Nava, S., Ferrer, M., Esquinas, A., Scala, R., Groff, P., Cosentini, R., . . . Grassi, M. (2013). Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: A randomised feasibility trial. The Lancet Oncology, 14, 219–227.
To determine the acceptability of solely using palliative noninvasive ventilation (NIV) versus oxygen therapy to manage breathlessness in patients with end-stage cancer and its effects in reducing dyspnea and opioid requirement
Multi-center, randomized, controlled trial
NIV was feasible and effective in decreasing dyspnea intensity and reducing morphine requirements in patients with end-stage cancer experiencing respiratory failure. However, additional studies validating these findings and determining the effects of NIV on survival and quality of life are needed.
This study offers clinicians a treatment modality that can be used in adjunct with opioids to significantly reduce breathlessness in patients with end-stage cancer. Additional studies are needed to determine the specific patient population that would benefit the most from this treatment, its cost effectiveness, patient satisfaction, the adverse effects of NIV, and the survival rate.
Nauseef, W. M., & Maki, D. G. (1981). A study of the value of simple protective isolation in patients with granulocytopenia. New England Journal of Medicine, 304, 448–453.
To evaluate protective isolation versus no isolation.
The authors evaluated single protective isolation (single-bed room and clean gowns, gloves, and masks for people entering room) versus standard care (two-bed room and reminder sign to wash hands).
Forty-three episodes of neutropenia occurred in adult patients.
This was a randomized study.
No significant difference was found between isolated and nonisolated patients regarding the incidence of infection, time of onset of first infection, and days with fever.
National Health and Medical Research Council (Australia). (2003). Clinical practice guidelines for the psychosocial care of adults with cancer. Retrieved from http://www.nhmrc.gov.au/publications/synopses/cp90syn.htm
Comprehensive, evidence-based guidelines were developed to assist healthcare professionals in providing optimal psychosocial care. The guidelines are multidisciplinary in focus, with recommendations applicable to diverse treatment settings.
Evidence was presented using levels I, II, III-1, III-2, III-3, and IV rating system with level I representing the gold standard.
Clinically relevant recommendations supported by level I and II evidence about depression include the following.
The treatment of depression should incorporate psychotherapeutic interventions and the use of medication.
Evidence of the efficacy of antidepressant medication in treating depression in patients with cancer is clear.
No evidence suggests that any particular antidepressant is superior to another.
Nasu, R., Nannya, Y., & Kurokawa, M. (2015). A randomized controlled study evaluating the efficacy of aprepitant for highly/moderately emetogenic chemotherapies in hematological malignancies. International Journal of Hematology, 101, 376–385.
To assess the additional effects of aprepitant in combination with conventional 5HT3 blocker-based prophylaxis for chemotherapy-induced nausea and vomiting (CINV) during highly or moderately emetic chemotherapy for hematologic malignancies
Patients were divided into two arms. Patients in the conventional antiemetic therapy arm received 5HT3 receptor antagonists (RAs) alone (19 patients, control arm), and patients in the treatment group received 5HT3 RAs plus aprepitant (22 patients, aprepitant arm). The incidence of CINV and the use of rescue medications were analyzed and compared between the two groups over the total period of 10 days from the start of chemotherapy. Oral food intake also was appraised by patients and sorted into four levels: (1) not impaired, (2) slightly impaired, (3) moderately impaired to about half of the usual amount, or (4) severely impaired.
Randomized, controlled study
This study revealed the benefit of adding aprepitant to highly emetic chemotherapy regimens for various hematologic malignancies. Sufficient antiemetic effects were achieved without obvious adverse events, and additional aprepitant use is recommended for patients who received chemotherapy for a hematologic malignancy. The additional research of individual chemotherapies that specifically prefer antiemetic intensification with aprepitant is warranted.
Aprepitant is a good option for nurses to recommend for patients receiving chemotherapy for hematologic malignancies. NK1s such as aprepitant are recommended in relevant guidelines.
Nasilowska-Adamska, B., Rzepecki, P., Manko, J., Czyz, A., Markiewicz, M., Federowicz, I., … Marianska, B. (2007). The influence of palifermin (Kepivance) on oral mucositis and acute graft versus host disease in patients with hematological diseases undergoing hematopoietic stem cell transplant. Bone Marrow Transplantation, 40, 983–988.
To assess the use of palifermin in the prevention of oral mucositis (OM) and acute graft-versus-host disease (GVHD) after hematopoietic stem cell transplant (HSCT)
IV palifermin was administered at 60 mcg/kg for three consecutive days before and after conditioning therapy. These patients were compared to a retrospective control group.
This was a multicenter study conducted in Poland.
This was a retrospective control trial.
Incidence of all grades of mucositis was lower in the palifermin group (p < 0.001). Incidence of grades 3–4 was 13% in the palifermin group and 43% in the control group (p < 0.001). Mean duration was significantly lower (p < 0.001). No statistically significant differences in the onset of OM, duration of TPN, opioid use, incidence of febrile neutropenia, or severe infection were observed. No statistical significance in acute GVHD measures were observed, although the authors suggested that a decrease in acute GVHD may occur. Additional studies are necessary.
Adverse events (e.g., rash, pruritis, erythema, generalized edema, taste alteration, mouth or tongue thickness and discoloration, proteinuria) were mild in 15 patients, moderate in 15 patients, and severe but not life-threatening in 4 patients. No events caused discontinuation of palifermin.
Nashwan, A. J. (2011). Use of chlorhexidine mouthwash in children receiving chemotherapy: A review of literature. Journal of Pediatric Oncology Nursing, 28, 295–299.
To evaluate the effectiveness of chlorhexidine mouthwash in children receiving chemotherapy
Databases searched were PubMed and ScienceDirect.
Search keywords were oral chlorhexidine, chemotherapy-induced mucositis/stomatitis, and pediatrics/children.
Studies were included in the review if they
Studies were excluded if they
Naraphong, W., Lane, A., Schafer, J., Whitmer, K., & Wilson, B.R. (2015). Exercise intervention for fatigue‐related symptoms in Thai women with breast cancer: A pilot study. Nursing and Health Sciences, 17, 33–41.
To test the feasibility and provide a preliminary evaluation of the effects of an exercise program for fatigue, sleep disturbance, mood, and symptoms in patients with cancer
Participants randomly were assigned to the treatment or control group. Patients in the control group received usual care, an educational booklet and DVD, and weekly telephone calls. Patients in the experimental group received initial one-on-one training sessions and were given exercise program kits containing written instructions, a pedometer, and an exercise log. Patients were to choose activities that provided low to moderate intensity exercise and perform these daily for at least 20 minutes. Participants also were asked to walk three to five days per week. Weekly phone calls to the experimental group were made to monitor participation and make adjustments to the walking prescription as needed. The program was planned for 12 weeks.
Randomized, controlled trial
Patients in the experimental group demonstrated a nonsignificant improvement in fatigue (d = -0.48). There were no significant group by time effects for other measures. Data were not collected after week 10 because of loss of subject follow-up.
The findings of this study support the known effect of exercise on cancer-related fatigue; however, the small sample in this study limits the strength of these findings.
This study provides minimal additional support for the benefits of exercise among women with breast cancer during active treatment. Exercise has been shown to be effective in reducing multiple symptoms, and nurses should encourage patients to be active.
Narabayashi, M., Saijo, Y., Takenoshita, S., Chida, M., Shimoyama, N., Miura, T., … Advisory Committee for Oxycodone Study. (2008). Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable adverse effects: An open-label trial. Japanese Journal of Clinical Oncology, 38(4), 296–304.
To investigate the efficacy and safety of switching from oral morphine to oral oxycodone and to evaluate this regimen in patients with renal impairment
Patients were rotated from controlled-release (CR) oral morphine to oral oxycodone CR via a 3:2 ratio. Immediate-release (IR) oxycodone was used for breakthrough pain (BTP) at 1/6 of the 24-hour oxycodone dose. If pain intensity was rated as moderate to severe or if more than 3 rescue doses of IR oxycodone were administered in 24 hours, oxycodone was titrated upward. If untoward side effects were experienced, the oxycodone dose was titrated downward. Patients were deemed successful if pain control was adequate for 10 days. Pharmacokinetic evaluation for renal impairment was conducted on patients with adequate relief.
This study was a multisite, outpatient setting study conducted at 14 sites in Japan.
This was a multicenter, open label, dose-titration study.
Rotation to oral oxycodone for patients who had inadequate pain control or significant adverse events with morphine was successful. Retention of oxycodone metabolites did not seem to exist in patients with renal compromise.
Oxycodone can be recommended as an alternative to morphine, and patients may experience fewer adverse events with oxycodone. Patients with renal compromise may benefit from oxycodone over morphine as morphine contributes to metabolite accumulation, leading to potential oversedation or adverse events.
Namkoong, K., DuBenske, L.L., Shaw, B.R., Gustafson, D.H., Hawkins, R.P., Shah, D.V., . . . Cleary, J.F. (2012). Creating a bond between caregivers online: Effect on caregivers' coping strategies. Journal of Health Communication, 17, 125–140.
To evaluate the effects of bonding experience among caregivers of patients with advanced lung cancer while participating in a structured, Internet-based education, communication, and coping skill-building program on caregiver coping strategies. (The main study results on caregiver quality of life and mood associated with this program were presented in 2010 by DuBenske et al. at the International Psyco-Oncology Society in Quebec.)
Patient and caregiver pairs were randomized to participate in the Comprehensive Health Enhancement Support System (CHESS), an Internet-based program incorporating an asynchronous support group, education, communication, and coping skill instruction (“Coping With Lung Cancer: A Network of Support” module), or a control group able to access the Internet freely and provided with several reputable websites on lung cancer.
Mutliple phases of care
A randomized controlled trial design was used, with attentional control of provision of Internet sites for the control group.
This paper focused on the effect of bonding among the caregiver participants in the CHESS group on coping. A mediating effect was noted using structural equation modeling, with the caregiver-perceived bonding with other group members positively associated with the three coping domains (active coping: β = 0.26, p < 0.05; positive reframing: β = 0.20, p < 0.05; instrumental support: β = 0.32, p < 0.01). Other variables such as age, gender, education level, caregiver comfort with the Internet at study entry, and baseline bonding and coping scores were not significant in the model. The report does not provide data on differences in outcomes between groups; it only cites a prior presentation of these findings that are apparently not yet published.
Caregivers of patients with lung cancer that participated in the CHESS program perceived increased levels of human bonding within their group, and this effect was related to coping.
This study illustrated that caregiver and patient participation in an Internet-based, self-paced support, educational, and coping program with a consistent group of peers facilitated human bonding with those in a similar situation, which apparently enhanced quality of life (per a reference to the results of the main study) and positive coping. It is valuable for nurses to encourage caregivers to engage in such a program where they can seek support, receive and share information, and be coached through communication skill-building from home at a time of their choosing. Because of the high attrition rate noted, it appears that more work to understand how to keep participants engaged over time for maximum benefit is needed.