Beidas, R.S., Paciotti, B., Barg, F., Branas, A.R., Brown, J.C., Glanz, K., . . . Schmitz, K.H. (2014). A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors. JNCI Monographs, 2014, 338-345.
To determine whether an exercise-based intervention was safe and effective for breast cancer survivors
Quasiexperimental
The number of lymphedema symptoms reduced from baseline to the 12-month follow-up visit (2.6 [SD = 2.6] to 1.7 [SD = 2.1], p = .002), but there was no statistically significant reduction in the severity of lymphedema symptoms from baseline to the 12-month follow up visit (p = .58). In addition, there was no difference in arm volume, measured as a percent of interlimb difference, at the 12-month follow-up visit (p = .98). Within this sample, four patients (8%) had new-onset lymphedema at the 12-month measurement and five (19%) had a flare-up of existing lymphedema.
The PAL intervention reduced the number of lymphedema symptoms but not the severity of symptoms experienced by participants. In addition, the intervention did not reduce the limb volume of participants. Participants were able, however, to complete the intervention, which took place mostly in the home setting, making it a feasible intervention for women with breast cancer.
When available, home-based exercise interventions like the ones described here may be beneficial for patients who are motivated to participate in and complete exercises at home. Nurses should assess patients for readiness to participate in a home exercise program and help patients find resources for planning an appropriate home-based program.
Begley, S., Rose, K., & O'Connor, M. (2016). The use of corticosteroids in reducing cancer-related fatigue: Assessing the evidence for clinical practice. International Journal of Palliative Nursing, 22, 5–9.
STUDY PURPOSE: To assess the evidence regarding the use of corticosteroids for fatigue among patients with advanced cancer
SAMPLE RANGE ACROSS STUDIES,
All studies reported improvement in patient-reported fatigue. Gaps were noted in information regarding side effects and the specifics of the dosage, etc., of the intervention.
Corticosteroids may improve fatigue in patients with advanced cancer, but potential adverse side effects have not been examined well.
Corticosteroids may improve fatigue in patients with cancer, but insufficient information about adverse effects exists. Steriods should not be used for a long duration—an intervention that may be useful for patients who desire short-term improvement in feelings of fatigue to participate in family events, etc.
Beer, T. M., Benavides, M., Emmons, S. L., Hayes, M., Liu, G., Garzotto, M., . . . Eilers, K. (2010). Acupuncture for hot flashes in patients with prostate cancer. Urology, 76, 1182–1188.
To determine the effect of acupuncture on hot flash (HF) frequency and intensity, quality of life, and sleep quality in patients undergoing hormonal therapy for prostate cancer.
Men with HF scores greater than four who received androgen-depriving therapy underwent acupuncture with electrostimulation biweekly for four weeks then weekly for six weeks using a predefined treatment plan. Patients completed a Hot Flash Diary daily for seven days prior to treatment then daily throughout the study.
The study enrolled men with prostate cancer who were treated with bilateral orchiectomy, gonadotropin-releasing hormone agonist, or antagonists with or without antiandrogen therapy. The sample group reported at least four HFs per day. They could not be receiving concurrent chemotherapy, estrogens, progesteronal agents, or gabepentin. They had to be off of selective serotonin reuptake inhibitor (SSRI) class antidepressants for at least two weeks; however, the SSRI prohibition was removed after 16 patients were enrolled to speed accrual. Patients with pacemakers or other electrical devices were excluded.
The study used an open-label, single arm, phase II design.
Acupuncture treatment was administered twice weekly, with an attempt to use the same practitioner throughout the treatment period. Specific acupuncture sites were used in all patients. The HF score was calculated from the Hot Flash Diary, and each HF was calculated to determine severity. The severity-adjusted HF scores were summed for seven days. Biomarkers were assessed at baseline; 2, 4, 6, and 10 weeks of treatment; and again after 6 weeks. The mean HF score was reduced after four weeks of therapy, then reduced to 52% of baseline at eight weeks. The HFDISs were available for 21 of the improved patients. The PSQI was available for 19 patients, but there was no statistical significance noted from baseline to after 10 weeks of treatment. No improvement in overall vitality was measured by the SF-36. No significant adverse effects were noted. Regarding the biomarkers, no change in the serum serotonin levels was noted for any patient. Urinary 5-HIAA had a nonsignificant trend toward reduced 5-HIAA concentrations, with the nonresponders (two patients) having an increase over time. The nonresponders' 5-HIAA concentrations were 129% of baseline, whereas the responders at week 10 showed 73.3% of baseline concentrations. The CGRP levels baseline sample results were so diverse that subsequent samples obtained during and posttreatment detected no meaningful differences. The variability in the CGRP samples reduced the statistical power of the study to detect differences.
The study suggested that acupuncture may be an active nonpharmacologic option for patients with prostate cancer experiencing HFs while undergoing hormonal treatment.
Further research is needed in the use of acupuncture in reducing HF scores and improving sleep quality in prostate cancer survivors. Further research may also be needed to determine if differences exist between genders for HF distress/occurrence and sleep quality, which may provide some direction for extrapolating research results with either gender group.
Beek, M.A., Gobardhan, P.D., Schoenmaeckers, E.J., Klompenhouwer, E.G., Rutten, H.J., Voogd, A.C., & Luiten, E.J. (2016). Axillary reverse mapping in axillary surgery for breast cancer: An update of the current status. Breast Cancer Research and Treatment, 158, 421–432.
STUDY PURPOSE: To review the evidence for axillary reverse mapping (ARM) and discuss the feasibility, safety, and relevance of this procedure
TYPE OF STUDY: General review/"semi" systematic
PHASE OF CARE: Active antitumor treatment
Evidence shows a wide range of visualization rates from 20%–90% and notes that rates are lower with sentinel lymph node biopsy (SNLB) than with axillary lymph node dissection (ALND). The definition of successful ARM, the volume of blue dye used, and the experience of the surgeon varied, all of which may affect these rates. Blue dye, flourescent dye, and radioisotopes have been used for visualization. No adverse events from the procedures have been noted. At present, no axillary recurrence has been reported in patients in whom lymph nodes were preserved. ARM may contribute to a reduction in upper extremity lymphedema, although current evidence is not strong enough to draw firm conclusions.
The preservation of lymph nodes with ARM appears to be safe and may contribute to a reduction in the incidence of upper extremity lymphedema.
The preservation of axillary lymph nodes in women undergoing surgery for breast cancer with ARM appears to be safe. The evidence suggests that ARM with lymph node preservation may reduce the prevalence of arm lymphedema; however, multiple limitations in the available evidence exist. Ongoing research of the long-term effects on patient outcomes is needed and underway.
Becker, G., Galandi, D., & Blum, H.E. (2007). Peripherally acting opioid antagonists in the treatment of opiate-related constipation: A systematic review. Journal of Pain and Symptom Management, 34, 547-565.
To evaluate evidence on the effectiveness of the peripherally acting mu-receptor antagonists alvimopan and methylnaltrexone in the management of opioid-induced constipation.
Databases searched were Ovid MEDLINE, Biological Abstracts, BIOSIS Previews, CINAHL, Evidence-Based Medicine Reviews (EBMR) (Cochrane Database of Systematic Reviews, ACP [American College of Physicians] Journal Club, Database of Abstracts of Reviews of Effectiveness [DARE], and the Cochrane Central Register of Controlled Trials [1966-May 2005]), PubMed (1996-May 2005), CancerLit (1963-June 2005), and Embase (1980-May 2002). A hand search also was conducted on bibliographies of books about palliative care. From that hand search, reference citations concerning constipation were identified to find additional clinical trials to include in the review.
Search keywords were constipation, intestinal obstruction, opioid bowel dysfunction, opioid related constipation, opioid-related disorders, peripherally acting opioid antagonist, opioid antagonist, opioid mu receptors, narcotic antagonists/naltrexone, methylnaltrexone, and alvimopan.
Studies were included in the review if
Studies were excluded if they had a small sample size (fewer than 10 participants) or used the Rome Diagnostic Criteria to define constipation.
Ten studies were appropriate for this review. However, four of the 10 had two or three parts performed in different populations or using different dosing regimens. The differing parts were treated as different studies and assessed individually, yielding 15 studies (10 randomized controlled trials and five phase II studies addressing dose and toxicity).
This systematic review looked mainly at the efficacy of using the peripherally acting opioid antagonists methylnaltrexone (nine studies) and alvimopan (six studies) in managing opioid-induced constipation. Internal validity of the studies was high, indicating methylnaltrexone and alvimopan may be effective in relieving opioid-induced constipation. However, most study participants were healthy volunteers or members of methadone programs.
Beck, M., Wanchai, A., Stewart, B.R., Cormier, J.N., & Armer, J.M. (2012). Palliative care for cancer-related lymphedema: A systematic review. Journal of Palliative Medicine, 15(7), 821–827.
To a conduct a systematic review of the published literature related to the effectiveness of cancer-related lymphedema management in palliative care
Databases searched were PubMed, MEDLINE, CINAHL, Cochrane Library databases, PapersFirst, Proceedings First, Worldcat, PEDro, National Guidelines Clearing House, ACP Journal Club, and Dare.
Search keywords were lymphedema (lymphoedema, lymphodema, elephantiasis, swelling, edema, and oedema) and palliative care (advanced disease and metastatic cancer).
Studies were included in the reivew if they related to lymphedema management in the setting of palliative care, including randomized controlled trials, cohort studies, case-control studies, meta-analyses, and systematic reviews.
Studies were excluded if they
Patients were undergoing end-of-life and palliative care.
The study identified four categories of lymphedema in the palliative care settings.
Only a few studies (4 out of 11) included objective measures of outcomes. All studies were in the category of \"Effectiveness Not Established\" assessed by the Oncology Nursing Society Putting Evidence Into Practice classification.
A lack of rigorously designed clinical research studies have been conducted pertaining to the treatment of lymphedema in patients with advanced or metastatic cancer.
This systematic review indicated that the identified procedures (closed-controlled subcutaneous drainage, MLD, compression therapy, and CDT) are relatively safe. Nurses may consider recommending these procedures to individuals with lymphedema and advanced or metastatic cancer. Nurse scientists need to conduct more rigorously designed studies to test the effectiveness of management of cancer-related lymphedema in palliative care.
Bechtel, T., McBride, A., Crawford, B., Bullington, S., Hofmeister, C.C., Benson Jr, D.M., . . . Devine, S.M. (2014). Aprepitant for the control of delayed nausea and vomiting associated with the use of high-dose melphalan for autologous peripheral blood stem cell transplants in patients with multiple myeloma: A phase II study. Supportive Care in Cancer, 22, 2911–2916.
To evaluate the efficacy of adding aprepitant to an antiemetic regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV)
Participants received aprepitant at 125 mg orally on day 1 followed by 80 mg orally at 24 and 48 hours after the initial dose of aprepitant. Ondansetron was given at 16 mg orally on day 1, and dexamethasone was given at at 12 mg orally on day 1 and at 8 mg orally on days 2–4. Breakthrough medications were used as needed. There was no comparison or control group. To evaluate nausea and vomiting, patients were assessed four to six times per day for the presence or absence of vomiting, the frequency of emetic episodes, the need for breakthrough antiemetic medication, and a nausea score provided by the nurse. Mean nausea scores were assessed every 24 hours beginning 24 hours after chemotherapy and continuing 120 hours after chemotherapy.
Prospective, single-arm study
Complete response was defined as no more than one emetic episode during the evaluation period. Of the 26 participants, 25 (96%) completely responded and needed no additional breakthrough medication. Twenty-four (92%) had no documented emetic episodes during the study period. Some degree of nausea was reported by 23 out of 26 (88%) patients, and the mean nausea score for the entire group during the study period was 0.7 (range = 0–10).
Adding aprepitant to a standard antiemetic regimen may result in lower rates of CINV associated with high-dose melphalan and stem cell transplant.
Adding aprepitant to standard antiemetic regimens may result in better controlled CINV. However, with such a small sample size and no comparison group, attributing these results to the intervention is difficult.
Bazire, L., Fromantin, I., Diallo, A., Lande, B., Pernin, V., Dendale, R., . . . Kirova, Y.M. (2015). Hydrosorb® versus control (water based spray) in the management of radio-induced skin toxicity: Results of multicentre controlled randomized trial. Radiotherapy and Oncology, 117, 229–233.
To report the efficacy of Hydrosorb versus water-based spray (control) to treat G1-2 radiodermatitis in patients with early stage breast cancer (BC) treated with normo-fractionated radiotherapy (RT)
PHASE OF CARE: Active treatment
Randomized, prospective, open-label, placebo-controlled study
No significant difference existed between Hydrosorb and placebo in the treatment of acute radioinduced dermatitis. A trend in improvement in pain was observed with the use of Hydrosorb; however, any additional treatment given for pain, which was allowed, was not described.
The ingredients of the patients' applied moisturizer were not defined and could have altered skin physiology in both arms. The frequency of Hydrosorb application was not defined. No actual grading of dermatitis existed per se. Changes in local treatment were allowed, but no information was provided regarding what additional treatments were done.
This study did not show that Hydrosorb was effective in preventing the increase of radiodermatitis severity. Patient instructions used here included outdated information, such as the need to avoid use of deodorants. Very limited evidence shows that topical treatments effectively prevent radiodermatitis.
Bauters, T.G., Verlooy, J., Robays, H., Benoit, Y., & Laureys, G. (2013). Emesis control by aprepitant in children and adolescents with chemotherapy. International Journal of Clinical Pharmacy, 35, 1021–1024.
To investigate the efficacy of aprepitant in children and young adolescents receiving highly or moderately emetogenic chemotherapy who experienced uncontrollable emesis in previous cycles
This was a retrospective, observational analysis in children and adolescents aged greater than three years treated with aprepitant at a hospital in Belgium. Patients were identified through pharmacy records. Data on the use of antiemetics and emesis control were retrieved from pharmacy and nursing files. Emesis was defined as at least one episode of vomiting during the current chemotherapy cycle. Complete vomiting control was defined as no vomiting during the current cycle while incomplete control was defined as at least one episode of vomiting. The use of aprepitant was recorded and analyzed for each patient and for every chemotherapy cycle in which aprepitant was given.
Retrospective, observational analysis over three years
Half the patients, representing a sizable percentage of episodes with complete emesis control, benefited from the use of aprepitant in combination with other antiemetics. This suggested the added value of aprepitant in patients receiving moderately or highly emetogenic cycles of chemotherapy, especially as all the included patients experienced uncontrollable emesis in previous cycles. Patients or parents with a positive experience with aprepitant asked for the availability of the product in subsequent cycles, which highlights its value.
Aprepitant achieved good results in preventing or reducing vomiting in children, which might improve compliance and patient and family satisfaction.
Bausewein, C., Booth, S., Gysels, M., & Higginson, I. (2008). Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database of Systematic Reviews (Online), 2(2), CD005623.
The objectives of the study were to
The study reported on a sample of 2,532 participants in 47 studies categorized into single intervention or multi-component interventions.
The following single interventions were identified.
The following multi-component interventions were identified.
A meta-analysis of the included studies was not possible due to hetereogeneity of the studies. Strong evidence suggests that neurologic muscular electrical stimulation and chest wall vibrations provide helpful relief of breathlessness in patients with COPD. However, the practical implications of the chest wall vibration interventions were only conducted in the respiratory laboratory. The evidence is moderately strong for walking aids having some benefits for patients with COPD with breathlessness by reducing the work of chest muscles. Moderate strength of evidence exists for breathing training being beneficial for breathless patients. Finally, not enough evidence exists to recommend usage of acupuncture, distractive auditory stimuli, relaxation, fan, counseling and support programs, or counseling and support programs in combination with relaxation and breathing training, case management, and psychotherapy.
Moderate evidence strength for walking aids and breathing retraining for COPD suggests these may be helpful interventions. Applicability in patients with cancer may be worth investigation.