Miaskowski, C., Cleary, J., Burney, R., Coyne, P., Foster, R., Grossman, S., . . . Zahrbock, C. (2005). Guideline for the management of cancer pain in adults and children. APS Clinical Practice Guidelines Series. Glenview, IL: American Pain Society.
PROCESS OF DEVELOPMENT: An interdisciplinary panel of experts in cancer pain management prepared these guidelines. When unavailable, recommendations were not made or were made on the recommendation of experts in that area.
Amara, S. (2008). Oral glutamine for the prevention of chemotherapy-induced peripheral neuropathy. Annals of Pharmacotherapy, 42, 1481–1485.
The purpose of the study was to determine what role glutamine plays in preventing peripheral neuropathy.
The author searched PubMed from 1990 to May 2008 with the key words glutamine, chemotherapy, peripheral neuropathy, neurotoxicity, safety, paclitaxel, platinum compounds, and vinca alkloids. To be included, studies had to evaluate the role of oral glutamine in preventing and treating chemotherapy-induced peripheral neuropathy (CIPN). Studies were excluded if they used glutamine in the reduction of other radiation or chemotherapy-induced related toxicities such as mucositis, cardiotoxicity, diarrhea, and cachexia.
Three clinical trials were reviewed for sample, inclusion/exclusion criteria, study design, and results given. No type of measurement was used to review the study quality. Of note, the article did not state if other studies were found in the literature review.
Study 1 suggested that glutamine helps to decrease symptoms of peripheral neuropathy. Study 2 suggested that glutamine can help prevent some symptoms of CIPN. And, finally, study 3 suggested that glutamine may reduce the occurrence of CPIN.
Although each study had a small sample size, glutamine did appear to help reduce symptoms of neuropathy. However, the systematic review concluded that a lack of sufficient evidence existed to recommend oral glutamine for the prevention of CIPN. Glutamine could be beneficial in patients receiving high-dose paclitaxel and oxaliplatin.
The safety and tolerability of glutamine was not mentioned.
Amar, D., Grant, F.M., Zhang, H., Boland, P.J., Leung, D.H., & Healey, J.A. (2003). Antifibrinolytic therapy and perioperative blood loss in cancer patients undergoing major orthopedic surgery. Anesthesiology, 98, 337–342.
To determine if e amino-caproic acid (EACA) will reduce perioperative blood loss in patients with cancer undergoing orthopedic surgery (intraoperative plus 48 hours)
Blood loss and RBC units transfused did not differ. The two treated groups had a significantly lower D-dimer level (P < 0.01).
Amadori, F., Bardellini, E., Conti, G., Pedrini, N., Schumacher, R.F., & Majorana, A. (2016). Low-level laser therapy for treatment of chemotherapy-induced oral mucositis in childhood: A randomized double-blind controlled study. Lasers in Medical Science, 31, 1231–1236.
To evaluate the efficacy of low-level laser therapy (LLLT) to reduce the severity of chemotherapy-related oral mucositis in children
Patients were randomized to receive LLLT or sham control interventions. Therapy began on day 1 of diagnosis of oral mucositis and was continued daily for the next three days. Study assessments were done immediately before beginning laser therapy, on day 4 after completion of laser therapy, and on day 7. Individuals who applied the laser treatment were not involved in mucositis data collection.
Progressive decline in mucositis severity occurred in both groups, and no significant difference in grading existed between groups. Pain scores were lower in those treated with laser therapy (p < 0.05), and those getting LLLT required less analgesia.
The findings suggested that LLLT may help the management of pain from oral mucositis among children receiving chemotherapy.
The findings did not show the efficacy of LLLT among children to reduce the severity of oral mucositis. Further well-designed research is needed to determine if a role exists for LLLT in children receiving chemotherapy.
Alvarez, J., Meyer, F. L., Granoff, D. L., & Lundy, A. (2013). The effect of EEG biofeedback on reducing postcancer cognitive impairment. Integrative Cancer Therapies, 12, 475–487.
To determine the feasibility of using electroencephalography (EEG) biofeedback (neurofeedback) and identify its potential effects on cognitive impairment, sleep quality, fatigue, and psychological symptoms.
Neurofeedback was provided using an EEG system that detects and alerts the brain of phase changes to increase brain flexibility and resilience. Single EEG sensors, placed at the left C3 and right C4 for each brain hemisphere, analyze EEG activity for identification of phase state changes in the brain. During the session, the patient listened to music while sitting quietly; brief interruptions of the music signal alerted the patient that the software detected phase changes and was providing the brain feedback. No patient response or action was required because it is believed that the brain uses the feedback for its own self-organization without conscious action. Patients had twice weekly sessions for 10 weeks. Assessments were performed prior to beginning the sessions and during the fourth, seventh, and tenth week of sessions.
The study was conducted at a single outpatient site in Ohio.
The study has clinical applicability for late effects and survivorship.
The study used a feasibility quasiexperimental design.
Significant symptom presence and dysfunction were reported by this sample at baseline, as compared to normative data. Baseline comparisons to normative sample showed significant differences from the norms in all measures, indicating significant dysfunction. FACT, FACIT, and PSQI scores improved over time, although not at a constant rate over longitudinal time points. At study conclusion, symptom report of dysfunction no longer differed significantly from normative populations on three of four FACT-C subscales, FACIT, and PSQI. The proportion of patients using sleep medications declined from 39% to 17% by study conclusion. No adverse effects of the intervention were identified.
EEG neurofeedback was shown to be feasible and potentially beneficial for improving cognitive function, sleep, and fatigue in breast cancer survivors.
This study reported a potentially promising intervention that may have a positive effect on several symptoms experienced by breast cancer survivors. Additional well-designed clinical trials are needed to assess the efficacy of this approach.
Altundag, K., Dizdar, O., Ozsaran, Z., Ozkok, S., Saip, P., Eralp, Y., . . . Karahoca, M. (2012). Phase II study of loading-dose ibandronate treatment in patients with breast cancer and bone metastases suffering from moderate to severe pain. Onkologie, 35, 254–258.
To determine the efficacy and safety of loading dose IV ibandronate in women with metastatic breast cancer and bone metastases
Ibandronate 6 mg per day was administered for 15 minutes on days 1, 2, and 3 of the study, and patients were followed up until day 14 of the study. Pain was assessed by visual analog scale (VAS) and functional performance index on days 1, 7, and 14. Patients were supplied with a pain diary and instructed to record at the same time each evening. Assessments for opioid use were performed using the Morphine Equivalent Daily Dose (MEDD) index.
Pain intensity decreased on days 7 and 14 versus day 1 using the VAS. Mean Karnofsky index score increased (80.8 [SD = 13.1] and 80.8 [SD = 13.2] on days 7 and 14 versus 77.7 [SD = 11.7] on day 1; p < 0.005 on both days).
This study demonstrates the short-term safety of an intensive ibandronate dosing schedule as indicated by the good tolerability profile and lack of effect on safety parameters including hematology, blood chemistry, and urine analysis. Intensive ibandronate therapy provides a well-tolerated alternative treatment option to analgesic use for patients requiring rapid relief of moderate to severe metastatic bone pain, particularly patients experiencing breakthrough or opioid-resistant pain.
Ibandronate therapy provides alternative pain relief to patients with breast cancer who have bone metastases and, thus, should improve quality of life with good tolerance and no renal safety concerns.
Alterio, D., Jereczek-Fossa, B.A., Zuccotti, G.F., Leon, M.E., Sale, E.O., Pasetti, M., … Orecchia, R. (2006). Tetracaine oral gel in patients treated with radiotherapy for head-and-neck cancer: Final results of a phase II study. International Journal of Radiation Oncology, Biology, Physics, 64, 392–395.
The study was conducted between July 2000 and December 2003.
This was a prospective, descriptive study.
Almyroudis, N.G., Osawa, R., Samonis, G., Wetzler, M., Wang, E.S., McCarthy, P.L., & Segal, B.H. (2016). Discontinuation of systematic surveillance and contact precautions for vancomycin-resistant enterococcus (VRE) and its impact on the incidence of VRE faecium bacteremia in patients with hematologic malignancies. Infection Control and Hospital Epidemiology, 37, 398–403.
To evaluate if discontinuing systematic VRE surveillance and contact isolation of colonized patients affects the incidence of vancomycin-resistant enterococcus (VRE) faecium bacteremia
Prospective nonrandomized observational study comparing the incidence of VRE faecium bacteremia in colonized patients with hematologic malignancies during the period of active surveillance/contact precautions versus no active surveillance/contact precautions
Comparing study periods, no significant difference existed in incidence of VRE bacteremia, MRSA bacteremia, and C-diff. Antibiotic utilization was not significantly different between study periods. Levofloxacin prophylaxis had no affect on the incidence of VRE bacteremia. Daily chlorhexidine bathing showed no effect on VRE colonization/bacteremia. No significant difference existed in aggregate antibiotic use and incidence of bacteremia ≤ 30 days prior between study periods. Nursing hours/patient day was not significantly different during study periods. No significant difference existed in patient demographics, patients per service, or underlying hematologic malignancies between study groups/periods.
In a single-site institution (with sporadic molecular epidemiology of VRE faecium in patients with hematologic malignancies), the incidence of VRE faecium bacteremia was not significantly different comparing study periods—active surveillance/contact precaution per institutional policy and after discontinuation of policy. Incidence of MRSA bacteremia and C-Diff remained stable.
A single-site study revealed that VRE bacteremia incidence in hematologic malignancy inpatients was not affected by VRE surveillance/contact precautions. Nursing practice measured as hours/patient day was not an effective measure for influencing nursing-sensitive infection-related outcomes. Larger multisite trials that include nursing-sensitive measures are needed to identify the most effective practices essential to prevent/control VRE bacteremia in high-risk patients.
Almenar Cubells, D., Bosch Roig, C., Jimenez Orozco, E., Alvarez, R., Cuervo, J.M., Diaz Fernandez, N., . . . LEARN II Study Group. (2013). Effectiveness of daily versus non-daily granulocyte colony-stimulating factors in patients with solid tumours undergoing chemotherapy: A multivariate analysis of data from current practice. European Journal of Cancer Care, 22, 400–412.
To provide information about patterns of granulocyte colony-stimulating factors (G-CSF) use in Spanish oncology clinical practice and to compare neutropenia-related outcomes in patients treated daily with G-CSF with patients receiving nondaily G-CSF (pegfilgrastim)
Medical records were reviewed for data collection and analysis of outcomes in patients who received pegfilgrastim compared to those who received daily G-CSF.
In the multivariate analysis following adjustment for possible confounding factors, a significantly higher risk (OR 1.73, 95% CI 1.004–2.97) of severe neutropenia was associated with daily G-CF versus pegfIlgrastim. The patient group receiving daily G-CSF had a 73% higher probability of grade 3 or 4 neutropenia. Patients receiving daily G-CSF experienced a greater number of dose reductions (38.4% versus 31/6%, p = 0.116) and delays (54.7% versus 41.7%, p = 0.013). Chemotherapy dose intensity of less than 85% also was greater in the daily G-CSF group (39.4% versus 28.9%,p = 0.030). Response rates also were lower in the daily G-CSF group. Complete responses were 17% for daily G-CSF versus 26.4% for the pegfilgrastim group (p = 0.028) and partial response was 41.2% for daily G-CSF versus 52% for the pegfilgrastim group (p = 0.009), again demonstrating better response in the pegfilgrastim group. The two main adverse reactions reported were bone pain and asthenia, with a higher incidence noted in the daily G-CSF group (6.2% versus 1.7%, p = 0.025). Patients receiving at least five days of daily G-CSF, versus those who received fewer than five days, experienced better outcomes.
G-CSF and pegfilgrastim can reduce the incidence and adverse outcomes of treatment-related neutropenia. If G-CSF is stopped prematurely, the efficacy is compromised. This study demonstrates that G-CSF often is initiated later than recommended following chemotherapy, and patients receive fewer days per cycle than required for optimum efficacy.
Daily G-CSF and pegfilgrastim are used prophylactically to reduce grade 3 or 4 neutropenia, incidence of FN, dose delays and reductions, and FN-related hospitalizations, and to increase response to chemotherapy, measured as complete, partial, or nonresponse per physician’s criterion. Suboptimal dosing is more prevalent with daily G-CSF because of starting later than recommended following myelosuppressive chemotherapy and stopping too early.
Allison, P. J., Nicolau, B., Edgar, L., Archer, J., Black, M., & Hier, M. (2004). Teaching head and neck cancer patients coping strategies: results of a feasibility study. Oral Oncology, 40, 538–544.
To test the feasibility of providing a psychoeducational intervention for people with head and neck cancer.
The NuCare coping strategies program used a self-study book and audiocassette designed to enhance personal control and teach emotional and instrumental coping responses. It consisted of training in problem solving, relaxation, coping skills, goal setting, communication, social support, and lifestyle factors. Three participants chose to receive it in a small group format, 33 chose one-on-one sessions with a therapist, and 23 chose a home format with no therapist. The outcomes measured were quality of life (QOL), anxiety, and depression.
The study was conducted at the head and neck oncology outpatient clinic of the Montreal Jewish General Hospital, Quebec, Canada.
Patients were undergoing the active treatment phase of care and were evaluated at baseline and three-month follow-up.
This was a prospective, nonrandomized, one-group, feasibility study.
The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLC-C30) was used to measure QOL and sleep.
Patients reported improvement in physical and social functioning and global QOL, sleep disturbance, fatigue, and depressive symptoms.