Loening-Baucke, V., & Pashankar, D.S. (2006). A randomized, prospective, comparison study of polyethylene glycol 3350 without electrolytes and milk of magnesia for children with constipation and fecal incontinence. Pediatrics, 118, 528–535.
To compare and evaluate the efficacy, safety, acceptance, and one-year outcome of two laxatives, polyethylene glycol (PEG) without electrolytes and milk of magnesia (MOM).
Patients were randomly assigned to intervention with PEG 3350 without electrolytes (Miralax®) or MOM by drawing a sealed envelope. Patients initially received 0.7 g/kg of PEG or 2 ml/kg of MOM daily.
Children’s Hospital of Iowa
Randomized controlled trial
PEG and MOM are effective and safe in long-term treatment, with PEG having better acceptance.
Lodge, J.P.A., Jonas, S., Oussoultzoglou, E., Malagó, M., Jayr, C., Cherqui, D., . . . Mimoz, O. (2005). Recombinant coagulation factor VIIa in major liver resection: A randomized, placebo-controlled, double-blind clinical trial. Anesthesiology, 102, 269–275.
Placebo versus two treatment arms of recombinant coagulation factor VIIa: 20 mcg/kg and 80 mcg/kg
Perioperative transfusion difference approached significance (P = 0.09). Mean requirements decreased with rFVIIa (P = 0.78). Blood loss during surgery decreased (P = 0.07).
A larger trial is needed for better evaluation.
Lockhart, P.B., Brennan, M.T., Kent, M.L., Packman, C.H., Norton, H.J., Fox, P.C., & Frenette, G. (2005). Randomized controlled trial of pilocarpine hydrochloride for the moderation of oral mucositis during autologous blood stem cell transplantation. Bone Marrow Transplantation, 35, 713–720.
Patients were given a 5-mg pilocarpine tablet or placebo starting the day before the conditioning regimen, every 4 hours, for a total of 4 tablets per day. Patients continued taking tablets until absolute neutrophil count (ANC) was greater than 500 for 48 hours, discharge from hospital, or mucosal recovery.
This was a prospective, double-blind, randomized, placebo-controlled trial. Patients were stratified by diagnosis and randomized by a computer-generated numbering scheme.
Despite prior small trials that showed a benefit, this study clearly did not. The intervention was not effective.
A standardized scoring system is needed.
Locke, D.E., Cerhan, J.H., Wu, W., Malec, J.F., Clark, M.M., Rummans, T.A., & Brown, P.D. (2008). Cognitive rehabilitation and problem-solving to improve quality of life of patients with primary brain tumors: A pilot study. Journal of Supportive Oncology, 6, 383–391.
*Withdrawals were due to tumor progression; new onset seizures; time commitment; caregiver issues; and fatigue.
Randomized controlled trial; longitudinal
Lloyd-Williams, M., Cobb, M., O'Connor, C., Dunn, L., & Shiels, C. (2012). A pilot randomised controlled trial to reduce suffering and emotional distress in patients with advanced cancer. Journal of Affective Disorders, 148(1), 141–145.
To determine if a focused narrative-interview intervention can alleviate symptoms of suffering, anxiety, and depression in patients with advanced cancer
Patients in a hospice day unit were randomized to one of two groups. In one, patients received the study intervention; in the other, usual care. The intervention was a single focused narrative interview in which a patient was encouraged to discuss his or her perspectives; sense of meaning; sense of suffering; and psychological, physical, and spiritual well-being. The emphasis was on enabling each patient to tell his or her story. Study assessments were done at baseline and at two, four, and eight weeks after the intervention.
Randomized controlled trial
Baseline scores indicated, on average, probable depression. At four weeks investigators noted a slight, but nonsignificant improvement in the depression score. Authors noted no other changes or differences between groups.
As result of narrative interview intervention in a hospice day program, findings did not show any substantial improvement in measures of depression or other symptoms.
Findings do not suggest that narrative interview, used as an intervention for depression and other symptoms, had any effect in this study.
Lloyd-Williams, M., Payne, S., Reeve, J., & Kolamunnage Dona, R. (2013). Antidepressant medication in patients with advanced cancer: An observational study. QJM, 106, 995–1001.
To observe the longitudinal effects of antidepressant medication in a cohort of patients with advanced cancer
Of the 628 patients with advanced cancer in the study, 25% were receiving antidepressants for a median of 9.5 weeks. Patients were followed for six months or until death. Consecutive patients in the daycare unit were eligible for inclusion. Patients completed study assessments at baseline and at eight, 16, and 24 weeks. A patient self-report was used to identify patients taking antidepressants.
Observational
Patients who stated that they took antidepressants had significantly higher depression scores on both measures. A subgroup analysis was completed for those with the highest PHQ-9 scores, assuming that effects might be seen in those with greater depression levels. However, there were no differences in results between those taking and not taking antidepressants.
The observational findings of this study suggest that antidepressant medication had little impact in reducing depression scores for patients attending Hospice daycare service.
This observational study did not show that antidepressants reduced depression among patients receiving Hospice care. However, there were several study design and measurement limitations. The role and effectiveness of antidepressants may vary among patients at different phases in the trajectory of cancer.
Ljungman, P., Engelhard, D., de la Cámara, R., Einsele, H., Locasciulli, A., Martino, R., . . . Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. (2005). Vaccination of stem cell transplant recipients: recommendations of the Infectious Diseases Working Party of the EBMT. Bone Marrow Transplantation, 35, 737–746.
To update previous recommendations (released in 1995 and last updated in 1999) for vaccinations in pediatric and adult hematopoietic stem cell transplantation (HSCT) recipients.
This resource was classified as a guideline.
Recommendations for 18 vaccinations were drawn from published data, most of which were specific to stem cell transplantation recipients. The strength of each recommendation and the quality of evidence supporting it are noted in a summary table, using grading standards endorsed by the Centers for Disease Control and Prevention (CDC).
Patients undergoing HSCT are advised to be vaccinated against bacterial and viral infections beginning six to 12 months after transplantation, with the exception of meningococcal vaccine. Because polysaccharide pneumococcal vaccines are ineffective in patients with chronic graft-versus-host disease (GVHD), antibiotic prophylaxis should be given to patients with GVHD in addition to the pneumococcal vaccine. Three doses of Haemophilus influenzae type B (Hib) conjugate vaccine, tetanus toxoid vaccine, and diphtheria toxoid vaccine should be given beginning six months posttransplantation and spaced one to three months apart. Routine vaccination against pertussis was not recommended. Bacillus Calmette-Guerin vaccine was specifically contraindicated in this population.
Inactivated influenza vaccine was recommended for all patients undergoing HSCT, beginning no earlier than four to six months posttransplantation. For patients undergoing allogeneic HSCT, influenza vaccination should be given annually (prior to influenza season) and continue at least as long as the patient remains immunocompromised. For patients undergoing autologous HSCT, the duration of yearly influenza vaccination should be assessed individually. Patients undergoing HSCT and those in close contact with them (e.g., family members and hospital staff who care for these patients) should be vaccinated against polio using the inactivated poliovirus vaccine only.
Patients undergoing HSCT should receive three doses of the inactivated vaccine, beginning six to 12 months following transplantation, with subsequent doses one to three months apart. Hepatitis B vaccination (HBV) is recommended for patients undergoing HSCT living in countries where HBV is recommended for the general public and should be given six to 12 months following HSCT. Vaccination with two doses of hepatitis A may be considered for patients who live or plan to travel to areas where the disease is endemic. The measles, mumps, and rubella (MMR) vaccine is generally recommended to begin no sooner that 24 months after HSCT but may be considered earlier if there is a high risk of measles. MMR is contraindicated in patients with chronic GVHD or ongoing immunosuppression. To prevent varicella, seronegative family members should be immunized with the varicella-zoster virus (VZV) vaccine. Seronegative patients undergoing HSCT may be considered for the VZV vaccine two years following transplantation, provided they are free of GVHD or ongoing immunosuppression. Vaccination of seropositive patients undergoing HSCT is not recommended.
Vaccination against yellow fever should only be considered in patients undergoing HSCT who must travel to areas of the world where yellow fever is endemic. Guidelines for serological testing of immune status are also included, again following the CDC grading standards. Immunity testing before vaccination is not necessary for tetanus toxoid, diphtheria toxoid, polio, influenza, pneumococcal, and Hib but is recommended for HBV, measles, mumps, and rubella (MMR), and varicella-zoster virus (VZV). Postvaccination testing to assess immune response is not recommended for tetanus toxoid, diphtheria toxoid, polio, Hib, or influenza. It is recommended for hepatitis B, MMR, and VZV and also may be considered for pneumococcal vaccine for patients at increased risk of poor response.
This article provided a concise summary for providers to use when considering the vaccination needs of HSCT recipients. It rated the strength of each recommendation using CDC guidelines. The article was extensively referenced to aid readers who wish to delve more deeply into the studies supporting each recommendation.
Li, J.R., Yang, C.R., Cheng, C.L., Ho, H.C., Chiu, K.Y., Su, C.K., . . . Ou, Y.C. (2013). Efficacy of a protocol including heparin ointment for treatment of multikinase inhibitor-induced hand-foot skin reactions. Supportive Care in Cancer, 21, 907–911.
To evaluate the efficacy of a protocol including topical heparin therapy for hand-foot skin reactions (HFSR) during multikinase (MKI) treatment
Heparin Z ointment contains 500 IU unfractionated heparin sodium in each 1 g. Heparin, a member of the glycosaminoglycan family, has anti-inflammatory properties and is effective in the treatment of ulcerative wounds. All patients experiencing HFSR received mutifaceted care, including thick socks, shock-absorbing shoes, and topical treatment with heparin Z ointment (Zeria Pharmaceutical Co., Ltd., Japan), twice daily, integrated with urea-containing cream twice daily. Treatment with heparin Z ointment continued daily until grade of toxicity was downgraded to 0. All patients were seen monthly, and those with HFSR were seen weekly. Patients whose grade was downgraded to 0 were considered cured of HFSR. Treatment responders were recorded as the sum of cured and improved patients.
Of patients whose grading was downgraded to 0, the highest percentage was in the axitinib group (50%), while 31.8% of the sunitinib group were downgraded to 0, which equated to the cure of HFSR. Patients with CRPC had a higher response rate on sunitinib therapy (80% to MRCC of 66.7%). A higher rate of HFSR was seen in patients with CRPC treated with sunitinib than those with MRCC treated with sunitinib. Only four patients required MKI dose reduction, and none of the 26 patients who experienced HFSR dropped out.
This study provides a new protocol for the treatment of HFSR in patients on MKI therapies who experience HFSR. It would appear beneficial for keeping patients on treatment with minimal need to decrease the dose.
Nurses are aware of the need for supportive care to decrease the incidence and severity of skin toxicities with MKI therapies. The use of heparin Z ointment as an additive intervention seems appropriate, particularly in light of heparin use in burned skin and wound healing. However, this study does not allow for inclusion as a new guideline intervention. More investigation with better designed trials is needed.
Li, A.M., Miao, J.H., Liu, H., Ma, Y.Z., & Sun, Z.C. (2015). Drug-induced skin toxicity and clinical nursing of VitK cream on colorectal cancer patients. Pakistan Journal of Pharmaceutical Sciences, 28(Suppl. 4), 1499–1503. Retrieved from http://connection.ebscohost.com/c/articles/109346621/drug-induced-skin-…
To discuss the affect of 0.1% VitK1 cream on cetuximab-induced skin toxicity in patients with colorectal cancer
Routine nursing was implemented for all patients. The experimental group also received VitK1 cream smeared on the face, neck, chest, back, and nail edges three times on the day of cetuximab infusion at 9 am, 3 pm, and 9 pm.
Dry skin, itchy skin, acne-like rash, skin dehiscence, and paronychia were evaluated in both groups after four cycles of cetuximab therapy (56 days) using the Common Toxicity Criteria, version 3.0, assessment scale. No grade 4 results were observed in either group. No significant differences existed in acne-like rash, paronychia, or dehiscence in either group. A significant difference existed in skin dryness and itch, favoring the experimental group. All patients had skin toxicities. No reports of discomfort were received from the experimental group, receiving VitK1 cream.
The VitK1 cream appeared to reduce skin dryness and itching.
Reducing or improving the existence of skin toxicities from cetuximab therapies allows patients to stay on therapies without an extreme decrease in quality of life. VitK1 cream had not been available in China; therefore, this study used the compounding of this cream with specific directions. Safeguarding the production of emollients and creams from compounding pharmacies has met recent scrutiny. Nurses need to ensure consistency with medical interventions when able. Providing for symptom management options, such as VitK1 cream, should promote patient adherence to therapy and improve outcomes. Few interventions have been shown effective for the prevention and management of skin toxicities. Further research is needed.
Li, N.L., Yu, B.L., Tseng, S.C., Hsu, C.C., Lai, W.J., Hsieh, P.F., . . . Chen, C.M. (2011). The effect on improvement of recovery and pain scores of paravertebral block immediately before breast surgery. Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists, 49(3), 91–95.
To investigate whether paravertebral block (PVB) implemented immediately before breast cancer surgery can affect pain and emesis and improve the quality of life of patients after breast cancer surgery
Consecutive patients received general anesthesia or PVB plus anesthesia before breast cancer surgery. Researchers compared the pain scores of both groups of patients at one hour and at six hours postoperatively and at midmorning of postoperative day 1 (POD1). At one hour, patients were observed in the postanesthesia care unit for one hour, where they were provided with analgesics to achieve a pain score of less than 4 on the Numeric Rating Scale (NRS). Choices of analgesic for patients with moderate to severe pain included intravenous morphine, 3–6 mg, and intravenous ketorolac, 30 mg. Patients with mild to moderate pain (a score of 4–7) received acetaminophen, 500–1000 mg, at the patient’s request. At six hours after surgery and on POD1, pain scores were recorded with patients at rest and during movement. Movement consisted of moving the arm until the arm and body were at a 90-degree angle. The amount of postoperative narcotics and the time to first request for pain medication was recorded.
Intervention study
After breast cancer surgery, PVB plus GA may provide better pain relief than does GA alone. The researchers observed higher QoR scores and less antiemetic use in the GA + PVB than in the GA group.
PVB may be a useful tool to decrease pain after breast cancer surgery and to reduce PONV, but more research is needed before researchers can draw definitive conclusions.