Chung, V.C., Wu, X., Lu, P., Hui, E.P., Zhang, Y., Zhang, A.L., . . . Wu, J.C. (2016). Chinese herbal medicine for symptom management in cancer palliative care: Systematic review and meta-analysis. Medicine, 95, e2793.
STUDY PURPOSE: To summarize the results from randomized, controlled trials (RCTs) of the effectiveness of Chinese herbal medicines (CHMs) for managing fatigue, paresthesias, chronic pain, anorexia, edema, and constipation
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Elder care, palliative care
Combining CHM with chemotherapy may improve fatigue in patients with breast cancer. Adding CHM to conventional treatment may improve pain control. CHM alone may improve constipation.
Further research needs to be performed on CHM treating cancer- and cancer treatment-related symptoms.
Chung, C., Lee, S., Hwang, S., & Park, E. (2013). Systematic review of exercise effects on health outcomes in women with breast cancer. Asian Nursing Research, 7, 149–159.
The physical, psychological, physiologic, and behavioral aspects of the patients included in most of the studies were changed significantly by the exercise interventions. Physiotherapy improved range of motion, shoulder function, and pain, regardless of the intervention dosages. The effect of the interventions on lymphedema wasn’t apparent at six months but was visible at 12 months’ follow-up. Eight weeks of aerobic exercise was effective for psychological and behavioral outcomes through 24 weeks postintervention, but no significant long-term physical health effects were apparent. Aqualymphatic therapy affected emotional and social quality of life (QOL) but not physical QOL or limb volume. Dance and movement was not effective for lymphedema or health-related QOL. It only was effective for breast cancer-related QOL. Home-based rehabilitation improved some range of motion but did not affect pain, lymphedema, or strength.
Physical therapy is beneficial for shoulder range of motion when implemented soon after surgery. Any type of structured exercise could improve shoulder mobility, range of motion, and shoulder function in a relatively short period of time. The long-term effects of physiotherapy need to be studied more extensively. Multimodal exercise and comprehensive rehabilitation, including physical therapy, had physical and psychological effects. Aerobic exercise and dance and movement had a positive psychological effect. Exercise is essential to lymphedema treatment and management.
Few of the studies included long-term follow-up to measure the effects of the interventions on lymphedema development and severity.
Informing patients with breast cancer about the importance of exercise after receiving surgery and teaching patients ways to decrease the limitations that may occur after surgery is necessary.
Chujo, M., Mikami, I., Takashima, S., Saeki, T., Ohsumi, S., Aogi, K., et al. (2005). A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence. Supportive Care in Cancer, 13, 503–514.
The intervention was a six-week structured psychosocial support group of 90 minutes led by a male psychiatrist and nurses with experience in facilitation cancer groups. Each group member received
Measurements were done at baseline, then immediately following the six-week intervention, then three months and six months later.
Eleven women refused to participate but were interested in group intervention and consented to answering questionnaires. These women were given materials after completion of the survey and the PMR tape.
The study design was quasi-experimental without a control group.
Results in the intervention group revealed significant changes in scores for tension-anxiety on POMS in the period up to three months after the intervention; no differences were noted at six months after the intervention.
Chuang, C. Y., Han, W. R., Li, P. C., & Young, S. T. (2010). Effects of music therapy on subjective sensations and heart rate variability in treated cancer survivors: a pilot study. Complementary Therapies in Medicine, 18, 224–226.
To determine the effects of music therapy on subjective sensations and physiologic parameters of heart rate variability (HRV) in treated cancer survivors.The hypothesis was that music therapy significantly affects the sensations of fatigue, comfort, and relaxation, as well as the activities of the sympathetic and parasympathetic nervous systems.
Participants were asked to sit and rest for five minutes to stabilize their heart and respiration rates when they first arrived in the group therapy room. An electrocardiogram (ECG) signal then was measured for five minutes, and fatigue, comfort, and relaxation were rated subjectively on the visual analog mood scales (VAMS) as a pretest. After participating in two hours of music therapy, the same procedure was performed again as a posttest.
The two-hour music therapy intervention consisted of three activities. In the first activity, the program aimed at establishing a rapport between therapists and participants through singing and listening. The song for the first activity was a popular Taiwanese song called ‘‘He is Our Treasure,’’ which had pleasant moderate rhythm and tempo. The second activity was to learn how to play the recorder. This activity used simple musical instrument learning to establish the participants’ self-confidence. The third activity was to perform the main five notes of a familiar melody song, ‘‘Grandfather’s Clock,’’ following the therapist’s electric keyboard accompaniment and conduct. This activity sought to encourage the participants to express themselves through playing the recorder and to create light and joyful emotions.
The study used a pre-/posttest, quasiexperimental design.
Comparison of the quantitative HRV measures at pre- and posttest revealed that the high frequency (HF) power and normalized HF power were significantly higher, and the low frequency (LF)/HF ratio and normalized LF power of HRV were significantly lower at posttest than at pretest (p < 0.05). The VAMS mean value for the fatigue level was significant lower after music therapy (p < 0.05). The VAMS mean value for relaxation level was significant higher after music therapy (p < 0.05).
In a small sample size including varied cancer diagnoses with limited information about the study participants, the assessment showed changes in fatigue, relaxation, comfort, and HRV.
Additional research is needed, including the use of psychometrically tested symptom instruments. Based on the descriptive findings in this very small initial study evaluating HRV, fatigue, and relaxation, it may not be appropriate to include it in PEP topic research. This study was completed by colleagues in a biomedical engineering school. Describing the process of how this was accomplished (e.g., surveys with nurses assisting) might be useful.
Cho, Y., Do, J., Jung, S., Kwon, O., & Jeon, J.Y. (2016). Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection. Supportive Care in Cancer, 24, 2047–2057.
To assess the benefits of standard physical therapy (PT) compared to PT with manual lymph drainage (MLD) on lymphedema incidence, shoulder function, pain, and cording in patients with breast cancer with axillary web syndrome (AWS)
PHASE OF CARE: Late effects and survivorship
This was a prospective, randomized trial of patients with breast cancer who had undergone surgery and were randomized to two therapy interventions.
All patients benefited from postoperative PT, but patients who had PT and MLD did not develop lymphedema. Measurements were not taken weekly, so when the changes in arm volume occurred cannot be identified. This study supports wearing compression during therapy. Patients are at risk for lymphedema even when engaging in supervised exercise.
Nurses need to vigilantly monitor for symptoms of pain in the ipsilateral limbs of patients with breast cancer to prevent loss of function, chronic pain, and lymphedema. As seen in this study, even pain at level 3 is significant. Patients need early PT referral to prevent arm disability and early lymphedema therapy.
Chow, E., Meyer, R.M., Ding, K., Nabid, A., Chabot, P., Wong, P., . . . Wong, R.K. (2015). Dexamethasone in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases: A double-blind, randomised placebo-controlled, phase 3 trial. Lancet Oncology, 16, 1463–1472.
To compare the efficacy of dexamethasone to placebo for prevention of pain flare after palliative radiotherapy
Patients were randomized to receive either 8 mg dexamethasone or placebo at least one hour before the start of radiotherapy and then daily while receiving radiotherapy. Patients completed study assessments at baseline, day 10, and day 42 after radiation treatment.
Median follow-up ranged from 1-39 months. Ninety-two patients experienced pain flare on days 0–10, 26% in the dexamethasone group and 35% in the placebo group (p = 0.05). The incidence of pain flare was 11.8% lower in the dexamethasone group (p = 0.01). No significant differences were noted between groups in overall pain reduction from radiotherapy or analgesic intake. Three patients on dexamethasone stopped the study medication due to hyperglycemic events. Two of these had preexisting diabetes.
Provision of 8 mg dexamethasone prior to and daily during palliative radiation therapy for bone metastases was effective in the prevention of radiation-associated pain flare compared to placebo.
This study showed that administration of dexamethasone during palliative radiation therapy for bone metastases was effective in preventing bone flare pain. A few patients developed hyperglycemic episodes while on dexamethasone, so nurses need to be aware of this potential, particularly in patients with preexisting diabetes. The purpose of palliative radiation is pain reduction, so it also makes sense to intervene to prevent pain flare that can occur from that treatment. Further research is warranted to compare prophylactic versus treatment of bone flare pain, and potential efficacy of other adjuvant medications.
Chow, E., van der Linden, Y.M., Roos, D., Hartsell, W.F., Hoskin, P., Wu, J.S., . . . Wong, R.K. (2014). Single versus multiple fractions of repeat radiation for painful bone metastases: A randomised, controlled, non-inferiority trial. The Lancet Oncology, 15, 164–171.
To assess two different radiation therapy fractionation approaches in patients with painful bone metastases needing repeat radiation therapy
Patients with radiologically confirmed bone metastases that had previously been treated with radiation were randomized to receive 8 Gy in a single fraction or 20 Gy in multiple fractions. Those getting 20 Gy received treatment in five fractions unless the target field was the spine or whole pelvis. Bone-modifying agents and systemic therapy were allowed at the discretion of the physician. Overall response to treatment was the primary endpoint at two months after beginning treatment. Pain assessments were done at days 7 and 14, monthly for 6 months, and at 9 and 12 months after radiation therapy. A difference of 10% with treatment response was established to determine noninferiority.
Unblinded, randomized, controlled noninferiority trial
In the ITT analysis, 28% in the 8 Gy group had response, and 32% of those in the 20 Gy group had overall response with a confidence interval that did not meet the noninferiority margin. In the per-protocol analysis, 45% of patients in the 8 Gy group and 51% in the 20 Gy group had overall response with a 95% confidence interval that met the 10% noninferiority margin. Patients in the 20 Gy group had more skin reddening and more frequent and severe anorexia, vomiting, and diarrhea (p < .05).
The per-protocol analysis showed that multiple fractionation was associated with slightly better pain response to treatment, but was also associated with more side effects.
Radiation therapy to areas of painful bone metastases is effective in reducing pain. Though a higher total dose was slightly more effective, it was also associated with more side effects. Nurses can use this knowledge to educate patients and to monitor appropriate patients for treatment side effects.
Chow, R., Chiu, L., Navari, R., Passik, S., Chiu, N., Popovic, M., . . . DeAngelis, C. (2015). Efficacy and safety of olanzapine for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) as reported in phase I and II studies: A systematic review. Supportive Care in Cancer, 24, 1001–1008.
STUDY PURPOSE: To summarize evidence from phase I and II trials in which olanzapine was used for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV)
PHASE OF CARE: Active antitumor treatment
The rate of complete control (no emesis, no rescue medication, and no significant nausea) was only identified in one study. Complete response rates were reported in three studies, and they ranged from 75%–100% in the acute phase and 72%–92.5% in the overall phase. In four trials, olanzapine was used as an adjunct with other antiemetics. One study was a retrospective chart review.
The findings of this study suggest that olanzapine can be beneficial in preventing CINV.
The potential role of olanzapine in the prevention and management of CINV is unclear. This review provides limited evidence of the effects of olanzapine for CINV. Future studies need to compare olanzapine as an adjuvant to recommended antiemetics or olanzapine as a single agent compared to regimens with clear efficacy for the prevention of CINV.
Chow, K.M., Chan, C.W., Chan, J.C., Choi, K.K., & Siu, K.Y. (2014). A feasibility study of a psychoeducational intervention program for gynecological cancer patients. European Journal of Oncology Nursing, 18, 385–392.
To test the feasibility of the implementation of a psychoeducational intervention program for patients with gynecologic cancer
This study consisted of a series of interventions consisting of multiple components based on a thematic counseling model for patients with newly diagnosed gynecologic cancers. Blinding was performed at randomization. Quantitative data on sexual functioning, uncertainty, quality of life, anxiety, depression, and support systems were collected at recruitment, following surgery, during hospitalization, and eight weeks following surgery. Both quantitative and qualitative methods were used in the data analysis. The intervention consisted of four psychoeducational sessions. An individual format was used for the first three sessions and a group format was used for the last session. All intervention sessions were conducted by the researcher. The researcher also met with the control group on four occasions during the same period: at recruitment, after surgery, once in-hospital, and once via telephone four weeks following surgery during which participants were invited to attend a support group. The researcher was a registered nurse experienced in gynecologic cancer care.
Single-blinded, randomized trial with a mixed-methods design
Thirteen patients were in the intervention group and 13 were in the control group. There were no statistical differences between the populations of the two groups. The compliance rate was 69.2% in the intervention group with the greatest lack of compliance occurring during the final session. The compliance rate for the control group was 46.2%. Statistic significance regarding trends of change in the outcome variables was not obtained. There was no statistic significance in the comparison of baseline outcome variables of the two groups. There was no statistic significance of intervention effects between the two groups, except in the area of uncertainty. The inconsistency subscale showed a statistic significance between the two groups with the intervention group receiving less inconsistent information regarding their illnesses. The intervention group demonstrated better trends for improvement than the control group in all categories although there were contradictory results in the scales measuring quality of life, perceived social support, anxiety, and depression.
This patient population has healthcare needs that currently are not being met. This particular study did not show statistically significant results regarding anxiety, depression, quality of life, and sexual functioning in patients with gynecologic cancer. Further research is indicated.
Further research is indicated regarding anxiety, depression, quality of life, and sexual functioning in patients with gynecologic cancer, particularly during the postoperative period. This study showed trends for overall improvement, indicating the importance of nursing in this population. Understanding the implications of cultural differences regarding the effects of gynecologic therapies is an important nursing responsibility.
Choo, S.P., Kong, K.H., Lim, W.T., Gao, F., Chua, K., & Leong, S.S. (2006). Electroacupuncture for refractory acute emesis caused by chemotherapy. The Journal of Alternative and Complementary Medicine, 12, 963-969.
To evaluate the use of electroacupuncture in preventing anthracycline-based chemotherapy-related nausea and vomiting (CINV) refractory to combination 5-HT3-antagonist and dexamethasone
Patients received electroacupuncture in addition to standard antiemetic prophylaxis. Acupuncture was started 10 minutes prior to start of chemotherapy infusion and then continued for an additional 20 minutes. The P6 acupuncture point was used, a second needle was inserted at a different point, and electrical stimulation was delivered.
This was a prospective trial.