Riechelmann, R.P., Burman, D., Tannock, I.F., Rodin, G., & Zimmermann, C. (2010). Phase II trial of mirtazapine for cancer-related cachexia and anorexia. American Journal of Hospice and Palliative Care, 27, 106–110.
To determine the proportion of patients who gained at least 1 kg at the end of week 4. Secondary endpoints were the proportion of patients whose appetite or health-related quality of life (HRQOL) improved at week 4.
Patients received the starting dose of 15 mg of mirtazapine orally at bedtime for three days. Thereafter they received 30 mg daily provided they tolerated the medication. Patients were weighed on a mechanical scale and were assessed for appetite change and side effects prior to starting the mirtazapine and at weeks 2, 4, and 8. HQOL was measured at baseline and at weeks 4 and 8. Demographics (age, gender, concurrent medications, disease site, and Eastern Cooperative Oncology Group performance status) were also assessed. Toxicity was assessed at every visit.
The study was an eight-week, open-label, noncomparative phase II trial.
At week 4, 4 of 17 patients (24%) had weight gain of 1 kg or more (range: 1–3.6 kg). One patient maintained weight, and two patients lost weight. Of the patients who gained weight, all improved by 2 or more points on the ESAS for appetite (range = 2–6 points). One of the responding patients demonstrated improved HQOL by 16 points, and three maintained HQOL. Mirtazapine was well tolerated, but two patients withdrew from the study due to side effects.
Nearly a quarter of patients in this study gained at least 1 kg after four weeks of therapy. Another quarter maintained their weight. While the results of the study indicate that mirtazapine appears to be a potentially useful agent in the management of cancer-related cachexia and anorexia, this study was small, with only four patients in each group.
The pathophysiology of cachexia is complex. There is currently no standard treatment for managing cancer-related cachexia. Mirtazapine may be a potential agent useful in the management of cachexia; however, additional research is necessary.
Richardson, J., Smith, J.E., McCall, G., & Pilkington, K. (2006). Hypnosis for procedure-related pain and distress in pediatric cancer patients: A systematic review of effectiveness and methodology related to hypnosis interventions. Journal of Pain and Symptom Management, 31(1), 7084.
To evaluate the evidence, from controlled clinical trials, relating to the effectiveness of hypnosis for reducing procedure-related pain and distress in pediatric cancer patients
Using rating scales in the pediatric population is a useful and valid procedure. Some studies included observations of procedure-related behavior, and these observations showed that the intervention yielded some benefit, although the observer's criteria are unspecified. Some studies showed that the level of hypnotizability, as measured by the Stanford Hypnotic Clinical Scale for Children, was related to analgesic effect, but this finding was invalid. Studies that noted and stratified for the sex of the pediatric patient reported that the child's sex was related to level of distress. Self-hypnosis was not evaluated but has been shown to have an effect on management of symptoms.
Studies reported that using hypnosis as specified had positive effects, resulting in statistically significant reductions in pain and anxiety or distress.
Work remains to be done in this area. Researchers should focus on age, developmental stage, and the association between the sex of the child and the effectiveness of the intervention.
Richardson, J., Smith, J.E., McCall, G., Richardson, A., Pilkington, K., & Kirsch, I. (2007). Hypnosis for nausea and vomiting in cancer chemotherapy: A systematic review of the research evidence. European Journal of Cancer Care, 16, 402–412.
STUDY PURPOSE: To systematically review the research evidence on the effectiveness of hypnosis for chemotherapy-induced nausea and vomiting (CINV)
TYPE OF STUDY: Systematic review
All the studies that focused on pediatrics were consistent in that hypnosis was a better treatment option than standard or controlled care. The weighted mean effect sizes indicated that hypnosis was even more effective when followed by therapist contact (D = 0.43) and cognitive behavior therapy (D = 0.18).
Hypnotherapy could be a clinically valuable intervention for anticipatory and acute CINV in children with cancer, but this older systemic review did not show the same results with adults.
Limited number of studies included
Nurses caring for pediatric patients should understand that hypnosis should be part of the toolbox for children who suffer from acute and anticipatory CINV.
Richard, P.O., Fleshner, N.E., Bhatt, J.R., Hersey, K.M., Chahin, R., & Alibhai, S.M. (2014). A phase II, randomized, double-blind, placebo-controlled trial of methylphenidate for reduction of fatigue in prostate cancer patients receiving LHRH-agonist therapy. BJU International. Advance online publication.
To determine if a 10-week regimen of methylphenidate could alleviate fatigue and improve quality of life in men with prostate cancer being treated with luteinizing hormone-
Subjects were randomized to receive either methylphenidate or a placebo for up to 12 weeks. Methylphenidate was given at a dose of 5 mg daily for two weeks followed by 5 mg twice daily for eight weeks. The dose was tapered back to 5 mg per day for the last two weeks. Patients were contacted by phone at week 2 for reminders to take the medication and to assess drug tolerance. Assessments were done when patients were seen in-clinic at weeks 6, 10, and 12.
Double-blind, placebo-controlled, randomized trial
FACIT scores improved significantly over the course of the study in all patients, but improvement was only statistically significant in the methylphenidate group (p = .008). The between-group difference in improvement was significant (p = .02). BFS scores also showed improvement in the methylphenidate group over time (p = .0006) but differences between study groups were not statistically significant. One patient discontinued the medication due to side effects.
Methylphenidate was shown in this small study to improve fatigue scores.
Methylphenidate may be helpful to some patients in managing fatigue during cancer treatment. Due mostly to sample size limitations, this study does not provide strong evidence for use of methylphenidate in men with prostate cancer.
Ricci, M., Pirotti, S., Scarpi, E., Burgio, M., Maltoni, M., Sansoni, E., & Amadori, D. (2012). Managing chronic pain: Results from an open-label study using MC5-A Calmare® device. Supportive Care in Cancer, 20, 405–412.
To assess the efficacy and acceptability of the MC5-A Calmare® device
The Calmare device produces electrical nerve stimulation that is transmitted to nociceptors in order to modulate the pain response. Electrodes were placed on the skin according to the area of pain to be treated. Patients could receive up to a maximum of four treatments per day. Ten 30-minute sessions of the stimulation therapy for two consecutive weeks were delivered Monday through Friday. Pre- and post-treatment assessments were done after the first week and after the tenth day of treatment. Patients continued their usual regimen of analgesics.
Patients were undergoing long-term follow-up care.
The study has clinical applicability for end-of-life and palliative care; and elderly care.
A prospective, exploratory, single-group, quasi-experimental design was used.
Numerical rating scale (NRS)
Participants had an overall decrease in pain. Mean value at the beginning of treatment was 5.4 for those with cancer and decreased to 1.4 at the end of the second week (p < 0.0001) and to 2.6 at the two-week poststudy follow-up (p < 0.0001). After the tenth day of treatment, mean value was 2.9 (p < 0.0001), and after the second week of follow-up, the mean one month of treatment pain reduction was 4.0 and 5.2 in patients with cancer and noncancer patients, respectively. No side effects were reported. Among those patients with cancer-related pain, 64% were deemed complete responders, and 7% achieved a partial response. No adverse effects were seen.
This pilot study demonstrated that cutaneous electrostimulation with the MC5-A Calmare® device was effective in chronic pain treatment.
Findings suggest that use of this device may provide benefit as adjunctive treatment for chronic pain control. Further well-designed research is needed to validate findings further.
Riblet, N., Larson, R., Watts, B.V., & Holtzheimer, P. (2014). Reevaluating the role of antidepressants in cancer-related depression: A systematic review and meta-analysis. General Hospital Psychiatry, 36, 466–473.
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Elder care, palliative care
The three effective antidepressants were mianserin, paroxetine, and fluoxetine. The mianserin group had a lower dropout rate than the placebo group, but with non-significant difference; higher depression response rate. Paroxetine group had higher dropout rate than placebo but with non-significant difference. The fluoxetine group had a significantly higher dropout rate when compared to a placebo. Paroxetine and fluoxetine were not associated with higher depression response rates when compared to a placebo. The evidence for the efficacy and tolerability of different antidepressants remains scarce for cancer-related depression, suggesting a great need for further randomized, controlled trials with placebo controls.
Opening database search dates varied. Heterogeneity among the studies complicated comparisons, causing small sample studies to be left out of at least two analyses. Only nine studies met the final criteria for inclusion, suggesting a need for research addressing the efficacy and tolerability of antidepressant use in patients with cancer and symptoms of depression.
Further research in patients with cancer and depression is needed to determine the best treatment guidelines. Mianserin showed the best results in these studies; however, it was reported that it is not available for sale in the United States. Research using other antidepressant drugs is needed. For example, tricyclic antidepressants and monoamine oxidase inhibitors should be studied. Paroxetine and desipramine did not show promising results in reducing depression in these studies.
Rinehart-Ayres, M., Fish, K., Lapp, K., Brown, C.N., & Rucker, B. (2010). Use of compression pumps for treatment of upper extremity lymphedema following treatment for breast cancer: A systematic review. Rehabilitation Oncology, 28(1), 10–18.
To assess if compression pumps decrease lymphedema compared with other treatments and to identify recommended parameters for use of compression pumps
Databases searched were MEDLINE, Ovid, PubMed, CINAHL, Scopus through January 2007, and hand searching from article references. Key search words were breast cancer, lymphedema, pneumatic compression, compression pumps, intermittent compression, and sequential compression. Studies were included in the review if they
Exclusion criteria were not specified.
Eighty-five articles were retrieved initially. Studies were categorized using Sackett’s levels of evidence. Additional discussion of study information was done, though specific methods were not described.
Among highest level studies, there were no differences between pneumatic compression and no intervention or compression garments or bandages.
There is no evidence that suggests use of intermittent compression pumps is effective in management of lymphedema or is any better than education about arm care and hygiene. There is no consensus about pressures to be used with compression pumps.
Findings do not support the use of compression pumps for lymphedema management secondary to breast cancer treatment. There is no information to establish appropriate and safe pressure levels for use.
Rheingans, J.I. (2007). A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses, 24(2), 81–94.
To assist the health care practitioner by summarizing research studies that have examined the use of nonpharmacologic adjunctive therapies (NATs) for symptom management in pediatric oncology patients
Investigators retrieved and reviewed 41 studies. Their review related to symptoms studied, modalities used, study design, sample size, and study results. The analysis included all 41 studies. The studies pertained to multiple modalities, including hypnosis, imagery, breathing, distraction, relaxation, cognitive behavioral therapy, art therapy, and music therapy.
Over all the studies, the results are mixed in regard to the effect of NATs on procedural pain. Some studies indicated that hypnosis produced promising results in reducing procedural pain. Cognitive behavioral therapy and distraction showed both an effect and no effect on pain. One study (based on observation and self-reporting) indicated that NATs had no effect on procedural pain. In a few studies, hypnosis (along with distraction and relaxation and cognitive behavioral therapy) produced significant pain reduction. Studies found that music therapy had little to no effect on the pain of bone marrow aspiration.
This review of NATs produced mixed results.
More research needs to be done in this area. Health care practitioners, patients, and families need education about NATs and their application to pediatric oncology.
Rexilius, S.J., Mundt, C., Erickson Megel, M., & Agrawal, S. (2002). Therapeutic effects of massage therapy and healing touch on caregivers of patients undergoing autologous hematopoietic stem cell transplant. Oncology Nursing Forum, 29, E35–E44.
In the control group, one of the researchers visited caregivers for about 10 minutes twice a week for three weeks and asked, “How are you doing?”
In the massage therapy and Healing Touch groups, caregivers were provided with six 30-minute sessions. A certified massage therapist administered massage therapy, and a certified therapist provided Healing Touch treatments.
Outpatient oncology clinic
Renouf, T., Leary, A., & Wiseman, T. (2014). Do psychological interventions reduce preoperative anxiety? British Journal of Nursing, 23, 1208–1212.
STUDY PURPOSE: To evaluate evidence regarding effects of psychoeducational interventions for preoperative anxiety
PHASE OF CARE: Active antitumor treatment
The report suggests that nursing interventions of a psychoeducational nature can reduce preoperative anxiety, based on findings of six randomized, controlled trials conducted from 1985 to 2005. Samples in these studies were self-selected, and the review identifies a number of study design aspects that would create risk of bias, inappropriate statistical analysis, and high volume of missing data and elimination of patients from data analysis. The review also stated that patients benefit from individualized information and have associated reduction in anxiety; however, review of these studies also suggested multiple design flaws, and this finding appears to be based on various authors’ recommendations rather than actual study findings.
There are multiple limitations of this review, and it does not provide strong support for effectiveness of various nursing interventions to reduce preoperative anxiety.
No information is provided about study sample types or actual quality of studies included. Findings stated in the article are not clearly derived from actual research results.
Due to study limitations, this review does not provide strong support for the efficacy of psychoeducational and informational interventions to reduce preoperative anxiety. Provision of preoperative patient education is a necessary component of care, but it may not be sufficient to alleviate anxiety.