Vignes, S., Porcher, R., Arrault, M., & Dupuy, A. (2011). Factors influencing breast cancer-related lymphedema volume after intensive decongestive physiotherapy. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 19(7), 935–940.
To analyze factors associated with treatment failure and success in lymphedema
All patients underwent complete decongestive therapy (CDT) with manual drainage, multilayer low-stretch bandages and specific exercises and skin care as recommended in international consensus guidelines. Patients were followed at 6 and 12 months and then yearly. At each patients were questioned about actual treatments used and responses were recorded
The study used a descriptive design.
MLD did not appear to reduce the risk of treatment failure for lymphedema. Compression therapy appears to be the main factor in stabilizing lymphedema volume.
Findings add to the growing body of evidence pointing to the critical nature of patient compliance with compression sleeves and bandaging over time for ongoing effective management of lymphedema. Findings suggested that being overweight may also contribute to potential for treatment failure. Nursing measures to provide support for treatment adherence and weight control are important areas for patient care. Interventions to facilitate adherence to compression therapy should be researched.
Vig, S., Seibert, L., & Green, M.R. (2014). Olanzapine is effective for refractory chemotherapy-induced nausea and vomiting irrespective of chemotherapy emetogenicity. Journal of Cancer Research and Clinical Oncology, 140(1), 77–82.
To retrospectively evaluate the efficacy of the addition of olanzapine in adults experiencing refractory chemotherapy-induced nausea and vomiting (CINV) stratified by chemotherapy emetogenicity
This was a retrospective chart review of adults receiving chemotherapy between January 2008 and January 2012. Inclusion criteria required that patients received one or more daily doses of olanzapine 10 mg per dose for the indication of refractory CINV during the same admission. Each patient must have received antiemetic prophylaxis and first-line rescue antiemetics appropriate for the emetogenicity level of the chemotherapy regimen according to National Comprehensive Cancer Network guidelines at the time of chemotherapy administration. Patients were excluded if olanzapine was used for anything other than refractory CINV.
Researchers measured the number of rescue antiemetics received following the first dose of olanzapine. Patients were stratified by chemotherapy emetogenicity level, age, gender, and number of prophylactic antiemetics received.
Thirteen women and 10 men were included in this study, the majority of whom were Caucasian (58%) and were most frequently being treated for advanced melanoma (36%) and non-Hodgkin lymphoma (24%). The addition of olanzapine was successful for 65% of patients receiving regimens with low to moderate emetogenicity (n = 23) and 70% of patients receiving regimens with high emetogenicity (n = 10). For these cohorts, olanzapine 5–10 mg was administered for one to eight days (median four days). More women (85%) than men (55%) were successfully treated with the addition of olanzapine. For patients receiving a serotonin antagonist, glucocorticoid, and aprepitant as prophylaxis, the addition of olanzapine was successful for controlling breakthrough nausea 68% of the time. Patients who received a prophylactic serotonin antagonist alone were treated successfully 63% of the time for breakthrough nausea with olanzapine. Cohorts 18 to 50 years old (n = 12) and over 50 years (n = 15) received relief with the addition of olanzapine 67% of the time.
Adding olanzapine contributed to the success of CINV management, particularly for women more often than men. Findings suggest that the addition of olanzapine for refractory to prophylactic and breakthrough antiemetic regimens in all levels of emetogenicity may be beneficial.
Nurses who assess and administer chemotherapy with low to moderate or high levels of emetogenicity should consider the addition of olanzapine for refractory CINV.
Vidal-Casariego, A., Calleja-Fernandez, A., Ballesteros-Pomar, M. D., & Cano-Rodriguez, I. (2013). Efficacy of glutamine in the prevention of oral mucositis and acute radiation-induced esophagitis: a retrospective study. Nutrition and Cancer, 65, 424-429.
To evaluate the effect of oral glutamine on the prevalence and severity of acute radiation-induced oral and esophageal mucositis
Data were collected retrospectively for patients receiving radiation therapy. Findings were compared between those who did and did not receive glutamine. Outcomes between those who were given glutamine early (prior to radiation therapy) versus late (after radiation therapy was begun) in the course of radiation therapy were compared. Data on nutritional status and interruptions in treatment were evaluated.
The study was conducted at a single site outpatient setting in Spain.
Patients were undergoing the active antitumor treatment phase of care.
This was a retrospective study.
The World Health Oragnization (WHO) mucositis grading scale was used.
Provision of oral glutamine prior to the beginning radiation therapy may be of benefit in the prevention of oral mucositis. Firm conclusions cannot be made because of multiple study limitations.
This study has numerous limitations and risks of bias, and it attempted to draw conclusions across a very heterogenous population of patients. Findings suggest that oral glutamine may be helpful in preventing oral mucositis in patients receiving radiation to the head and neck area, and it appears that glutamine treatment may be most beneficial if treatment is begun prior to the initiation of radiation therapy.
Vickers, A. J., Straus, D. J., Fearon, B., & Cassileth, B. R. (2004). Acupuncture for postchemotherapy fatigue: a phase II study. Journal of Clinical Oncology, 22, 1731–1735.
Traditional Chinese acupuncture was performed twice per week for four weeks or once per week for six weeks. The acupuncturists used points commonly used for fatigue.
Acupuncture was delivered in an Integrative Medicine clinic.
The study used a single-arm, phase II, pilot design.
Mean improvement was 31.1% (confidence interval [CI] [20.6%, 41.5%]); 39% of patients improved by greater than 40%. Younger and less depressed patients showed a greater response.
Acupuncture may affect serotonin pathways. No adverse events occurred.
Certified acupuncturists are needed. Once weekly treatment was preferable. The intervention seemed to show benefits that suggest it is worthy of further study.
Vickers, A.J., Feinstein, M.B., Deng, G.E., & Cassileth, B.R. (2005). Acupuncture for dyspnea in advanced cancer: A randomized, placebo-controlled pilot trial [ISRCTN89462491]. BMC Palliative Care, 4, 5.
Treatment consisted of two phases: acupuncture and acupressure. Patients were randomized to receive a single session of true or placebo acupuncture. Semi-permanent acupuncture studs then were inserted, and patients applied pressure to the studs twice a day to provide ongoing stimulation to acupuncture points.
Dyspnea scores were slightly higher for patients receiving true versus placebo acupuncture immediately after and for the one week daily follow-up, but the difference was not statistically significant.
Acupuncture technique as used in this trial is unlikely to have an effect on dyspnea.
Veness, M.J., Foroudi, F., Gebski, V., Timms, I., Sathiyaseelan, Y., Cakir, B., et al. (2006). Use of topical misoprostol to reduce radiation-induced mucositis: Results of a randomized, double-blind, placebo-controlled trial. Australasian Radiology, 50(5), 468–474.
200 mcg of misoprostol or placebo was dissolved in 15 ml of water. Patients swished in oral cavity for two minutes, then swallowed. Patients were advised to gargle before swallowing.
The study was comprised of 83 patients with squamous cell carcinoma of the head and neck, older than 18 with a total radiation dose higher than 50 Gy.
Misoprostol arm: n = 42
Placebo arm: n = 41
1999–2002
Double-blind, placebo-controlled, randomized trial
Extent of RTOG grade 3 mucositis (incidence and duration).
Secondary endpoints were time to development of mucositis, extent of grade 2 mucositis, patient weight, general well-being using VAS, and oropharyngeal or oral soreness.
RTOG, VAS
No significant differences were found for endpoints. More patients in the misoprostol arm reported increased levels of oral or oropharyngeal soreness.
Did not accrue adequate patients according to statistical analysis.
12% patient withdrawals
Velthuis, M. J., Agasi-Idenburg, S. C., Aufdemkampe, G., & Wittink, H. M. (2010). The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. Clinical Oncology (Royal College of Radiologists (Great Britain)), 22, 208–221.
To evaluate short- and long-term effects of different exercise parameters during adjuvant treatment on cancer-related fatigue.
Databases searched were CINAHL, EMBASE, MEDLINE, Scopus, PEDro, and Cochrane Library to 2008. Hand searching was performed using reference lists from articles obtained.
Search keywords were cancer (and related terms), chemotherapy, radiotherapy, hormone*, exercise, cycle, train*, walk, and fatigue.
Studies were included in the review if
No exclusion criteria were specified.
Initally, 1,097 articles were identified. A final set of 18 articles met the inclusion criteria. The PEDro scale was used to rate the methodological quality of the research. Fifteen studies were considered to be of high quality, with a score 4 or greater (range 2–8).
Overall Findings in Breast Cancer
Home-Based Exercise
Exercise was home-based and self-monitored in seven studies. Interventions consisted of walking for 10 to 45 minutes per week and for three to six times per week. In one study, the participants also performed resistance exercises. Cancer treatments and timing of the programs varied. Adherence ranged from 70% to 100%.
Supervised Exercise Programs
Supervised programs were used in five studies. Three involved aerobic exercises, and the others included groups with stretching and/or resistance exercises. Most were performed for 10 to 30 minutes three times per week. Programs were completed by 39% to 100% of partcipants.
Overall Findings in Prostate Cancer
Four studies were performed in patients with prostate cancer; three were supervised and one was home-based.
Findings in Multiple Myeloma and Acute Myeloid Leukemia
One study was performed in each of these patient groups. One was of low quality. Both had nonsignificant reductions in fatigue.
Only short-term effects could be analyzed because only one study described any longer-term effects of physical exercise. No significant adverse effects overall were seen. Supervised aerobic exercise programs were more effective in reducing fatigue than home-based programs. There were significant positive effects during breast cancer treatment, with small to moderate effect sizes. The most effective frequency intensity or duration of exercise could not be determined. Reported adherence to the exercise program varied widely.
Findings showed that exercise had at least a small beneficial effect in reducing fatigue for patients during adjuvant treatment. Supervised programs may be more effective than self-managed home-based programs. More research on the effects of resistance exercise, home-based exercise, and most effective exercise parameters are needed. Longer-term outcomes and patient adherence need to be examined further. Research on the effects of exercise in other patient types is also needed.
Vehreschild, M.J., von Bergwelt-Baildon, M., Tran, L., Shimabukuro-Vornhagen, A., Wisplinghoff, H., Bangard, C., . . . Vehreschild, J.J. (2014). Feasibility and effectiveness of posaconazole prophylaxis in combination with micafungin bridging for patients undergoing allogeneic stem cell transplantation: A 6-yr analysis from the Cologne cohort for neutropenic patients. European Journal of Haematology, 93, 400–406.
To compare the effectiveness of two antifungal prophylaxis regimens in the setting of hematopoietic cell transplantation (HCT)
The study compared patient outcomes between patients undergoing HCT who received only 200 mg posaconazolel three times daily for 100 days to those who also received intermittent IV micafungin at 50–100 mg. Micafungin was provided for patients who were unable to take the oral medication for any reason. The decision to switch to micafungin was at the physician’s discretion.
PHASE OF CARE: Active antitumor treatment
Mean number of febrile days was 5.9 in the posaconzole group and 4.3 in the group also receiving micafungin (p = 0.051). The number of possible IFI in the group receiving micafungin bridging was significantly lower (16% versus 3.8%, p = 0.005). Those receiving micafungin bridging had higher fungal-free survival at 100 days post-HCT (p = 0.009). There was no difference in overall survival between groups.
Use of IV micafungin in patients unable to take oral posaconazole was effective in reducing fungal infections.
This study shows that intermittent use of IV micafungin was effective for patients unable to take oral posaconazole for antifungal prophylaxis following HCT. Both of these regimens were shown to be feasible and effective. Further research in this area is warranted to determine most effective drug combinations and timing to prevent breakthrough IFI.
Vehreschild, J. J., Sieniawski, M., Reuter, S., Arenz, D., Reichert, D., Maertens, J., . . . Cornely, O. A. (2009). Efficacy of caspofungin and itraconazole as secondary antifungal prophylaxis: analysis of data from a multinational case registry. International Journal of Antimicrobial Agents, 34, 446–450.
To compare caspofungin and itraconazole as secondary prophylaxis in patients with hematological malignancies.
Physicians completed case report forms via the intranet for data collection and analysis. Physicians did not follow any specific protocol, drug selection was based upon individual discretion and timing, and dosages of medications used varied. Outcomes were assessed at the end of neutropenia.
Patients were undergoing the active antitumor treatment phase of care.
This study was observational.
Incidence of breakthrough IFD was similar in both groups of patients (31.9%–32.1%). There were no significant differences between groups in any other outcome measures. Death attributable to IFD ranged from 3.6% to 4.3%. Aspergillosis was the most frequent infection, followed by candidiasis. Overall mortality was 16%.
No differences were found in efficacy between these two medications; however, no conclusions could be drawn due to multiple study limitations and significant differences between patient groups in the sample.
*Substantial variability in patient characteristics that would influence findings, variability in methods of treatment, other measures used for infection prevention, etc.
This study provided no evidence to differentiate the efficacy between these two medications for secondary antifungal prophylaxis.
Rodriguez Vega, B., Palao, A., Torres, G., Hospital, A., Benito, G., Perez, E., . . . Bayon, C. (2011). Combined therapy versus usual care for the treatment of depression in oncologic patients: A randomized controlled trial. Psycho-Oncology, 20(9), 943–952.
To compare the effects—on quality of life and symptoms of depression—of an intervention consisting of a psychotherapeutic intervention, narrative therapy, plus escitalopram to the effects of usual care plus escitalopram
The initial sample was composed of 1,026 patients, between March 2006 and June 2008, with a diagnosis of breast, lung, or colorectal nonmetastatic cancer, three months after cancer diagnosis and no later than two years after diagnosis. Investigators used the Hospital and Anxiety Depression Scale (HADS) to screen participants for depression. A total of 150 had depressive disorder according to DSM-IV-TR criteria. The study contained 72 participants, 33 in usual care and 39 in combined care. Escitalopram was administered on a fixed-flexible schedule in both groups, beginning with 10 mg per day and adjusted up to 20 mg per day by week 8. A minimum of six months treatment was established for both groups. The narrative intervention was carried out individually during 12 weekly sessions, each 45 minutes long, and was guided by a treatment manual. Of the sessions, 10% were videotaped to help ensure adherence. Usual care consisted of oncologist-adminstered antidepressant. The oncologist followed a protocol and reported side effects of the medication. The follow-up of patients in the usual-care group was similar to that of patients in the treatment group. Investigators assessed depression-related outcome at weeks 12 and 24.
Two-center randomized controlled trial
Demographic variables did not differ significantly between the two groups. Gender and age were unbalanced because of cancer types. At 12 and 24 weeks, the combined-therapy group showed significantly greater improvement in all the dimensions of function (p < 0.01), pain scale (p = 0.02), global health (p = 0.02), and global quality of life (p = 0.007). Between groups there were no statistically significant differences in symptoms of depression. From week 12 to 24, study retention was higher in the combined-treatment group (p = 0.01).
Using combined therapy for major depression in patients with cancer results in significant improvements in quality of life but does not result in a significant reduction in symptoms of depression. Narrative therapy is an integrative intervention designed to address components of critical importance in patients with depression. The therapy may have a positive impact on patient’s fears and worries about medication interactions and side effects.
The interventions proved to be acceptable to patients. The intervention shows good potential for dissemination, is relatively easy to implement, and improved compliance. The intervention may be a low-cost means of improving the quality of life of patients with cancer.