Falkowski, S., Trouillas, P., Duroux, J. L., Bonnetblanc, J. M., & Clavère, P. (2011). Radiodermatitis prevention with sucralfate in breast cancer: fundamental and clinical studies. Supportive Care in Cancer, 19, 57–65.
To determine if sucralfate has a role in the prevention of radiodermatitis. A 1% concentration of sucralfate in lotion was tested.
Several zones on the breast were laid out by the investigators, with one zone in the irradiated field left untreated, one with sucralfate, and one that was not within the field of radiation therapy (RT). All patients were instructed to apply sucralfate lotion twice a day, one to two hours prior to treatment and within two hours after RT.
Unspecified
The study used a quasiexperimental design—patients were used as their own controls.
No radioprotective effect was demonstrated with sucralfate.
Fahy, A.S., Jakub, J.W., Dy, B.M., Eldin, N.S., Harmsen, S., Sviggum, H., & Boughey, J.C. (2014). Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting. Annals of Surgical Oncology, 21, 3284–3289.
To evaluate whether paravertebral block use affected opioid use, antiemetic use, and length of stay in patients receiving mastectomies
Patient data were collected from medical records from the time periods before and after the use of paravertebral blocks (PVBs). Patients receiving unilateral mastectomies had unilateral PVBs, and those receiving bilateral mastectomies had bilateral PVBs. Blocks were placed preoperatively. All patients had general anesthesia. Prophylactic opioids and antiemetics were given intraoperatively at the discretion of the anesthesia team. Pain scores were documented with vital sign monitoring postoperatively. The results of those who had PVBs were compared to a cohort of patients who did not have PVBs.
Retrospective cohort comparison
In a multivariate analysis that was controlled for age and surgeon, there was no significant difference between groups in length of stay. The percentage of patients requiring antiemetics was higher in the no-PVB group (57 versus 39%, respectively, p < 0.00001). The amount of opioids required was higher in the no-PVB group on the day of surgery (47.6 versus 40.1 morphine equivalents, respectively, p < 0.0001). Despite differences in opioid consumption, there were no significant differences between groups in pain scores. The greatest difference in opioid consumption was seen in patients receiving immediate bilateral reconstructions.
The use of PVBs in patients receiving mastectomies was associated with lower antiemetic and opioid consumption on the day of surgery.
The findings of this study suggested that among patients receiving mastectomies, PVBs may reduce the need for postoperative antiemetics and opioids. However, it was not clear that the procedure actually reduced postoperative pain. This procedure appeared to be most beneficial for women having the most extensive surgical procedures. Additional well-designed research is warranted to determine the clinical benefits of PVB and its role in improving perioperative pain control.
Fabian, C. J., Molina, R., Slavik, M., Dahlberg, S., Giri, S., & Stephens, R. (1990). Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion. Investigational New Drugs, 8, 57–63.
Evaluate effectiveness of pyridoxine for treating PPE in patients with metastatic colon cancer who are receiving continuous 5-FU
Patients were treated with 5-FU 200 mg/m2 by continuous infusion (CI) until moderate to severe toxicity developed.
Five previously untreated patients who developed PPE were given oral pyridoxine (50 or 150 mg every day) when moderate PPE changes were noted.
Study conducted between September 1984 and July 1986.
N: 25
KEY DISEASE CHARACTERISTICS: Patients with metastatic colon cancer receiving continuous 5-FU infusion (200–300 mg/m2/day).
SITE: Multi-site
LOCATION: University of Kansas Medical Center; Fred Hutchinson Cancer Research Center
Skin toxicity was graded as follows.
PPE developed in 16 of the 25 patients. The five previously untreated patients who developed PPE received 50 or 150 mg of oral pyridoxine per day when moderate PPE changes were noted. Reversal of PPE without interruption of 5-FU was seen in four out of five patients, and these patients continued 5-FU for a median of six months after developing PPE.
Oral pyridoxine may reduce incidence and severity of PPE symptoms associated with 5-FU continuous infusion.
Fabi, A., Ciccarese, M., Metro, G., Savarese, A., Giannarelli, D., Nuzzo, C.M., … Cognetti, F. (2008). Oral ondansetron is highly active as rescue antiemetic treatment for moderately emetogenic chemotherapy: Results of a randomized phase II study. Supportive Care in Cancer, 16, 1375–1380.
To test the efficacy and safety of two different schedules of ondansetron as rescue antiemetic treatment in patients who were refractory to standard antiemetic prophylaxis for delayed emesis following moderately emetogenic chemotherapy (MEC)
Patients were randomly allocated to one of two treatment groups for rescue antiemetic treatment: intramuscular ondansetron 8 mg or oral ondansetron 16 mg for days two to six (antiemetic prophylaxis was provided by ondansetron 8 mg IV plus dexamethasone 8 mg IV for acute emesis and dexamethasone 8 mg for four days for delayed emesis).
The study was conducted at a single site, outpatient setting.
All patients were in active treatment.
The study design was a prospective trial (open label, phase II, randomly assigned to treatment group).
Oral ondansetron 16 mg was significantly superior to intramuscular ondansetron 8 mg for nausea and vomiting control during days two to six (p < 0.01). The two arms had a similar adverse event profile. A higher degree of personal satisfaction was found with oral ondansetron.
Because of its high efficacy and excellent tolerability, oral ondansetron is an important option in the management of MEC-related delayed emesis refractory to standard antiemetic prophylaxis.
The oral form of ondansetron could provide satisfactory rescue for breakthrough delayed emesis when compared to the Intramuscular form of ondansetron, with a similar adverse event profile.
Ezzone, S., Baker, C., Rosselet, R., & Terepka, E. (1998). Music as an adjunct to antiemetic therapy. Oncology Nursing Forum, 25, 1551–1556.
Patients were randomly assigned to the control group (usual antiemetic protocol) or experimental group (usual antiemetic protocol plus music intervention during the 48 hours of high-dose cyclophosphamide administered as part of the preparative regimen for autologous or allogeneic bone marrow transplantation). The experimental group listened to self-selected music (by portable compact disc players and headphones) for 45 minutes at 6, 9, and 12 hours after the start of each infusion as an adjunct to antiemetic therapy.
The study was conducted at a comprehensive cancer center in the midwestern United States.
The study design was a randomized, controlled clinical trial.
Significant differences were found between scores on the VAS for nausea and number of episodes of vomiting; less nausea and fewer instances of vomiting were reported in the experimental group.
Music as an adjunct to antiemetic therapy for chemotherapy-induced nausea and vomiting with high-dose chemotherapy can be effective.
Ezzo, J., Manheimer, E., McNeely, M.L., Howell, D.M., Weiss, R., Johansson, K.I., . . . Karadibak, D. (2015). Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database of Systematic Reviews, 5, CD003475.
PHASE OF CARE: Late effects and survivorship
Nurses need to provide early identification and education to affect patients' lymphedema treatment. MLD is a safe component of lymphedema therapy. Long-term adherence to treatment and garments are needed maintain reductions in swelling.
Ezzo, J., Vickers, A., Richardson, M.A., Allen, C., Dibble, S.L., Issell, B., … Zhang, G. (2005). Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. Journal of Clinical Oncology, 23, 7188-7198.
Database searched was MEDLINE (1966-Dec 2003).
Search keywords were acupuncture, alternative medicine, electroacupuncture, moxibustion, “injections, intramuscular”, “Medicine, Traditional Chinese”, acupressure, transcutaneous electrical nerve stimulation (TENS), and TENS. These were combined with nausea, vomiting, emesis, antiemetic therapy, and antineoplastic agents/adverse effects.
Studies were included in the review if they
Studies were excluded from the review if they had a high possibility of bias.
In all, 14 studies were identified and reviewed.
In the nine studies that evaluated acute vomiting management via acupuncture-point stimulation, acute vomiting was reduced but nausea severity was not.
In the seven studies that assessed acute nausea via acupressure, acute nausea severity was reduced.
Three studies that evaluated delayed vomiting did not support the intervention.
In the five studies using acupuncture-point stimulation, the intervention did not reduce delayed vomiting.
The pooled results of 11 studies using acupuncture-point stimulation plus antiemetics for chemotherapy-induced nausea and vomiting (CINV) showed significant reduction in acute vomiting and marginal statistical significance for reducing acute nausea.
Electroacupuncture provided protective effects for acute vomiting, but acupuncture did not. Acupressure was effective for acute nausea in patients using “state-of-the-art” antiemetics. However, placebo effects may have influenced results.
Eyles, C., Leydon, G.M., Hoffman, C.J., Copson, E.R., Prescott, P., Chorozoglou, M., & Lewith, G. (2015). Mindfulness for the self-management of fatigue, anxiety, and depression in women with metastatic breast cancer: A mixed methods feasibility study. Integrative Cancer Therapies, 14, 42–56.
To determine the feasibility and acceptability of mindfulness-based stress reduction to manage the symptoms of fatigue, anxiety, and depression in women with metastatic breast cancer
An eight-week mindfulness-based (Kabat Zinn) stress reduction course was taught by a trained, experienced instructor. The sessions in weeks 1 and 8 were two and a half hours, and week 2–7 sessions were two hours. Week 6 included a day of mindfulness of four and a half hours. Home practice with CDs 30 minutes a day was recommended. Sessions were done in a group setting.
Mixed method design using qualitative and quantitative data with repeated measures
Qualitative data consisted of interviews one to two weeks prior to the course and four months after the course. Quantitative data consisted of four questionnaires delivered at five time points: the Brief Fatigue Inventory (BFI), the Hospital Anxiety and Depression Scale (HADS), the EuroQol Quality of Life-5 Dimensions, and the Toronto Mindfulness Scale (TMS) at baseline and at weeks 4, 8, 15, and 24. Quantitative data consisted of one questionnaire at two time points: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) at baseline and at week 24.
A group mindfulness-based stress reduction intervention appeared feasible for patients with stable advanced cancer. However, the intervention as used here was time intensive. This type of intervention may be helpful in dealing with some symptoms in patients with advanced disease.
There is an opportunity to study mindfulness-based stress reduction in patients with metastatic breast cancer and other patients with advanced disease. This study showed that this may be feasible; however, recruitment was difficult, and patients identified barriers related to severity of illness, time commitment, and travel to attend sessions.
Eyigor, S., Karapolat, H., Yesil, H., Uslu, R., & Durmaz, B. (2010). Effects of Pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study. European Journal of Physical and Rehabilitation Medicine, 46, 481–487.
To investigate the impact of Pilates exercise on physical parameters, as well as on fatigue, depression and quality of life among women with breast cancer.
Patients selected for participation were randomly assigned to a home exercise program or to the hospital exercise program. Those in the hospital program performed Pilates exercise for one hour per day three times a week for eight weeks. All patients were given an instructional booklet showing pictures of the exercise program as well as information about lymphedema prevention and activities of daily living. All patients were instructed to perform these exercises once daily at home and to walking 20 to 30 minutes per day, three days a week. Assessments were performed prior to the intervention and eight weeks after the exercise program.
The phase of care was late effects and survivorship.
This was a prospective, randomized two-group, pre-/post study.
Supervised Pilates exercise appears to have positive effects on depression and physical functioning. There was no effect seen on fatigue. A substantial number of those on a home exercise program failed to complete the study, and findings and comparisons are limited by the small sample size.
This study provides some evidence that exercise can be of benefit to patients in managing depression. The study has multiple limitations.
Evensen, J. F., Bjordal, K., Jacobsen, A. B., Løkkevic E. & Tausjø, J. E. (2001). Effects of Na-sucrose octasulfate on skin and mucosa reactions during radiotherapy of head and neck cancers--a randomized prospective study. Acta Oncologica, 40, 751–755.
To evaluate the protective effects of Na-sucrose octasulfate (NaSOS) on radiation-induced skin damage in patients with head and neck cancer.
Each patient was his or her own control. NaSOS was applied on one side, and the placebo was applied to the other. It was started on day 1 of radiation therapy (RT) treatment. The gel was applied twice a day during RT and for two weeks after.
Norway
The study used a quasiexperimental, double-blind, vehicle-controlled design. Each patient was his or her own control.
There was no significant protective effect with use of NaSOS.