Diedrich, B., Remberger, M., Shanwell, A., Svahn, B.M., & Ringden, O. (2005). A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 x 109 per L versus 30 x 109 per L in allogeneic hematopoietic progenitor cell transplant recipients. Transfusion, 45, 1064–1072.
To compare differences in the number of platelet transfusions received and episodes of hemorrhagic bleeding, based upon a prophylactic transfusion trigger of either less than 10 x 109 per L or less than 30 x 109 per L, in patients undergoing allogeneic hematopoietic progenitor stem cell transplants
Patients were randomized (after stratification) to receive prophylactic platelet transfusions at either less than 10 x 109 or less than 30 x 109 per L. The number of transfusions received, the types of bleeding episodes, and the number of red blood cell transfusions were recorded 7 days pre- to 30 days post-transplantation. The results of the morning lab draws identified the need for transfusion based upon the trigger group (T 10 or T 30). In addition, patients were assessed daily (if inpatient) and twice weekly (if outpatient) by nurses blinded to the treatment arm. A special research nurse was used to collect study data.
Prospective, randomized trial
There were no significant differences between the groups based upon donor type, origin of hematopoietic progenitor cells, age, or conditioning regime used. There was a significantly lower number of transfusions received in the T 10 group (median 4 versus 10, p < 0.001) without a significant difference in the episodes of bleeding between groups.
The evidence suggests that the trigger for prophylactic platelet transfusions in patients undergoing allogeneic hematopoietic progenitor stem cell transplants may be safely decreased from 30 x 109 to 10 x 109 per L.
Note that the logistic regression multivariate analysis of factors associated with platelet transfusions before day 30 and before day 60 demonstrate wide confidence intervals (95% CI, 3.08–18.7 and 95% CI 1.82–9.67, respectively).
Nurses will care for patients at risk of life threatening bleeding and need to be aware of indications for platelet transfusion. A lower threshold for prophylactic transfusion may conserve the blood supply.
Didem, A., Ayfer, E., & Ayse Ferda, O. (2014). The effect of chewing gum on oral mucositis in children receiving chemotherapy. Health Science Journal, 8, 373–382.
To determine if chewing gum is efficacious in the prevention and treatment of oral mucositis in children receiving chemotherapy regimens
Quasi-experimental study with a control group
Chewing gum was an effective option for preventing and treating oral mucositis in pediatric patients with acute lymphoblastic leukemia, acute myeloid leukemia, Hodgkin lymphoma, and Wilms tumors.
Didem, K., Ufuk, Y.S., Serdar, S., & Zumre, A. (2005). The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Research and Treatment, 93(1), 49–54.
The experimental group underwent complete decongestive therapy that included lymph drainage using the Foldi method, multilayer compression bandage, elevation, remedial exercises, and skin care. The control group underwent standard physical therapy that included compression bandages, elevation, head-neck and shoulder exercises, and skin care. Both groups had a home program of bandaging, skin care, and walking. Therapy was three times per week for four weeks.
The study used a prospective trial design.
Mean percentage reduction in edema was 55.7% in the experiential group and 36% in control group (p < 0.05). Only 45% had limitation of range of motion to start. Reduction in shoulder mobility was 48.1% in the experiential group and 42.3% in control group before treatment. Shoulder flexion and abduction movements in both groups were increased after treatment (p < 0.05). No significant difference was found in shoulder external rotation in both groups (p > 0.05). No difference was found between groups in shoulder mobility.
Patients were similarly classified using circumferential and volumetric measurements; therefore, either of the methods can be used.
Didem, K., Ufuk, Y.S., Serdar, S., & Zumre, A. (2005). The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Research and Treatment, 93(1), 49–54.
The study included an experimental group and a control group. The experimental group received complete decongestive therapy (CDT) that included lymph drainage (Foldi method), multilayer compression bandage, elevation, remedial exercises, and skin care. The control group received standard physical therapy that included compression bandages, elevation, head and neck and shoulder exercises, and skin care. Both groups had a home program of bandaging, skin care, and walking. Therapy was three times per week for four weeks.
The study took place at a school of physical therapy.
A prospective trial design was used.
Either of the methods can be used.
Dibble, S.L., Luce, J., Cooper, B.A., Israel, J., Cohen, M., Nussey, B., Rugo, H. (2007). Acupressure for chemotherapy-induced nausea and vomiting: A randomized clinical trial. Oncology Nursing Forum, 34, 813-820.
To compare the differences in chemotherapy-induced nausea and vomiting (CINV) in women receiving chemotherapy for breast cancer among three groups: acupressure, acupressure placebo, and usual care
Subjects were randomized to one of three groups: acupressure to P6 point (active), acupressure to S13 point (placebo), or usual care. Participants in the acupressure groups were taught to apply acupressure wrist devices by research assistants unaware of the active pressure point. All participants completed daily logs for 21 days. Patients measured nausea and vomiting and recorded methods for controlling the symptoms, including antiemetics and acupressure. Research assistants, who had received two hours of training on the study protocol, instructed participants. In an examination or private room, the participants were taught to find a quiet place each morning to perform the acupressure treatment to both P6 points sequentially either as treatment or practice. During the day, participants in the acupressure groups were encouraged to apply digital pressure to one of the points whenever nausea occurred regardless of where they were. Each session was six minutes in the morning and three minutes each during the rest of the day. Self-ratings were completed on a daily basis prior to bedtime. All participants were called or seen on day eight for review of the log and coaching, if needed.
The study was conducted in community oncology programs associated with M.D. Anderson Cancer Center and nine independent sites.
This was a multicenter, longitudinal, randomized controlled trial.
In conjunction with pharmaceutical management, acupressure at P6 was found to reduce the amount and intensity of delayed CINV in women undergoing treatment for breast cancer.
Acupressure is a safe and effective tool to be offered to women undergoing breast cancer chemotherapy treatment.
Dibble, S.L., Chapman, J., Mack, K.A., & Shih, A. (2000). Acupressure for nausea: Results of a pilot study. Oncology Nursing Forum, 27, 41-47.
To compare the effects of usual care (regular antiemetics) versus usual care plus acupressure training on nausea and its intensity in women receiving chemotherapy for breast cancer
The intervention involved finger acupressure bilaterally at the P6 and ST36 acupressure points located on the forearm and knee for a maximum of three minutes for each point every morning or as needed for nausea. Baseline and poststudy questionnaires and a daily log were used to collect data.
The study was conducted in two sites located in urban areas in the western United States: an outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice.
Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea.
DiRenzo, N., Montanini, A., Mannina, D., Dondi, A., Muci, S., Mancuso, S., … Federico, M. (2011). Single-dose palonosetron for prevention of chemotherapy-induced nausea and vomiting in patients with aggressive non-Hodgkin's lymphoma receiving moderately emetogenic chemotherapy containing steroids: results of a phase II study from the Gruppo Italiano per lo Studio dei Linfomi (GISL). Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 19(10), 1505-1510.
To evaluate the efficacy and safety of a single dose of palonosetron, a second-generation serotonin type 3 (5-HT3) receptor antagonist, in patients with aggressive non-Hodgkin lymphoma receiving moderately emetogenic chemotherapy (MEC)-containing steroids
Patients received a single IV bolus of palonosetron (0.25 mg) over 30 minutes before administration of chemotherapy (day 1), and patients were assessed from day 1 through day 5. The antiemetic response was evaluated during the acute, delayed, and overall phases, as well on each day.
This multisite was conducted in Italy.
This was a prospective, open label, nonrandomized, phase II study.
A single dose of palonosetron is effective, tolerable, and safe in control of CINV in patients receiving MEC-regimen-containing steroids.
A single dose palonosetron infusion is a tolerable and safe option for patients receiving MEC-containing steroids. A single-dose palonosetron infusion could be less expensive in comparison to multiple administration of IV infusions of the first generation 5-HT3 RAs, which also could save time and required workforce.
Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., & Hecht, F. M. (2012). Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: results of a pilot randomized controlled trial. Journal of Alternative and Complementary Medicine, 18, 473–479.
To assess the feasibility and effects of pranayama (regulation and expansion of breath) among patients receiving chemotherapy. To test the efficacy of pranayama in alleviating common chemotherapy-associated symptoms (fatigue, sleep disturbance, stress, anxiety, and depression) and improving quality of life (QOL). To evaluate patients' responses to the use of pranayama in alleviating common chemotherapy-associated symptoms affecting QOL.
Participants were randomized 1:1 in blocks of four. The allocation sequence was generated by the study statistician and then transferred to sealed numbered envelopes. The study staff enrolled participants and implemented the allocation sequence, which was concealed from the study staff until study assignment. Blinding of participants was impossible due to the intervention, which consisted of a 60-minute class once per week taught by yoga instructors and twice daily home practice that totaled 20 to 30 minutes per day, along with usual care during two cycles of chemotherapy. The control group received only usual care during the initial cycle of chemotherapy, and the pranayama intervention along with usual care during the second cycle of chemotherapy.
Patients were undergoing the active treatment phase of care.
The study was a randomized, controlled trial.
Sixteen of 18 participants completed all study measures: eight from the control group and eight from the treatment group. The study intervention had no adverse effects. Increased yoga practice was associated with statistically significant reductions in sleep disturbance (p = 0.04) and anxiety (p = 0.04). The mental component of QOL approached statistical significance (p = 0.05).
This was the first study of a pure pranayama intervention for patients with cancer, and it demonstrated that yoga breathing is a feasible and safe intervention for this patient population. Any increase in the yoga breathing practice correlated with improvements of chemotherapy-associated symptoms and QOL. Researchers should confirm these findings by means of a larger study.
Among patients with cancer who are undergoing chemotherapy, pranayama breathing techniques may help decrease sleep disturbance and anxiety and increase the mental component of QOL. Pranayama breathing, supplemented with reminders during and between treatments, seems to be an intervention that is feasible for this group of patients.
Dhinakaran, M., Jain, K., Benjamin, K.E., Kaur, P., & Dhinakaran. (2014). Effect of complete decongestive therapy (CDT) in upper limb lymphedema in breast cancer patients. Indian Journal of Physiotherapy and Occupational Therapy, 8, 87–91.
To identify the long-term effect of complete decongestive therapy (CDT) to decrease lymphedema and enhance quality of life in patients after radical mastectomy with unilateral upper extremity lymphedema
Volume of the affected limb was decreased by 80.22 (95% confidence interval [CI] [–96.71, –63.73]) from baseline to the third month (p < 0.0001). Mean change in quality of life at the second month as compared to baseline was significant (69.95, 95% CI [66.49, 73.42], p < 0.0001).
CDT may be effective in reducing the volume in the lymphedema limb and in enhancing breast cancer survivors’ quality of life.
More rigorously designed studies are needed to examine the effectiveness of CDT in patients with lymphedema. Note that patients who underwent lumpectomy also developed lymphedema.
Dharmawardene, M., Givens, J., Wachholtz, A., Makowski, S., & Tjia, J. (2015). A systematic review and meta-analysis of meditative interventions for informal caregivers and health professionals. BMJ Supportive and Palliative Care. Advance online publication.
PHASE OF CARE: End of life care, various stages of diseases (dementia, advanced disease including cancer, children chronic illness) care
APPLICATIONS: Pediatrics, Elder care, Palliative care
Focusing on the outcomes for ICGs, the combined evidence from the controlled trials supports use of meditative interventions to minimize ICG’s depression, anxiety, and stress. Combined evidence from the pre- and postmeditative intervention studies supported their use in alleviating ICG burden. However, the insufficient study rigor and number prevent ed conclusions about the meditative interventions' effects on caregiver energy, fatigue, hope, confusion, and grief or life satisfaction. The insufficient number of studies prevents assessment of effect of meditation on caregivers’ capacity for decision making, patient advocacy, or resilience.
The effect of a meditative intervention on caregivers of patients with cancer should be explored with more studies using rigorous designs possessing higher statistical power. The initial data from this study indicate that a meditative intervention may benefit the ICGs of patients with various illnesses.