Bausewein, C., Booth, S., Gysels, M., Kuhnbach, R., & Higginson, I.J. (2010). Effectiveness of a hand-held fan for breathlessness: A randomised phase II trial. BMC Palliative Care, 9, 22.
The objective of the study was to determine effectiveness and acceptance of use of a handheld fan to relieve breathlessness in patients with advance chronic obstructive pulmonary disease (COPD) and cancer.
Patients were randomly assigned to the fan or control groups. Control patients were given a wristband and instructed to wear it constantly and pull it at short intervals when breathless. Patients in the intervention group were given a handheld fan, shown how to use it (aimed at the central part of the face), and given a booklet with instructions for use. Data were collected at baseline and by monthly postal questionnaires for six months or until the patient died.
The study was conducted in an unspecified single site in the United Kingdom.
The study was a randomized controlled trial.
A modified Borg scale was used.
This study shows that use of a handheld fan for breathlessness was not effective.
Findings do not show any benefit of a handheld fan to help patients with the sensation of breathlessness.
Baumann, F.T., Zopf, E.M., Nykamp, E., Kraut, L., Schüle, K., Elter, T., . . . Bloch, W. (2011). Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: Benefits of a moderate exercise intervention. European Journal of Haematology, 87, 148–156.
To demonstrate the effects of an exercise program on endurance, strength, lung function, and quality of life in patients undergoing allogeneic transplantation.
Forty-seven patients undergoing allogeneic transplantation during a three-year period were recruited and randomized into either the exercise group (EG) or the control group (CG). The EG received daily aerobic endurance training with a cycle and ADL training, involving relaxation, stair climbing coordination, and strengthening. Exercise was done 20–30 minutes per day, twice daily. CG patients received standard physiotherapy for 20 minute five days per week, consisting of active and passive mobilization with low intensity. Fatigue measurement was conducted two days after admission and one day before discharge. Exercise began the first day after transplantation.
Increase in the experience of fatigue in the CG. Deterioration of physical function was seen in both study groups. There was improved emotional state for patients in the EG (p = .028). Relative endurance improved in EG both groups. There was no significant group by time effect on fatigue. No effect for strength, lung function, or anthropometric assessments reached significance in either group.
The only significant difference between the two groups was found in relative endurance in favor of EG.
Physical activity during acute phase of transplantation appears safe and can improve physical endurance and strength.
Baumann, F.T., Drosselmeyer, N., Leskaroski, A., Knicker, A., Krakowski-Roosen, H., Zopf, E.M., & Bloch, W. (2011). 12-week resistance training with breast cancer patients during chemotherapy: Effects on cognitive abilities. Breast Care, 6, 142–143.
To evaluate the effectiveness of resistance training on cognitive abilities in patients with breast cancer undergoing neoadjuvant chemotherapy
The intervention group (IG) participated in 60 minutes of resistance training (three sets of 8–12 reps for 10 different exercises at 55%–75% maximum effort) twice a week for 12 weeks. The control group (CG) did not receive any information. Cognitive evaluations were performed in the IG prior to them receiving the intervention and at study conclusion (one to two weeks after end of chemotherapy) for both groups.
Patients were undergoing active treatment.
Prospective, non-randomized controlled trial
The IG's d2 Test of Attention scores improved (p = 0.049), but no significant differences were observed in comparison to the CG. The IG d2 error rate decreased from baseline by 1.12 points (p = 0.017) but was significantly different from the CG at baseline (p = 0.040) and post-intervention (p = 0.019). The IG short-term verbal memory was marginally improved from baseline (p = NS) but was significantly better than CG scores (p = 0.048). IG Wilde test scores for working memory showed significant improvement from baseline (p= 0.049), but no significant difference existed between IG and CG scores.
Improvements were seen in focused attention and concentration, working memory, and verbal memory for the IG. Although no differences were observed in verbal memory and attention between the IG and CG, the CG did not have baseline evaluations performed for adequate group comparisons.
Benefits of physical activity, predominately aerobic exercise, have improved symptoms of fatigue, sleep disturbances, affect, and cognitive function. Using resistance training may improve short-term verbal memory, working memory, attention, and concentration. Further study is warranted.
Bauer, C., Laszewski, P., & Magnan, M. (2015). Promoting adherence to skin care practices among patients receiving radiation therapy. Clinical Journal of Oncology Nursing, 19, 196–203.
To optimize patient adherence to Oncology Nursing Society's (ONS's) Putting Evidence Into Practice (PEP) recommendations for skin care and to evaluate associated satisfaction and skin condition
A skin care protocol was developed, including cleansing, use of a moisturizer, protection from the sun, and avoidance of skin friction. Patients were given written instruction sheets and videos, skin care kits were provided free of charge and nurses rehearsed to provide consistent verbal information. Outcomes measured included adherence, patient satisfaction, and skin condition. Teaching was reinforced in week 1 and 3. Adherence and skin condition were measured weekly. Results were compared to a cohort of patients who had been managed under a previous protocol. A random selection of patients who had received previous care was selected for comparison.
PHASE OF CARE: Active antitumor treatment
The onset of skin reactions was later among the new protocol group, but differences from previous care were not significant. By week 5, the proportion of patients with grade 3 and 4 was lower among patients in the current protocol. Adherence to skin cleansing and moisturizing was 93%–95%. Of the patients, 87% were extremely satisfied with the education they received.
The findings suggest that teaching patients to follow a consistent skin care protocol can be beneficial in the prevention of severe radiodermatitis.
Regular skin cleansing during radiation therapy is a recommended part of care. This study showed that a nursing educational and care protocol could facilitate patient compliance to skin cleansing and other aspects of skin care, and may improve patients' skin condition during radiation therapy.
Batlle, M., Morgades, M., Vives, S., Ferra, C., Oriol, A., Sancho, J.M., ... Ribera, J.M. (2014). Usefulness and safety of oral cryotherapy in the prevention of oral mucositis after conditioning regimens with high dose melphalan for autologous stem cell transplantation for lymphoma and myeloma. European Journal of Haematology, 9(6), 487–491.
To compare the effectiveness of oral cryotherapy (OC) to room temperature saline rinses in prevention of oral mucositis (OM) in patients with multiple myeloma (MM) and lymphoid neoplasias (NHL, HL) for autologous stem cell transplantation (ASCT)
An oral care protocol with sodium bicarbonate mouthwash from day 7 of ASCT until hospital discharge was implemented for all patients in the study. The intervention group received oral cryotherapy before infusion for 10 minutes, during infusion for 15 minutes, and after HDmel for 15 minutes. The control group received saline salt rinses at room temperature, but the schedule was not described in the study. Nurses assessed for oral mucositis on the day before ASCT and on days 3, 6, 9, and 12 after infusion.
Oral mucositis was significantly lower in the intervention group (44%) compared to the control group (82%) (p < 0.001). Grades III and IV oral mucositis were also lower in the intervention group (15%) compared to the control group (31%) (p = 0.031). There was no difference between groups in the onset or duration of mucositis.
OC is more effective than oral saline rinses in the prevention of OM, including grades III-IV OM in patients receiving conditioning regimens.
OM can interfere with nutrition and quality of life and can lead to secondary infections. Effective prophylaxis is needed to have good outcomes. Although this study had limitations, OC reduced severity of OM, is cost effective, and is well tolerated by patients. Therefore, it does offer an effective and inexpensive supportive measure.
Bass, P., Karki, S., Rhodes, D., Gonelli, S., Land, G., Watson, K., . . . Cheng, A. C. (2013). Impact of chlorhexidine-impregnated washcloths on reducing incidence of vancomycin-resistant enterococci colonization in hematology-oncology patients. American Journal of Infection Control, 41, 345–348.
To evaluate the impact of daily use of 2% chlorhexidine washcloths on the incidence of vancomycin-resistant enterococci (VRE) colonization.
The incidence of VRE colonization among oncology inpatients was examined before and after the introduction of daily use of chlorhexidine-impregnated washcloths. Each day, patients were given four impregnated washcloths, which were used individually for cleaning different parts of the body. Rectal swabs were taken on all new admissions and weekly during the inpatient stay. The baseline period was March to June 2010, and the experimental period was July to October 2010. Patients were in single rooms, although patients colonized with resistant organisms were roomed together. Prior bed occupancy with a patient colonized with VRE was used as a covariate in analysis.
Patients were undergoing the active antitumor treatment phase of care.
This was an observational study with a historical control.
During the baseline period, 7.8% of the previously uncolonized patients acquired VRE, compared to 3.8% during the experimental period (relatve risk [RR] = 0.48; 95% confidence interval [CI] [0.21, 1.09]). There was no significant effect of prior bed occupants with VRE on VRE acquisition. Patients who shared a room with a VRE-positive patient had significantly higher VRE rates (p < 0.001). There were no significant differences in central line-associated bloodstream infection rates, and few MRSA isolates were found.
The findings do not support the effectiveness of using chlorhexidine-imgregnated washcloths for the reduction of VRE colonization.
The findings from this study do not support the effectiveness of using chlorhexidine-impregnated washcloths to prevent VRE colonization.
Baruth, M., Wilcox, S., Der Ananian, C., & Heiney, S. (2013). Effects of home-based walking on quality of life and fatigue outcomes in early stage breast cancer survivors: A 12-week pilot study. Journal of Physical Activity and Health [Epub ahead of print].
To examine the effects of a home-based walking program on quality of life and fatigue.
Women were randomized to the usual care, wait list control, or intervention groups. Those in the intervention group received a 30 minute in-person counseling session and follow-up telephone counseling calls in weeks 1, 2, 4, 7, and 10. Counseling calls applied constructs of social cognitive therapy, discussing specific behavior change principles that could be used to increase walking, using a semi-structured script. Walking plans were designed for gradual increases in frequency, duration, and intensity. Women in the usual care group were asked to maintain their usual activity levels. Those in the intervention group were asked to keep daily activity logs and were given pedometers.
Fatigue declined in all patients. There was a greater decline among the intervention group, but the difference was not significant. Estimated activity level of walking METs was not significantly different between groups at baseline, but levels post-intervention are not reported. Overall, participants in the intervention group completed 86% (range = 62%–100%) of prescribed walking sessions.
Findings suggest relatively good adherence to home-based walking prescriptions and suggest that this activity may improve fatigue symptoms.
Findings suggest that a prescription for a home-based walking program can be a practical way to improve or maintain physical activity among women with breast cancer after initial treatment, and that this activity can improve symptoms of fatigue. There were multiple limitations to this study; however, multiple studies have shown that exercise is effective to reduce fatigue. Previous findings regarding self-managed exercise programs have been mixed. This pilot study suggests that a prescription for exercise, patient counseling and follow-up contacts may facilitate performance of home-based exercise.
Barton, D.L., Wos, E.J., Qin, R., Mattar, B.I., Green, N.B., Lanier, K.S., . . . Loprinzi, C.L. (2011). A double-blind, placebo-controlled trial of a topical treatment for chemotherapy-induced peripheral neuropathy: NCCTG trial N06CA. Supportive Care in Cancer, 19, 833–841.
The purpose of this study was to evaluate a compounded topical gel containing baclofen 10 mg, amitriptyline HCL 40 mg, and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO).
Participants were randomized to receive 1.31 g of a compounded gel containing 10 mg of baclofen, 40 mg of amitriptyline HCL, and 20 mg of ketamine versus an identical looking placebo gel. Instructions were to apply one level spoonful of gel topically to each area of pain, numbness, and/ or tingling, twice a day (in the morning and before bed), for four weeks duration. Participants were not allowed to treat more than four areas of pain, numbness, and/or tingling at a single time (i.e., a maximum of four spoonfuls of gel per application). A small subset of participants was asked to have blood drawn at the end of the four weeks to measure concentrations of drugs and their metabolites.
The study was conducted at 16 separate academic institutions in the United States.
Phase of care
Applications
The study was a double-blind, randomized, placebo-controlled trial.
Significant improvements in neuropathy symptoms in the hand and functioning of the hands were identified. Results in the feet were not as marked. Systemic absorption was minimal. Analysis of change in sensory neuropathy showed an effect size of about 0.28 (Cohen’s d, p = 0.053) in favor of the intervention. For the measurement subscale for motor neuropathy, the effect size of the change from baseline was 0.38 (p = 0.021). When analyzed as an ordinal scale outcome variable of negative change, no change or positive change for neuropathy symptoms, no significant difference was found between groups. No differences were noted between groups in the mood, pain, or quality-of-life measures.
Topical application of baclofen, 40 mg of amitriptyline HCL, and 20 mg of ketamine may be a useful approach to treatment of neuropathic pain related to CIPN, particularly if pain in the hands exists.
A limitation of this research was that the authors could not get U.S. Food and Drug Administration approval for the doses they originally wanted to use because of limited data on systemic absorption.
Nurses may consider use of this novel topical compound, but more data is needed before definite recommendations can be made.
Barton, D. L., Atherton, P. J., Bauer, B. A., Moore, D. F., Jr., Mattar, B. I., Lavasseur, B. I., . . . Loprinzi, C. L. (2011). The use of Valeriana officinalis (Valerian) in improving sleep in patients who are undergoing treatment for cancer: a phase III randomized, placebo-controlled, double-blind study (NCCTG Trial, N01C5). Journal of Supportive Oncology, 9, 24–31.
To assess the effect of a standardized preparation of valerian in improving sleep in patients undergoing therapy for cancer.
Patients receiving therapy for cancer who reported sleep difficulty of 4 or greater on a scale of 0 to 10 with a life expectancy of more than six months and an Eastern Cooperative Oncology Group (ECOG) performance score of 0 or 1 were included. Patients were randomized to receive 450 mg of oral valerian or placebo to be taken one hour before bed for eight weeks. Valerian capsules used contained 0.8% of valerenic acid. Valerian and placebo capsules were stored together so the placebo capsules would have a similar smell to the valerian capsules. Study measures were completed at baseline and four and eight weeks. Toxicity was assessed every two weeks using the Common Terminology Criteria for Adverse Events (CTCAE).
Patients were undergoing the active treatment phase of care.
The study was a randomized, controlled trial.
Total PSQI scores were not significantly different between the two groups over time. Although fewer patients in the valerian group reported sleep problems at week 8 than patients in the placebo group (64% versus 80%), no statistically significant changes in sleep problems were observed from baseline to week 8 in either group. Amount of sleep was significantly improved in the valerian group from baseline to week 4 (p = 0.008), but not from week 4 to week 8. Statistically significant improvement was observed in the valerian group in sleep latency, and 43% of patients reported reduced time to fall asleep compared to 32% of patients in the placebo group.
The Fatigue Inertia subscale of the POMS was significantly different from weeks 4 (p = –0.004) and 8 (p = 0.02), with better scores reported in the valerian group. The valerian group also scored significantly better from baseline to weeks 4 and 8 on the Fatigue Now subscale (p = 0.003 and p = 0.01, respectively) and the Usual Fatigue subscale (p = 0.02 and p = 0.046, respectively) of the BFI.
No significant differences were observed between groups for self-reported side effects at any of the data collection points. The placebo arm reported a significantly higher incidence of grade 1 alkaline phosphatase toxicity (p = 0.049).
The study showed that valerian provides no statistically significant improvement in sleep quality in patients undergoing treatment for cancer. Additional study on the effects of valerian on daytime fatigue may be warranted.
The study findings do not support the use of valerian in patients with cancer and insomnia. Additional study is needed to determine the effects of valerian on fatigue in this patient population.
Barton, D.L., Loprinzi, C.L., Quella, S.K., Sloan, J.A., Veeder, M.H., Egner, J.R., … Novotny, P. (1998). Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. Journal of Clinical Oncology, 16, 495–500.
The purpose of the study was to examine the effect of vitamin E in breast cancer survivors.
Participants received an eight-week supply of study medication (400 IU of vitamin E succinate or placebo twice daily) labeled with the days and weeks for dosing.
One hundred twenty-five (125) women aged 33–67were randomized; 5 participants on the placebo-arm withdrew before starting study medication, which resulted in 120 patients assessable for toxicity. One hundred five (105) participants completed five weeks of study; 104 finished all nine weeks.
In this placebo-controlled, randomized, crossover trial, women were stratified by age (18 to 49 years and 50 years and older), current tamoxifen use (yes or no), duration of hot flashes (less than 9 months versus 9 months or more), average frequency of flashes (2–3 per day, 4–9 per day, or 10 or more per day), and current multivitamin use (yes or no).
Baseline hot-flash counts for each woman were obtained for the first seven days. Starting the second week and for the remaining seven weeks, study medication was taken, and the women continued to keep a daily diary of hot flash severity and frequency.
Treatment efficacy was measured using three variables: mean daily hot-flash frequency, mean daily hot-flash severity (grades 1 to 4 to representing mild, moderate, severe, and very severe), and mean daily hot flash score (frequency times average severity). All factors were measured during the last week of each treatment and compared with baseline week. The 105 participants who finished the first treatment period showed a similar reduction in hot flash frequencies for the two study arms. (25% versus 22%; p = .90). This effect represents an average decrease of roughly 1.6 hot flashes per day to a level of 4.7 hot flashes per day. The hot flash score decreased by 28% with vitamin E and 20% with placebo (p = .68). A crossover analysis, however, showed that vitamin E was associated with a minimal decrease in hot flashes (one less hot flash per day than was seen with a placebo) (p ≤ .05). At the study end, participants did not prefer vitamin E over the placebo. No toxicity was demonstrated.
Although this trial was able to show a hot flash reduction with vitamin E compared to a placebo, the clinical magnitude of this reduction was marginal