Assess effects of complementary treatment with a combination of sodium selenite, proteolytic plan enzymes, and Len culinaris lectin on side effects of hormone therapy

Women with breast cancer undergoing adjuvant hormone therapy were included in the analysis. Complementary treatments were used for four weeks.

• N = 729  
• AGE: Not provided
• FEMALES: 100%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Patients were included in analysis if symptom scores were at least 3 on a six-point scale

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

PHASE OF CARE: Active anti-tumor treatment

Retrospective observational

Symptom severity scored from 1 (no side effects) to 6 (extreme side effects)

After four weeks of treatment, mean score for arthralgia went from 4.83 to 3.23 (p < 0.001). Women also experienced less mucosal dryness (p < 0.001). There were no severe adverse effects reported.

Findings suggest that the complementary intervention assessed here may be beneficial in reducing symptoms of arthralgia induced by adjuvant hormonal therapy in women with breast cancer without significant side effects.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement/methods not well described
• Measurement validity/reliability questionable
• Other limitations/explanation: Use of other interventions for pain control are not discussed. It is not clear how and when symptoms were actually measured.

This study has several design limitations, but does suggest that the complementary therapy with sodium selenite, proteolytic enzymes, and L culinaris might be helpful in reducing some side effects of adjuvant hormonal therapy.

To compare analgesic effects of cryoanalgesia and parecoxib for patients undergoing lobectomy for lung cancer

Patients undergoing open thoracotomy either received cryoanalgesia or parecoxib. Cryoanalgesia was performed on four intercostal nerves. The cryoprobe was placed on each nerve and application was done to induce a temperature of -55 to -65 degrees centigrade. For the other group, 40 mg of parecoxib was given IV push. Postoperative pain and respiratory function was assessed and recorded for seven days.

• N: 178   
• AGE: Mean age = 67.5 years (range = 41-78)
• MALES: 65.7%  
• FEMALES: 34.3%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Most had stage II or III lung cancer

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: China

PHASE OF CARE: Active anti-tumor treatment

Observational

Visual analog scale for pain

During the first week, pain scores of those who received cryoanalgesia were significantly lower than those who received parecoxib (p < 0.05). One month after surgery, those who had cryoanalgesia felt no apparent pain, while the other group had persistent incisional and abdominal pain (p < 0.05). There was no difference between groups 6 months after surgery. Patients in the cryoanalgesia arm used less morphine postoperatively (p < 0.05)

Cryoanalgesia may be an effective approach for short-term postoperative patient management.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• Measurement/methods not well described
• Other limitations/explanation: The protocol for administration of postoperative pain medications, type of medications, and total dosages are not reported. Method of VAS data collection was not clearly described.

Cryoanalgesia appears in this study to have beneficial effects for postoperative pain management for patients undergoing lobectomy for lung cancer. Further research is warranted to evaluate effects of cryoanalgesia in comparison to other known effective approaches.

STUDY PURPOSE: Determine the current state of the science regarding use of cannabinoids for cancer pain

TYPE OF STUDY: Systematic review

DATABASES USED: CINAHL, BIOSIS, PUBMED, Cochrane collaboration

INCLUSION CRITERIA: RCT examining effects of cannabis or cannabinoids on cancer pain

EXCLUSION CRITERIA: Non-cancer pain, non-RCTs

TOTAL REFERENCES RETRIEVED: 81

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale used to evaluate study quality. Six studies used a crossover design and two were parallel group design. All were deemed to be of low to moderate quality

FINAL NUMBER STUDIES INCLUDED: 8 

TOTAL PATIENTS INCLUDED IN REVIEW: 683

SAMPLE RANGE ACROSS STUDIES: 10 to 360

KEY SAMPLE CHARACTERISTICS: All patients had moderate to severe pain

PHASE OF CARE: Not specified or not applicable     

APPLICATIONS: Palliative care

Studies examined oral THC, nabiximols, oral synthetic analog of THC, and oral benzypranoperidine. The majority of studies showed analgesic effects when compared to placebo and strongest evidence was seen for nabiximols.

Cannabinoids appear to be useful adjuncts for cancer pain not completely relieved by opioids, but there is a lack of high-quality evidence.

• Limited number of studies included
• Mostly low quality/high risk of bias studies
• Low sample sizes

Cannabinoids may be useful adjuncts to analgesics for cancer-related pain management. However, the evidence reviewed here was mainly of low to moderate quality. Further well-designed research is warranted.

To compare effects of nabilone versus placebo on quality of life and symptoms

Patients were randomized to receive placebo or nabilone 0.5 mg at bedtime during the first week, and increased as needed to a maximum of 1 mg twice daily. Concomitant use of other analgesics was permitted.

• N = 52, 32 at week 7   
• AGE: Mean = 63.15 years
• MALES: 80%  
• FEMALES: 20%
• CURRENT TREATMENT: Radiation, combination radiation and chemotherapy
• KEY DISEASE CHARACTERISTICS: All had head and neck cancer; most were oropharynx
• OTHER KEY SAMPLE CHARACTERISTICS: 13.5% were current smokers

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

PHASE OF CARE: Active anti-tumor treatment

Placebo-controlled RCT

• EORTC QLQ-C30 for quality of life
• VAS for pain

There were no significant differences between groups in pain or quality of life. There were no differences between groups in use of other analgesics.

No benefit of nabilone was found in this study.

Small sample (< 100)

Nabilone was not found to be of benefit for patients with head and neck cancer during radiation therapy in this study.

STUDY PURPOSE: To critically appraise and synthesize evidence regarding the safety and effectiveness of bisphosphonates and denosumab for controlling pain from bone metastasis

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE, EMBASE, Cochrane Collaboration, through January 2014

INCLUSION CRITERIA: RCT or meta analysis design, adult patients reported efficacy of pain reduction and/or side effects.

EXCLUSION CRITERIA: Abstracts, studies dealing only with prevention of skeletal-related events, economic or quality of life impact.

TOTAL REFERENCES RETRIEVED: 1,585

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: GRADE system used for study evaluation. Overall quality of evidence was rated as very low.

FINAL NUMBER STUDIES INCLUDED: 43 

TOTAL PATIENTS INCLUDED IN REVIEW: 15,064

SAMPLE RANGE ACROSS STUDIES: 9 to 5,544

KEY SAMPLE CHARACTERISTICS: Patients with bone metastases

PHASE OF CARE: Late effects and survivorship     

APPLICATIONS: Palliative care

Medications included clodronate, etidronate, pamidronate, ibandronate, zoledronic acid, and denosumab. Some of these had very few studies, and results comparing effectiveness of one over another for pain relief showed mixed findings. The authors concluded that evidence of any of these for direct pain relief is weak, mainly due to methodologic concerns.

Direct evidence for effectiveness of bone-modifying agents for relief of pain is weak; however, evidence suggests that these medications may help prevent pain by delaying onset of bone pain.

• Mostly low quality/high risk of bias studies
• High heterogeneity

Findings suggest that bisphosphonates and denosumab may benefit patients by delaying onset of bone pain, and that overall these medications are safe. Findings also suggest that this is probably most beneficial in patients with a relatively long life expectancy (months to years). Benefits may not be gained for patients with life expectancy of only weeks to months given the mechanism by which bone pain is affected.