• FINAL NUMBER STUDIES INCLUDED = 6 
• TOTAL PATIENTS INCLUDED IN REVIEW = 78
• SAMPLE RANGE ACROSS STUDIES: 74–227 patients

APPLICATIONS: Palliative care

Four studies included reported pain intensity, and the meta-analysis did not show a significant impact on pain intensity. Two of the four studies looking at patient attitudes showed decreased patient barriers to analgesic use. The studies reported improved patient knowledge.

Nurse-led psychoeducational interventions improved patient knowledge for pain management, reduced barriers to analgesic use, and may have reduced pain intensity.

• High heterogeneity
• Very few studies included in the review

This review did not add substantially to the current body of evidence regarding the effects of psychoeducational interventions on pain management. It did show that psychoeducational interventions can be beneficial in improving patient knowledge, reducing patient barriers to analgesic use, and possibly reducing pain intensity.

To determine if mecapegfilgrastim, a biosimilar, is as effective as pegfilgrastim in preventing febrile neutropenia (FN) in patients with advanced non-small cell lung cancer

One hundred fifty-one patients were split into three groups—two with two different doses of mecapegfilgrastim and one with normal saline (control). After the initial cycle, the control group received recombinant human granulocyte–colony-stimulating factor (rhG-CSF), while the other two groups continued their doses of mecapegfilgrastim.

• N = 146 
• MEAN AGE = 55.89 years 
• MALES: 69.2%, FEMALES: 30.8% 
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Non-small cell lung cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Patients receiving platinum-based chemotherapy

• SITE: Multi-site   
• SETTING TYPE: Not specified    
• LOCATION: China

• PHASE OF CARE: Active antitumor treatment

• Double-blind, three-group, randomized trial followed by an open-label

• Neutropenia grade 3 or 4 (absolute neutrophil count [ANC] 1–0.5 x 10⁹/l)
• FN temperature of 38.5 degrees with neutropenia as above
• Duration of neutropenia from nadir to ANC 2 x10⁹/L
• Depth of ANC nadir

For the first phase of the study, both mecapegfilgrastim arms showed a lower incidence of grade 3 or greater neutropenia (p < 0.0001 and p = 0.0001). For the second phase, which was unblinded, the incidence of FN was lower across all cycles with both doses of the biosimilar (p < 0.023 and p < 0.0001) compared to placebo. No significant differences existed in FN incidence in those cycles when compared to G-CSF. Time to ANC recovery was significantly lower with the biosimilar compared to placebo and no different from the time to recovery with G-CSF.

Both doses of mecapegfilgrastim were effective in reducing neutropenia within each cycle of chemotherapy compared to rhG-CSF.

• Risk of bias (no blinding)
• Risk of bias (sample characteristics)
• Findings not generalizable

As more biosimilars make their way to the market, studies such as this will be important in determining the care nurses provide to their patients. Nurses need to be aware of current literature and the implications for their patients. This study showed that the biosimilar CSF was more effective than placebo and as effective as G-CSF.

To examine effects of music therapy and progressive muscle relaxation (PMR) training on depression and anxiety in Chinese patients with breast cancer 

Patients randomly were assigned to the intervention group (which received the music and PMR intervention) or a usual care group after a radical mastectomy. To avoid contamination, intervention and control patients were placed in different inpatient areas. Music therapy involved listening to music via headphones connected to an MP3 player for 30 minutes twice per day. This began within 48 hours after surgery. Patients selected their preferred music. PMR training was conducted on the second postoperative day. Training was conducted twice per day for 30 minutes until discharge. Patients were encouraged to do PMR and music listening exercises together. Patients in the control group received the usual postoperative nursing care only. Study measures were obtained the day before surgery and the day before hospital discharge. Data collectors were blinded to group assignment.

• N = 170  
• MEAN AGE = 47.01 years (SD = 9.5 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Most had modified radical mastectomy and 89% had chemotherapy immediately after surgery

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

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled, single-blinded trial

• Zung Self-Rating Depression Scale (SDS)
• State-Trait Anxiety Inventory (STAI)

Analysis showed that there was a significant reduction in anxiety and depression over time alone (p < .001) as well as by group (p < .001), and there was a significant interaction between group and time (p = .0009). Depression scores declined an average of 7.2 points in the intervention group and 4.6 points in the control group. Anxiety scores declined an average of 16 points in the intervention group and 11 points in the control group. Hospital stay time was significantly lower in the intervention group (p < .001). Hospital stay length was shorter in the intervention group.

The findings of this study suggest that the combination of PMR and listening to music was helpful in reducing anxiety and depression in women after mastectomies.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results
• Findings not generalizable
• Other limitations/explanation: No information was provided regarding other potential confounders such as postoperative complications, pain levels, etc. that could influence reported outcomes. Data collection was conducted via face-to-face interview, and although it was stated that data collectors were blinded, it is not clear where the data collection took place. If it took place in the hospital, data collectors could deduce group assignment because of the different locations in the hospital. This study was of Chinese women, so applicability to other groups is not known. It is not clear in the report whether all sessions of the intervention were guided by the investigators or done by the patients on their own. It is not clear how, if supervised by investigators, the patient could listen to the PMR training if they also were listening to music via headphones.

Listening to music and using progressive muscle relaxation may have a positive impact on anxiety and depression in patients postoperatively. These are low-risk, low-cost interventions that may be beneficial. The findings of this study showed that those who had the intervention also had shorter hospital stays. There is insufficient evidence to determine the real impact of this intervention on duration of hospitalization; however, these findings suggest that this area deserves further exploration.

To compare the effectiveness of Mepilex^® Lite dressings versus usual care in the time to healing of postirradiation dermatitis in patients with nasopharyngeal carcinoma

• Control arm: Routine wound care and cleansing with a saline solution
• Intervention arm: Wound cleansing followed by application of Mepilex Lite dressing
• Primary endpoint: Time to wound healing (i.e., time between recruitment and complete reepithelialization with absence of any moist desquamation)
• Signs of infection also were measured.
• Assessments were made at baseline and then every Monday, Wednesday, and Friday.

• N = 88 started, 83 completed    
• AGE = Adults aged 50 years or younger (n = 50), adults aged 50 years or older (n = 38) 
• MALES: 62.5% (n = 55), FEMALES: 37.5% (n = 33)
• KEY DISEASE CHARACTERISTICS: Nasopharyngeal carcinoma
• OTHER KEY SAMPLE CHARACTERISTICS: Concurrent chemoradiation, three cycles of neoadjuvant cisplatin and 5FU chemotherapy, Chinese patients. There was no significant difference in the participant characteristics between the treatment and control arm.  These characteristics include age, Karnofsky Performance Status Scale, initial wound size, cancer staging, or radiotherapy technique.

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Southeast Asia

• PHASE OF CARE: Active antitumor treatment

This was a systematic, inpatient, controlled clinical trial investigating the effect of Mepilex Lite dressings on radiation-induced dermatitis in patients with nasopharyngeal cancer who were undergoing curative-intent radiotherapy.

• Modified Radiation Induced Skin Reaction Assessment Scale (RISRAS) was used to assess erythema, dry desquamation, moist desquamation, necrosis, and patient symptoms such as pruritus, burning, discomfort, and impact on daily life.
• Wound pain was measured using a visual analog scale of 0–10
• Sleep problem, neck mobility, and appearance disturbance were measured using a 10-point Likert scale of 0 (less) to 10 (more distress) 

Median time to wound healing  was 16 days (95% CI 12–19 days) in the Mepilex Lite group and 23 days (95% CI 19–27 days) in the control group (p = 0.009). Initial wound size of greater than or equal to 10 cm² (p = 0.005), lymph node classification of 3 (p < 0.001), and AJCC overall stage III and IV (p = 0.003) were associated with prolonged wound healing time. No signs of infection were identified in either group. Participants in the Mepilex Lite group had significantly less (X = 4.38) sleep problems than the control group (X = 7.23, p = 0.005). Wound pain was significantly less in the Mepilex Lite group (X = 5.31) as compared to the control group (X = 6.89, p = 0.02). There was no difference in the neck mobility and appearance disturbance between the treatment and control groups.

Mepilex Lite dressing provides a promising alternative in the treatment of radiation dermatitis in nasopharyngeal carcinoma and is worthy of further research.

• Small sample (< 100)
• Risk of bias (no blinding)
• Other limitations/explanation: It would have been impossible to blind the researchers or the participants when only one arm involved a dressing.

This was a small, randomized, controlled clinical trial that was not blinded. Mepilex Lite dressing significantly decreased the time to wound healing of radiation dermatitis among individuals being treated for nasopharyngeal carcinoma. Additional studies are needed in a large, more diverse population of patients with cancer.

• FINAL NUMBER STUDIES INCLUDED = 7 (initially reported as eight studies, but one was excluded because the Likert scale was used instead of the VAS to assess pain)
• TOTAL PATIENTS INCLUDED IN REVIEW = 403 patients with pancreatic cancer, 196 patients undergoing CPB, and 207 undergoing medical management
• KEY SAMPLE CHARACTERISTICS: Mean age of CPB patients was 57–67 years; mean age of control patients was 60–68 years; proportion of males was similar between groups among the studies; the CPB methods and the pharmaceuticals were similar; the use of ethanol concentrations varied from 30%–100%

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Elder care and palliative care

The VAS scores of the CPB groups were lower at two, four, and eight weeks after the procedure, but not all studies found that the CPB group used fewer pharmacologic agents than the control groups. Most studies showed that the CPB groups experienced less pain although the patients in these group also used nonsteroidal anti-inflammatory drugs (NSAIDS) or morphine to control their pain.

This meta-analysis found that at four weeks, groups receiving a CPB had a lower pain score. However, these results were not sustained at eight weeks, and the trend continued to the day before death with increaseing usages of NSAIDS and morphine in both groups.

• Across the various studies, there was limited postintervention consistency in pain evaluation intervals.
• The concentrations of ethanol used in CPBs varied significantly between studies. 
• CPB techniques varied across the studies.

The findings of this meta-analysis show consistent results in regard to the efficacy of CPB in decreasing pain for patients with pancreatic cancer short-term and overall.

STUDY PURPOSE: To evaluate caregiver outcomes related to telehealth interventions in palliative care

TYPE OF STUDY: Systematic review

• FINAL NUMBER STUDIES INCLUDED = 9 
• TOTAL PATIENTS INCLUDED IN REVIEW = 527
• SAMPLE RANGE ACROSS STUDIES: 8–217
• KEY SAMPLE CHARACTERISTICS: One study included patients with cancer. Four studies were of patients in hospice.

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care

Four studies used videophones for communication with medical professionals, and two used telephones for counseling. Two studies showed a reduction in caregiver anxiety with the intervention. One study showed a significant reduction in caregiver burden, and one showed no difference in caregiver burden measures. Individual studies also showed improved family function, reduction in caregiver negative mood, decreased depression over time, and reduced stress over time among caregivers. Overall, 66.7% showed positive effects of the interventions. All studies concluded that the approach was feasible, and most revealed that caregivers were satisfied with the intervention.

Telehealth interventions might improve the caregiving experience. Additional research in this area is needed.

• Mostly low quality/high risk of bias studies
• Low sample sizes
• The content of interventions is not well described.

Telehealth intervention approaches may be an effective way to deliver various aspects of care and caregiver interventions. This can be a practical alternative to other approaches, particularly for caregivers in rural or underserved communities. Additional research is warranted to also identify the most effective components of these types of interventions.

To evaluate whether spore powder of Ganoderma lucidum (G. lucidum) has beneficial effects on fatigue and overall quality of life in patients with breast cancer undergoing endocrine therapy.

Patients in the experimental group received spore powder of G. lucidum 1,000 mg three times a day for four weeks (from Beijing Great Wall Pharmaceutical Factory, batch # B20050008). This is a traditional Chinese medicine that contains polysaccharides, alkaloids, enzymes, and proteins. The control group received placebo for four weeks. Outcomes were evaluated at baseline and the end of four weeks. 

• The total sample was comprised of 48 women, with 25 patients in the experiemental group and 23 in the control group.  
• Median age was 51.3 years (standard deviation [SD] = 9.8) in the experiemental group and 53.2 years (SD = 8.7) in the control group (p > 0.1).
• Patients were stage I to IIIA. 
• Multimodal treatment included surgery, radiation and/or chemotherapy, and endocrine therapy for all patients. 
• Duration of endocrine therapy varied from more than six months to up to five years. 
• No statistically significant differences existed between the groups.
• Patients received endocrine therapy for breast cancer.
   

The study was conducted at the Third Affiliated Hospital of Harbin Medical University in Harbin, China, from June 2009 to September 2010.

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for patients undergoing endocrine therapy.
   

The study was a randomized, placebo-controlled trial.

• Functional Assessment of Cancer Therapy–Fatigue (FACT-F)
• Hospital Anxiety and Depression Scale (HADS)
• European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30)
• Biological Markers of Fatigue:  tumor necrosis factor (TNF) and interleukin-6 (IL-6)
• Safety and toxicity tests, such as a renal function test, liver function test, and the Common Toxicity Criteria version 2.0 scale
• Fatigue was measured with a single-item numeric rating scale with possible values from 0 (a great deal of fatigue) to 10 (no fatigue).
• Energy was measured with a single item, “How much energy have you had during the past 4 weeks?,” with possible values from 0 (no energy at all) to 10 (a great deal of energy).
   

No serious adverse effects occurred. No significant changes occurred in the renal and liver function tests. Fatigue scores were improved in the experimental group at four weeks (p < 0.01), but no significant improvement occurred in the control group. At four weeks, anxiety and depression scores had improved significantly from baseline in the experimental group. No significant improvement occurred over time in the control group.

The pilot suggested that spore powder G. lucidum may have beneficial effects on cancer-related fatigue and quality of life in patients with breast cancer undergoing endocrine therapy with no significant safety concerns.

• The study had a small sample size, with less than 100 patients.
• Nonspecific aspects of the intervention (social support) may influence the study. 
• Patients were healthy (e.g., no other comorbid conditions).
• No blinding was performed.
   

Additional research should be conducted in a larger randomized, controlled trial.

The purpose of this study was to investigate whether berbamine has clinical benefit in reversing imatinib-related neutropenia. Berbamine is an alkaloid derived from the Berberis aristata plant that has been used in China for managing leukopenia associated with cancer and chemotherapy.

Patients self-selected, with consultation with their doctors, which treatment approach they wanted to have.

In patients who did not receive berbamine, the imatinib dose was adjusted according to guidelines so that those who developed an absolute neutrophil count (ANC) of less than 1.0 x 10⁹/L had imatinib withheld until their ANC was 1.5 x 10⁹/L or higher.

In the berbamine group, a daily dose of 336 mg orally was given to patients who developed grade 2 neutropenia (between the above 2 ANC levels) to prevent development of grade 3 or above. If grade 3 or above, the patients had imatinib withheld until they recovered to grade 1 or lower, and berbamine was continued until they had a stable count of an ANC of 2 x 10⁹/L or greater for more than four weeks.

• The sample consisted of 33 patients with a median age of 38 years and a range of 14–69 years.
• Fifty-four percent of the sample were male, 46% were female.
• All had chronic phase chronic myeloid leukemia. 
• Most had had previous therapy with interferon- or hydroxyruea-based chemotherapy.
• All had previous grade 2 or higher neutropenia with imatinib.
   

A single-site setting in China

Active antitumor treatment

Non-randomized two group comparison

Twenty patients chose to use berbamine and were treated preemptively. Incidence of grade 3 or higher neutropenia was 15% in the berbamine group and 38.5% in the comparison group—which was not a statistically significant difference.

Recovery time for patients treated with berbamine was a median of 42 days compared to 79 days in controls (p = 0.043). There was no difference between groups in disease response to treatment rates. The only adverse events with berbamine reported were symptoms of nausea in two patients.

Berbamine appears to be well tolerated by these patients overall. No firm conclusions can be drawn from this study.

• Small sample size (less than 100 participants)
• Risk of bias (no control group) 
• Risk of bias (no blinding)  
• Risk of bias (no random assignment)
• Findings not generalizable

Berbamine, a naturally occurring alkaloid compound from a Chinese traditional plant, may have some applicability and benefit for patients receiving imatinib for chronic myeloid leukemia. This particular study does not provide strong support for this use due to numerous study limitations. Further well-designed research with appropriate sample sizes in these types of patients, as well as other groups at risk for development of severe neutropenia, is warranted.

STUDY PURPOSE: To examine the efficacy and cost-effectiveness of various azoles for antifungal prophylaxis in patients with hematologic malignancies undergoing chemotherapy or cell transplantation

TYPE OF STUDY: Meta-analysis and systematic review

• FINAL NUMBER STUDIES INCLUDED = 21
• TOTAL PATIENTS INCLUDED IN REVIEW = 5,505
• SAMPLE RANGE ACROSS STUDIES: Not provided
• KEY SAMPLE CHARACTERISTICS: Duration of antifungal prophylaxis and follow-up ranged from 70–100 days; 39% underwent hematopoietic cell transplantation (HCT), and the most common disease was acute myeloid leukemia (AML).

PHASE OF CARE: Active antitumor treatment

Overall, proven or probable fungal infection occurred in 5% of the study population—45% were Candida and 49% were Aspergillus. All triazoles were better than placebo, except for itraconazole. Various triazoles differed in terms of tolerability and specific treatment-related side effects. Comparative efficacy analysis was in favor of posaconazole based on numerous outcomes evaluated. Itraconazole was associated with more study withdrawals but was also the least costly. Incremental cost-effectiveness ratios (ICER) were calculated for each agent. This analysis showed that posaconazole had a higher ICER than comparators. All triazoles except for intraconazole capsules were found to be effective in reducing fungal infection.

The findings suggest that posaconazole may more cost-effective for antifungal prophylaxis than the other triazoles examined. Itraconazole capsules were not shown to be effective.

• Low sample sizes
• Did not include patients of other high risk groups, such as GVHD. No direct head-to-head comparison of individual azoles, though the network meta-analysis approach was used to enable this comparison. The study was done in Singapore, so cost, etc., information may not be applicable in other areas.

The findings showed that all azoles other than itraconzole capsules were effective for antifungal prophylaxis, and that posaconazole may be the most cost-effective agent.

The objective of the article was to review studies that evaluated nonpharmacologic interventions for breathlessness management in patients with lung cancer.

Databases searched were Cochrane Library, EMBASE, PubMed, Ovid, EBSCO Host as a search engine for CINAHL, Pre-CINAHL (2007), Health Source: Nursing/Academic Edition, and MEDLINE (all searched 1990-July 2007).

Search keywords were breathlessness, dyspnea, management, interventions, treatment, non-pharmacological, and lung cancer.

Nonpharmacologic interventions for breathlessness in patients with lung cancer were included.

Pharmacologic interventions for breathlessness, studies that did not include patients with lung cancer, descriptive studies, and studies not published in English literature were excluded.

One hundred sixty-nine abstracts were retrieved, 15 articles were reviewed, and five studies ultimately were included. Studies were eliminated based on selection criteria. Standardized abstraction procedures were used to evaluate included studies.

A total of 370 patients were in the five studies included [Corner (20), Bredin (103), Connors (14) , Hately (30), Moore (203)].

All studies included behavioral, psychological, and educational interventions, although the method of delivery varied between studies.

Evidence is moderately strong to suggest benefit of a counseling and supportive educational intervention to alleviate breathlessness in patients with lung cancer. While all studies showed benefit with a multicomponent nonpharmacologic intervention approach, whether all components are warranted or whether one component is more/less effective than another is inconclusive.

Studies were limited by small sample size or high attrition rates.

Nurses should consider providing support and counseling for breathing techniques, relaxation, and breathing retraining in patients with breathlessness and lung cancer.