Vitale, K.M., Violago, L., Cofnas, P., Bishop, J., Jin, Z., Bhatia, M., ... Satwani, P. (2014). Impact of palifermin on incidence of oral mucositis and healthcare utilization in children undergoing autologous hematopoietic stem cell transplantation for malignant diseases. Pediatric Transplantation, 18, 211–216.
To determine if administration of palifermin during autologous hematopoietic stem cell transplantation (AHSCT) in children will lower incidence of oral mucositis and shorter duration of hospitalization
Patients received palifermin 60 µg/kg/day IV for the three consecutive days prior to myeloablative conditioning and for the three consecutive days after the end of chemotherapy. All patients received six total doses. Treating physicians were responsible for the decision to administer palifermin. Data were collected using electronic and paper medical charts.
No statistical difference in grades III-IV mucositis (p = 1.0), lower incidence in grades III–IV (p = 0.047) in patients receiving solid tumor regimen, and no difference in length of hospitalization
Palifermin administration did not result in a statistically significant decrease in incidence and grade of oral mucositis, nor did it result in shorter hospitalization.
High doses of chemotherapy prior to AHSCT causes significant morbidity due to oral mucositis. A larger study is needed to confirm findings of lower incidence of grades III and IV mucositis in the solid tumor regimens.
Vissers, D., Stam, W., Nolte, T., Lenre, M., & Jansen, J. (2010). Efficacy of intranasal fentanyl spray versus other opioids for breakthrough pain in cancer. Current Medical Research and Opinion, 26(5), 1037–1045.
To compare the effectiveness of oral morphine to that of rapid-onset opioids, intranasal fentanyl spray (INFS), oral transmusocal fentanyl citrate, and fentanyl buccal tablets in the management of breakthrough cancer pain (BTCP)
Databases searched were MEDLINE, EMBASE, and BIOSIS Citation Index. The search was for the period 1996–October 2007. In addition, investigators searched conference proceedings. Pre-published data regarding INFS were included.
Search keywords included the generic and brand names of opioids and combinations of generic and brand names and pain and episodic, breakthrough, transient, flare, incident, exacerbation and transitory, cancer, malignant, tumor, and neoplasia.
Studies were included if they were
The initial review was of 128 abstracts. Assessment of abstracts and full articles, according to inclusion criteria, identified six RCTs for analysis.
PID was measured at various time points across studies. Meta-analysis demonstrated that INFS provided the greatest reduction in pain within 15 minutes, with a 99% probability in all comparisons. Oral morphine was no better than placebo within the first 45 minutes of a breakthrough episode. Oral morphine was only better than placebo after 45 minutes. INFS provided better relief than did buccal fentanyl before 45 minutes and better relief than did oral transmucosal fentanyl citrate for the first 60 minutes.
Findings show that INFS provides better rapid-onset pain relief for BTCP than does oral morphine, transmucosal oral fentanyl, and buccal fentanyl tablets. Oral morphine showed the same level of pain relief as placebo for the first 30 minutes, showing that oral morphine is an inappropriate treatment for BTCP.
All studies involved an initial period in which appropriate dosing of INFS was established for each patient. Effective use of INFS necessitates determination of individualized dose.
Visovsky, C., Bovaird, J., & Tofthagen, C., & Rice, J. (214). Heading Off Peripheral Neuropathy with Exercise: The HOPE Study. Nursing and Health, 2, 115–121.
To determine the effectiveness of an aerobic and strength training program on neurotoxic symptoms, gait, balance, and quality of life in women with breast cancer treated with taxol
Women with breast cancer treated with taxol were randomized to either a strength/aerobic exercise program, which they performed at home, or to breast cancer education. The program was conducted for 12 weeks. Data were collected at baseline, every four weeks, and then three months postintervention. Education was provided to the control group, occurred at the same intervals as study group assessments, and lasted for 45 minutes. They also received reminder telephone calls every other week for data collection and equalized contact.
PHASE OF CARE: Active antitumor treatment
No significant differences existed in results between the groups regarding neurotoxic symptoms, gait or balance, or quality of life. No significant differences existed between groups regarding stage of disease, level of exercise, age, taxol dose, or breast cancer symptoms.
The results indicated that patients randomized to the exercise group experienced a small but insignificant positive effect on neurotoxic symptoms, gait, and balance.
Home exercise programs produced a small to moderate positive effect on gait and balance, symptoms, and quality of life. A large, randomized trial with patients receiving neurotoxic chemotherapy will help determine if this can be a positive intervention.
Virizuela, J.A., Escobar, Y., Cassinello, J., Borrega, P., & SEOM (Spanish Society of Clinical Oncology). (2012). Treatment of cancer pain: Spanish Society of Medical Oncology (SEOM) recommendations for clinical practice. Clinical & Translational Oncology, 14, 499–504.
To describe—in accordance with the World Health Organization (WHO) treatment strategy of pain stages—the classification, evaluation, and treatment of chronic cancer pain in adults
The resource is consensus-based, but authors did not delineate the development process.
Authors did not state any results.
Recommendations adhere to WHO guidelines for stage of pain. Authors provide some recommendations about the management of breakthrough and intractable pain, citing specific dosage suggestions for opioid formulations and coanalgesic drugs used with neuropathic pain. Authors recommend rapid-onset opioids based on transmucosal fentanyl as drugs of choice for the treatment of breakthrough pain. The resource cites sedation as the best option for refractory pain.
The basis of evidence for these recommendations is unclear. The recommendations do not reflect recent research, particularly in the area of intractable pain. The resource is primarily a reiteration of the WHO step-analgesic recommendations, which some of the most current research is challenging.
The resource provides recommendations from a professional group; nurses should keep in mind that the base of evidence regarding these recommendations is unclear.
Viola, R., Kiteley, C., Lloyd, N.S., Mackay, J.A., Wilson, J., Wong, R.K., & Supportive Care Guidelines Group of the Cancer Care Ontario Program in Evidence-Based Care. (2008). The management of dyspnea in cancer patients: A systematic review. Supportive Care in Cancer, 16(4), 329-337.
The objective of this study was to evaluate the effectiveness of four drug classes: opioids, phenothiazines, benzodiazepines, and systemic.
Databases searched were HealthSTAR, MEDLINE, CINAHL, EMBASE, Cochrane Library and Database of Abstracts and Reviews of Effects Issue 2, American Society of Clinical Oncology conference proceedings (1995-2006), Canadian Medical Association Infobase, and National Guidelines Clearing House. Reference lists from relevant articles were searched for additional trials
Search keywords were dyspnea, breathlessness, shortness of breath, respiratory distress, breath and shortness, and breath and difficult combined with terms for pharmacologic agnets, study designs, and publication types.
Inclusion criteria included
• Systematic reviews
• Meta-analyses
• Evidence-based practice guidelines
• Fully published or abstract reports of randomized or nonrandomized controlled studies of opioids, phenothiazines, or benzodiazepines administered by any route involving adult patients with dyspnea
• Subjects with any advanced disease
• Studies involving corticosteroids, only if the primary advanced disease was cancer
• Studies in which one of the outcomes reported was dyspnea, measured by a patient-reported scale.
Exclusion criteria included
• Studies in languages other than English
• Stuides eported in letters or editorials.
The total sample across 29 trials was 600 patients, with individual sample sizes ranging from 4-101. Trials included involved
Viola, R., Kiteley, C., Lloyd, N.S., Mackay, J.A., Wilson, J., Wong, R.K., & Supportive Care Guidelines Group of the Cancer Care Ontario Program in Evidence-Based Care. (2008). The management of dyspnea in cancer patients: A systematic review. Supportive Care in Cancer, 16(4), 329-337.
This systematic review evaluated the effectiveness of four drug classes (opioids, phenothiazines, benzodiazepines, and systemic corticosteroids) to relieve dyspnea experienced by patients with advanced cancer.
A criterion for inclusion in the review was a controlled trial involving the specified drug classes; however, trials were not limited to cancer except for corticosteroids.
The review identified three systematic reviews (one with meta-analysis), two practice guidelines, and 28 controlled studies.
Systemic opioids, administered orally or parenterally, can be used to manage dyspnea in patients with cancer. Oral promethazine also may be used alone or in addition to systemic opioids. Nebulized morphine, prochlorperazine, and benzodiazepines are not recommended for the treatment of dyspnea, and promethazine must not be used parenterally because of the concern for serious tissue damage when administered intravenously.
Villadolid, J., & Amin, A. (2015). Immune checkpoint inhibitors in clinical practice: Update on management of immune-related toxicities. Translational Lung Cancer Research, 4, 560–575.
RESOURCE TYPE: Expert opinion
PROCESS OF DEVELOPMENT: Review of clinical trials results and clinical experience
Currently, limited evidence regarding the effects of interventions for adverse events with immunotherapy exists, and current information is based on initial clinical trial results and personal clinical experience.
Nurses need to be aware of the myriad adverse effects that can occur with immunotherapies, and recognize that many of them can occur long after treatment has concluded. This means that patient teaching and ongoing follow-up to assess for these effects are crucial. Current sources point to the importance of early detection and interventions for the management of adverse effects to prevent more severe negative patient outcomes. As opposed to some other sources, these authors recommend against “knee jerk” implementation of systemic corticosteroids for diarrhea because such treatment may mask the development of severe colitis.
Vilela, L. D., Nicolau, B., Mahmud, S., Edgar, L., Hier, M., Black, M., . . . Allison, P. J. (2006). Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. Journal of Otolaryngology, 35, 88–96.
The Nucare program was a short-term psychoeducational coping strategies intervention. Three delivery formats were offered: (1) small group, (2) one-to-one, and (3) a home format with didactic material. The didactic material comprised a workbook, cassette or CD containing spoken instruction to guide the individual through the workbook, and music to accompany the relaxation training component. Outcomes were quality of life (QOL) and depressive symptoms.
Outpatient oncology clinic at the Jewish General Hospital Montreal, Canada
Patients were undergoing the long-term follow-up phase of care.
This was a feasibility study with a prospective, nonrandomized design, two groups, and repeated measures at baseline and three and four months.
Compared with their baseline scores, the intervention group had improved physical and social functioning, global QOL, fatigue, sleep disturbance, and depressive symptoms. The control group showed no changes in QOL or depressive symptoms.
Vilela, L. D., Nicolau, B., Mahmud, S., Edgar, L., Hier, M., Black, M., . . .Allison, P. J. (2006). Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. Journal of Otolaryngology, 35, 88–96.
The aim of the Nucare program intervention was to educate individuals with cancer on how to cope with the disease. Didactic materials consisted of a workbook, a cassette/CD guide to supplement the workbook material, and music to accompany the relaxation training component. The following eight components were emphasized in the Nucare program: good coping, ways of thinking, communication, effective use of social support, problem-solving techniques, goal setting, healthy lifestyle, and relaxation training. The intervention was delivered in three formats: (1) small-group (three to four participants with a trained therapist), (2) one-to-one (a participant and a therapist); or (3) home (the participant was provided with didactic material to use at home with no therapist). Data were collected at baseline and three to four months later.
Patients were included if they
Baseline
Follow-up
Patients who were in palliative or terminal care or who were unable to complete the outcomes questionnaires were excluded.
Outpatient clinic at the Jewish General Hospital in Montreal
Patients were undergoing the active treatment phase of care.
The study used a feasibility, prospective, nonrandomized design.
European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30)
On the EORTC QLQ-C30, a statistically significant improvement was observed in fatigue (p < 0.05) in the intervention group. The control group showed deterioration at follow-up, but it was not significant.
Vilela, L.D., Nicolau, B., Mahmud, S., Edgar, L., Hier, M., Black, M., ... Allison, P.J. (2006). Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. Journal of Otolaryngology, 35(2), 88–96.
To show the effectiveness of the Nucare program, a short-term psychoeducational intervention for patients with a cancer diagnosis, on the ability of individuals with cancer to cope with their disease
The sample was composed of 101 participants. The sample consisted of a convenience sample of patients with head or neck cancer. Participants had completed cancer treatment. The control group was matched to the internvention group in terms of length of time since diagnosis and stage of cancer.
Feasibility study using a prospective, nonrandomized design
From baseline to follow-up, the test group showed improvement in most quality-of-life scores and statistically significant improvement of depression (1.2 points, p < 0.05). The control group showed deterioration in most of the EORTC QLQ-C30 and HADS scores at follow-up. However, none of the changes was statistically significant at the 5% level.
Intervention delivery is feasible.