer who have clinically relevant anxiety or depression. More systematic research, such as placebo-controlled studies, is required.
Cangiano, C., Laviano, A., Meguid, M.M., Mulieri, M., Conversano, L., Preziosa, I., & Rossi-Fanelli, F. (1996). Effects of administration of oral branched-chain amino acids on anorexia and caloric intake in cancer patients. Journal of the National Cancer Institute, 88, 550–552.
To evaluate the efficacy of oral branched-chain amino acids versus placebo on anorexia and food intake in patients with cancer
A mixture of 4.8 g branched-chain amino acids was administered three times daily versus placebo powder three times daily for 60 minutes before each meal for seven consecutive days.
Multiple institutions in Italy that were not listed or further described
A double-blinded, placebo-controlled, randomized trial design was used.
Nutritional status was within normal limits for both groups prior to and at the end of study. Daily caloric intake was significantly increased in the treatment arm. There was no change in the placebo group. Incidence of anorexia was significantly decreased in the treatment arm (100% prior to and 45% at the end of study). There was no significant change in the placebo arm (100% prior to and 84% at the end of study). Blood tests showed a significant increase in plasma amino acid levels and a decrease in free tryptophan levels in the treatment arm and no change in levels noted in the placebo arm.
Candy, B., Jones, L., Goodman, M.L., Drake, R., & Tookman, A. (2011). Laxatives or methylnaltrexone for the management of constipation in palliative care patients. Cochrane Database of Systematic Reviews, 1, CD003448.
To update the information available on the effectiveness of laxatives and methylnaltrexone for constipation management in palliative care patients.
Databases searched were MEDLINE and the Cochrane Central Register of ControlLed Trials (Central).
Search keywords were laxatives, methylnaltrexone, and palliative care.
Studies were included in the review if
Studies were excluded if they reported on healthy volunteers, drug misuse–related constipation, or bowel obstruction.
A total of 186 references were retrieved. If citation screening did not identify whether a study was eligible, the full text was reviewed for acceptability. Two authors independently screened studies and discussed differences of opinion. Randomized controlled clinical trials were evaluated for inclusion.
Well-designed clinical trials are needed to help identify which laxatives are most effective for palliative care patients with constipation.
Very few clinical trials effectively evaluated the use of laxatives in this patient population.
Candy, D., & Belsey, J. (2009). Macrogol (polyethylene glycol) laxatives in children with functional constipation and faecal impaction: A systematic review. Archives of Disease in Childhood, 94, 156–160.
To determine whether more precise guidance can be given regarding use of osmotic laxatives, and to assess the evidence for their use in children with constipation.
Databases searched were PubMed, Embase, the Cochrane Library, and Google Scholar. Reference lists were also hand searched.
Search keywords were polyethylene glycols, lactulose, senna, bisacodyl, picosulphate, constipation, defecation, cathartics, infant, child, preschool, adolescent, and clinical trial.
Studies were included in the review if they
Initial searching provided 100 clinical trials and 71 review articles. A final group of seven trials was identified for consideration in this review.
The seven final studies encompassed data on 594 patients.
The review highlights the necessity of considering what treatment children will accept in managing symptoms.
This review was done in children with functional constipation, so findings may not be clearly applicable in children with constipation related to cancer treatment. PEG may be helpful and more effective than lactulose in the management of constipation in children with cancer, and may be more accepted than milk of magnesia.