Toth, M., Marcantonio, E.R., Davis, R.B., Walton, T., Kahn, J.R., & Phillips, R.S. (2013). Massage therapy for patients with metastatic cancer: A pilot randomized controlled trial. Journal of Alternative and Complementary Medicine, 19, 650–656.
To determine the feasibility and effects of providing therapeutic massage at home for patients with metastatic cancer
The study shows that therapeutic massage at home is a feasible intervention. However, its effects on anxiety or pain were not conclusive. The small and uneven sample sizes across groups are a major weakness of the study. Although two measures were used for anxiety, the authors did not state which measures were used for the main analysis. Validity of measurements (i.e., alertness, and quality-of-life measure) is also problematic.
The role of nurses for this intervention is not clear. The massage therapy given in the present study was a professional intervention.
Toseland, R.W., Blanchard, C.G., & McCallion, P. (1995). A problem solving intervention for caregivers of cancer patients. Social Science and Medicine, 40, 517–528.
An experienced oncology social worker with a master’s degree in social work led six individual, one-hour counseling sessions. All participants attended at least four sessions. The sessions included three components: support, problem solving, and coping skills.
Regional medical oncology center
The study was a properly designed randomized controlled trial: intervention (n = 38) versus standard available care (n = 40).
For caregivers who reported high levels of burden, the intervention led to a significant improvement in their ability to cope with pressing problems. No main effects of the intervention were found on any outcome variable. For caregivers who reported low marital satisfaction, the intervention led to improvement in physical, role, and social functioning.
Torta, R., Siri, I., & Caldera, P. (2008). Sertraline effectiveness and safety in depressed oncological patients. Supportive Care in Cancer, 16, 83–91.
To examine the effectiveness and safety of the antidepressant sertraline (selective serotonin reuptake inhibitor) in treating somatic and emotional symptoms of depression in patients with cancer
To evaluate the effect of sertraline treatment on quality of life (QOL)
The intervention was a 12-week trial with a flexible dose regimen of sertraline. Patients started at a dosage of 25 mg/day, with a possible increase to 100 mg/day. The treatment response was assessed at baseline (T0), week 4 (T1), and week 12 (T2).
Patients were undergoing the active treatment phase of care.
An open-label, noncomparative, prospective pilot study design was used.
Mean daily dose of sertraline was 57.50 (+_18.74) mg at T1 and 57.41 (+_18.10) mg at T2. Both mean depression scores, analyzed by HADS and MADRS scales, and HADS anxiety scores significantly decreased during the 12 weeks of study (all p values < 0.05). Mean Mini-MAC scores showed that hopelessness and anxious preoccupation decreased significantly at T2 compared with T0 (p < 0.05). QOL improved over time (p < 0.05). CGI was improved over the treatment period; however, no statistical tests were involved. No severe adverse effects were observed. Six patients reported varying degrees of side effects (nausea, agitation, insomnia, and dizziness).
Sertraline may be effective for the treatment of depressed outpatients with cancer. However, stronger evidence is needed.
Nurses can inform patients of a possible option to decrease depressive symptoms during chemotherapy.
Torta, R., Siri, I., & Caldera, P. (2008). Sertraline effectiveness and safety in depressed oncological patients. Supportive Care in Cancer, 16, 83–91.
To examine the effectiveness and safety of sertraline on somatic and emotional symptoms of depression and on the quality of life of cancer patients
The intervention was a 12-week trial with a flexible-dose regimen of sertraline (a selective serotonin reuptake inhibitor). Patients started the regimen with a dose of 25 mg/day, with a possible increase to 100 mg/day. The treatment response was assessed at baseline (T0), at week 4 (T1), and at week 12 (T2).
Single site (outpatient)
Active treatment
Open-label noncomparative prospective pilot study
Mean daily dose of sertraline was 57.50 (±18.74) mg at T1 and 57.41 (±18.10) mg at T2. Both mean depression scores, HADS and MADRS, and HADS anxiety scores significantly decreased during the 12 weeks of the study (all p's < 0.05). Mean mini-MAC scores show that hopelessness and anxious preoccupation decreased significantly at T2, compared with scores at T0 (p < 0.05). Quality of life improved over time (p < 0.05). CGI improved over the treatment period; however, no statistical tests were involved. No severe adverse effects were observed. 6 patients reported varying degrees of side effects (e.g., nausea, agitation, insomnia, dizziness).
Sertraline may be effective; a more definitive conclusion requires stronger evidence.
Nurses can tell patients that sertraline may be an option in the treatment of symptoms of depression during chemotherapy.
Torta, R., Siri, I., & Caldera, P. (2008). Sertraline effectiveness and safety in depressed oncological patients. Supportive Care in Cancer, 16, 83–91.
Sertraline was started at a dosage of 25 mg/day in a single daily dose, with a possible dosage increase based on individual response and tolerability until 100 mg/day. A minimum dosage of 50 mg/day had to be reached. Patient outcomes were assessed at baseline (T0), week 4 (T1), and week 12 (T2).
Psychooncology Unit, St. Giovanni Battista Hospital, University of Turin, Italy
Patients were undergoing the active treatment phase of care.
The study used a pilot, open-label, noncomparative, prospective design.
Montgomery-Åsberg Depression Rating Scale (MADRS)
For lassitude (fatigue), a subitem on the MADRS, there was a significant difference between baseline and week 12. Between baseline and week 4, an improvement was evident but not significant. Fatigue was not a major outcome.
Torta, R., Leombruni, P., Borio, R., & Castelli, L. (2011). Duloxetine for the treatment of mood disorder in cancer patients: A 12-week case-control clinical trial. Human Psychopharmacology, 26, 291–299.
To investigate the efficacy and tolerability of duloxetine in patients with cancer with mood disorder
Consecutive patients with diagnosed mood disorder started a regimen of duloxetine. They received an initial dose of 30 mg/day for one week, then 60 mg daily. If response was poor after one month, the dose was increased to 120 mg. Benzodiazepines were allowed as needed during the first two weeks. Study assessments were done at baseline, week 4, and week 12. Analysis compared results pertaining to those who had cancer and to those who did not.
Prospective observational design
Overall, 20% of patients dropped out of the study. Of the patients with cancer, 15% dropped out due to agitation, insomnia, or tachycardia. Analysis showed similar response over time of those with and without cancer diagnoses. Depression and anxiety by all measures declined at all follow-up times (p < 0.001).
Duloxetine was effective in reducing anxiety and depression in patients with and without cancer. The majority of patients tolerated the medication well.
Findings suggest that antidepressant use by patients with cancer who also have clinically relevant mood disorders can improve symptoms of anxiety and depression. Note: Most antidepressant studies that show a positive impact involve use by patients who have clinically relevant mood disorders at baseline.
Torres Lacomba, M., Yuste Sanchez, M.J., Zapico Goni, A., Prieto Merino, D., Mayoral del Moral, O., Cerezo Tellez, E., & Minayo Mogollon, E. (2010). Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: Randomised, single blinded, clinical trial. BMJ (Clinical Research Ed.), 340, b5396.
To determine effectiveness of an early physiotherapy program in reducing the risk of secondary lymphedema in women after surgery for breast cancer
Early therapy included manual lymph drainage, stretching exercises for key muscle groups, progressive active and assisted shoulder exercises, proprioceptive facilitation exercises without resistance along with education consisting of instruction with printed materials. All patients were followed up 4 weeks after surgery and at 3, 6 and 12 months. Follow-up time points were somewhat flexible by design; however, actual differences in follow-up are not described. If secondary lymphedema occurred, complex decongestive therapy was carried out.
The study took place in an outpatient setting in Spain.
The study used a randomized, single-blinded, controlled trial design.
Incidence of secondary lymphedema was 25% in the control group compared to 7% in the intervention group (p = 0.01). In both groups the volume of the affected arm increased over time. In the control group, the volume was an average of 5.1% greater in the affected arm compared to 1.6% greater in the intervention group (p = 0.0065). Survival analysis showed that secondary lymphedema developed more rapidly in the control group and the protective effect of early physiotherapy remained for a longer time.
Early physiotherapy can be an effective intervention for prevention or mitigation of secondary lymphedema after surgery for breast cancer within one year after surgery.
Early physiotherapy and related exercises are helpful in preventing or mitigating lymphedema in the short term for patients who have had surgery for breast cancer involving axillary lymph node dissection. Ongoing research in this area is needed to determine effective strategies in the longer term for this chronic problem.
Topkan, E., Yildirim, B.A., Guler, O.C., Parlak, C., Pehlivan, B., & Selek, U. (2015). Safety and palliative efficacy of single-dose 8-Gy reirradiation for painful local failure in patients with stage IV non-small cell lung cancer previously treated with radical chemoradiation therapy. International Journal of Radiation Oncology, Biology, Physics, 91, 774–780.
To investigate the safety and efficacy of single-dose palliative chest reirradiation for pain control
Patients who had been treated with three-dimensional conformal radiation therapy (RT) and concurrent cisplatin-based therapy were given reirradiation to the chest area previously included in the > 90% prescribed dose region. Pain management was evaluated according to the World Health Organization step ladder.
Retrospective, descriptive study
There were no radiation-associated toxicities greater than grade 2. The median VAS score before reirradiation was 7 (range = 4–9), and the median score after reirradiation was 3 (range = 0–8, p < 0.001). Thoracic disease was stabilized in 33.3% of patients and partially regressed in 21.1%. No factors predicting better pain responses were identified.
Reirradiation to the chest area was effective for most patients in reducing pain associated with non-small cell lung cancer. It was not associated with severe adverse effects. Two patients developed esophagitis, and three developed pneumonitis. The median time to the lowest pain score was 27 days, and the mean duration of relief was 6.1 months.
Locoregional failures at the margins of previous RT fields can be associated with severe pain in patients with lung cancer. This study suggested that single-dose reirradiation may reduce pain.
Topkan, E., & Karaoglu, A. (2006). Octreotide in the management of chemoradiotherapy-induced diarrhea refractory to loperamide in patients with rectal carcinoma. Oncology, 71(5–6), 354–360.
This study was prospectively designed.
The primary goal was complete resolution of CRTID. The secondary goal was prevention of treatment delays attributed to diarrhea.
Tookman, A. J., Jones, C. L., Dewitte, M., & Lodge, P. J. (2008). Fatigue in patients with advanced cancer: a pilot study of an intervention with infliximab. Supportive Care in Cancer, 16, 1131–1140.
In the original protocol, infliximab was given as an intravenous infusion at 5 mg/kg over a two-hour period, followed by a two-hour observation period, at baseline and two, four, and every four weeks after that if improvement was demonstrated. After a patient suffered a serious infection following the week 2 infusion, the dosing regimen was amended to 5 mg/kg at week 0 and every four weeks after if improvement was observed. The first five patients were treated under the original protocol, and the next 12 were treated according to the amended protocol. Patient outcomes were evaluated at every time point.
Outpatient, daytime therapy clinics for specialist palliative care at the Marie Curie Hospice, United Kingdom
Patients were undergoing the palliative phase of care.
This was an open-label, pilot study.
Fatigue Severity Scale (FSS)
The infliximab intervention did not show an overall improvement of fatigue in patients. However, a small cohort of six patients showed an improvement in FSS scores over time with repeated infliximab infusions, although this difference did not reach statistical significance. The six patients shared a similar profile of NSCLC that was progressive through chemotherapy and received the amended protocol treatment.