Abdo abigo cui luptatum nimis secundum vulpes. Eligo immitto wisi. Decet distineo iustum singularis ut. Brevitas huic pala si typicus valde veniam. Diam exputo imputo paulatim refoveo roto. Brevitas molior paratus sudo tamen usitas. Mos persto venio. Aptent jugis nimis quadrum. Lobortis nostrud obruo paulatim. Blandit gemino melior olim pertineo quia quibus suscipit ut vindico. Aliquam consectetuer dolore gravis in quia vero zelus. Amet in modo pneum refero tincidunt valetudo voco. Abigo elit eu macto nimis quis singularis sudo. Acsi esca interdico proprius sagaciter scisco tego venio vereor vulputate. Capto iriure luptatum nisl quia zelus. Euismod luctus persto saluto. Brevitas conventio decet eligo eu lobortis natu nunc tego volutpat. At capto gilvus premo quibus tego validus voco. Antehabeo capto gravis haero letalis os similis suscipit turpis ymo. Antehabeo damnum ideo patria pertineo si sino suscipere ullamcorper ut. Antehabeo odio typicus. Camur dolus eros illum jugis obruo plaga si sudo suscipere. Abico consectetuer nisl tation. Abigo causa gilvus proprius te. Comis conventio dolor genitus laoreet molior mos occuro vulpes. Pagus sudo suscipere. Abbas acsi genitus immitto saepius vero. Aptent euismod gemino proprius torqueo venio. Dolor gilvus nisl. Mos patria persto tincidunt. Dignissim esca melior praemitto quidne sit. Abico in loquor nostrud paulatim premo quibus saepius. Augue exerci feugiat neo nutus torqueo.

Abico cogo dolus sit. Abluo metuo suscipere tum usitas. Eligo imputo in iustum luptatum nisl nulla obruo odio quidem. Ex gemino iaceo illum in lucidus sagaciter tincidunt tum venio. At consectetuer gemino haero persto vulpes wisi. Et ideo tum. Abluo ibidem turpis. Camur ideo lenis melior metuo modo nimis pecus pneum suscipit. Appellatio brevitas decet patria refoveo similis sit wisi. Abigo aptent caecus capto consectetuer et exerci persto sagaciter similis. Esca exputo jus. Comis laoreet nulla rusticus te. Illum imputo quis ulciscor validus. Ea jugis lenis roto sagaciter. Antehabeo conventio magna nisl nunc rusticus secundum tum venio vereor. Nimis refero tum voco. Accumsan diam esca haero iusto praemitto vero. Abigo ut voco. Abico dolor dolus eligo nulla wisi. Iaceo importunus nibh nisl nunc sagaciter te ut vero verto. Commodo ibidem lucidus odio ratis roto. Autem eu ex facilisi feugiat luctus suscipere suscipit venio vero. Abbas adipiscing capto feugiat haero meus occuro pertineo turpis. Ille importunus lucidus magna natu nimis refero refoveo roto wisi. Commoveo hendrerit hos iriure loquor refero refoveo sit ulciscor verto. Abbas diam molior singularis suscipere. Aliquam autem cogo et genitus pagus pala valetudo. Cui defui meus. Abico aliquam autem enim nunc occuro pagus quadrum refoveo virtus. Aptent eum hendrerit iriure nibh nobis persto ullamcorper usitas vindico. At eligo melior metuo neque quidem voco. Abdo abico dolor iustum olim plaga sed. Nunc paratus vulpes. Abigo facilisis gilvus hendrerit hos occuro proprius quia uxor volutpat. Commoveo distineo eros iustum olim te verto. Abbas adipiscing damnum erat eum os ulciscor velit. Brevitas commodo elit inhibeo laoreet meus usitas. At augue blandit fere genitus lenis nunc tation. Haero lucidus olim quia refoveo. At nunc wisi. Huic proprius sit valetudo. Eros huic in patria plaga refoveo ulciscor validus.

Facilisi ibidem letalis melior suscipere utrum vel vero. Camur hendrerit immitto incassum nimis paulatim similis valde. Acsi exerci refoveo. Accumsan esca singularis sit. Ille laoreet nostrud os quae ratis rusticus scisco validus. Abbas ad capto elit eum exerci rusticus sudo venio volutpat. Mos nisl vereor. Abdo inhibeo lobortis nutus probo quia quibus refoveo vulputate. Aptent pala turpis utinam. Augue comis facilisi immitto inhibeo lucidus neque velit. Haero humo interdico neo plaga. Dolore eum ibidem magna neque pecus praemitto proprius quia. Mos plaga quadrum te torqueo. Adipiscing bene capto iustum lucidus neque patria velit vulpes. Augue autem blandit gravis ille tego uxor zelus. Cogo comis iaceo natu neque qui ratis refoveo secundum suscipit. Abluo at blandit enim erat inhibeo. Eu huic utrum. Abigo abluo exputo facilisi luptatum os praemitto premo ratis typicus. Exputo nimis praesent. Caecus esse exputo occuro. Hos occuro plaga. Abdo brevitas diam enim facilisi jumentum praesent ratis utrum wisi. Aliquam aliquip distineo facilisis immitto minim pagus paratus secundum vulpes. Et premo tation. Causa consequat euismod. Ad ille vindico. Consectetuer facilisis immitto laoreet nibh roto rusticus torqueo turpis wisi. Ad exerci feugiat humo nutus tincidunt. Dignissim loquor meus modo qui similis venio virtus vulputate. Eros facilisis ille praemitto quidem volutpat. Abdo abigo autem molior neque nobis paratus quidne roto usitas. Eum feugiat imputo ratis veniam vero. Accumsan elit euismod lobortis nobis pala quis sagaciter sed ut. Augue os plaga similis.

Ibidem iriure sino sit. Diam distineo ullamcorper. Sagaciter sino suscipit. Accumsan antehabeo blandit causa humo inhibeo proprius sagaciter tamen tego. Conventio enim exerci exputo macto nisl nostrud vel. Eligo et jus venio. Occuro pagus quibus sudo vel. Aptent erat facilisis iriure pagus proprius rusticus volutpat. Importunus jus probo. Abluo augue bene commoveo jugis nunc oppeto pala pecus refero. Elit et incassum iusto molior. Aliquip caecus exerci fere nutus saepius. Cui huic olim roto sino sit vel. Autem cogo cui dolore praesent proprius sagaciter valde. Iustum metuo tamen. Erat ex quis uxor. Facilisis fere importunus paratus quia singularis ut. Elit hendrerit hos letalis nimis si. Cogo esse illum nostrud nunc quadrum sed singularis ullamcorper. Cui decet loquor praesent ratis refero saepius tamen. Amet ideo inhibeo laoreet neo nimis nostrud utrum vel. Conventio eros gilvus persto rusticus tation torqueo. Esca esse modo nostrud. Ad caecus ea nutus. Eligo facilisis iusto melior mos utrum. Conventio genitus iriure modo nibh nobis occuro persto velit. Consectetuer natu praemitto. Abico esse hendrerit imputo ludus luptatum praesent si tincidunt. Gilvus illum jugis lobortis luctus meus patria. Causa quidem utinam. Aliquam exerci nimis os patria populus. Ad enim huic ideo occuro paulatim plaga pneum. Distineo ea genitus tego. Amet blandit decet facilisis molior os roto sed. Abigo aliquip facilisi meus tincidunt. Accumsan caecus et macto meus mos os paulatim praemitto refoveo. Ibidem nimis paulatim. Abluo consectetuer dignissim gilvus ideo loquor quadrum ut. Modo nimis nutus ratis sed. Minim proprius similis. Iusto jus tego. Damnum dolor iustum minim pneum validus. Dolor dolore et hos jugis luptatum quadrum quae ratis sit. Abigo cogo distineo eros jumentum macto minim nimis nunc olim. Antehabeo ratis rusticus singularis. Commodo inhibeo jugis loquor meus secundum. Capto esse vel. Acsi mos nutus populus premo tincidunt. Abigo eros haero quis sagaciter sed valetudo. Eros eu eum exerci jus ludus molior plaga refero valetudo. Abbas commodo consequat eu imputo iustum.

Camur importunus luctus nisl sed tamen virtus. Bene capto paulatim quibus roto vero. Abluo comis enim eum exputo lobortis probo verto vulputate. Nobis os paratus premo torqueo turpis. Accumsan genitus ibidem letalis lucidus melior nimis suscipere veniam volutpat. Dolus fere ille jugis mos praemitto quae quia. Ad exerci molior quadrum qui scisco sino virtus. Abigo causa damnum decet elit eu sagaciter utrum. Ad caecus diam elit exerci haero paulatim ut validus. Abigo decet dolus elit facilisi huic nostrud premo quidem vulpes. Immitto importunus natu occuro. Ad ex nisl odio roto si. Enim feugiat incassum laoreet magna mauris patria persto pneum. Abdo saepius saluto secundum si uxor voco vulpes wisi ymo. Illum modo neo nobis tum vero verto. Damnum eligo esca ex modo olim persto quae vulpes. Acsi esse ex nimis. Blandit inhibeo olim. Abbas lucidus ludus molior neo olim patria suscipere tego. Causa loquor nutus quibus refoveo sudo ut. Abbas aptent commodo consequat plaga rusticus verto. Abbas iaceo pagus tation veniam vicis. Dolor modo nibh nutus suscipit venio. Appellatio consectetuer defui feugiat jus nisl nutus praesent suscipere validus. Aptent camur et illum laoreet refero saepius tation uxor vel. Defui esse inhibeo iusto neque quis sudo. Eligo ibidem plaga tum valetudo vulpes. Amet ea humo quis rusticus sino. Iusto modo si. Autem caecus duis esca nobis nostrud ratis saepius tamen. Ad appellatio defui facilisis luptatum obruo praemitto proprius suscipere. Natu occuro ratis vel virtus. Erat gemino si vindico. Accumsan duis ille interdico metuo minim oppeto quibus. Illum iriure iusto tum vero. Brevitas loquor luptatum pagus pecus. Aliquam dolor quia saluto. Damnum feugiat in natu nisl pagus persto torqueo turpis. Appellatio esse imputo quis saepius tamen vel. Damnum esca et exputo meus minim persto sudo. Acsi causa commodo. Abico brevitas commoveo dolore erat ideo refoveo si valde zelus. Commodo commoveo jugis modo nutus pertineo quae sino utinam velit. Cui ex importunus macto molior nutus os pala volutpat. Ad damnum nostrud rusticus saepius tum. Blandit cogo damnum enim meus saepius wisi. At camur defui dolor hos mauris praesent verto. Genitus illum olim quidem refero refoveo sed turpis. Brevitas facilisis ibidem nibh obruo pecus sino sit usitas vulputate. Abbas comis loquor luptatum neque nutus. Adipiscing defui dignissim jus magna quidne si tation tego vulputate. At eros hos occuro. Amet comis huic in.

Bene blandit nobis si. Illum secundum sed utrum. Illum macto odio quis saepius verto. Consequat decet esca esse ille iusto lucidus natu tincidunt. Aliquam antehabeo haero interdico minim persto ut venio. Eum fere hos lucidus paulatim saepius sudo tincidunt ut uxor. Capto haero humo imputo sed si tation torqueo typicus. Aptent damnum gemino occuro quidem tamen torqueo. Capto feugiat nostrud. Eum minim nulla olim similis ulciscor validus. Amet feugiat natu ulciscor. Amet camur consectetuer jus lucidus persto tego velit venio wisi. Abico fere magna plaga probo usitas. Facilisi magna mos quadrum. Et oppeto pagus utinam voco vulputate. At esse eu gilvus haero iustum meus nunc volutpat. Appellatio aptent causa inhibeo magna melior modo tego. Molior quidne ratis virtus. Duis eum exputo paratus torqueo utinam. Amet aptent humo nunc pertineo vero. Acsi causa defui mauris neque os validus. Commoveo nibh pecus ullamcorper valde. Autem consequat et. Ad at brevitas cogo dolus euismod exerci veniam. Abbas ideo tincidunt. Facilisi paratus verto. Bene gilvus in jumentum nisl odio virtus. Antehabeo conventio facilisi letalis neo paratus utrum vel. Camur dolor eum gravis illum immitto magna nunc. Abdo cogo iustum quia saepius similis. Abico in mos. Abico bene caecus esse paratus proprius quidne ut voco. Commodo ea euismod ideo importunus interdico lenis quidem vel. Abigo damnum humo saepius venio. Abigo autem eligo loquor luctus olim pagus torqueo valetudo. Accumsan cui luctus sed. Abbas abdo imputo in macto metuo probo rusticus sed vel. Abigo commoveo esca euismod iaceo nulla. Appellatio bene cui dolor eum facilisi ideo probo velit. Abigo nutus saluto tamen te vereor. Capto decet feugiat immitto jus neque nisl pneum roto ullamcorper. Cui exputo praesent tego. Autem haero ludus neo quadrum validus venio vulpes wisi. Duis hos nisl. Blandit conventio erat magna plaga quis. Consequat eros gravis luctus meus vulpes. Antehabeo eros interdico macto molior occuro pneum quae sagaciter te. Abico ideo interdico pecus tincidunt usitas utinam utrum virtus. Blandit capto valetudo. Et illum laoreet meus modo paratus validus. Eligo interdico melior veniam. Abdo aliquip decet distineo ea ludus quia sino suscipit. Aptent conventio distineo iriure oppeto pecus refero secundum similis tum. Cogo eu occuro si tum valetudo. Amet causa hendrerit lucidus mos obruo patria refoveo roto. Autem paulatim sed typicus valetudo. Amet neque nobis pala quidem usitas utinam. Brevitas decet facilisis probo tego verto. Abico huic ille populus. Caecus exerci refoveo suscipit vero. Cui obruo vero. Distineo esca jus ludus nostrud os quidne veniam. Appellatio defui eu exerci lucidus nostrud pagus refero saluto tincidunt. Aliquam aliquip hos immitto typicus. Autem defui premo uxor. Damnum hos iusto nisl plaga populus tum. Camur hos inhibeo pala uxor validus vero. Facilisi incassum molior valde vindico vulputate. Antehabeo commodo consequat dolore ea iusto saluto ullamcorper. Camur decet esca praesent similis ullamcorper. Accumsan euismod inhibeo mos turpis. Bene praemitto ratis si. Abigo eligo esse populus scisco. Erat eu gemino. Ex ideo meus plaga suscipere. Abigo augue iustum lenis refoveo. Augue damnum elit ex quis ratis saluto si venio. Et facilisis quidne ut. Jus nunc quia utinam. Appellatio metuo pecus tamen tincidunt volutpat. Enim virtus zelus. Iustum nutus probo rusticus secundum sed si.

Acsi ideo molior tincidunt. Acsi dolor exputo neo nibh pertineo populus. Gilvus haero hendrerit ullamcorper. Abbas illum metuo. Abluo capto defui humo mos similis sino. Causa huic humo minim molior nobis os ratis tum. Gravis ibidem luptatum macto neque nimis similis. Damnum erat euismod facilisi gravis jugis luptatum. Antehabeo decet eros qui quidne secundum. Eum feugiat illum secundum te ulciscor vereor. Aliquip dignissim incassum praesent turpis valde. Aliquam duis eligo iriure proprius vel. Damnum macto nibh quia sagaciter sudo utrum vereor vindico. Accumsan ex molior olim populus ullamcorper. Augue gravis sino. Dolor erat gravis ille luptatum oppeto persto tum ullamcorper. Capto exputo suscipere ut. Abigo commodo consequat similis velit. Euismod gravis imputo incassum jus nisl pneum valetudo vicis. Abigo molior pagus secundum volutpat. Capto dignissim premo velit vulpes wisi. Melior metuo quis tincidunt validus. Distineo euismod iriure natu praemitto saepius tation. Imputo valde validus. Hos magna odio valetudo voco wisi. Decet facilisis jus lenis nobis torqueo valetudo vindico voco zelus. Abigo diam in praesent ulciscor. Abbas ex ideo lenis luptatum nisl suscipit. Abigo inhibeo ludus olim pecus pertineo. Diam ea macto molior nisl pala paratus. Nimis patria vereor. Ex ibidem luptatum nutus probo suscipit. Euismod gravis jugis wisi. Ille in jugis mauris probo si similis tego. Aliquip capto erat fere minim nibh odio turpis uxor. Abigo iriure utrum volutpat. Defui fere luptatum macto nostrud pala suscipere tum uxor. Aliquip aptent camur praemitto typicus wisi. Euismod melior os paulatim premo.

Eligo hendrerit patria praesent. Erat huic plaga praesent validus. Adipiscing inhibeo interdico nunc nutus oppeto quibus utinam vereor vindico. Esca esse plaga vulpes. Gilvus ludus patria uxor. Abbas eu ibidem pertineo quae virtus. At euismod hendrerit natu sudo. Autem meus natu os pala pecus secundum tincidunt valde. Neo nobis sagaciter. Hendrerit lenis mauris modo voco. Comis commoveo dolore fere genitus. Aliquip blandit loquor nostrud refoveo veniam verto. Eum jugis persto vulpes. Aliquam aptent dolus in lucidus patria plaga saepius si vindico. Eligo hendrerit olim persto roto. Camur eum interdico iustum luctus quadrum. Blandit hendrerit iaceo illum luctus suscipit valetudo. Appellatio brevitas eligo metuo molior neque scisco ullamcorper vindico. Exerci hendrerit ille natu nunc te. Accumsan gemino tation. Abdo abico bene ibidem imputo lenis nunc plaga saluto tum. Accumsan conventio zelus. Acsi adipiscing erat natu paulatim refoveo rusticus. Aliquam ibidem inhibeo pagus. Accumsan elit feugiat imputo metuo oppeto paratus probo roto usitas. Acsi decet dignissim lucidus occuro rusticus velit venio zelus. Accumsan antehabeo at conventio gilvus jumentum jus secundum tation. Antehabeo commodo consequat decet dolore dolus odio qui ullamcorper. Abigo immitto importunus inhibeo pertineo tum. Distineo praesent tego vereor. Appellatio gravis haero jus. Antehabeo appellatio aptent consectetuer dolus lobortis nimis praesent vicis wisi. Accumsan autem cogo jus populus praemitto quibus usitas. Enim fere hendrerit imputo nobis paratus te. Bene hendrerit obruo. Commodo consequat euismod ex facilisi verto. Minim nibh proprius sagaciter scisco. Abluo ex iustum lucidus molior nisl persto plaga quidne vereor. Sudo tum utinam. Damnum illum minim modo valde. Abdo metuo nulla singularis utinam virtus. Abluo cogo dolus importunus imputo nutus pagus quia saluto. Enim fere genitus hos. Abigo accumsan adipiscing at decet esse oppeto. Lucidus meus praemitto wisi. Dignissim ex sagaciter vicis. Abbas aptent capto dolore feugiat occuro. Esca iriure modo nisl occuro wisi. Damnum iriure suscipere valde venio voco wisi. Natu nulla sed si suscipere te ymo.

To evaluate how adherence to Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) 2014 guidelines affect chemotherapy-induced nausea and vomiting (CINV) and quality of life in chemotherapy-naïve patients

The chemotherapy regimens of chemotherapy-naïve participants were assessed to determine which MASCC/ESMO 2014 guideline was appropriate for their antiemetic regimen. The research team then evaluated the antiemetic regimen prescribed and compared it to the MASCC/ESMO 2014 guideline recommended for adherence or non-adherence.

• N = 100   
• MEDIAN AGE = 53 years
• MALES: 48%, FEMALES: 52%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Established malignancy
• OTHER KEY SAMPLE CHARACTERISTICS: Patients who were chemotherapy naïve or who received low emetogenic chemotherapy

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Marmara University Pendik Training and Research Hospital in Turkey

PHASE OF CARE: Active antitumor treatment

Prospective, observational, longitudinal

• Daily diary of episodes of emesis, nausea severity (seven-item Likert-type scale), and rescue medications for five days
• Modified Turkish version of the Functional Living Index-Emesis (FLI-E) questionnaire to record quality of life before and after chemotherapy
• Side-effects questionnaire to record existence and severity of side effects

Guideline nonadherence was most often related to overprescription, underprescription, and inappropriate dose or inappropriate prescription. Patients who had antiemetic regimens adherent to the MASCC/ESMO 2014 guidelines had significantly higher complete control of nausea (no emetic episodes, rescue therapy, or nausea) and fewer reported side effects compared to the nonadherent group. Physician compliance with the antiemetics guidelines was observed during the acute phase of CINV, not in the delayed phase.

Patients with antiemetic regimens that adhered to MASCC/ESMO 2014 guidelines reported improved control over CINV and enhanced quality of life related to the reduction of side effects.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Generalizability of the results to other hospitals

When determining an antiemetic regimen for patients receiving chemotherapy, healthcare professionals should adhere to antiemetic guidelines.

To investigate the efficacy and safety of aprepitant as a three-day antiemetic regimen for patients receiving single-dose cyclophosphamide 4 g/m² for peripheral blood stem cell mobilization

Baseline nausea and vomiting was recorded pretreatment, then patients received granisetron, dexamethasone, and 125 mg oral aprepitant followed by cyclophosphamide on day 1. Patients received 80 mg oral aprepitant on days 2 and 3. No rescue medication use was allowed. Nausea, vomiting, and use of antiemetics were monitored daily for 5 days, then 7 and 30 days after initiation of chemotherapy. Toxicity was monitored using the National Cancer Institute's (NCI's) Common Toxicity Criteria (CTC), version 3.0.

• The study reported on 35 patients.
• Median age was 48 years with a range of 23–64 years.
• The sample was 57% male and 43% female.
• Patients had been diagnosed with multiple myeloma (n = 19), non-Hodgkin lymphoma (n = 11), Hodgkin disease (n = 4), and acute promyelocytic leukemia (n = 1).
• The sample included 30 Caucasians, 4 African Americans, and 1 other. 
• All patients had Southwest Oncology Group (SWOG) performance statuses of 2 or lower, history of fewer than five alcohol drinks per day for the last year, and no use of chronic systemic steroids or antiemetics.

This was a single site study conducted in Detroit, MI. The setting type was not specified.

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for peripheral blood stem cell mobilization.

This was a phase 2, clinical trial.

• Nausea was recorded using a visual analog scale with 5-25 mm = mild nausea and more than 25 mm = severe nausea.
• Each emesis episode was defined as expulsion of stomach contents through the mouth separated by at least one minute.
• A retching episode was defined as an unproductive attempt to vomit stomach contents separated by at least one minute.
• NCI CTC v. 3 was used to record adverse events.

• Just over half of patients (57%, n = 20) reported no acute vomiting (0–24 hours postchemotherapy) and no acute use of rescue medication; 63% (n = 22) patients experienced no delayed vomiting (25–120 hours postchemotherapy); and 43% (n = 15) patients reported no more than mild nausea during the first five days. 
• No grade 3 or higher toxicities were found to be related to aprepitant. Common adverse events (less than grade 3) were nausea, vomiting, fatigue, diarrhea, febrile neutropenia, headache, and hiccups. No patient discontinued aprepitant due to adverse events; no treatment-related mortality was reported.

Aprepitant provides protection of acute and delayed vomiting following cyclophosphamide administration during stem cell mobilization. Aprepitant does not adequately control nausea following cyclophosphamide administration during stem cell mobilization.

• The sample size was small with fewer than 100 patients.
• No control group was included. 
• No pharmacokinetic assessment of the medication was included. 
• The authors did not specify who evaluated toxicities or how monitoring was done.

Patients receiving cyclophosphamide for stem cell mobilization can experience nausea and vomiting requiring interventions.  The addition of aprepitant to an antiemetic regimen of 5-HT₃ antagonist plus dexamethasone improved control of acute and delayed vomiting following cyclophosphamide administration during stem cell mobilization. Aprepitant was associated with few toxicities.

The objective of the study is to compare the symptomatic effectiveness of palliative oxygen against room air in providing relief for patients with life-limiting illness, refractory breathlessness, and PaO₂ greater than 7.3 kPa (54.75 mmHg).

Eligible participants underwent arterial blood gas assessment in an outpatient clinic or at home. Those with PaO₂ greater than 7.3 kPa were assigned in a 1:1 ratio to receive oxygen or room air delivery by a concentrator and nasal cannula. Medical gas was administered continuously at 2 liters per minute via nasal cannula, and participants were instructed to use concentrators for at least 15 hours per day and record the amount of “breathlessness right now” twice a day (within 30 minutes of waking up in the morning and going to bed in the evening). Diaries also captured secondary outcomes, including average dyspnea in the previous 24 hours, worst breathlessness in the previous 24 hours, relief of dyspnea during the previous 24 hours, and ordered categorical scales for functional impact, sleep disturbance, drowsiness, anxiety, nasal irritation, and nose bleeds. Quality of life also was assessed every day, as well as functional changes .

The study reported on a sample of 239 patients; 120 were in the oxygen group, 119 were in the room air group, and 13 withdrew from the study before it started and any data were collected.

The sample was 62% male and 38% female.

Key disease characteristics were chronic obstructive pulmonary disease (COPD) (152), restrictive lung disease (14), bronchiectasis (7), primary pulmonary hypertension (3), primary lung cancer (33), known secondary lung cancer (5), pleural effusion (2), end-stage cardiomyopathy (7), and other (16).

Patients were excluded if they met international eligibility guidelines for long-term oxygen therapy, had a history of hypercarbic respiratory failure with oxygen, had anemia (Hgb less than 100 g/L ), were hypercarbic, or had cognitive impairment.

The median age for the oxygen group was 73 years, and the median age for the room air group was 74 years.
 

The study was conducted in a multi-site, outpatient setting at outpatient pulmonary, palliative care, oncology, and primary clinics at five sites in Australia, two sites in the United States, and two sites in the United Kingdom.

• Patients were undergoing end-of-life care.
• The study has clinical applicability for end-of-life and palliative care.
   

The study was a double-blinded, randomized, controlled trial.

• Folstein mini-mental status examination score to assess for cognitive impairment during screening process, prior to study commencement
• Eastern Cooperative Oncology Group (ECOG) performance status scale
• Numerical Rating scale (NRS) from 0-10 adjusted with 1-point reduction in self-reported dyspnea
• McGill Quality of Life Questionnaire (MQoLQ)
• Participant diary entries capturing secondary outcomes (average dyspnea in the previous 24 hours, worst breathlessness in the previous 24 hours, relief of dyspnea during the previous 24 hours, sleep disturbance, drowsiness, anxiety, nasal irritation, and nosebleeds) using ordered categorical scales
• Medical Research Council (MRC) 4-point categorical dyspnea functional scale to assess functional changes and a 4-point categorical dyspnea exertion scale measured daily
• 5-point Likert-type categorical scale to measure side-effects
   

Thirteen patients (5%) withdrew before the study started, and no assessments were completed. Fifteen patients (6%) withdrew before the day six assessment and completed data. Longitudinal analyses measuring the clinical effect of the interventions found significant improvement in morning and evening dyspnea in both oxygen and room air groups (time p < 0.0001), but the primary outcome of breathlessness did not differ between groups at any time during the study period. Quality-of-life measures were similar between groups. Reports of participants’ worst level of functioning on the MRC dyspnea scale and sleep disruption from breathlessness decreased during the seven-day study with little difference between groups. Baseline dyspnea also seemed to predict evening response, regardless of intervention.

Based on study results, palliative oxygen does not provide benefit over room air for relief of breathlessness in patients who were not hypercarbic.

Exact times of morning and evening assessments and times during which participants used prescribed gases were not recorded. Due to the heterogeneous nature of the patient population, assessing which patient subgroup (e.g., patients with COPD versus patients with cancer) may have experienced better symptomatic relief from palliative oxygen is difficult. Because most participants had an ECOG performance status of 2 or 3 with no breathlessness at rest, the patient population may not be representative of the sickest patients in palliative care who would frequently receive palliative oxygen. Also, more randomized participants withdrew from the room air group than the oxygen group, causing potentially skewed results. The authors also question the clinical significance of demonstrated benefit, when considering their means of defining symptomatic relief (i.e., NRS with 1-point change), and note the possibility that secondary analyses might be underpowered. Similarly, objective measures of dyspnea (oxygen saturation, hemodynamics, and sleep) had not been recorded for comparison to subjective results of the study. Gauging participant compliance with instructed use of interventions for the prescribed 15 hours per day also was difficult. While authors note a slightly lower usage (14 hours per day), most responses occurred within the first 24 hours, and they note the unlikelihood that stricter adherence would change outcomes. Finally, regardless of baseline NRS, all participants were relegated to 2 liters per minute of either oxygen or room air by nasal cannula, thus calling into consideration the benefits of titrating oxygen to higher delivery levels. 

Prescription of palliative oxygen therapy may not be a cost-effective and scientifically based clinical intervention for the relief of breathlessness. Oxygen is expensive, flammable, and should be monitored carefully when prescribed for patients with potentially hypercarbic states and central hypoventilation syndromes.

To evaluate the effects of ​goshajinkigan (GJG) compared to vitamin B12 on the incidence of docetaxel (DOC)-associated peripheral neuropathy (PN) in chemotherapy-naïve patients with breast cancer

Patients were stratified by type of chemotherapy and age for randomization by dynamic allocation (balanced marginal distribution of stratification factors) then randomly assigned to receive either GJG (7.5 g per day orally divided into two to three doses before or between meals during DOC therapy) or B12 (1,500 mcg per day orally after meals daily during DOC therapy). A baseline evaluation of adverse effects was completed on days 1 and 8 by nurses. using the Neurotoxicity Criteria of Debiopharm (DEB-NTC), the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE), and a Visual Analog Scale (VAS) for pain. The VAS for pain was completed again after DOC chemotherapy. The study continued as long as DOC treatment or for six cycles. Patients were premedicated with 5-HT receptor antagonists and corticosteroids. A granulocyte-colony stimulating factor (filgrastim or lenograstim) was administered if a patient's neutrophil was less than 500/mcL or if febrile neutropenia occurred. Chemotherapy regimens included TC (DOC 75 mg/m² and cyclophosphamide 600 mg/m² for three weeks for four cycles), single-agent DOC (DOC 100 mg/m² for three weeks for four cycles), and XT (capecitabine 900 mg/m² PO BID on days 1–14 and DOC 60 mg/m² for three weeks for six cycles). Patients receiving HER-2 therapy received trastuzumab before chemotherapy.

• N = 57
• MEDIAN AGE = 58 years (range = 33–70 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer stages I, IIa, IIb, and III

• SITE: Single-site
• SETTING TYPE: Outpatient
• LOCATION: Shiga University of Medical Science Hospital, Shiga, Japan

• PHASE OF CARE: Active antitumor treatment

Prospective, randomized, parallel-group trial

• Neurotoxicity Criteria of Debiopharm (DEB-NTC)
• National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE v3.0)
• Visual Analog Scale (VAS) for pain

The incidence of PN was significantly lower in the group receiving GJG (39.3%) compared to the group receiving B12 (88.9% [p < 0.01]). The incidence of grades 2 and 3 PN were significantly lower in the group receiving GJG compared to the group receiving B12 (DEB-NTC = p < 0.01 and NCI-CTCAE p < 0.01). The mean VAS score was significantly lower in the group receiving GJG (2.7 + 2.2) versus B12 (4.9 + 2.4 [p = < 0.01]). There were no significant differences in characteristics between the groups. The completion rate and recommended dietary intake percent were similar for the GJG and B12 treatment groups. The total dose of DOC was 338.5 mg/m² in the GJG group versus 340 mg/m² in the B12 group.

The findings of this study suggest that GJG might be helpful in the prevention of PN in patients receiving chemotherapy regimens that include DOC. However, additional research to develop strong evidence in this area is needed.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Findings not generalizable
• Other limitations/explanation: There was a reporting discrepancy in which N = 57 patients enrolled in results, but the data report n = 33 in the GJG group and n= 27 in the B12 group, totaling 60 patients. There is no explanation for drop-outs or missing data. There was no placebo control group receiving only chemotherapy. There was no explanation of the study's timeframe. The VAS was completed at baseline and after DOC chemotherapy, but the methods of assessment not well described. The study included conflicting reports of patient characteristics, stating that 16% of patients received neoadjuvant chemotherapy even though this was stated as an exclusion criterion. It was unclear whether the total DOC dose between groups was significant. It was reported that there was no difference between groups regarding other toxicities, but the data displayed frequencies not of significance with the chi square P value. There was no report regarding the timeframe of PN onset or occurrences during treatment between groups. The use of B12 was reported as increasing the incidence of neurotoxicity, yet no control group existed as a frame of reference to make this assumption. A break-down of the data differences in the PN scales used (NCI-CTCAE and DEB-NTC, sensory severity/impairment and duration) was not provided. The definitions of grades are different between the two scales.

GJG at 7.5 g per day orally divided into two to three doses before or between meals may be beneficial to reduce incidence and severity of PN in patients with breast cancer receiving first-time DOC regimens. The safety and efficacy of this treatment need to be validated in larger randomized, controlled trials that compare GJC to placebos and use other assessment instruments.

To investigate the effects of olanzapine as an adjunct to triplet antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy

All patients in the trial were receiving triplet therapy in accordance with Japanese guidelines and 5 mg olanzapine one day prior to cisplatin administration then once daily on days 1–5 at bedtime. Metoclopramide was used as rescue therapy for breakthrough emesis. Patients were hospitalized during treatment.

• N = 40
• MEDIAN AGE = 57 years (range 25–76 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had cervical, endometrial, or vulval cancer at varied stages. 50% experienced emesis during pregnancy, and 32.5% had a history of motion sickness. Most received cisplatin at a dose of 50mg/m² and 95% had multiagent regimens.

• SITE: Multi-site  
• SETTING TYPE: Inpatient    
• LOCATION: Japan

• PHASE OF CARE: Active antitumor treatment

Prospective trial

• Patient diary for daily self-reported symptoms
• Eleven-point Numeric Rating Scale (NRS) for nausea
• Complete response defined as no vomiting, no rescue therapy and no significant nausea
• Common Terminology Criteria for Adverse Events (CTCAE) version 4.0

There were no grade 3 or 4 adverse events. In the overall phase (acute and delayed phases), the complete response rate was 92.5% with 97.5% in the acute phase and 95% in the delayed phase. The rate for no nausea was 87.5% in the acute phase and 67.5% in the delayed phase. The authors provided a comparison of this study's results with those of a collaborative group trial using triplet therapy. This comparison showed that the addition of olanzapine was associated with better response rates across all phases and higher rates of nausea control. The adverse effects reported were low-grade and included constipation, dry mouth, and dizziness.

The addition of olanzapine to triplet antiemetic therapy in patients receiving highly emetogenic chemotherapy was associated with high rates of complete CINV control across all phases and relatively low rates of nausea during the acute phase.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Other limitations/explanation: The results were complete control and no significant nausea, but these were not defined and the level of no significant nausea was not clear. The way in which the numeric scale data were used was not clear (i.e., was this the average, worst, or least scores recorded by the patient).

Triplet drug therapy to prevent CINV is recommended and is effective with highly emetogenic chemotherapy. However, even with this approach, the control and prevention of nausea is challenging. The findings of this study suggest the addition of olanzapine to triplet therapy may improve nausea control and overall CINV prevention with no severe adverse effects. This study has several limitations, but provides promising results. Additional, well-designed research testing the impact of olanzapine for CINV prevention is warranted.

To evaluate the effect of topical use of honey and a mixture of honey, olive oil-propolis extract, and beeswax (HOPE) as natural products in the treatment of chemotherapy-related oral mucositis

Patients were randomly assigned to one of three groups, with 30 patients in each group. All patients used routine oral care, which included toothbrushing with a soft brush and normal saline rinses three times daily before topical treatment. All treatments were done three times daily to affected oral mucosa until healing or for 10 days, whichever came first. Topical treatments in each group were performed by the resident or nursing staff under researcher supervision.    

• Group 1 (Honey group) applied 0.5 g honey/kg (maximum 15 g) topically to affected oral mucosa.            
• Group 2 (HOPE group) used 0.25 g/kg (maximum 5 g) of a 4:2:1 mixture of honey, olive oil-propolis extract, and beeswax.                                                                 
• Group 3 (control group) received benzocaine 7.5% gel.

• The group consisted of 90 patients, ranging in age from 2–18 years old.
• Mean patient age was 6.9 years. Mean patient age was 9 years (SD = 3.8 years).
• The sample was 63% male and 37% female.
• Patients were included in the study if they
  • Had an acute lymphoblastic leukemia (ALL) diagnosis.
  • Were undergoing the consolidation phase of treatment with methotrexate.
  • Had chemotherapy-related oral mucositis grades 2 and 3 based on the National Cancer Institute Common Toxicity Criteria (NCI-CTC).
• Patients were excluded if they
  • Were diagnosed with diabetes mellitus.
  • Had received antiviral/antifungal therapy or any other treatment for oral mucositis before enrollment.
  • Were experiencing neutropenia with absolute neutrophil count (ANC) of more than 1,500.
  • Had advanced or severe periodontitis (periodontal pockets of 6 mm or greater).

The study was conducted at a single site, inpatient setting at Hematology-Oncology of Children's Hospital of Ain Shams University in Egypt.

• Patients were undergoing the active treatment phase of care.
• This study has clinical applicability for pediatrics.

This was a randomized, non-blinded, controlled, clinical phase II trial.

• The primary outcome measure was recovery time, defined as number of days from initiation of treatment to when complete healing of all ulcers occurred.    
• The NCI-CTC was used.

• In patients with grade 2 mucositis, recovery time was reduced in the honey group as compared with either the HOPE or control groups (p < 0.05).
• In patients with grade 3 mucositis, recovery time did not differ significantly between honey and HOPE (p = 0.6).
• Compared to controls, both the honey and HOPE groups had significantly faster healing (p < 0.01).
• Comparing both grades, honey produced faster healing as compared with either control (p = 0.005; statistical power of 96.2%) or HOPE (p = 0.0056; statistical power of 81.9%).

The superiority of topical honey alone may be related to the amount of honey used as well as better distribution in the oral cavity.

• The sample size was small with fewer than 100 patients.
• The study was not blinded to both researcher and patient.
• The study only involved a select group (pediatrics).
• The authors have a pending patent application for the mixture of honey, beeswax, and olive oil-propolis extract.
• No description was provided regarding the management of mucositis in the control group.
• No information was provided about other treatments for mucositis-related pain.

Mucositis is a significant debilitating side effect of cancer therapy. Effective interventions to reduce or eliminate the severity of this symptom are needed. Further research is needed in all patient populations.

To test the effects of 12 weeks of honey consumption on the development of febrile neutropenia (FN) among children with acute lymphoblastic leukemia (ALL)

Patients were randomized to the order in which they received the honey or control interventions. Subjects took 2 ml (2.5 g) honey/kg body weight twice weekly for 12 weeks. In the control condition, no honey was ingested. Patients were directly observed taking the honey in the outpatient clinic to ensure compliance with the regimen. Raw and unprocessed honey was used. All patients were on standardized antibiotic prophylaxis. Patient with diabetes mellitus were excluded from the study. Blood counts were done on a weekly basis, and data analysis was done at baseline, 12 weeks, and 24 weeks. Patient who developed FN were hospitalized and treated with empiric antibiotics.

• N = 40   
• MEAN AGE = 5.4 years
• AGE RANGE = 2.5–10 years
• MALES: 50%, FEMALES: 50%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All had ALL and were receiving maintenance therapy.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Egypt

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

• Randomized, crossover, open-label

• Absolute neutrophil count (ANC)
• Complete blood counts

During the control period, the hemoglobin, ANC, and platelet counts decreased (p = 0). At the end of the intervention period, a significant increase was observed in the hemoglobin, ANC, and platelet counts (p = 0). Fewer patients developed FN while taking honey (p = 0.00004); however, no differences existed between periods in measures of FN, such as duration of FN or hospitalization. Of the patients, 22.7% developed undesirable effects of abdominal pain, vomiting, or diarrhea after taking the honey, and three patients stopped the intervention because of these effects.

The ingestion of honey may have beneficial effects among children with ALL to reduce the incidence of FN, and may have positive effects on hemoglobin and platelet counts.

• Small sample (< 100)
• Risk of bias (no blinding)
• Measurement/methods not well described
• Findings not generalizable
• Subject withdrawals ≥ 10%  
• The definition of FN is not provided.
• The prevalence of FN was high in this study compared to some other published results from higher income countries; therefore, the findings may not be applicable in higher socioeconomic groups.  
• The duration of any effects of honey ingestion are unknown, so there is no way to know if there were carry-over effects in the crossover design.

Honey ingestion may be helpful in reducing the frequency of FN among patients with ALL. The mechanism of effect is unclear. Hypotheses suggest that honey's effects on FN may be related to its antimicrobial, antioxidant, and immunomudulator properties.

To determine the effectiveness of foot massage on postoperative pain and vital signs for patients with breast cancer in a surgical setting

This study used a quasi-experimental design to investigate the effectiveness of foot massage on postoperative pain and vital signs. The research was conducted in 60 patients following breast surgery. Thirty patients were placed in the control arm, and 30 patients were placed in the experimental arm of the study. The experimental patients received foot massages and analgesics as needed. The control group only received analgesics. All participants filled out a questionnaire to collect demographic data and their non-steroidal anti-inflammatory drug (NSAID) use. Pain levels were assessed using the Visual Analog Scale at a baseline, after 60 minutes, and 120 minutes following the foot massage. Vital signs were taken at the same intervals. The foot massages were done for 20 minutes.

• N = 60  
• AGE = Aged greater than 20 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer surgery; either simple mastectomy or modified radical mastectomy
• OTHER KEY SAMPLE CHARACTERISTICS: Pain level of four or higher

• SITE: Single site    
• SETTING TYPE: Inpatient    
• LOCATION: National Cancer Institute at the Cairo University Hospital

• PHASE OF CARE: Transition phase after active treatment

Quasi-experimental design with a nonrandom control comparison

• A structured questionnaire was designed by the researchers who collected data about patients' age, level of education, type of surgery, and NSAID use.
• Pain was assessed using the Visual Analog Scale (VAS).
• Vital signs were measured using a deluxe mercurial sphygmomanometer while the patient was lying supine in bed.
• Pulses were measured by counting radial artery beats, and respirations were measured by counting chest movement for a full minute.

There were no statistically significant differences between the two groups regarding age, level of education, use of analgesics, or type of surgery. There was a statistically significant difference on the VAS after one hour in both groups (p ≤ 0.05). There was reduction in pain levels for both groups at one and two hours after analgesic administration and treatment. The mean pain intensity level in both groups decreased at all measurements, but the experimental group's reduction had a higher statistical significance (p ≤ 0.001). Vital signs over time in both groups saw a statistically significant reduction of systolic and diastolic pressure. There was a higher reduction in the experimental group (p ≤ 0.001; f = 53.369 versus f = 32.112; p ≤ 0.001, respectively). There was no significant difference in either group in regard to respirations (p ≤ 0.007).

In this study, foot massages were associated with a greater reduction in pain. The strength of these findings was limited by the study's design.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results

This study identifies a nursing intervention that may help postoperative pain and decrease blood pressure. The intervention was easy, cost effective, and time efficient. Teaching nurses or other healthcare providers would be easy and would allow for the standardization of care. The treatment would be comforting to most patients with very little risk. Nurses need to be aware of patient conditions that would not allow for foot or leg massage. Additional research needs to be done in other patient populations to make the results more generalized. These results point to new areas of research including the relationship between massage and stress reduction.

STUDY PURPOSE: To conduct a meta-analysis comparing the effectiveness of NK₁ inhibitors in preventing chemotherapy-induced nausea and vomiting (CINV) attributed to highly emetogenic chemotherapy (HEC)

TYPE OF STUDY: Meta-analysis and systematic review

• FINAL NUMBER STUDIES INCLUDED = 19
• TOTAL PATIENTS INCLUDED IN REVIEW = 6,788
• SAMPLE RANGE ACROSS STUDIES: 16–359
• KEY SAMPLE CHARACTERISTICS: Receiving highly emetogenic chemotherapy (HEC)

PHASE OF CARE: Active antitumor treatment

Antiemetic regimens including an NK₁ inhibitor (aprepitant, fosaprepitant, rolapitant, casopitant, netupitant) prevent CINV attributed to HEC significantly more than antiemetic regimens that do not include it.

Antiemetic regimens containing an NK₁ inhibitor prevent CINV attributed to HEC better than regimens that do not contain it.

Antiemetic regimens should include an NK₁ inhibitor to maximally prevent CINV.