Alavi, A.A., Eshraghi, M., Rahim, M.B., Meysami, A.P., Morteza, A., & Hajian, H. (2011). Povidone-iodine and bleomycin in the management of malignant pleural effusion. Acta Medica Iranica, 49(9), 584-587.
The objective of this study was to compare the effectiveness of bleomycin as a sclerosing agent with povidone-iodine with respect to efficacy, cost, accessibility, safety, ease of administration, and number of doses for complete response.
Forty participants were assigned into two treatment groups of bleomycin treatment or povidone-iodine treatment via block randomization. A 28Fr. chest tube was placed in all patients at the bedside under local anesthesia with opioids given for pain. The following day, both groups had a sclerosing agent instilled in the chest tube for one hour; bleomycin at 1 mg/kg in 60 mL saline in the study group and povidone-iodine 10%, which was diluted to obtain a final concentration of 2.5% povidone-iodine in the control group. Both groups had 5 mL of 2% lidocaine solution added to the sclerosing agent. In both groups, the chest tubes were clamped for one hour and then connected to water seal. All patients were admitted to the same unit in the hospital and experienced the same post-pleurodesis respiratory and pain management protocols. The chest tube remained in place until output decreased to 200 mL; if high output persisted more than 10 days, a Heimlich valve was placed and patients were discharged from the hospital. Chest x-rays were obtained post-chest tube removal and at 30 days post-procedure to evaluate size of pleural effusions. Pain and dyspnea after drainage ratings were recorded at discharge and at 30 days post-op.
The sample was comprised of 39 patients.
Key disease characteristics included
Key sample characteristics included
This single-site study was conducted in the inpatient unit at Valiasr Hospital in Tehran, Iran.
The study was a randomized clinical trial.
When compared with povidone-iodine, bleomycin offers the advantage of being more effective for dyspnea symptoms one month post-procedure. However, both methods appear similar in terms of pain scores, dyspnea at discharge, and recurrence of pleural effusions at one-month follow-up. For patients with concerns of iodine absorption or side effects, bleomycin would be a comparable sclerosing agent.
Alam, M., Roongpisuthipong, W., Kim, N.A., Goyal, A., Swary, J.H., Brindise, R.T., . . . Yoo, S. (2016). Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. Journal of the American Academy of Dermatology. Advance online publication.
To determine if brief guided imagery or music can reduce patient pain and anxiety during cutaneous procedures
Consecutive adults undergoing surgery for basal or squamous cell carcinoma of the face were randomized to three groups: (a) guided imagery, (b) music, or (c) control. The guided imagery patients were sent a recording of the guided imagery by mail and instructed to listen to this at least once daily starting at least four days before surgery. Those in the music group listened to music via earphones during the surgery. Patients in the other two groups also wore earphones during the surgery, but without any sound. Pain and anxiety scores were obtained before and after the procedure on the day of surgery.
There were no significant differences in average change in pain or anxiety scores between groups.
The visual imagery and music interventions as used here had no apparent effect on perioperative pain or anxiety.
This study did not show an effect of music or visual imagery on perioperative pain or anxiety. The lack of effects may be associated with the ways in which the interventions were provided or in the study design—it would be expected that pain should increase postoperatively and anxiety would decline after the surgery was completed. In addition, analysis was done regarding pre- and post-symptom change rather than actual postoperative symptom levels.
Al-Majid, S., Wilson, L.D., Rakovski, C., & Coburn, J.W. (2015). Effects of exercise on biobehavioral outcomes of fatigue during cancer treatment: Results of a feasibility study. Biological Research for Nursing, 17, 40–48.
To determine the feasibility of an exercise intervention among women receiving treatment for breast cancer and to examine the effects of exercise on hemoglobin (Hb) and maximum oxygen volume (VO2MAX) and their association with changes in cancer-related fatigue (CRF) and quality of life (QOL) while investigating changes in selected inflammatory markers
The intervention consisted of a supervised, progressive treadmill exercise program two to three times times per week delivered in a rehabilitation center for the duration of chemotherapy (9–12 weeks).
Random assignment with repeated measures
Feasibility: The recruitment rate was 45.7%, the retention rate was 87.5%, the adherence rate was 95%–97%, and the tolerance rate was 93%.
Efficacy: There were no differences in VO2MAX at baseline between the groups. The exercise group maintained pretreatment VO2MAX levels throughout chemotherapy, and the usual-care group showed a significant decline of as much as 6.3 ml/kg per minute that continued three to four weeks after treatment. CRF outcomes favored the exercise group, and QOL, physical well-being, and functional well-being declined significantly in both the experimental and usual-care groups.
Recruitment to exercise interventions is difficult. The type of exercise, location, and the choice of a self-lead or a supervised intervention may influence the decision to participate. Retention may be influenced by flexibility in scheduling and the allowance of make-up sessions. Exercise did not have a significant effect on CRF or QOL. Changes in the inflammatory markers favored the exercise group. Exercise may protect against a decline in VO2MAX but not Hb concentrations.
This study addressed exercise dose in terms of intensity, duration, and frequency when prescribing exercise as an intervention. The inclusion of inflammatory markers is a potential benefit that future research could use to quantify the effects of an exercise intervention.
Al Jaouni, S.K., Al Muhayawi, M.S., Hussein, A., Elfiki, I., Al-Raddadi, R., Al Muhayawi, S.M., . . . Harakeh, S. (2017). Effects of honey on oral mucositis among pediatric cancer patients undergoing chemo/radiotherapy treatment at King Abdulaziz University Hospital in Jeddah, Kingdom of Saudi Arabia. Evidence-Based Complementary and Alternative Medicine (eCAM), 2017, 5861024.
To evaluate the effects of honey on severe oral mucositis
Patients were randomized to the honey or control group. The experimental group was given a topical application of honey before the development of mucositis. Both groups received routine oral hygiene with lidocaine, mycostatin, daktarin mouth gel, and mouthwash.
Open-label, randomized, controlled trial
Analysis showed an absolute risk reduction for the development of grade 3–4 mucositis of 35% among those using honey (p = 0.02). Less Candida colonization (p = 0.003) and bacterial colonization (p = 0.003) were seen in the honey group.
Honey may have some benefit in the management of oral mucositis.
There may be some benefit from the use of honey to coat oral mucosa in the management of chemotherapy-induced oral mucositis. This study had several limitations.
Akhu-Zaheya, L.M., Khater, W.A., & Lafi, A.Y. (2016). The effectiveness of hologram bracelets in reducing chemotherapy-induced nausea and vomiting among adult patients with cancer. Cancer Nursing. Advance online publication.
To determine if the use of a hologram bracelet is effective in the management of chemotherapy-induced nausea and vomiting (CINV) in adult patients with cancer
A hologram bracelet was used as the intervention, and a counterfeit bracelet was used as the placebo. The control group did not use any bracelet. All groups received standard antiemetics. Data were collected through three cycles of chemotherapy for each participant using daily diaries and the Functional Living Index-Emesis (FLIE) questionnaire. The hologram bracelet is said to stabilize body energy by covering very low intensity magnetic fields. Theoretically, it attracts special charges that affect the brain in terms of regulating neurotransmitters that play a role in causing nausea and vomiting. Another theory is that the hologram reflects infrared rays into the body, which stimulate secretion of these same neurotransmitters. Data were collected at baseline, on the first day of chemotherapy, and then daily on days 2–5 for three cycles. Patients were randomized to one of three groups: hologram, placebo, and usual care control.
PHASE OF CARE: Active antitumor treatment
Less anticipatory chemotherapy-induced vomiting (CIV) severity existed in the hologram group in cycles 2 and 3 (p < 0.5). The hologram group experienced less anticipatory chemotherapy-induced nausea (CIN) only during the cycle 3 (p < 0.03). In the acute phase, no difference in CIV existed between the three groups but less CIN in the intervention group at all three cycles (all p's < 0.05). In the delayed CIV phase, the severity and frequency of CINV was significantly lower in the hologram group. Men experienced a greater positive effect than women. Overall, the hologram group had positive effects on both nausea and vomiting but greater effects on nausea. A decrease in antiemetic use was also noted. In evaluating the FLIE, higher mean scores were found in the hologram group during all three cycles of chemotherapy (p < 0.05).
The use of the hologram bracelet worn at all times during three cycles of emetogenic chemotherapy showed a significant decrease in CINV, higher levels of activities of daily living, and decreased use of antiemetics. Antiemetic prophylaxis regimens are not clearly described.
The use of a hologram bracelet may be effective as a complement to standard antiemetic use in reducing CINV but especially in increasing quality of life during treatment. This may have an effect particularly on nausea symptoms.
Akechi, T., Okuyama, T., Onishi, J., Morita, T., & Furukawa, T.A. (2009). Psychotherapy for depression among incurable cancer patients. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005537.
To investigate the effectiveness of psychotherapy for treating depression in incurable cancer patients and to evaluate the effectiveness of psychotherapy on anxiety, general psychological distress, control of cancer symptoms, quality of life, and coping measures
Databases used, in September 2005, were Cochrane Pain, Palliative and Supportive Care Group Register, Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and PsycINFO. Investigators looked for additional studies in the SciSearch database and contacted the authors of significant studies to identify trials for inclusion. Search keywords were psychotherapy, aromatherapy, art therapy, autogenic training, behavior adjustment therapy, biofeedback, implosive therapy, relaxation, yoga, hypnotherapy, imagery and psychotherapy, counseling, group therapy, socio-environmental therapy, depression, depressed, depressive, neoplasm, tumor, cancer, and carcinoma or malignancy. Authors provide extensive detailed lists of the search strategies and terms used with each database.
To be included in the analysis, studies had to
Excluded from the analysis were interventions that were not considered forms of psychotherapy, such as aromatherapy and therapeutic touch.
The initial search identified 176 studies for possible inclusion. Of these, two independent raters identified 16 studies as potentially suitable. Six of these were eliminated because they involved interventions such as aromatherapy or structured nursing assessment. The final set of literature included 10 studies. None met risk-of-bias criteria for “good” study quality.
Of the 10 studies analyzed
The duration of interventions, across studies, was 3–5 sessions.
Six studies had data that could be used in the meta-analysis of the effects of psychotherapy on depression. All used the Profile of Mood States (POMS) scale. Four involved supportive psychotherapy, one involved cognitive behavioral therapy, and one used problem-solving therapy.
Five studies could be used in the meta-analysis of the effect of psychotherapy on anxiety and general psychological distress. The five studies included 242 participants in the psychology arm and 169 in the control.
Other findings follow.
Findings suggest that the depression that patients with advanced cancer experience can be effectively ameliorated by psychotherapeutic intervention. However, questions remain concerning duration of effectiveness and timing of interventions. Most studies included in the meta-analysis investigated the impact just after or during continuous cancer treatment and included a limited number of sessions. Effectiveness is further in question because studies did not show that patients were clinically depressed or suffered from depressive disorders. Authors noted that the effects of psychotherapy, as revealed in the meta-analysis, were almost comparable to those observed with antidepressant pharmacotherapy.
Although the analysis discovered significant findings regarding the use of psychotherapeutic interventions for depression, anxiety, and psychological distress, the quality of individual studies was not high and studies involved significant heterogeneity. Subjects’ physical status was not clearly defined. Some studies involved patients during active treatment, so it is unclear if findings are applicable to patients with end-stage disease. The cost associated with psychotherapeutic interventions requiring trained mental health professionals could not be evaluated. Providing such interventions for many patients may be impossible, from the financial standpoint. Not enough studies met the criteria for meta-analysis to allow the authors to determine the impact of demographic and cultural differences on findings. These differences may influence involvement in and response to psychotherapy. Similarly, differences between types of therapy employed could not be evaluated.
Future research in this area should clarify the cost-effectiveness of psychotherapy. This area could benefit from research studies of higher quality, which would clarify effectiveness. Investigators noted that experts often recommend specific types of therapy, particularly cognitive behavioral therapy. However, this systematic review points to the need for more well-designed clinical trials to clarify the actual effect of each therapy on depression as well as on other patient outcomes.
Aisa, Y., Mori, T., Kudo, M., Yashima, T., Kondo, S., Yokoyama, A., … Okamoto, S. (2005). Oral cryotherapy for the prevention of high-dose melphalan-induced stomatitis in allogeneic hematopoietic stem cell transplant recipients. Supportive Care in Cancer, 13, 266–269.
Patients kept ice chips and ice-cold water in their mouths for 15 minutes before and during as well as for an additional 90 minutes after melphalan infusion. Patients were advised to continue swirling ice chips around in their mouths and to gargle and swallow ice-cold water every 10–20 minutes throughout oral cryotherapy. Patients were consecutively compared with a historical control group (no cryotherapy). Fludarabine was administered at 25 mg/m2 daily for five days; melphalan was administered at 70 mg/m2 daily for 15 minutes for two days.
The sample consisted of 18 patients undergoing allogeneic hematopoietic stem cell transplant (HSCT) receiving fludarabine and high-dose melphalan (140 mg/m2).
Common toxicity criteria (CTC) grading of stomatitis (0–4) was done every day from the first day of HSCT to day 28. The maximum grade recorded for each participant was considered that patient's grade.
The sample size was small sample, and the control group was based on historical reports.
Ahvazi, N.C., Hemati, S., & Mohamadianpanah, M. (2015). Effect of increase in duration of aprepitant consumption from 3 to 6 days on the prevention of nausea and vomiting in women receiving combination of anthracycline/cyclophosphamide chemotherapy: A randomized, crossover, clinical trial. Advanced Biomedical Research, 4, 238–9175.168605. eCollection 2015.
To evaluate the effect of an increased duration of aprepitant for the prevention of chemotherapy-induced nausea and vomiting (CINV)
Women scheduled to receive AC regimens (doxorubicin and cyclophosphamide) enrolled in the study were randomly assigned to two groups. One group received a three-day aprepitant regimen in the first course of chemotherapy and six days in the second course. The other group received six days of aprepitant in the first course and three days in the second course of chemotherapy. All patients also received 8 mg dexamethasone IV on day 1 followed by 80 mg dexamethasone daily. During the six day course, dexamethasone was given for six days, and on the three-day regimen, it was given for three days. A 30-day washout existed between courses. Study measures were done at baseline for both chemotherapy cycles and seven days later.
Sixty-three percent had CR with the six-day regimen compared to 39% with the three-day regimen (p < 0.001). The order of treatment regimens did not affect results.
The use of aprepitant and dexamethasone for six days was more effective than a three-day regimen for the prevention of CINV.
Findings suggest that the provision of an antiemetic regimen for a longer duration in patients receiving highly emetogenic chemotherapy may be more beneficial to prevent CINV than current three-day regimens. Further well designed research in this area would be helpful.
Ahmed, M., Rubio, I.T., Kovacs, T., Klimberg, V.S., & Douek, M. (2016). Systematic review of axillary reverse mapping in breast cancer. The British Journal of Surgery, 103, 170–178.
STUDY PURPOSE: To discuss the usefulness and safety of axillary reverse mapping (ARM) of the arm and breast during surgery on the development of breast cancer-related lymphedema
TYPE OF STUDY: Systematic review
PHASE OF CARE: Late effects and survivorship
This review showed that the ARM technique is feasible and can result in low rates of lymphedema, and identification of ARM lymphatics and nodes was higher with ANC than SNB. The rate of lymphedema during SNB was 0%–6% and 5.9%–24% during lymphatic preservation at ANC, both of which are still lower than previously stated rates. Ochoa et al. reported a lymphedema rate of 2.5% for SNB alone and 2% with ARM. Casabona et al. reported no cases of lymphedema. Crossover nodes were identified in four studies assessing ARM in SNB, two of which were metastases. Kuusk et al. identified 1/ 5 nodes, and Ochoa et al. identified 2/14 nodes, thereby suggesting that crossover nodes are not common during ARM and however many metastases are present (0%–20%). Metastases were detected at the same rate (0%–19%) in patients where ARM nodes were not preserved when identified. Ochoa et al. reported 5/27 ARM positive nodes and Han et al. reported 2/17 positive ARM nodes during SNB, while Tausch et al. identified 13/58 metastases ARM nodes during ANC.
The implications for nursing would be in the area of low-level laser therapy (LLLT) patient education, understanding of the ARM technique, and evidence related to lymphedema rate. For the present, nurses need to be knowledgeable of clinical trials involving the ARM technique and stay current with lymphedema management.
Ahmedzai, S.H., Nauck, F., Bar-Sela, G., Bosse, B., Leyendecker, P., & Hopp, M. (2012). A randomized, double-blind, active-controlled, double-dummy, parallel-group study to determine the safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate/severe, chronic cancer pain. Palliative Medicine, 26, 50-60.
To determine whether oxycodone/naloxone prolonged-release tablets (OXN PR), as compared with oxycodone prolonged-release tablets (OxyPR), can improve constipation and maintain analgesia in patients with moderate or severe chronic cancer pain.
Stopping their prestudy opioid and laxative medication, eligible patients were randomized to receive one of two treatments, OXN PR or OxyPR, for a four-week double-blind treatment phase. After beginning the study, patients attended three additional clinic visits, once weekly. Oxycodone immediate-release capsules were available as pain rescue medication and bisacodyl tablets were available as laxative rescue medication. Evaluations of bowel function, pain control, use of rescue medication, and use of laxative medication during the prior seven days were performed at each clinic visit. Quality-of-life (QOL) assessments were conducted at screening and study end.
Patients were undergoing the active treatment phase of care.
This was a randomized, double-blind, active-controlled, double-dummy, parallel-group, phase II trial.
OXN PR, as compared with OxyPR, seems to provide comparable analgesia for patients with moderate or severe cancer pain while significantly improving bowel function and reducing symptoms of constipation.
Demographic characteristics were generally well balanced between treatment groups, with the exception of a slightly higher percentage of patients aged 65 years or younger in the OXN PR group.
OXN PR seems superior to OxyPR with respect to bowel function by reducing constipation without compromising pain relief. In addition, patients receiving OXN PR had improved QOL with decreased opioid-induced constipation complications.