Olsen, D. L., Raub, W., Jr., Bradley, C., Johnson, M., Macias, J. L., Love, V., & Markoe, A. (2001). The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy. Oncology Nursing Forum, 28, 543–547.
To determine if the use of aloe and mild soap versus mild soap (Dove) alone would decrease the incidence of skin reactions. Aloe gel included aloe vera, triethanolamine, d-α tocopherol (natural Vitamin E), carbomer, tetrasodium ethylenediaminetetraacetic acid (EDTA), methylparaben, and imdazolidinyl urea.
Participants were randomized to use aloe vera gel and mild soap or mild soap alone. The skin care regimen began on the first day of treatment. Aloe was to be applied liberally after treatment each day, reapplied throughout the day, and rinsed off prior to treatment (no time frame identified). Assessments were performed on day 1 and in weekly reviews. Clinicians could order supplemental skin products as they deemed necessary.
Comprehensive Cancer Centre, University of Miami
The study was a prospective, randomized, blinded clinical trial.
The only significant difference found was delayed time to observation of a skin change with aloe in those with a cumulative dose greater than 2,700 cGy (p = 0.01).
No clear benefit of aloe vera was demonstrated.
Oliveira, S.S., Del Giglio, A.B., Lerner, T.G., Zanellato, R.M., Tiemi, L., Reifur, L., . . . Del Giglio, A. (2013). Paullinia cupana for control of hot flashes in breast cancer patients: A pilot study. Einstein (Sao Paulo, Brazil), 11, 435–438.
To evaluate the efficacy of Paullinia cupana in decreasing the number and severity of hot flashes in breast cancer survivors
The intervention consisted of 50 mg of dry extract of Paullinia cupana taken orally twice per day for six weeks. If patients presented unacceptable side effects, the intervention was stopped or the patient was removed from the study. All patients were trained to record each hot flash from a week before the initiation of the study until the sixth week. Severity was classified using published reports. The moments that were recorded took place at beginning of week 2 and then weekly until week 6. During each visit, patients' diaries were reviewed to check the severity of symptoms.
Phase-II pilot study without a control group
Of the 15 patients, 10 had a significant decrease greater than 50% in hot flash severity scores (p < .0001). The results demonstrated a statistically significant decrease in the number of hot flashes experienced by participants (p = .0009).
Although the authors reported a statistically significant decrease in the number and severity of hot flashes with the intervention of Paullinia cupana, there are many concerns regarding this study. The safety and purity of Paullinia cupana need to be established prior to recommendations of use.
It is important to be aware of a supplement (Paullinia cupana) that has been reported to decrease hot flashes in women after breast cancer treatment. Nurses also need to understand that this supplement has not been tested by the U.S. Food and Drug Administration, so the contents of this supplement cannot be proven. This study does not report any adverse effects from the agent; however, caffeine is known to be associated with adverse side effects.
Oldervoll, L. M., Kaasa, S., Hjermstad, M. J., Lund, J. A., & Loge, J. H. (2004). Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? European Journal of Cancer (Oxford, England: 1990), 40, 951–962.
Databases searched were PubMed, PsycINFO, CANCERLIT, and Cochrane Library through May 2003.
Twelve randomized trials were included. Nonrandomized trials, pilot studies, and studies in which exercise was combined with other therapies, such as cognitive therapy or diet, were excluded. Outcomes were fatigue, health-related quality of life, physical exercise capacity (maximal oxygen consumption), and other physical performance measures. Treatment evaluated aerobic exercise training (10 studies) and resistance exercise (two studies).
Three studies reported a significant reduction in fatigue. One study observed a significant reduction in fatigue, although this did not reach statistical significance. In another study, no statistical analyses were performed to examine between-group differences.
The reviewed studies indicated promising effects on both physiological and psychological outcomes. However, the reviewed studies differed widely in the length of the exercise program, its intensity, content, and frequency, and the timing of the interventions in relation to the patient’s disease and treatment.
Future exercise intervention studies should also identify fewer and more specific endpoints.
Oldervoll, L. M., Loge, J. H., Lydersen, S., Paltiel, H., Asp, M. B., Nygaard, U. V., . . . Kaasa, S. (2011). Physical exercise for cancer patients with advanced disease: a randomized controlled trial. The Oncologist, 16, 1648–1657.
To test the hypothesis that physical exercise reduces fatigue and improves physical performance in patients with advanced cancer.
Patients were randomly assigned to physical exercise (PE) or usual care (UC) groups. The PE group had two exercise sessions per week that lasted 50 to 60 minutes after a 10-minute warm-up. Exercise was performed in groups of two to eight and was supervised by a physiotherapist. Sessions included circuit training and stretching/relaxation. Focus was on muscle strength, balance, and aerobic endurance. Pre- and postintervention were performed at baseline at immediately after the intervention period.
This was a randomized, controlled trial.
Median survival times for all included patients were 11.1 months in the PE group and 12.3 months in the UC group. In the PE group, exercise adherence was 69% on average (11 of 16 sessions). Regression analysis showed no significant between-group effect in physical fatigue (estimated mean difference = -0.3; confidence interval [-1, 1.0]; p = 0.62). There were significant differences between groups in shuttle walk test (p = 0.008) and grip strength (p = 0.01) results. There were no apparent effects of the exercise intervention on mental or total fatigue, including mental and physical fatigue.
Findings showed that such an exercise program is feasible in patients with advanced disease and limited life expectancy. Findings did not provide support for the hypothesis that exercise reduces fatigue in this group of patients.
Exercise programs are feasible for patients with advanced disease. Study findings did not show that the intervention improved the symptom of fatigue, but it did improve some physical performance.
Oldenmenger, W.H., Sillevis Smitt, P.A., van Montfort, C.A., de Raaf, P.J., & van der Rijt, C.C. (2011). A combined pain consultation and pain education program decreases average and current pain and decreases interference in daily life by pain in oncology outpatients: A randomized controlled trial. Pain, 152(11), 2632–2639.
To test the effect, on pain severity and interference with daily life, of standard care versus care supplemented with pain education
Patients were referred by primary care providers and randomly assigned to the pain education program or standard care. The education intervention was provided in clinics and by telephone. Intervention included enhancing knowledge about pain and pain treatment. Patients were contacted weekly by telephone. During each call they reviewed pain outcomes and side effects and received reinforcement education as necessary. In the report of the study, authors did not described standard care. The study was conducted over eight weeks. The study was originally designed to evaluate three groups; however, because of low recruitment the study compared only two interventions.
Phases of care: multiple phases of care
Randomized controlled trial
Average reduction in pain intensity declined in both groups. The decline was 0.8 (20%) greater in those receiving the intervention program (p = 0.03) than in those receiving standard care. Pain-related interference declined more in the intervention group (p < 0.01). In the group that received the intervention, the percentage of patients who received both round-the-clock and as-needed medication increased: Of those receiving the intervention, 88% changed to this approach. In the group receiving standard care, 50% changed to the approach (p = 0.003). Adherence was initially the same across both groups. In the last two weeks, however, adherence was 74% in the standard-care group and 85% in the intervention group (p = 0.028).
The educational and support intervention was associated with greater decline in pain severity and pain-related interference, more aggressive pharmacologic management, and slightly better patient adherence over an eight-week period.
Findings from this study support evidence that psychoeducational interventions can improve pain management and pain outcomes in patients with cancer-related pain. Incorporating such interventions and related follow-up programs into nursing practice can greatly benefit patients with chronic pain.
Oldenmenger, W.H., Lieverse, P.J., Janssen, P.J., Taal, W., van der Rijt, C.C., & Jager, A. (2012). Efficacy of opioid rotation to continuous parenteral hydromorphone in advanced cancer patients failing on other opioids. Supportive Care in Cancer, 20, 1639–1647.
To describe the analgesic efficacy and side effects of parenteral hydromorphone among patients with severe cancer-related pain
Medical records were reviewed and data were collected retrospectively for patients admitted to a palliative care unit for pain management because of uncontrolled pain or severe side effects from their current pain regimens. Patients were started on parenteral hydromorphone. After starting the intervention, pain intensity and side effects were recorded twice daily. All patients had previously received opioids.
Adequate pain control was reported for 83% of patients, and among those who had improvement, the decline in mean pain score was significant (p < .001), ranging from a 2.7–3.1-point reduction. Seventeen percent had no response. Survival analysis showed continued effect of hydromorphone for 150 days for those who continued on the study (35 patients).
Switching to parenteral hydromorphone was effective for pain control in some patients who had either uncontrolled pain or severe side effects with previous pain medication regimens.
Findings suggest that opioid rotation to parenteral hydromorphone was effective for some patients who had either uncontrolled pain or unacceptable opioid side effects. This study provides rather weak evidence because of numerous study limitations, but, for those patients at the end of life with intractable pain or significant adverse effects on current pain regimens, alternative approaches that may be effective are important to consider. Parenteral hydromorphone may be an appropriate alternative for these patients.
Okumura, L.M., Rodrigues, F.A., Ferreira, M.A., & Moreira, L.B. (2016). Aprepitant in pediatric patients using moderate and highly emetogenic protocols: A systematic review and meta-analyses of randomized controlled trials. British Journal of Clinical Pharmacology. Advance online publication.
STUDY PURPOSE: To review the safety and efficacy associated with triple therapy (aprepitant, ondansetron, and dexamethasone) when given to children and adolescents receiving moderately emetogenic chemotherapy (MEC) and highly emetogenic chemotherapy (HEC)
TYPE OF STUDY: Meta-analysis and systematic review
Triple therapy with aprepitant, dexamethasone, and ondansetron had a 52% relative risk reduction in the development of chemotherapy-induced vomiting, and febrile neutropenia was not significantly different in patients receiving triple therapy compared to patients receiving dual therapy.
Triple therapy may reduce chemotherapy-induced vomiting in pediatric patients receiving MEC and HEC.
Pediatric patients receiving MEC and HEC may benefit from receiving triple therapy (aprepitant, ondansetron, and dexamethasone) for the prevention of chemotherapy-induced vomiting.
Oki, E., Emi, Y., Kojima, H., Higashijima, J., Kato, T., Miyake, Y., . . . Maehara, Y. (2015). Preventive effect of Goshajinkigan on peripheral neurotoxicity of FOLFOX therapy (GENIUS trial): A placebo-controlled, double-blind, randomized phase III study. International Journal of Clinical Oncology, 20, 767–775.
To evaluate the effectiveness of goshajinkigan (GJG) in reducing peripheral neurotoxicity in patients receiving FOLFOX for colorectal cancer
Patients with colorectal cancer were randomized to receive either GJG 7.5 mg three times daily or placebo in a double-blind manner. The time to grade 2 or higher neuropathy was the primary endpoint.
PHASE OF CARE: Active antitumor treatment
Double-blind, placebo-controlled, randomized study
Time to grade 2 or higher neuropathy as described by Common Terminology Criteria for Adverse Events (CTCAE), version 3.0, and the DEB-NTC. Standardized questions regarding symptoms of neurotoxicity and examples of answers were used to facilitate accurate classification and grading of symptoms. Grades were determined by physicians and were documented in patient records.
A total of 142 patients were evaluable. Incidence of grade 1 peripheral neuropathy was 43.8% in the GJG group and 62.4% in the placebo group; incidence of grade 2 or higher was 50.6% in the GJG group and 31.2% in the placebo group. Time to development of neuropathy was also significantly less in the GJG group (p = 0.007). GJG did not reduce time to neuropathy even for grade 1. Adverse events other than neuropathy showed no difference between the two groups. Secondary endpoints of dose intensity and treatment cycle were higher in the GJG group (not significant).
GJG did not decrease the time to grade 2 neuropathy; in fact, it seems to have hastened development. There was some effect on the dose intensity and treatment cycle given, but this was not a significant difference.
A total of 155 patients in each arm were planned, but after a total of 155 patient enrolled, an interim analysis was performed and the study was stopped at that time because of findings that GJG was not as effective as hoped. Nurses must ask patients medications, including all supplements, to educate patients on potential interactions and potential harm from supplemental medications. This is marketed in Japan for treatment for diabetic neuropathy but does not seem to be effective for chemotherapy-induced neuropathy, and education of patients is key.
Oh, P.J., & Kim, J. 2016. The effects of nonpharmacologic interventions on cognitive function in patients with cancer: A meta-analysis. Oncology Nursing Forum, 43, E205–E217.
STUDY PURPOSE: To examine nonpharmacologic intervention effects on cognitive function in adult survivors of cancer, and to examine whether these effects are driven by psychological or behavioral intervention types
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Elder care
Eleven studies used psychological interventions, and three used behavioral interventions. All studies used standard care control groups, with intervention durations of two weeks to more than one year that included an average of 16 one-hour sessions. Psychological interventions used individual-based cognitive rehabilitation (n = 10) with three using computer-based retraining programs. Outcomes included subjective cognitive function (n = 5), attention (n = 6), memory (n = 8), executive function (n = 7), verbal ability (n = 3), and multiple domains (n = 7). Low risk bias assessments: Rrandomization (n = 5), allocation concealment (n = 3), blinded participants or personnel (n = 2), blinded personnel conducting outcome assessment (n = 4), attrition (n = 12), reporting bias (n = 14), monitoring procedures, and manual use (n = 13). Statistical heterogeneity ranged from none to moderate (I2 = 0%–68%). Significant treatment effects existed for nonpharmacologic interventions on memory (n = 8, d = 0.21, 95% confidence interval [CI] [0.04, 0.38], p = 0.02, I2 = 0%) and perceived cognitive function (n = 5, d = 0.41, 95% CI [0.2, 0.61], p < 0.001, I2 = 0%). Subgroup analysis for psychological interventions was significant for effect on perceived cognitive function (n = 3, d = 0.35, 95% CI [0.13, 0.58], p = 0.002, I2 = 0%).
The treatment effects of nonpharmacologic interventions significantly improved memory and perceived cognitive function. The meta-analysis indicated that psychological interventions significantly improved perceived cognitive function. No treatment effects from other interventions were observed, and no effects on cognitive performance in domains of executive function, attention, and verbal ability were observed. Most studies reviewed in this meta-analysis did not provide sufficient evidence to demonstrate improvement in cognitive performance. Further study is warranted using RCT designs to increase the sample pool to observe positive treatment effects.
Nonpharmacologic interventions, specifically those involving psychological interventions, have demonstrated improvements in memory and self-reported cognitive function in adult survivors of cancer.
Oh, B., Butow, P. N., Mullan, B. A., Clarke, S. J., Beale, P. J., Pavlakis, N., . . . Vardy, J. (2012). Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: A randomized controlled trial. Supportive Care in Cancer, 20, 1235–1242.
To examine the effects of medical qigong on self-reported cognitive function in patients with cancer
Participants were randomized to 10 weeks of medical qigong or usual care. Self-reports of cognitive functioning were evaluated at baseline and at the conclusion of the 10-week intervention. The medical qigong program was a weekly 90-minute group class that included a 15-minute discussion of health, 30 minutes of gentle stretching and body movement in a standing position, 15 minutes of movement in a sitting position, and 30 minutes of meditation and breathing. Two sessions were offered each week; participants could attend one or both of the sessions but had to attend for a minimum of 7 of the 10 weeks. Participants also kept a diary.
The study was a stratified, randomized controlled trial of a subset of patients from a larger study.
Participants in the intervention group showed significant improvement in perceived cognitive functioning on both the EORTC QLQ-C30 (p = 0.014) and FACT-Cog (p = 0.029) compared to the control group (usual care) over time at 10 weeks' follow-up.
Results suggest that medical qigong may improve patients' perception of their cognitive functioning. However, further studies are needed with a larger sample size, objective measures, and longer follow-up to determine whether results are sustainable.
The study suggests that qigong may be beneficial in improving cognitive function in patients with cancer. However, the drop-out rate was significant at 33%. Drop outs occurred for multiple reasons, but it shows that qigong may not be a realistic intervention for some patients with cnacer. Further studies on the specific impacts qigong has on cognitive ability need to be conducted.