Du, S., Hu, L., Dong, J., Xu, G., Jin, S., Zhang, H., & Yin, H. (2015). Patient education programs for cancer-related fatigue: A systematic review. Patient Education and Counseling, 98, 1308–1319.
Interventions included exercise in eight studies, sleep hygiene in seven, relaxation training in six, and nutritional guidance in six. Six studies included the use of a booklet as supplement material. Four studies included telephone follow-up, and one was provided via an Internet-based program. The program duration ranged from 1 week to 12 weeks. Attrition rates ranged from 7%–46.7%. Two studies demonstrated significant reduction of fatigue with ES ranging from –0.76 to –1.41 (p < 0.001). Six studies concluded achieving a limited positive effect, with a small effect size and no statistical significance. One study showed no effect, and one showed worse outcomes in the intervention group. High heterogeneity existed across trials, so no meta-analysis was deemed appropriate.
Inconsistent evidence of effects of patient education programs on cancer-related fatigue existed across all 10 studies.
Some mixed evidence exists regarding the effects of patient education programs on cancer-related fatigue, which are related to the variability in interventions that have been studied. More rigorous research is needed to sort out those program characteristics and populations of patients who can benefit most from educational interventions.
Dranitsaris, G., Mazzarello, S., Smith, S., Vandermeer, L., Bouganim, N., & Clemons, M. (2016). Measuring the impact of guideline-based antiemetic therapy on nausea and vomiting control in breast cancer patients with multiple risk factors. Supportive Care in Cancer, 24, 1563–1569.
The purpose of this study was to determine if guideline-based antiemetic therapy would improve chemotherapy-induced nausea and vomiting (CINV) in patients with multiple risk factors for CINV
Patients from all risk levels had similar rates of acute and delayed vomiting; however, acute and delayed nausea remained higher in the high-risk patients.
By assessing patient risk factors for CINV and prescribing antiemetic therapy based on patient risk stratification, acute and delayed vomiting may be managed; however, acute and delayed nausea remained significantly higher in the highest risk patients.
Drake, R.D., Lin, W.M., King, M., Farrar, D., Miller, D.S., & Coleman, R.L. (2004). Oral dexamethasone attenuates Doxil®-induced palmar-plantar erythrodysesthesias in patients with recurrent gynecologic malignancies. Gynecologic Oncology, 94, 320–324.
To evaluate the effectiveness of oral dexamethasone in attenuating or eliminating palmar-plantar erythrodysesthesias (PPE) induced by pegylated liposomal doxorubicin (PLD) (Doxil®) in patients with recurrent gynecologic malignancies.
Patients were initially treated with PLD without dexamethasone (median number of cycles = 5). Patients who experienced grade 2 to 4 PPE had treatment delayed until symptom resolution, and then were retreated without dose reduction.
Patients in group 1 received a tapering oral dexamethasone regimen (8 mg BID) starting one day before infusion for five days, 4 mg BID on day 6, and 4 mg on day 7.
In group 2, patients who were not receiving dexamethasone and experienced grade 2 to 4 PPE had a weekly dose delay for up to two weeks until symptom resolution. If resolution occurred within three weeks of the delay, a 25% dose reduction was made. Patients who had persistent grade 3 or 4 PPE had PLD withdrawn.
University of Texas Southwestern Medical Center in Dallas
This was a prospective, observational trial.
National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) was used to assess PPE (grades 1–4).
Oral dexamethasone appears to be effective in attenuating or eliminating PLD-induced PPE in patients with recurrent gynecologic malignancies.
The sample size was small.
Do, T., Medhekar, R., Bhat, R., Chen, H., Niravath, P., & Trivedi, M.V. (2015). The risk of febrile neutropenia and need for G-CSF primary prophylaxis with the docetaxel and cyclophosphamide regimen in early-stage breast cancer patients: A meta-analysis. Breast Cancer Research and Treatment, 153, 591–597.
PHASE OF CARE: Active antitumor treatment
883 patients across studies did not receive G-CSFs, of which 21.97% developed FN (adjusted rate 23.2%). Compared to patients who did not receive G-CSFs, patients who received G-CSFs had an OR of 0.077 (95% CI [0.013, 0.460]), a 92.3% lower incidence rate. Patients younger than age 65 also had a lower rate of FN (4.2%–66.7%) compared to patients 65 and older (7.7%–88.2%).
Use of G-CSFpp significantly reduces the risk of FN in patients with early-stage breast cancer receiving TC therapy. Patients younger than age 65 also have a reduced risk of FN compared to patients 65 years and older.
The reporting of findings differed between use of G-CSF (OR) and no use (%). They did report a 93% lower risk with use of G-CSF. The reporting of age differences did not differentiate between use or no use of G-CSF.
Aside from the limitations noted above, use of G-CSF as primary prophylaxis reduces the risk of FN in this patient population. Oncology nurses should be aware of the risks of FN in patients being treated with TC for early-stage breast cancer and promote use of G-CSFpp.
Doss, J.J.K. (2014). Effectiveness of foot massage on level of pain among patients with cancer. Asian Journal of Nursing Education and Research, 4, 228–231.
To evaluate the effectiveness of foot massage on pain in patients with cancer
This research was a nonrandomized, two-group, quasi-experimental time series design conducted among 60 patients with cancer. The experimental group received a 30-minute foot massage over a three-day period. Pain was assessed using the Numeric Rating Scale for pain, which used a 0–10 range. Pain was assessed prior to the intervention and after the intervention for three days.
Nonrandomized, two-group, quasi-experimental, time series trail
On day 1, all patients in both groups reported severe pain. On day 2, most of the patients reported moderate pain with no measurable differences between the two groups. On day 3, the experimental group reported mild to no pain, and there was no change in the control group from day 2. The intervention group experienced a significant reduction in pain (p < 0.001).
This study shows the need to understand the purpose of foot massage techniques on pain levels in patients with cancer. The researcher assumed that with a decrease in pain, there would be an increase in patients' quality of life including stability in physiologic, psychological, sexual, vocational, and lifestyle aspects. These areas were not measured, and additional research is needed.
Foot massage is an easy and cost-effective nursing intervention that could be used to help ease patient pain. This research article identified the need to continue research in this area. The patient parameters need to be more specific in future research designs.
dos Santos, L.V., Souza, F.H., Brunetto, A.T., Sasse, A.D., & da Silveira Nogueira Lima, J.P. (2012). Neurokinin-1 receptor antagonists for chemotherapy-induced nausea and vomiting: A systematic review. Journal of the National Cancer Institute, 104(17), 1280–1292.
To evaluate the overall effectiveness and safety of neurokinin 1 (NK1) receptor antagonists (RAs) in the prevention of chemotherapy-induced nausea and vomiting (CINV) when compared to standard antiemetic regimens including a 5-HT3 RA plus dexamethasone
Databases searched were MEDLINE, Embase, Cochrane Central Register of Controlled Trials (Central), and Latin American and Carribean Health Sciences Literature (LILACS).
Search keywords were neurokinin, aprepitant, casopitant, ezlopitant, netupitant, vestipitant, chemotherapy-induced nausea and vomiting, nausea in cancer patients, vomiting in cancer patients, and randomized trials.
Studies were included in the review if they
No specific exclusion criteria were identified.
A total of 4,034 references were retrieved.
Two reviewers assessed the quality of each study. Items from Delphi list and Jadad score were utilized for data extraction; however, the authors did not describe if any specific scoring system was used for quality assessment.
All patients were in active antitumor treatment.
The addition of an NK1 RA increased CINV control in the acute, delayed, and overall phases.
The use of an NK1 RA may be associated with a statistically significant increase in the risk of severe infection. A more comprehensive evaluation of the safety profile of NK1 RAs and additional appraisal of specific data from RCTs is needed.
dos Santos Martins, S.P., Ferreira, C.L., & del Giglio, A. (2017). Placebo-controlled, double-blind, randomized study of a dry guarana extract in patients with head and neck tumors undergoing chemoradiotherapy: Effects on fatigue and quality of life. Journal of Dietary Supplements, 14, 32–41.
To determine if the use of guarana extract affects fatigue or quality of life in patients with head and neck cancer undergoing chemoradiotherapy
Patients were randomized to receive either guarana or placebo, with both given twice daily before meals for six weeks while they were undergoing chemoradiotherapy. The patients receiving guarana took 50 mg twice daily. The patients were assessed three times throughout treatment at day 1, day 21, and day 42, and once three weeks after the completion of treatment on day 63. The three assessments during treatment corresponded with cisplatin administration. Each assessment included fatigue and quality of life questionnaires, evaluation for guarana toxicity according to the World Health Organization scale, as well as weight and renal function.
PHASE OF CARE: Active antitumor treatment
Phase II, placebo-controlled, double-blind, randomized study
No statistically significant reduction in fatigue or improvement in quality of life was identified in either group using any questionnaire. Some initial or transient improvements were noted but were not statistically significant or did not last the length of treatment. The authors do not recommend the use of guarana in this patient population.
This intervention was not successful for this patient population. Although the authors reported some positive benefits, based upon the description of the results, it is unclear if this is related to the guarana or other factors that could influence quality of life in the patient population.
In terms of nursing practice, this study highlights the significance of malnutrition, weight loss, and mucositis in this patient population, and addressing these complications of chemotherapy and radiation in this patient population seems like a promising area for nursing attention and research.
Dorr, W., & Herrmann, T. (2007). Efficacy of Wobe-Mugos E for reduction of oral mucositis after radiotherapy: Results of a prospective, randomized, placebo-controlled, triple-blind phase III multicenter study. Strahlentherapie und Onkologie, 183(3), 121–127.
Proteolytic enzymes comprised of papain (100 mg), trypsin (40 mg), and chymotrypsin (40 mg) were administered orally 3 x 4 tablets per day.
The study reported on 69 patients with tumors of the oropharynx or oral cavity undergoing a radiation dose higher than 40 Gy.
The study was conducted at a multicenter site from June 1996 to May 2000.
This was a prospective, randomized, triple-blind, placebo-controlled, parallel group study.
No statistically significant difference was found in analysis. Treatment with Wobe-Mugos E resulted in an earlier onset of mucositis and increased average scores for treatment duration.
The sample was not sufficient according to power analysis.
Döring, M., Hartmann, U., Erbacher, A., Lang, P., Handgretinger, R., & Müller, I. (2012). Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis. BMC Infectious Diseases, 12, 151.
The primary objective was to evaluate the safety of caspofungin (CAS) in pediatric patients following allogeneic hematopoietic stem cell transplantation (HSCT) when compared with intravenous (IV) liposomal amphotericin B (L-AmB). The secondary objectives evaluated the incidence of aspergillosis, candidiasis, and other fungal infections in pediatric patients following allogeneic HSCT.
This was a retrospective analysis of pediatric patients receiving either CAS or L-AmB after allogeneic HSCT between January 2006 and June 2010. All patients received L-AmB (1 mg/kg/day) during conditioning from day –8 through day 0. Patients who underwent transplantation between January 2006 and August 2008 were continued on L-AmB until oral antimycotic therapy was started prior to discharge (group 1). All patients undergoing transplantation between September 2008 and June 2010 were switched to CAS starting on day 1 until oral antimycotic therapy was started prior to discharge (group 2). The observation period was defined as the time from the start of IV antimycotic prophylaxis until three weeks after switching to oral antimycotic prophylaxis three to four days before inpatient discharge. Patients were observed for tolerability, safety, and efficacy of caspofungin, and infection rates were compared between the two groups.
This was a single-center, retrospective study.
Biochemical laboratory results were measured.
Leukopenia was observed for a median duration of 12 days in both groups. Median duration of therapy was 23 days (range 9–72) in group 1 (L-AmB) and 24 days (range 14–49) in group 2 (CAS). There was no incidence of proven aspergillosis or another invasive fungal infection in either group. No proven fungal breakthrough infections were observed in either group three weeks after the conclusion of IV fungal therapy. No patient died of an invasive fungal infection. Clinical side effects related to treatment were observed in 8.3% of patients in group 1 and 3.3% in group 2, with four patients in the L-AmB arm being switched to CAS due to side effects. There was a statistically significant but transient increase in alanine aminotransferase (ALT)/aspartate aminotransferase (AST) in both groups, and hypokalemia occurred significantly (p = 0.006) in the L-AmB arm (group 1).
This study retrospectively showed that the efficacy of the two antifungal agents used for prophylaxis was good with no proven invasive fungal infection noted in either group. This could be an option to limit the side effects and potential nephrotoxicity noted in L-AmB administration. Larger, prospective studies are needed for true recommendations.
* Findings may not be generalizable to adult patients, but they could be generally applied to pediatric patients undergoing allogeneic HSCT, which is a small group.
Nursing is imperative in the monitoring and administration of medications in this setting. The need for monitoring, especially for infusion reactions, hypokalemia, and nephrotoxicity, is higher in those receiving L-AmB. The use of CAS may reduce this need, but nurses must still be vigilant to identify fever or other symptoms in these patients.
Döring, M., Blume, O., Haufe, S., Hartmann, U., Kimmig, A., Schwarze, C. P., . . . Muller, I. (2014). Comparison of itraconazole, voriconazole, and posaconazole as oral antifungal prophylaxis in pediatric patients following allogeneic hematopoietic stem cell transplantation. European Journal of Clinical Microbiology & Infectious Diseases, 33, 629–638.
To explore the efficacy of itraconazole, voriconazole, and posaconazole for breakthrough fungal infections with a secondary objective of analyzing the safety and feasibility of these three different regimens in a pediatric hematopoietic stem cell transplantation (HSCT) population
This study consisted of the observation of 150 pediatric patients split into three groups between the ages of 0.6–17.7 years with hematologic malignancies undergoing allogeneic HSCT. All patients received one of the azoles as primary oral antifungal prophylaxis following HSCT. Fifty consecutive patients from 2006 to 2007 were in the itraconazole group, 50 consecutive patients from 2006 and 2010 in the voriconazole group, and 50 consecutive patients from 2010 to 2011 were in the posaconazole group when the center switched to posaconazole for prophylaxis. The observation period lasted from the start of oral prophylactic treatment till two weeks after the withdrawal of therapy.
Retrospective, single-center survey; one sample t-test used the Wilcoxon matched-pairs signed-rank test
Possible invasive fungal infections occurred in 4% of the itraconazole group, 6% of the voriconazole group, and 0% of the posaconazole group. There were no significant differences comparing all three. Adverse events occurred in 12% of the itraconazole group, 14% of the voriconazole group and 8% of the posaconazole group (no significant difference). All three groups showed a significant increase in ALT and AST as well as a significant difference between baseline and maximum levels of ALT and AST without clinical symptoms. Bilirubin also was increased during all three drug regimens but remained within the upper limits of normal. The kidney parameters (BUN/Cr) also showed an increase in all three groups but were not above reference values. Other adverse effects included hyponatremia. Cyclosporine (CsA) levels were evaluated in select patients in all three groups requiring dosage adjustments with a 12% dose reduction of CsA in the itraconazole and voriconazole group and as much as a 25% dose reduction in the posaconazole group.
Current guidelines for the use of oral antifungal prophylaxis in pediatric patients after HSCT are based on insufficient data. Despite the positive results, showing efficacy of all three drugs, it was comparable with no proven or probable fungal invasive infections. The analysis of a larger number of patients is required.
Because of the small number of current trials, larger trials are needed to compare each of the azoles as monoprophylaxis. Additional studies are needed to better understand the side effect profiles of the azoles and their interactions with antibiotics or immunosuppressants.