Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of exercise on cancer-related fatigue: A meta-analysis. American Journal of Physical Medicine and Rehabilitation, 93, 675–686.
PHASE OF CARE: Multiple phases of care
There was a moderate effect on fatigue, sleep disturbance, and depression with exercise in the intervention groups (p < 0.001) compared to the control group. The benefits of exercise did not differ by type of exercise intervention (P = 0.85 for interaction). However, the effect of exercise on fatigue reduction may differ by underlying malignancy type with a stronger effect in solid tumors versus hematologic and mixed-malignancy types (P = 0.01 for interaction). There was a stronger effect on depression in females (p = 0.03). Patients with solid tumors seemed to experience a greater benefit.
Exercise can have an effect on fatigue despite the type of exercise and phase of care when delivered.
The clinical effect of what is considered a significant reduction in Functional Assessment of Cancer Therapy - Fatigue was questioned. The terms physical activity and exercise were used interchangeably, and the meaning of structured exercise was not well-explained.
Patients may be given several options for kinds of exercise to improve fatigue based on their preference while still receiving the benefit of improved fatigue.
Tomiska, M., Tomiskova, M., Salajka, F., Adam, Z., & Vorlicek, J. (2003). Palliative treatment of cancer anorexia with oral suspension of megestrol acetate. Neoplasma, 50, 227–233.
To evaluate the effect of different doses of oral suspension of megestrol acetate (MA) on appetite, quality of life, body weight, and anthropometric measures in patients with advanced cancer
Researchers evaluated a fixed dose of MA (480 mg) versus escalating doses of MA. Patients were evaluated at baseline, two, four, and eight weeks.
The study was a randomized, multicenter, blinded, two-arm trial.
Twelve patients were evaluated at eight weeks (eight patients died, one withdrew from study, and one stopped because of side effects). Therefore, the patients were evaluated as a single group regardless of whether they were receiving a fixed dose or an escalating dose of MA. There was statistically significant improvement in appetite over baseline in all patients at two weeks (p = 0.0001), four weeks (p = < 0.01), and eight weeks (p = 0.022). Overall quality of life improved in the majority of patients at two and eight weeks, but it was not statistically significant. There was no statistically significant improvement in body weight or other measures. In terms of side effects, 4 of 19 patients experienced clinically significant edema, resulting in 1 patient withdrawing from the study.
Original aims of the study could not be met because of the small sample size, so no conclusions can be drawn about the effectiveness of oral MA suspension or optimal or superior dose of MA.
Tomé-Pires, C., & Miró, J. (2012). Hypnosis for the management of chronic and cancer procedure-related pain in children. International Journal of Clinical and Experimental Hypnosis, 60, 432–457.
STUDY PURPOSE: To review published trials of hypnotic treatments for children with chronic and cancer-related pain
TYPE OF STUDY: Systematic review
DATABASES USED: MEDLINE, PsycINFO, Cochrane Collaboration
KEYWORDS: Children, hypnosis, pain
INCLUSION CRITERIA: RCT; patients 18 years old or younger; Catalan, English, French, Portuguese, or Spanish languages; included patients with chronic pain or cancer procedure-related pain
EXCLUSION CRITERIA: Abstracts only, not published in full in peer-reviewed journals
TOTAL REFERENCES RETRIEVED: 81
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: No study quality evaluation reported
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics
All studies in children with cancer were related to acute procedure-related pain and anxiety. Hypnotic interventions were better at reducing pain than no treatment, standard care, placebo, and attention control. Compared to other psychological treatments, hypnosis had about the same effectiveness as cognitive behavioral therapy. Comparison of hypnosis to distraction showed mixed results. Younger patients had significantly better responses to hypnosis. Parents of those receiving hypnosis had lower anxiety. Results of hypnosis on anxiety were mixed. One study showed similar effects between hypnosis and play. Calculated effect sizes with hypnosis showed decrease in pain of 20%–80%. In four studies that included follow up at 3–12 months, therapeutic effects appeared to be long-lasting.
Hypnosis is effective in reducing acute procedure-related pain among children with cancer.
Studies tended to have small samples, and many of these studies were done by the same group of researchers.
Findings of this systematic review support the use of hypnosis in children undergoing invasive procedures for reduction in pain. Nurses can advocate for availability of this intervention in pediatric settings.
Tomblyn, M., Chiller, T., Einsele, H., Gress, R., Sepkowitz, K., Storek, J., . . . Centers for Disease Control and Prevention. (2009). Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biology of Blood and Marrow Transplantation, 15, 1143–1238.
To update previously published guidelines from 2000 for the prevention of infection in patients receiving any type of hematopoietic stem cell transplantation (HSCT). Patients analyzed were adults and pediatric populations receiving allogeneic or autologous HSCT.
The resource was presented as an evidence-based guideline. An international group of experts from identified professional organizations reviewed and graded evidence and developed recommendations.
The volume and highly specific process were not discussed.
Recommendations were made, and possible opportunistic infections at pre-engraftment, post-engraftment, and late phases of HSCT were identified. Recommendations included
Timing and appropriate individuals for various immunizations are important considerations, and it is recommended that users of this information refer to the full report. Overall, use of live vaccines is contraindicated for these patients; vaccination is contraindicated in those with chronic graft-versus-host disease or when patients are still immunosuppressed.
Some recommendations were based on expert opinion due to lack of research evidence in the area.
Specific interventions for prevention of infection among HSCT recipients is a complex field, and healthcare providers who work with these patients need to be aware of current knowledge. Evidence in this area continues to evolve as HSCT techniques change and further evidence is gained regarding the immediate and long-term effects of HSCT.
Tomazevic, T., & Jazbec, J. (2013). A double blind randomised placebo controlled study of propolis (bee glue) effectiveness in the treatment of severe oral mucositis in chemotherapy treated children. Complementary Therapies in Medicine, 21, 306-312.
To assess the efficacy of propolis versus placebo for the treatment of chemotherapy-induced severe oral mucositis (OM) treatment as a complementary and alternative medicine to alleviate severe OM from cancer therapy in the pediatric population. Propolis is a resinous material collected by bees from various plant sources and mixed with the bee’s salivary enzymes and beeswax. Recent scientific evidence suggests that honeybee products include anti-inflammatory, antioxidant, and antimicrobial properties.
The pediatric patients randomly were assigned to two groups: propolis or placebo. The oral care protocol consisted of teeth brushing.
The propolis or placebo was applied twice a day—once in the morning and once in the evening. The patients' OM was assessed according to the modified Eilers Oral Assessment Guide (OAG) twice a week when the patients were in the hospital. Patients were followed for the period of the chemotherapy or the first six months of the chemotherapy. An average of 0.38 g of propolis or placebo was used for each application. Each patient was given an information folder to reinforce cooperation and help them remember the protocol. A protocol follow-up regarding side effects and efficacy was assessed by questionnaire.
OM was clinically assessed using a dental mirror and portable head light. OM was scored according to the modified Eilers OAG twice a week.
The study assessed OM episode frequency, duration, and severity. The OM episode frequency and OM mean duration were assessed. The frequency of severe OM and duration of OM were not statistically significant between the study groups. Thus, the findings found that severe OM was of slightly shorter duration and of a lesser extent in the propolis group. The study results demonstrated that almost half of the patients enrolled in the study suffered from severe OM. Severe OM was seen in 18 (45%) patients. In the propolis group, 8 of 19 (42%) patients had OM, while in the placebo group, the corresponding number was 10 of 21 (48%). Twenty-four episodes of severe OM were recorded—10 (42%) in the propolis group and 14 (58%) in the placebo group.
The authors do not recommend propolis in severe OM as a treatment plan. Because of the limitations in the study design, further clinical studies are needed to verify whether the use of propolis in OM treatment truly is not justified.
The study was limited to the pediatric population in one hospital. Therefore, there is a need to replicate it with a different study population and multiple settings to establish regular use and guidelines.
Togni, S., Maramaldi, G., Bonetta, A., Giacomelli, L., & Di Pierro, F. (2015). Clinical evaluation of safety and efficacy of Boswellia-based cream for prevention of adjuvant radiotherapy skin damage in mammary carcinoma: A randomized placebo controlled trial. European Review for Medical and Pharmacological Sciences, 19, 1338–1344. Retrieved from http://www.europeanreview.org/article/8795
To explore the anti-inflammatory and radiodermatitis prevention efficacy and safety of a Boswellia-based topical cream among patients with breast cancer
PHASE OF CARE: Active antitumor treatment
Significantly more visually intense erythema existed in the placebo group compared to the Boswellia group in general (p = 0.009) and when no concurrent chemotherapy was used (p = 0.018). However, no statistically significant difference existed when concurrent chemotherapy was used (p = 0.258). A highly significant decrease was observed in the use of supplemental steroid cream in the Boswellia group (25%) compared to the placebo group (63%, p < 0.0001). More participants in the Boswellia group had grade 1 RTOG scores, and more participants in the placebo cream group had grade 2 scores. However, the difference was not significance (p = 0.066). No significant differences in adverse effects existed between groups.
Further studies are needed to compare Boswellia serrata with other topical products among patients with breast cancer undergoing radiotherapy.
The process of randomization was not well described. The first two authors are employed by and fourth author is a consultant for a company that develops botanical pharmaceuticals. Patient use of both a topical steroid cream with Boswellia serrate cream may prohibit the full pharmacologic outcome of using just one topical cream.
Boswellia serrata may be useful in reducing breast radiodermatitis. However, additional larger and independent studies are needed.
Tofthagen, C., Boses, S., Healy, G., & Jooma, N. (2015). Evaluation of group acupuncture for cancer-related symptoms: A retrospective analysis. Journal of Palliative Medicine, 18, 878–880.
To evaluate the effects of group acupuncture on specific cancer-related symptoms in persons with cancer receiving outpatient treatment
Retrospective participants completed an assessment prior to the first study and following weekly treatments; received group acupuncture at a rate of up to eight patients an hour provided in a staggered fashion by one practitioner. Meridian diagnosis established the acupoint prescription based on patient symptom complaint. Instead of standardized treatments, many factors were considered to tailor individual acupuncture treatments for the patients symptoms.
Patients completed a pre-study and pre-treatment assessment for seven basic cancer-related symptoms (pain/numbness, dry mouth, headache, fatigue, sleep trouble, nausea, digestion) on a numeric rating scale (0–10).
Patients who completed four group acupuncture treatments reported significantly less pain/numbness and problems with digestion. There were no significant changes in any of the other symptoms (sleep, fatigue, dry mouth, headache, or nausea). Comparing baseline symptom data to week 3 revealed no significant improvement for any symptom.
This retrospective analysis pilot study of mostly patients with breast cancer with unknown treatment/medical history were evaluated over four weeks of acupuncture treatment, revealing significantly reduced reports of pain/numbness and digestive complaints after the fourth treatment. It could not be determined if this was clinically meaningful or a durable response.
Tofil, N.M., Benner, K.W., Faro, S.J., & Winkler, M.K. (2006). The use of enteral naloxone to treat opioid-induced constipation in a pediatric intensive care unit. Pediatric Critical Care Medicine, 7, 252–254.
To describe the effects of enteral naloxone for the treatment opioid-induced constipation.
Patients in the treatment group received opioids and enteral naloxone for suspected opioid-induced constipation. Patients in the control group received opioids and were randomly chosen from patients receiving opioids during the study period.
Pediatric intensive care unit of a children’s hospital in Alabama
This was a retrospective study conducted from January 2003 to February 2004.
Enteral naloxone may be effective for increasing stool output in opioid-induced constipation but carries risk of withdrawal symptoms. Additional study is needed.
To, J., Goldberg, A.S., Jones, J., Zhang, J., Lowe, J., Ezzat, S., . . . Sawka, A.M. (2014). A systematic review of randomized controlled trials for management of persistent post-treatment fatigue in thyroid cancer survivors. Thyroid, 25, 198–210.
PHASE OF CARE: Late effects and survivorship
Two studies examined use of T3 and T4. In one study comparing the combination of T3 and T4 to T4 alone, the fatigue subscale of the Profile of Mood states showed significant improvement at five weeks. One study using T4 compared to maintenance TSH suppression showed improvement in one subscale of the multidimensional fatigue scale at six months but no change in other fatigue subscales. Two references that reported on one study examined the impact of an exercise program.
There is insufficient evidence to demonstrate the impact of the administration of T3 or T4 on fatigue in patients who had thyroid cancer.
There was a small number of studies included, the number participants recruited in the identified studies was small, and some of these studies were of low quality.
There is insufficient evidence to evaluate any benefits of the administration of T3 or T4 for the management of fatigue among patients receiving TSH suppressive therapy
Timsit, J.F., Schwebel, C., Bouadma, L., Geffroy, A., Garrouste-Orgeas, M., Pease, S., . . . Dressing Study Group. (2009). Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: A randomized controlled trial. JAMA, 301, 1231–1241.
To assess chlorhexidine-impregnated sponge dressings for prevention of catheter-related infections
Patients were randomly assigned to one of four treatment groups. Groups were (a) standard dressing every three days, (b) chlorhexidine sponge dressing every three days, (c) standard dressing every seven days, and (d) chlorhexidine dressing every seven days. Insertion sites were the radial artery or subclavian vein whenever possible. Insertions were done with maximal barriers and antisepsis techniques. Semitransparent dressings were used for all. Povidone-idodine was used for skin antisepsis with each dressing change. Patients were followed for 48 hours after discharge from the ICU. A noninferiority analysis was planned with the identification of a 3% difference in catheter-related infection (CRI) rate as the comparison value. Only cultured catheters were considered to compare three- versus seven-day dressing intervals.
Use of chlorhexidine dressings overall were associated with a 0.6 CRI rate compared to 1.4 in the control groups per 1,000 catheter days (hazard ratio [HR] = 0.39, p = 0.03). Of those assigned to seven-day dressings, 50.6% had more frequent unplanned dressing changes. There was no significant difference in colonization rate between those having three- and seven-day dressing intervals. There was a slight but insignificant increase in skin colonization in the seven-day group at the time of catheter removal. Overall, the rate of central line–associated bloodstream infection (CLABSI) was lower (p = 0.005) with sponge dressings.
Use of chlorhexidine sponge dressing reduced the incidence of catheter-related bloodstream infections. Analysis by dressing change interval did not show any significant difference in outcomes.
Findings showed lower CLABSI rate and risk with use of chlorhexidine-impregnated sponge dressings. Findings also suggest no difference in infection outcomes related to catheters according to the frequency of dressing changes, although more than half of patients assigned to dressing changes every seven days needed changes more frequently for soiling or separation. Chlorhexidine-impregnated dressings can reduce CLABSI rate, and less frequent catheter dressing changes can be done with no apparent increase in infections.