Fernandes, R., Mazzarello, S., Stober, C., Vandermeer, L., Dudani, S., Ibrahim, M.F., . . . Clemons, M. (2016). Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: A systematic review. Breast Cancer Research and Treatment, 161, 1–10.
STUDY PURPOSE: To determine whether colony-stimulating factors or antibiotic prophylaxis are optimal choices for the prevention of febrile neutropenia in patients receiving docetaxel-cyclophosphamide chemotherapy
TYPE OF STUDY: Systematic review
PHASE OF CARE: Active antitumor treatment
Hospital admission because of febrile neutropenia (FN) occurred in a median of 13% of patients, and 7.5%, on average, had delays in chemotherapy because of FN. DC chemotherapy was associated with median FN rates of 6.6% with and 31.3% without primary prophylaxis.
FN prophylaxis was associated with lower FN rates; however, the study results could not differentiate the efficacy of antibiotics versus colony-stimulating factors.
Patients receiving DC chemotherapy benefit from primary FN prophylaxis. Insufficient evidence exists to determine the comparative efficacy of prophylaxis with antibiotics versus colony-stimulating factors.
Ferguson, S.E., Malhotra, T., Seshan, V.E., Levine, D.A., Sonoda, Y., Chi, D.S., . . . Abu-Rustum, N.R. (2009). A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery. Gynecologic Oncology, 114(1), 111–116.
To evaluate the effect of bupivacaine-morphine patient-controlled epidural analgesia (PCEA) versus IV morphine patient-controlled analgesia (PCA) on pain at rest and during coughing and on time to potential discharge, length of hospital stay, nausea, vomiting, pruritus, and overall patient satisfaction
Control group received IV morphine PCA 1 mg/hour basal rate with rescue dose of 1 mg every 10 minutes as needed by PCA. The women in the treatment arm had thoracic epidural morphine-bupivacaine PCEA 100 mcg/ml with 0.05% bupivacaine basal rate 4 mg/hour with rescue boluses of 4 ml every 30 minutes. In both treatment arms, therapy was titrated to ensure adequate pain control with treatment of any side effects.
Prospective randomized trial
Visual analog scale (VAS), a 10-point pain scale regarding side effects
For the first six postoperative days, women treated with PCEA morphine-bupivacaine had less pain at rest and during coughing than did women treated with conventional IV PCA. The incidence and severity of adverse effects were not significantly different between groups.
Nurses must be knowledgeable about postoperative care, the complications associated with abdominal surgery, and optimization of perioperative PCEA.
Ferguson, C.M., Swaroop, M.N., Horick, N., Skolny, M.N., Miller, C.L., Jammallo, L.S., . . . Taghian, A.G. (2016). Impact of ipsilateral blood draws, injections, blood pressure measurements, and air travel on the risk of lymphedema for patients treated for breast cancer. Journal of Clinical Oncology, 34, 691–698.
To investigate the relative merits of the current guidelines advising patients to avoid ipsilateral blood draws, injections, blood pressure measurements, trauma, and wearing compression sleeve for air travel to reduce the risk of developing lymphedema
Patients with newly diagnosed breast cancer from 2009–2014 were prospectively screened for lymphedema in bilateral arms using an optoelectronic perimeter, an infrared light to measure arm circumference and volume. Participants were measured at preoperative baseline, postoperatively, and after chemotherapy and/or radiation therapy at regular follow-up oncology visits. (Regular means between three to seven months.) Patients were also measured at their request. At each measure, patients completed a questionnaire and reported on blood draws, injections, blood-pressure readings, trauma, and frequency and length of flights. A total of 3,040 measurements were made.
PHASE OF CARE: At start of breast cancer, up to six months of follow-up
A prospective screening study to assess for lymphedema in patients with newly diagnosed breast cancer from 2009 to 2014
The researchers used an optoelectronic perimeter to calculate bilateral arm volumes preoperatively, postoperatively, again after chemotherapy and/or radiation therapy, and at regular follow-up oncology visits (every three to seven months). The relative volume change (RVC) formula was used to quantify limb volume changes in unilateral limb involvement, and the weight-adjusted volume change (WAC) formula was used to quantify limb volume changes for bilateral limb involvement. Lymphedema was defined as RVC or WAC scores greater than or equal to 10%. Patients completed the questionnaire regarding limb risk behaviors, including blood draws, blood pressures, injections, and trauma.
No association of nonprecautionary limb behaviors and the development of lymphedema existed among patients with breast cancer in this prospective study. ALND, BMI greater than or equal to 25, RLND, and cellulitis were associated with increases in limb volume.
Although most lymphedema precautionary behaviors are “expert opinion,” this study does not dismiss the need for such affected limb precautionary behaviors. Continue with all such precautionary behaviors. Just as all patients do not develop lymphedema, patients develop lymphedema from an array of activities.
Ferguson, R.J., McDonald, B.C., Rocque, M.A., Furstenberg, C.T., Horrigan, S., Ahles, T.A., & Saykin, A.J. (2012). Development of CBT for chemotherapy-related cognitive change: Results of a waitlist control trial. Psycho-Oncology, 21, 176–186.
To evaluate the efficacy of a brief cognitive behavioral therapy to manage chemotherapy-related cognitive dysfunction
Randomized clinical trial
Participants who received the intervention experienced a significant improvement in verbal memory, as measured by the CVLT-II total score (p < 0.05). In contrast, no difference was found in either information processing speed (DKEFS scales and WAIS-III subscale) or patients’ self-report (MASQ) of their cognitive functioning.
Although the cognitive behavioral therapy intervention was formulated to assist patients in dealing with memory and attention problems, significant improvement in total score was found only in verbal memory. Because improvement was not found in information processing speed, alternative strategies may need to be developed to help patients compensate in other cognitive domains. Although patients reported high satisfaction with the intervention, self-report scores did not indicate any improvement in their cognitive functioning.
Ongoing cognitive problems have been reported by many patients after completion of cancer treatment. Cognitive behavioral training has been suggested as a strategy to assist patients in dealing with the impact of these problems. However, further studies are needed to determine strategies for specific cognitive domains that are feasible in the outpatient setting.
Ferguson, R.J., Ahles, T.A., Saykin, A.J., McDonald, B.C., Furstenberg, C.T., Cole, B.F., & Mott, L.A. (2007). Cogntive-behavioral management of chemotherapy-related cognitive change. Psycho-Oncology, 16, 772–777.
The study was conducted to examine Memory and Attention Training (MAAT) as a possible intervention for cognitive dysfunction. MAAT consists of four cognitive-behavioral components.
The MAAT intervention contained
This was a prospective, longitudinal, single-arm pilot study.
Participants rated the MAAT program with high levels of general satisfaction post-treatment, and reported that it was helpful with improving memory, attention, and compensatory skills.
Neuropsychological test results revealed improvement on verbal memory (p = 0.001), executive functioning (p < 0.001), and psychomotor functioning (p = 0.001). Moderate to large treatment effect sizes (0.47 to 0.67) were observed in the MASQ total score and subscales immediately post-treatment, and the visual perceptual scale (0.63) was significant at the two month follow-up. Self-report in cognitive function in participants’ daily lives improved significantly over baseline and was sustained across all follow-up periods (p = 0.001). Similar patterns of improvement were observed on MASQ subscales of attention and concentration, spatial memory, verbal memory, and language.
MAAT is a feasible and possibly effective cognitive-behavioral, non-pharmacologic management approach to a common problem for many cancer survivors.
Fenton-Kerimian, M., Cartwright, F., Peat, E., Florentino, R., Maisonet, O., Budin, W., . . . Formenti, S. (2015). Optimal topical agent for radiation dermatitis during breast radiotherapy: A pilot study. Clinical Journal of Oncology Nursing, 19, 451–455.
To assess which of the three topical emollients commonly used for the skin care of patients undergoing whole breast radiation therapy minimizes the grade of dermatitis and cost of product, and to evaluate their effect on quality of life.
A total of 30 patients were randomized to three groups of 10 patients each and received one of three different skin care products to apply during radiation therapy to the whole breast (Calendula cream twice daily, RadiaPlex (hydrogel cream) twice daily, or mometasone twice weekly during the first and second weeks of radiation and daily during week three, plus Aquaphor daily). Weekly skin evaluations were conducted by a medical doctor or a nurse practitioner and RN. Another skin assessment was conducted at one week, one month, and three months post radiation therapy. Life quality index forms were completed by the patients at during visits.
PHASE OF CARE: Active antitumor treatment
Randomized, controlled trial using three commonly used topical emollients
Weekly skin assessment by a medical doctor or a nurse practitioner and RN at one-week follow-up, one-month follow-up, and three-month follow-up visits. Completion of a Dermatology Life Quality Index (DLQI) (visual analog survey) or DLQI upon enrollment to study, during enrollment, and after radiation.
Skin assessment findings and quality of life index scores showed no significant difference based on the product used. All patients experienced grade 1–2 (maximum) dermatitis. Patients did not report a significant decline in their quality of life scores based on the amount of radiation dermatitis they experienced. The maximum grade of dermatitis occurred the first week after completing treatment. Time to maximum skin reaction and time to resolution of the skin reaction for each of the three study arms were equal. A difference in cost existed between the three products (the Calendula cream was the least expensive at approximately $11 per 6.7 oz tube, the mometasone was approximately $48 per unknown dose size, and the RadiaPlex was the most expensive agent at $59 per 6 oz tube).
In this small pilot study, no significant difference was observed between three commonly used topical emollients on the occurrence or severity of radiation dermatitis among patients undergoing whole breast radiation. A cost difference existed between the three products.
Future research involving multicenter trials and larger sample size could support standard of care recommendations for the most cost-effective product (Calendula cream). The findings show no significant difference in the effectiveness of the three tested agents in terms of severity of radiation dermatitis or decrease in quality of life.
Fenlon, D.R., Corner, J.L., & Haviland, J.S. (2008). A randomized controlled trial of relaxation training to reduce hot flashes in women with primary breast cancer. Journal of Pain and Symptom Management, 35, 397–405.
The study sought to assess the efficacy of relaxation training in reducing the incidence of hot flashes in women with primary breast cancer.
The intervention group received a single relaxation training session and was instructed to use practice tapes on a daily basis at home for one month; the control group received no intervention.
The study enrolled150 women from three breast cancer centers in England.
The study was a randomized controlled trial.
The incidence of flashes was measured using a diary, kept by the women, of every flash as it occurred over the period of one week. The women also gave a measure of the severity of each flash using four predefined categories: (a) length of flash, (b) physical manifestation, (c) emotional response, and (d) behavioral response. For each of these domains, four levels of severity (graded 1–4) were assigned, using the Hunter Menopause Scale.
Of 150 women recruited to the trial, 104 women completed it to the primary endpoint at one month, and 97 completed all three months. The incidence and severity of hot flashes, as recorded by diaries, significantly declined over one month (p < 0.001 and p < 0.01, respectively), compared with the control group. Distress caused by flashes also significantly declined in the treatment group over one month (p < 0.01), compared with the contro.l No significant differences between the treatment group and the control group at three months and no changes in anxiety or QOL were reported.
A large amount of attrition marred the trial.
Fenig, E., Brenner, B., Katz, A., Sulkes, J., Lapidot, M., Schachter, J., . . . Gutman, H. (2001). Topical Biafine and Lipiderm for the prevention of radiation dermatitis: A randomized prospective trial. Oncology Reports, 8, 305–309.
To evaluate of the use of Biafine or Lipiderm to prevent radiodermatitis
Participants were randomized to one of three trial arms: Biafine, Lipiderm, or control (no prophylactic treatment). Study preparations were applied twice daily, starting 10 days prior to the beginning of radiation therapy and continuing until 10 days after treatment. Skin treatment was upgraded if necessary to steroids (grade 3 reaction), antibiotics (grade 4 reaction) or pause in therapy (grade 5 reaction).
The study took place at a single site.
The study used a randomized controlled trial design.
The study does not refute or support use of these products for an existing skin reaction and did not show a radioprotective effect.
Fenig, E., Brenner, B., Katz, A., Sulkes, J., Lapidot, M., Schachter, J., … Gutman, H. (2001). Topical Biafine and Lipiderm for the prevention of radiation dermatitis: a randomized prospective trial. Oncology Reports, 8, 305–309.
To evaluate the use of Biafine or Lipiderm to prevent radiodermatitis.
Participants were randomized to one of three trial arms: (a) Biafine, (b) Lipiderm, or the (c) control (no prophylactic treatment).
Study preparations were applied twice daily, staring 10 days prior to the beginning of radiation therapy (RT) and continuing until 10 days after treatment. Skin treatment was upgraded if necessary to steroids for grade 3 reaction antibiotics for grade 4 reactions or pause in therapy for grade 5 reactions.
Single site
The study was a randomized, controlled trial.
The study neither refutes nor supports use of these products for existing reactions. These products did not show radioprotective effects.
Feng, Y., Wang, X. Y., Li, S. D., Zhang, Y., Wang, H. M., Li, M., . . . Zhang, Z. (2011). Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality. Journal of Traditional Chinese Medicine, 31, 199–202.
To study the effect of acupuncture on depression and insomnia in patients with malignant tumors.
One time per day for 20 to 30 minutes, over a course of 30 days, patients in the intervention group received acupuncture on these acupoints: Fenglon (ST-40), Yinlingquan (SP-9), Xuehai (SP-10), Sanyinjiao (SP-6), Yintant (EX-HN3), Baihui (DU-20), Sishencong (EX-HN1), Neiguan (PC-6), and Shenmen (TF-4). Patients in the control group received fluoxetine, 20 mg/day. Depression scores and sleep ratings were collected before and after the three-day treatment.
Patients were undergoing the active treatment phase of care.
The study was a randomized, controlled trial with intervention and control groups.
Pretreatment SDS scores of the treatment and control groups were 64.12 (SD = 5.34) and 64.24 (SD = 4.98), respectively, with no significant difference (p > 0.05). After treatment, SDS scores of the treatment and control groups were 43.64 (SD = 5.28) and 50.76 (SD = 5.42), which showed significant difference (p < 0.05). HRSD scores of both groups showed no significant difference before treatment (p > 0.05); however, after-treatment scores were 9.88 (SD = 1.27) in the treatment group and 13.72 (SD = 2.05) in the control group (p < 0.05). These results indicate that both acupuncture and fluoxetine were effective in reducing depression scores in these patients, with acupuncture showing greater effectiveness. PSQI scores of the treatment group, before and after treatment, were 14.48 (SD = 1.71) and 7.92 (SD = 1.22), respectively, with a significant difference (p < 0.001). The control group's PSQI scores, 13.92 (SD = 2.59) and 11.44 (SD = 1.89), did not reach significance (p > 0.05). Results indicate that acupuncture improved sleep quality in more patients than did fluoxetine.
Both acupuncture and fluoxetine were associated with reduced depression scores and some improvement in sleep. Due to the lack of a real control group and no control over cancer type and treatment phase, drawing a conclusion about the effectiveness of the intervention is difficult.
Acupuncture is a nonpharmacologic intervention that shows promise in reducing depression and improving sleep quality in patients with cancer and depression.