Ng, C.G., Boks, M.P., Roes, K.C., Zainal, N.Z., Sulaiman, A.H., Tan, S.B., & de Wit, N.J. (2014). Rapid response to methylphenidate as an add-on therapy to mirtazapine in the treatment of major depressive disorder in terminally ill cancer patients: A four-week, randomized, double-blinded, placebo-controlled study. European Neuropsychopharmacology, 24, 491–498.
To test the effectiveness of major depression treatment using add-on therapy methylphenidate to mirtazapine compared with the addition of placebo to mirtazapine in terminally ill patients with cancer (prognosis of living less than three months)
Four-week, randomized, double-blind, placebo-controlled trial
Symptom relief by day 3 was noted among patients with the add-on therapy. Scores on the depression scale and severity of illness were improved by day 3 and day 14, respectively.
Early patient screening for depression among patients in palliative care is highlighted. Improved depression scores were noted by day 3 and improved the severity of illness by day 14. Consider add-on therapy with a fixed dose of mirtazapine and adding methylphenidate as described for patients with cancer with major depressive disorders in palliative care. Whether or not the rapid antidepressant effect of methylphenidate outweighs the potential for significant adverse effects needs to be individually determined for each patient.
Nguyen, T.N., Nilsson, S., Hellstrom, A.L., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing, 27, 146–155.
To evaluate the effect of music in children with cancer who undergo lumbar puncture (LP)
Children were randomized to use either earphones with music (intervention group ) or earphones without music (control group) using iPods. The researcher and physician were blinded to participant group assignment. Immediately prior to the LP procedure, heart rate, blood pressure, oxygen saturation, and respiratory rate were obtained, and pain and anxiety scores were recorded. Directly after the procedure was finished, anxiety was remeasured. Self-reported pain was obtained before, during, and after LP. Physiologic parameters were recorded throughout the procedure. No local anesthetics or other analgesics were administered, which was usual care. Ten children in each group were chosen to be interviewed as well immediately after the LP procedure.
A double-blind, randomized controlled trial design was used.
Pain scores during LP were significantly lower for the music group (p < 0.001), 2.35 compared to 5.65 in controls. Pain scores after the procedure were also lower for the music group (p < 0.003). Anxiety scores after 10 minutes of music before LP were lower for children in the music group (p < 0.001). Anxiety after LP was also lower in the music group (p < 0.001) compared to controls; however, pre- and post-differences in anxiety in both intervention and control groups were minimal. Heart rate and respiratory rate were significantly different between the two groups, with lowered heart (p = 0.012) and respiratory rate (p = 0.009) during the procedure. In interviews, most of the children in the music group indicated that listening to their favorite music helped them feel calm and took their minds off the procedure.
Use of music as a distraction may be helpful to reduce pain and anxiety in children undergoing lumbar puncture.
This study does not provide convincing support for effectiveness of listening to music to reduce anxiety, but it appeared to reduce pain during the procedure. Music provision is a potentially low-risk and low-cost intervention that may be helpful to reduce pain and anxiety in children who are undergoing uncomfortable procedures. Further study of the use of music in combination with other forms of distractions and methods to combat pain are indicated. It is not clear if providing music via use of iPod and earphones is the best approach, as children in this study did indicate that the earphones were somewhat uncomfortable, and use of earphones for multiple patients could be a potential source for transmission of infection.
Nguyen, D.T., Shayani, S., Palmer, J., Dagis, A., Forman, S.J., Epstein, J., & Spielberger, R. (2015). Palifermin for prevention of oral mucositis in allogeneic hematopoietic stem cell transplantation: A single-institution retrospective evaluation. Supportive Care in Cancer, 23, 3141–3147.
To evaluate possible differences between the severity and duration of oral mucositis (OM) and other clinical end points previously found to be associated with OM in patients who received palifermin compared to those who did not
A retrospective chart review of 99 consecutive patients who received an allogeneic hematopoietic stem cell transplantation (AHSCT) with palifermin from December 2006 to December 2009 was conducted, and 30 patients who received AHSCT from January to December 2005 served as control group (this group was treated before palifermin became standard of practice). Palifermin was administered for three consecutive days with the third dose 24 hours before the initiation of fractionated total body irradiation and three additional doses after the completion of the conditioning regimen (days 0–2). All patients received a comprehensive oral care regimen, and oral assessments were conducted every three days by a certified respiratory therapist.
OM developed in 95% of patients in the palifermin group and all 30 patients in the control group. Severe OM developed in 34% of the palifermin group and 80% of the control group (p < 0.0001) with the median duration of OM 13 days with palifermin and 18 days with the control. The median duration of sever OM was not found to be different between groups. The median duration patient-controlled analgesia use was shorter in the palifermin group as was the use of opioids. No significant difference in the duration of total parenteral nutrition use was found.
Palifermin reduced the incidence of severe OM and the overall duration of OM in this study. This supported the use of palifermin.
This study supported palifermin use in this population. However, additional studies providing evidence on quality of life and patient-reported outcomes are needed.
Ng, C.G., Boks, M.P., Roes, K.C., Zainal, N.Z., Sulaiman, A.H., Tan, S.B., & de Wit, N.J. (2014). Rapid response to methylphenidate as an add-on therapy to mirtazapine in the treatment of major depressive disorder in terminally ill cancer patients: A four-week, randomized, double-blinded, placebo-controlled study. European Neuropsychopharmacology, 24, 491–498.
To evaluate whether adding methylphenidate to mirtazapine in the treatment of depression in terminally ill patients with cancer will cause an earlier antidepressant response compared to patients receiving mirtazapine and a placebo
Patients initially were interviewed by a psychiatrist to confirm the diagnosis of major depressive symptoms using the Mini-International Neuropsychiatric Inventory. Patients were randomized and double-blinded (1:1) to receive either methylphenidate (MPH) or a placebo with mirtazapine (MTZ). Patients taking MTZ received a fixed dosage while MPH was first dosed at 5 mg BID then increased, if needed, after day 3. Outcomes were assessed at baseline and at six subsequent follow-up visits during the double-blind treatment on days 3, 6, 9, 14, 21, and 28. Assessments included the Montgomery-Asberg Depression Rating Scale and the Clinical Global Impression–Severity scale.
Randomized, double-blinded, placebo-controlled study
Although this was a small-scale study and the dropout rate was high, this study has implications for a small subset of patients. The addition of MPH to the standard treatment of depression may improve the response rates of terminally ill patients with cancer, beginning as early as three days after starting treatment. MPH must be used with caution due to side effects.
Psychosocial assessment, which includes depression, is extremely important to the nursing profession. For those who care for terminally ill patients with cancer, having options to improve quality of life for a patient suffering from depression can have significant clinical implications. Using MPH may be one option to consider when seeking quick results in treating a major depressive disorder in terminally ill patients. MPH must be used with caution due to potential side effects, and the need for further research in this population is indicated.
Newton, P.J., Davidson, P.M., Macdonald, P., Ollerton, R., & Krum H. (2008). Nebulized furosemide for the management of dyspnea: Does the evidence support its use? Journal of Pain & Symptom Management, 36(4), 424-441.
The objective of the study is to synthesize information regarding the effect of nebulized furosemide in managing dyspnea.
The final sample included 42 articles, including 39 randomized controlled trials; 2 studies in cancer, 35 in asthma, 8 studies in health volunteers, and 1 in chronic obstructive pulmonary disease.
Dyspnea was only measured in five studies reviewed.
This review demonstrates a lack of strong evidence in the area of nebulized furosemide for dyspnea and little evidence was found in the management of dyspnea in patients with cancer.
Newell, S.A., Sanson-Fisher, R.W., & Savolainen, N.J. (2002). Systematic review of psychological therapies for cancer patients: Overview and recommendations for future research. Journal of the National Cancer Institute, 94, 558–584.
The study involved searches of the MEDLINE, Healthplan, PsychLIT, and Allied and Complementary Medicine databases. The articles included were published prior to December 1998.
The study consisted of a critical review of psychological therapies used by patients with cancer. Authors identified 627 relevant articles reporting 329 intervention trials. Authors identified 11 papers discussing 15 trials of fair quality and exploring interventions aimed at reducing depression.
Despite increased use of RCT designs, the methodological quality was generally suboptimal.
No intervention can be recommended for depression reduction, but interventions involving group therapy, education, structured counseling, cognitive-behavioral therapy (CBT), communication-skills training, and self-esteem building warrant further exploration before recommendations can be made.
Newby, T.A., Graff, J.N., Ganzini, L.K., & McDonagh, M.S. (2015). Interventions that may reduce depressive symptoms among prostate cancer patients: A systematic review and meta-analysis. Psycho-Oncology. Advance online publication.
PHASE OF CARE: Multiple phases of care
The meta-analysis across all studies with all types of interventions showed a positive effect of intervention (p = 0.002). In four studies using exercise, there was no significant effect. Across three studies of psychosocial interventions, including psychotherapy and peer support, the was an overall significant effect (point estimate –0.961, p = 0.003). In two studies of educational interventions, there was no statistically significant effect.
The findings of this study suggest that psychosocial interventions can be effective in reducing depressive symptoms among patients with prostate cancer.
The majority of studies included were of low quality. The authors stated that in multiple-arm studies, outcomes were only used in certain selected study arms. For each subanalysis, there were few individual studies. There were some discrepancies in the report regarding the number of studies included. Samples were mixed in terms of inclusion of patients who did or did not have clinically relevant depressive symptoms. Most studies were brief, and the long-term benefits of the interventions were not clear.
Although this analysis provides relatively limited evidence regarding the effectiveness of individual types of interventions, its findings do suggest that some intervention is more effective than doing nothing. Nurses need to identify patients with symptoms of depression and those at risk for depression and take action.
Nes, A.G., & Posso, M.B. (2005). Patients with moderate chemotherapy-induced mucositis: Pain therapy using low intensity lasers. International Nursing Review, 52(1), 68–72.
Laser energy 35 J/cm2 once a day for five days after the development of chemotherapy-induced \"moderate\" mucositis.
Laser has an 830 nm wavelength with a potency of 250 mW.
Each patient was informed of the oral hygiene protocol:
Avoid spicy food acid fruits, alcohol, and food and drinks with high temperature.
Use a soft toothbrush and avoid dental floss.
Only use mouth solution provided by health personnel (3% bicarbonate).
Do not smoke.
The study was conducted March-August 2002.
Thirteen individuals were treated. Convenience sample for chemo-induced mucositis-related pain.
Mucositis was determined using the Brown methodology. Patients determined to have moderate mucositis (score 13-18) were included in the study.
Non-parametric study
VAS pain scale
Brown methodology for classification of mucositis.
Significantly lower pain (p = 0.007) after each treatment. Average pain reduction was 67%. Pain reduction across the five days of treatment was also significant (p = 0.000).
Authors note that after five days, pain is usually reduced to such an extent not to require further treatment.
Limited sample size, short study – no control
Other factors may have contributed to pain reduction, including normal healing and placebo effect.
Optimal energy level is not determined.
Cost is high, and treatment is not available at most centers.
Main focus of study was on pain .
Nelson, N.L. (2016). Breast cancer-related lymphedema and resistance exercise: A systematic review. Journal of Strength and Conditioning Research. Advance online publication.
PHASE OF CARE: Late effects and survivorship
Performing structured RET is safe and effective in increasing muscle strength in patients with breast cancer.
Nelson, K.A., Walsh, D., & Hussein, M. (2002). A phase II study of low-dose megestrol acetate using twice-daily dosing for anorexia in nonhormonally dependent cancer. American Journal of Hospice and Palliative Care, 19, 206–210.
To evaluate the efficacy of a low dose of megestrol acetate (MA) in debilitated patients with cancer experiencing cachexia
Participants received 80 mg of MA twice daily after meals. After a two-week treatment period, participants were evaluated for efficacy, side effects, and satisfaction.
Consecutive patients (convenience sample)
Patients with advanced cancer and any degree of weight loss were eligible for the study. Of the 20 patients who were evaluable,
Excluded from the study were patients with
This single-site study took place in a large midwestern city at a large academic medical center with a cancer center.
The study was a phase II trial with a nonrandomized design and a descriptive, observational setup.
Outcomes included appetite, satisfaction, and side effects. Appetite and satisfaction were evaluated using a questionnaire that included one question for appetite (0 = absent, 4 = better than normal) and one yes/no question on satisfaction (Are you satisfied with the way the medication affected your appetite?). This empirical indicator appears to have been developed by the research team, although this is not clearly explicated. Side effects were measured using a “Side Effect Profile” (a list of MA side effects developed from a number of previous studies using varying doses of MA).
Fifteen out of 20 patients were deemed “responders.” Most responders had an appetite change of one degree in the categorical question, and 16 answered that they were “satisfied” with the way the medication affected their appetite. There were no significant differences in results based on gender, age, or performance status. The third outcome, side effects, was not specifically reported according to the Side Effect Profile. Researchers reported that five patients developed symptoms not present before the study; in three patients, these were considered drug-related.
The researchers concluded that a low dose of MA given twice daily was an effective appetite stimulant in patients with advanced cancer.