Pergolizzi, S., Iati, G., Santacaterina, A., Palazzolo, C., Di Pietro, A., Garufi, G., & Ferrau, F. (2006). Treatment planning in patients with bone metastases. Final results of a prospective study using pre-medication with fentanyl to improve irradiation reproducibility. Supportive and Palliative Cancer Care, 2, 71–75.
To evaluate the compliance to radiation treatment planning of patients with bone metastases who have been premedicated with transdermal fentanyl
Fentanyl was delivered at 25–50 mcg/hour starting a week before treatment planning and during simulation. Immobilization devices were not mandatory.
Italy
Prospective study
Transdermal fentanyl is efficacious and associated with minimal side effects.
Previous studies have shown that perception of improved quality of life positively influences duration of survival.
Pérez, Y. L., Medina, J. A., Perez, I. L., & Garcia, C. M. (2011). Prevention and treatment of radiodermatitis using a non-adhesive foam dressing. Journal of Wound Care, 20, 130–135.
To measure healing (defined as complete re-epithelialization of the wound) and injury progression during radiation therapy (RT).
Data were collected daily from the onset of wet dermatitis until its resolution.
All patients received routine care, as described in the departmental protocol for the treatment of radiodermatitis.
The agent used was Mepilex Lite—a nonadhesive, thin, absorbent foam dressing with a soft silicone layer and film backing.
Participants were examined weekly based on Radiation Therapy Oncology Group (RTOG) Assessment Criteria 0 to 4
At onset of moist/wet desquamation, daily records were kept regarding the progression of lesions with photographs and a pain assessment until full healing was achieved.
This was an observational study with no blinding.
All wounds (20/20) progressed to full healing.
No infections occurred.
Mean total healing time was 9.5 days (range 3–22 days).
Patient rating of experience (scale from 1 to 10, with 1 being the worst and 10 being the best)
Positive clinical and patient-centered outcomes were observed.
Although the observational study showed efficacy and safety in a small number of patients, further studies need to be developed that include blinding, randomization, controls, and potential for multicenter involvement.
Moist wound healing has been shown in numerous studies to be beneficial for healing, although there have been conflicting results with the use of hydrocolloidal dressings. Consideration as to cost-effectiveness and patient ability to access dressings without significant out-of-pocket costs must be determined.
Perez, D., Sharples, K.J., Broom, R., Jeffery, M., Proctor, J., Hinder, V., . . . Findlay, M. (2015). A randomised phase IIb trial to assess the efficacy of ReCharge ice cream in preventing chemotherapy-induced diarrhoea. Supportive Care in Cancer, 23, 3307–3315.
To assess the efficacy of ReCharge ice cream in reducing the number of days with chemotherapy-induced diarrhea (CID)
Eligible patients were randomized 1:1 to ReCharge or placebo, administered as one 11 g placebo serving or ReCarge daily for 10–18 days prechemotherapy and continued for six weeks from the start of chemotherapy.
The mean number of days with CID was not statistically significant on ReCharge versus placebo. There were no statistically significant differences between the treatment arms.
The study did not demonstrate effectiveness of ReCharge in reducing diarrhea.
ReCharge is not effective in CID management.
Pereira, J., & Phan, T. (2004). Management of bleeding in patients with advanced cancer. Oncologist, 9, 561–570.
PURPOSE: To review an article with associated continuing medical education on the management of bleeding in patients with advanced cancer. Local interventions include suggestions for wound management.
Hudson, P., Quinn, K., Kristjanson, L., Thomas, T., Braithwaite, M., Fisher, J., & Cockayne, M. (2008). Evaluation of a psycho-educational group programme for family caregivers in home-based palliative care. Palliative Medicine, 22, 270–280.
To develop, implement, and evaluate a group education program to prepare family caregivers who assume primary care for a relative/friend receiving home-based palliative care
Participants attended three group educational sessions (1.5 hours each) held over a three-week period in one of six palliative care service settings. Educational sessions involved education on the caregiver role, identification of palliative care services, strategies for responding to patient needs, strategies to maintain caregiver well-being, and specific content related to preparing for death and dying care. Evaluation of the intervention included participant completion of seven validated instruments (producing nine outcomes) before program commencement, following program completion, and two weeks following the program. Qualitative assessments also occurred via semistructured interviews with at least one participant per program (16) within two weeks of program completion and via facilitator journals to reflect perceptions of the program.
A quasi-experimental, time-series design was used.
A repeated measures analysis of variance on all nine variables over three testing times found multivariate effects for time (p < 0.001), including moderate associations between time and combined dependent variables (effect size by eta² = 0.36). The intervention had significant effects (p < 0.01 or better) on caregiver preparedness, perceptions of rewards, competence, and having needs met, and this effect was sustained up to two weeks post-program. Caregiver burden showed a significant (p < 0.001) increase between time 2 (post-program) and time 3 (two weeks post-program) of assessment, a finding perhaps related to poor patient prognosis. Social support and optimism levels appeared stable. Qualitative findings demonstrated overall favorable program feedback and appreciation of practical advice on available resources and symptom management provided.
This study found that a conceptually based psychoeducational group intervention for caregivers caring for a dying patient had some positive effects on caregiver preparedness, competence, rewards, and unmet needs. However, the program did not improve caregiver optimism, burden, or social support.
Findings from this study continue to support the need for oncology nurses to assess and intervene with evidence-based programs focused on meeting the needs of caregivers of terminally ill patients. Results did not show an effect of the intervention to reduce caregiver burden; however, qualitative results desmonstrated caregiver appreciation of information on available resources and symptom management, pointing to the value of provision of this type of information to caregivers.
Peoples, A.R., Bushunow, P.W., Garland, S.N., Heckler, C.E., Roscoe, J.A., Peppone, L.L., . . . Morrow, G.R. (2015). Buspirone for management of dyspnea in cancer patients receiving chemotherapy: A randomized placebo-controlled URCC CCOP study. Supportive Care in Cancer, 24, 1339–1347.
To evaluate whether buspirone alleviates dyspnea in patients with cancer and, secondary, whether it improves anxiety.
Patients with grade 2 or higher dyspnea per OCD tool were randomized to receive buspirone or placebo for a 28-day intervention on a fixed-dose titration. Treatment was discontinued after day 28. Baseline information was obtained including demographic info and MMRCDS. Assessments were then completed using OCD and STAI-S prior to starting protocol, within 5-7 days starting protocol, and after 28 days.
Buspirone did not significantly improve dyspnea or anxiety in patients with cancer.
Buspirone was not an effective treatment option for dyspnea in patients with cancer.
Buspirone should not be used as a treatment option for dyspnea in patients with cancer.
Penha, T. R., Ijsbrandy, C., Hendrix, N. A., Heuts, E. M., Voogd, A. C., von Meyenfeldt, M. F., & van der Hulst, R. R. (2013). Microsurgical techniques for the treatment of breast cancer-related lymphedema: A systematic review. Journal of Reconstructive Microsurgery, 29(2), 99–106.
To summarize available literature on lymphatic microsurgery for breast cancer-related lymphedema
Patients were undergoing the active antitumor treatment phase of care.
Very limited evidence exists regarding the efficacy of microsurgical techniques for the prevention and management of upper extremity lymphedema in patients with breast cancer who had axillary lymph node excision. The best findings were seen with inguinal lymph node transfer. Consistent positive findings and minimal reported adverse effects were reported. However, high quality-evidence is lacking.
Findings are limited because of the low number of studies, small samples, and lack of high-quality research. Additionally, follow-up duration varied, and most studies did not report rates related to the ability to discontinue conservative management for lymphedema.
Microsurgical techniques for the prevention of lymphedema are promising; however, further high-quality research studies with long-term follow-up are needed.
Pekyavas, N.O., Tunay, V.B., Akbayrak, T., Kaya, S., & Karatas, M. (2014). Complex decongestive therapy and taping for patients with postmastectomy lymphedema: A randomized controlled study. European Journal of Oncology Nursing, 18, 585–590.
To evaluate the effects of Kinesio® taping with decongestive therapy in women with breast cancer-related upper extremity lymphedema
Patients with grade 2 or 3 lymphedema were randomly assigned to one of three groups, (1) complete decongestive therapy (CDT) and bandaging, (2) CDT, bandaging, and Kinesio taping, or (3) CDT and Kinesio taping. The study continued for 10 treatment sessions. After completion, all patients were provided with compression garments. Patients were instructed to continue exercises at home. Treatments were done by a lymphedema therapist, and patient assessments were done by a physiotherapist who was blinded to treatment allocation. Patients were assessed at baseline, after 10 days of treatment, and one month after the completion of treatment. Each group received five sessions per week for two weeks.
Single, blinded, randomized, three-group design
All groups experienced a significant reduction in arm volume during the treatment period. Those groups whose treatment included Kinesio taping had the greatest volume of reduction during the treatment period and from baseline to one month after treatment (p < 0.05). All groups experienced a reduction in associated symptoms, and there were no differences in symptoms between groups.
The addition of Kinesio taping to CDT in women with breast cancer-related lymphedema was associated with significant improvements in arm volume as measured in this study.
Kinesio taping in addition to CDT with and without bandaging may improve the effectiveness of lymphedema management. Additional larger studies are warranted for the evaluation of the role of Kinesio taping in lymphedema management. Lymphedema can be a distressing symptom, and the combined therapy tested here may be beneficial for patients. Long-term impact and associated costs need to be explored, and effectiveness in patients with varying lymphedema stages needs to be evaluated.
Peixoto, R.D., & Hawley, P. (2015). Intravenous lidocaine for cancer pain without electrocardiographic monitoring: A retrospective review. Journal of Palliative Medicine, 18, 373–377.
To document the clinical benefits and side effects of intermittent intravenous lidocaine infusions for severe cancer-related pain
The records of patients who received at least one IV lidocaine infusion were reviewed. Patients were categorized as having a major, a minor, or no response. The protocol was infusion over one hour with no loading dose. The first dose was given at 5 mg/kg in a concentration of 1–4 mg/ml. Doses were increased to a maximum of 10 mg/kg in 2 mg/kg increments. Allergies to local anesthetics, liver failure, cardiac failure, heart block, uncontrolled seizures, or systolic blood pressure greater than 160 were considered contraindications to lidocaine infusion.
Retrospective, descriptive study
Response was defined as either a decrease of three or more points on a 10-point scale, a patient report of “much better” pain relief, or movement from moderate to mild pain (considered a major response).
Overall, 49% of patients had a major response, 23.5% had a minor response, and 27.5% had no response. In addition, 43.1% had some adverse effect during at least one of the infusions, but only one patient's infusions were discontinued. The most common temporary side effects were drowsiness (30.7%), perioral numbness (13.4%), nausea (5.7%), and minor blood pressure fluctuations (3.8%). No patients had palpitations or more serious events. Responses were felt by the end of the infusion, and they often improved over the next few days and lasted from a few hours to more than four weeks.
The results of this study showed clinical benefits for pain reduction for the majority of patients with insufficient control taking strong opioids. There were few adverse effects using this protocol.
This study suggested that intravenous lidocaine infusions can be safely administered in multiple settings without electrocardiogram monitoring and was effective for pain reduction in the majority of patients for varying lengths of time. Lidocaine infusion is a promising option for appropriate patients who have refractory pain. If patients are screened for cardiac problems prior to infusion, are observed, and are able to report side effects during infusion, this treatment could be administered in a variety of settings under close nursing supervision.
Pectasides, D., Dafni, U., Aravantinos, G., Timotheadou, E., Skarlos, D.V., Pavlidis, N., … Fountzilas, G. (2007). A randomized trial to compare the efficacy and safety of antiemetic treatment with ondansetron and ondansetron zydis in patients with breast cancer treated with high-dose epirubicin. Anticancer Research, 27(6C), 4411–4417.
To compare oral ondansetron to oral dissolving tablet (ODT) ondansetron at the same dose (8 mg twice daily for three days)
This was a phase II, randomized trial.