Ashing, K., & Rosales, M. (2014). A telephonic-based trial to reduce depressive symptoms among Latina breast cancer survivors. Psycho-Oncology, 23(5), 507–515.
Test the effectiveness of a paraprofessionally delivered, telephonic-based, psycho-educational intervention (telephone sessions plus survivorship booklet) to reduce depressive symptoms compared with the control condition (survivorship booklet only)
Intervention was based on the contextual model of health-related quality of life and the cognitive behavioral framework. Participants allocated to the intervention condition received eight 40–50-minute, biweekly, psychoeducational telephone services. Telephonic sessions involved seven domains: basic breast cancer information; managing medical and physical issues, follow-up care, and cancer resources; coping skills and problem-solving training; balancing emotions and stress management; family and social concerns; sexual health concerns; and financial issues and employment concerns. A booster and debriefing session took place one month after completion of telephone sessions.
PHASE OF CARE: Late effects and survivorship
Randomized, controlled trial
Center for Epidemiological Studies Depression Scale (CESD) to assess depressive symptoms in addition to demographic and clinical characteristics
A statistically significant decrease in depressive symptoms was seen among Latina patients with breast cancer in the intervention condition compared with Latina patients with breast cancer in the control condition, after controlling for depressive symptoms at T1 and language (p < 0.05). English-language-preferred and Spanish-language-preferred Latina patients with breast cancer in the intervention condition showed an eight-point decrease in depressive symptoms from baseline to follow-up, whereas those in the control condition showed no significant change.
These findings support the success of psycho-educational telephonic intervention in significantly reducing depressive symptoms among Latina patients with breast cancer, regardless of language. This is a great way to address distress among the ethnically diverse population of patients with cancer.
This study represents a novel psycho-educational trial implemented by paraprofessionals. This could be a cost effective approach that would improve distress symptoms in a minority population with cancer. With proper training, nurses and social workers may implement this intervention, which will contribute to better patient outcomes.
Asdourian, M.S., Skolny, M.N., Brunelle, C., Seward, C.E., Salama, L., & Taghian, A.G. (2016). Precautions for breast cancer-related lymphoedema: Risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis. Lancet Oncology, 17, E392–E405.
STUDY PURPOSE: To examine the literature regarding precautionary and lifestyle behaviors to prevent adverse effects with arm lymphedema secondary to breast cancer surgery
TYPE OF STUDY: General review/\"semi\" systematic
PHASE OF CARE: Late effects and survivorship
Nine studies looked at air travel and risk of lymphedema. No consensus among studies regarding the utility of compression garment use during air travel was found, and no evidence exists to show that its use is of benefit or a risk to patients. Five studies regarding temperature extremes were included. Two studies conducted in China reported benefit from local heat therapies, and one study showed that sauna use may be associated with increased risk. Findings were insufficient to draw firm conclusions. Four studies looked at risk and the use of the affected arm for blood pressure monitoring. Two studies showed some evidence that blood pressure measurement was associated with increased lymphedema. Ten studies looked at venipuncture and lymphedema risk or outcomes. Conflicting reports were seen, and most evidence was of low quality. Eight studies involving the relationship between infection and incident worsening of lymphedema were reviewed. Of these, six suggested a significant relationship between worse lymphedema outcomes and infection, injury, or cellulitis.
Insufficient evidence exists to draw firm conclusions about the necessity of precautionary guidelines for behavior to reduce the potential for incident worsening of lymphedema and related adverse effects, although guidelines are based on sound physiological principles. Studies have shown that skin infections and inflammation are significant risk factors.
This study adds to a growing body of evidence encouraging the questioning of traditional patient teaching for risk reduction behaviors aimed at reducing the risk of incident worsening of arm lymphedema after surgery for breast cancer. Insufficient evidence shows that risk reduction behaviors are effective in reducing risk; however, insufficient evidence supports that elimination of these behaviors is safe for patients. Traditional patient teaching to avoid the use of tourniquets or limb constriction, wounds or punctures, exposure to extreme temperatures, the use of compression garments with air travel, and maintain cleanliness are founded in sound physiological rationale. Such risk reduction behaviors are not overly restrictive and are sensible aspects of patient teaching for self-care.
Schiffer, C.A., Mangu, P.B., Wade, J.C., Camp-Sorrell, D., Cope, D.G., El-Rayes, B.F., . . . Levine, M. (2013). Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 31(10), 1357–1370.
STUDY PURPOSE: To develop an evidence-based guideline on central venous catheter (CVC) care for patients with cancer
TYPE OF STUDY: Systematic review
DATABASES USED: MEDLINE (PubMed) and the Cochrane Collaboration Library
KEYWORDS: Authors did not state which keywords were utilized.
INCLUSION CRITERIA: As long as the randomized clinical trials included a majority of patients with cancer, they were included for this review. Most recent trials were included as opposed to older trials. Authors searched from 1980–July 2012 in databases that were published in English.
EXCLUSION CRITERIA: No specific exclusion criteria were mentioned by authors. Randomized controlled trials (RCTs) were excluded if patients with CVCs were compared to patients with permanent catheters.
TOTAL REFERENCES RETRIEVED = 133, plus an unspecified number of pre-existing guidelines that were discovered during the search
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: 108 RCTs of patients with cancer and 25 meta-analyses or systematic reviews were found in the search. Several pre-existing guidelines also were discovered during the literature search.
Not enough evidence was found to suggest only one type of CVC for patients or to suggest only one insertion site or approach for tunneled lines. A CVC bundle should be used for line insertion and maintenance.
Evidence is insufficient to recommend one type of CVC for patients with cancer. The choice of catheter needs to be patient-specific, avoiding femoral lines because of increased risk of infection. Hand hygiene, barrier precautions during catheter insertion and utilization, and chlorhexidine skin antisepsis during insertion are recommended to prevent catheter-related infections. Cultures should be drawn prior to antibiotic administration when an infection is suspected.
Hand hygiene and maximum barrier protection should be used during any type of catheter manipulation to avoid infection. Routine flushing with normal saline is recommended for patency. Blood cultures should be collected from CVCs prior to antibiotic administration. Tissue plasminogen activator should be used for catheters with patency issues. Routine prophylaxis with anticoagulants is not recommended for catheter-associated thrombus.
Ashamalla, H., Jiang, M. L., Guirguis, A., Peluso, F., & Ashamalla, M. (2011). Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. International Journal of Radiation Oncology, Biology, Physics, 79(5), 1358-1363.
To study the effect of acupuncture on hot flashes in men with prostate cancer treated with androgen deprivation
Men with hot flashes occurring at least 3 or more times per day for at least three days before enrollment were enrolled. They completed hot flash diaries with resulting hot flash scores at baseline, daily for at least 6 weeks, and then monthly for 8 months (targeted time was 36 months). Acupuncture was administered by same acupuncturist twice a week for 4 weeks to the same 10 points with electro stimulation applied to 8 of the 10 points per protocol.
The study enrolled men with locally advanced prostate cancer, who had been treated with androgen deprivation therapy as an adjuvant to radiation therapy, radical prostatectomty, or brachytherapy. All men must have had hot flashes occurring at least 3 or more times per day for at least three days before enrollment. Patients could not be receiving medications for hot flashes nor have a history of acupuncture treatment.
PHASE OF CARE: Active Treatment
APPLICATIONS: Late effects & survivorship; Elderly care
Prospective single arm trial
Mean initial Hot Flash Score (HFS) was 28.3, which decreased to 10.3 (p= 0.0001) at 2 weeks post-treatment, 7.5 (p = 0.0001) at 6 weeks post-treatment, and 7.0 (p= 0.0001) at 8 months post-treatment. Clinical improvement for each patient was defined as the percent decrease in the mean HFS at each time point. The mean improvement at weeks 2 and 6 was 68.4% and 89.2%.
In this limited sample size, acupuncture appeared to reduce hot flash symptoms experienced by men treated with androgen deprivation for their locally advanced prostate cancer.
Further research is needed in larger sample sizes to determine effectiveness, and the reproducibility of the study when using multiple providers. The study explored the long term benefits of using acupuncture and suggested (demonstrated) an 80.3% decrease in HFS at the 8-month follow-up.
Arving, C., Sjödén, P. O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., & Brandberg, Y. (2007). Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19.
To compare if individual psychosocial support for patients with breast cancer provided by oncology nurses specially trained in cognitive behavioral techniques was as effective as that given by psychologists or standard care.
Patients received individualized psychosocial support interventions using cognitive behavioral techniques, such as relaxation, distraction, activity scheduling, and ways to improve communication. The frequency of sessions varied based on patients' perceptions of need. Patients were randomized in blocks of nine into one of three alternatives: 60 received individual psychosocial support by a specially trained oncology nurse, 60 received it from a psychologist, and 59 received standard care. Outcomes measured were quality of life (QOL), fatigue, nausea, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties.
The study was conducted at the Department of Oncology, Uppsala University, Sweden.
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized, quasiexperimental study using repeated measures at baseline and at one, three, and six months.
The results revealed statistically significant group by time interactions for global QOL and health status, nausea and vomiting, and systemic therapy side effects. Intervention groups showed statistical differences on the insomnia, dyspnea, and financial difficulties EORTC subscales, in favor of one or both of the interventions.
Arving, C., Sjödén, P. O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B. & Brandberg, Y. (2007). Individual psychosocial support for breast cancer patients: a randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19.
Patients were randomized to two intervention groups: Individual Psychosocial Support, provided by a trained oncology nurse (INS), and Individual Psychosocial Support, provided by a psychologist (IPS). Both interventions used the same techniques of relaxation, distraction, activity scheduling, and ways to improve communication. The number of sessions and time intervals between sessions varied according to the needs and desires of individual patients. Each session lasted 45 to 60 minutes, in which patients' problems were identified and developments were made to help manage these problems. Patients were provided with written and oral instructions on how to practice these strategies. Quality of life questionnaires were administered at baseline and at one, three, and six months.
Department of Oncology, Uppsala University Hospital
Patients were undergoing the active treatment phase of care.
This was a prospective, randomized study.
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
Intervention groups had lower fatigue scores on the EORTC-QLQ-C30 at baseline, one month, and six months; these differences were minimal and not statistically significant.
Arving, C., Sjödén, P.-O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., et al. (2007). Individual psychosocial support for breast cancer patients: A randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30, E10–E19.
To compare individual psychosocial support (cognitive behavioral therapy [CBT]) for patients with breast cancer provided by oncology nurses specially trained in psychologic techniques (INS), or the same support given by psychologists (IPS), versus standard care provided in Sweden.
Measures were done at one, three, and six months after inclusion in study.
The sample was comprised of 179 patients with breast cancer who were about to start adjuvant therapy.
A prospective, randomized study design was used.
Results indicated that CBT offered by specially trained nurses is just as effective as CBT offered by psychologists. Statistically significant improvements in anxiety over time (p < 0.01) were shown between the INS and IPS groups versus the standard care group.
Arvaniti, K., Lathyris, D., Clouva-Molyvdas, P., Haidich, A.B., Mouloudi, E., Synnefaki, E., . . . Catheter-Related Infections in ICU (CRI-ICU) Group. (2012). Comparison of oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: A multicenter, randomized, controlled study. Critical Care Medicine, 40, 420–429.
To evaluate the effectiveness of oligon central venous catheters (CVC) and chlorhexidine biopatch to reduce CVC-related infections. Oligon catheters are impregnated with antimicrobial silver, platinum, and carbon.
Patients were randomized to receive either a standard polyurethane catheter, a standard catheter plus biopatch, or an oligon catheter. All catheters were triple lumen. Standard maximum barrier insertion techniques were used, and dressing change frequency was every three days with a transparent dressing. Those getting the biopatch had the biopatch changed with regular dressing changes. The primary study endpoint was catheter colonization. A decision to remove the catheter was made by individual physicians.
There were no differences in catheter colonization rates, CRI, or CLABSI between groups. There were no differences between groups in number of catheter days, CLABSI incidence per 1,000 catheter days, or other factors potentially associated with development of CLABSI. Analysis showed that use of jugular or femoral insertion site and cancer diagnosis were significantly associated with development of catheter colonization (p < 0.05).
Findings did not support efficacy of BIOPATCH dressings or antimicrobial catheters for prevention of catheter-related colonization or infections.
Findings did not show efficacy of chlorhexidine-BIOPATCH CVC dressings or antimicrobial impregnated short-term catheters to prevent catheter colonization and related CVC-infection related outcomes.
Arslan, M., & Ozdemir, L. (2015). Oral intake of ginger for chemotherapy-induced nausea and vomiting among women with breast cancer. Clinical Journal of Oncology Nursing, 19, E92–E97.
To determine the effects of ginger on chemotherapy-induced nausea and vomiting (CINV) in women receiving adjuvant anthracycline for breast cancer
Patients were randomly assigned to control and treatment groups. Women in the intervention group consumed 500 mg of powdered ginger mixed with yogurt twice daily after an initial dose 30 minutes prior to chemotherapy. Both groups received triplet antiemetic therapy. Patients were followed for five days and were asked to record episodes of vomiting and retching and to evaluate their nausea using a numeric 10-point scale four times per day in a diary. The numeric scale also was used on the first day of chemotherapy to collect baseline data. Patient diaries were collected at the end of the five-day study period.
Randomized, controlled trial
Nausea severity was significantly lower in the experimental group after the intervention on study days 2–5 (p = 0.0001). The number of vomiting episodes also was lower in the experimental group on some study days (p < 0.05).
The use of ginger as an adjuvant to triplet antiemetics among women receiving anthracycline-based chemotherapy resulted in lower acute and delayed nausea severity.
Advances in antiemetic drugs have substantially improved the prevention and control vomiting in the acute and delayed phases of CINV. However, the prevention of nausea has been difficult to achieve. Findings from this study suggest that the use of ginger in combination with triplet antiemetics can be beneficial in reducing the severity of nausea.
Arrieta, O., Vega-Gonzalez, M.T., Lopez-Macias, D., Martinez-Hernandez, J.N., Bacon-Fonseca, L., Macedo-Perez, E.O., . . . de la Garza-Salazar, J. (2015). Randomized, open-label trial evaluating the preventive effect of tetracycline on afatinib-induced skin toxicities in non-small cell lung cancer patients. Lung Cancer (Amsterdam, Netherlands), 88, 282–288.
To evaluate the effectiveness of prophylactic tetracycline on afatinib-induced skin toxicities
Afatinib was given after disease progression with chemotherapy. Patients receiving afatinib were randomly assigned to receive general dermatological recommendations (control group) or 250 mg tetracycline every 12 hours in addition to general recommendations. All were receiving 40 mg afatanib every day until disease progression or toxicity. Dosage of afatinib was reduced to 30 mg daily for grade 3 or prolonged grade 2 toxicity. General recommendations provided to all patients were brief baths with lukewarm water, use of sunscreen, emollient creams, hypoallergenic soap, and fingernail care. Study assessments were conducted at baseline, week 2, and week 4 by a blinded assessor.
PHASE OF CARE: Active antitumor treatment
Most common toxicities were rash (65.6%), pruritus,(42.2%), mucositis (41.1%), paronychia (33.3%), skin fissures (24.4%), folliculitis (24.4%), and trichomegaly (22.2%). No grade 5 toxicities existed. Rash incidence was 75.5% in the control group versus 55.5% in the tetracycline group (relative risk [RR] = 0.4, p = 0.046), and rash severity of grade 2 or higher was 15.6% in the tetracycline group compared to 35.6% among controls (RR = 0.35, p = 0.03). Incidence of paronychia was lower in the tetracycline group, but group differences were not statistically significant. No other differences existed between groups in skin effects, and no differences existed between groups in the proportion of patients who required afatinib dose reductions. Most patients developed maximum rash intensity between weeks 1 and 4 of treatment. No relationship existed between rash incidence or severity and general disease outcomes.
Prophylactic tetracycline was effective in reducing the incidence and severity of rashes associated with afatinib use.
Very limited evidence exists for effective interventions to prevent or treat skin toxicities associated with epidermal growth factor receptor inhibitor (EGFRI) administration. Although the use of antibiotics has been suggested, currently little research demonstrates their efficacy. This study begins to fill that evidence gap, showing that tetracycline can be effective in reducing the incidence and severity of skin toxicity. This is a relatively low-cost and generally safe intervention to reduce adverse skin effects in patients receiving EGFRIs.