Tassinari, D., Sartori, S., Tamburini, E., Scarpi, E., Raffaeli, W., Tombesi, P., & Maltoni, M. (2008). Adverse effects of transdermal opiates treating moderate–severe cancer pain in comparison to long-acting morphine: A meta-analysis and systematic review of the literature. Journal of Palliative Medicine, 11(3), 492–501.
To compare the safety profiles, adverse effects, and patients' preferences regarding slow-release oral morphine and transdermal opiates
Compared to slow-release oral morphine, transdermal opiates were associated with fewer cases of constipation. Patients tended to prefer transdermal opiates to slow-release formulations.
Compared to slow-release oral morphine, transdermal opiates appear to be associated with fewer cases of constipation; transdermal opiates may be a better alternative for pain control in patients with constipation. This review suggests that patients may prefer pain medication via the transdermal route. Clinicians should consider constipation and preference in individualizing pain management.
Tassinari, D., Sartori, S., Tamburini, E., Scarpi, E., Tombesi, P., Santelmo, C., & Maltoni, M. (2009). Transdermal fentanyl as a front-line approach to moderate-severe pain: A meta-analysis of randomized clinical trials. Journal of Palliative Care, 25, 172–180.
To compare transdermal fentanyl to slow-release oral morphine—in terms of safety, efficacy, and patient compliance—in patients who have stable opiate requirements for pain control
Of the 117 trials retrieved, 11 were considered potentially eligible. The analysis included five trials. Three trials included patients with cancer, and two included patients without cancer. The quality of the reports was evaluated using the Jadad scale.
Side-effect profiles of transdermal fentanyl and oral slow-release morphine differ, but in this analysis authors observed no significant differences in overall side effects and patient preference regarding the two approaches. Transdermal fentanyl appears to be a valid alternative to oral opiates.
Findings should be interpreted with caution, given the limitations of this meta-analysis. Additional research comparing transdermal and other medication delivery routes for pain control is warranted. Transdermal opiates may be particularly useful for patients using opiate switching. Addressing individual patients' needs and concerns may mean that side-effect profiles play an important role in the selection of a medication delivery route.
Taspinar, A., & Sirin, A. (2010). Effect of acupressure on chemotherapy-induced nausea and vomiting in gynecologic cancer patients in Turkey. European Journal of Oncology Nursing, 14, 49–54.
To evaluate the effect of a wristband acupressure for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with gynecologic cancers
Patients completed diaries daily for five days while they were receiving chemotherapy. Based on their treatment protocol, patients received a wristband 21 to 28 days later, along with written and verbal instructions and demonstration on its use. Patients were instructed to wear the wristbands constantly and to complete the patient diaries for the five days while receiving chemotherapy. On the sixth day, patients completed questionnaires about the wristbands. All patients received standard antiemetics and recorded medication use in their diaries.
The study was conducted at multiple outpatient sites in Turkey.
All patients were in active treatment.
This was a prospective clinical trial with a pre/post-test design.
Acupressure wristbands worn by patients with gynecologic cancers during chemotherapy administration were associated with a significant reduction in nausea but not vomiting or retching. Less antiemetic medication was used with the acupressure wristband.
Acupressure wristbands may provide some relief of nausea during chemotherapy treatment; however, they do not appear to provide relief from retching or vomiting.
Taso, C.J., Lin, H.S., Lin, W.L., Chen, S.M., Huang, W.T., & Chen, S.W. (2014). The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: A randomized controlled trial. The Journal of Nursing Research, 22, 155–164.
To examine the effectiveness of an eight-week yoga program on depression, anxiety, and fatigue in women undergoing adjuvant chemotherapy for breast cancer
Patients were randomized to yoga and control groups. Control group patients received usual care and maintained ordinary daily activity routines. The yoga group had 60-minute sessions including meditation and breathing exercise, yoga exercises, and a cool-down. The program was provided twice per week over eight weeks. Study measures were obtained at baseline, at week 4, at week 8, and at four weeks after the conclusion of the intervention. It is not clear if yoga sessions were provided in a group setting or what the timing was related to chemotherapy treatments.
Randomized, controlled trial
Fatigue level and its influence on daily life were lower in the experimental group after eight weeks, which was maintained at three weeks postintervention (p < .001). In the control group, the fatigue level increased after eight weeks (p < .001). In the control group, the influence of fatigue on daily life initially declined but increased from baseline after eight weeks. In those participants with higher baseline fatigue levels, in the first four weeks, benefits were fewer in the experimental group. There were no differences between groups in anxiety or depression. Participation in the yoga sessions was 90% overall.
Yoga participation was associated with improvement in fatigue and the influence of fatigue on daily activities after four weeks. Yoga had no effect on measures of anxiety or depression.
Yoga can be beneficial for patients to reduce fatigue during active treatment as shown in this study. Findings that those with higher fatigue scores did not show fatigue reduction until after four weeks suggest that patients with greater fatigue may need a longer program than others to derive full benefits. There was no apparent effect of participation in yoga sessions on anxiety or depression.
Tasmacioglu, B., Aydinli, I., Keskinbora, K., Pekel, A.F., Salihoglu, T., & Sonsuz, A. (2009). Effect of intravenous administration of paracetamol on morphine consumption in cancer pain control. Supportive Care in Cancer, 17, 1475–1481.
To examine the effectiveness of IV administration of paracetamol on the control of cancer pain and its possible contribution as reduction of opioid consumption
Patients were randomized to receive IV administration of saline (control) or 1 g of paracetamol on top of morphine.
The study was double-blind, placebo-controlled, and randomized.
Both treatments resulted in improved VAS and PRI scores compared to baseline. However, groups did not differ in terms of VAS and PRI scores, morphine consumption, side-effect frequencies, laboratory values, ECOG stats, and patient satisfaction. The study failed to confirm any benefits of add-on treatment with IV administration of paracetamol.
There was no benefit derived from adding IV paracetamol to morphine in an effort to enhance the effectiveness or contribute to reduction in opioid consumptions.
The study had a small sample.
This study further supports the growing body of evidence that adding paracetamol to an opioid does not necessarily improve pain control or minimize the need for opioid. Pain management needs to be individualized. Further study in this area is warranted.
Tas, D., Uncu, D., Sendur, M.A., Koca, N., & Zengin, N. (2014). Acupuncture as a complementary treatment for cancer patients receiving chemotherapy. Asian Pacific Journal of Cancer Prevention, 15, 3139–3144.
To investigate the effects of acupuncture on nausea, vomiting, pain, sleep quality, and anxiety in patients who were hospitalized or undergoing chemotherapy
Acupuncture was given for three days. On the day of hospitalization and after three days, study assessments were completed. Chemotherapy-induced nausea and vomiting (CINV) was not measured in patients receiving chemotherapy for the first time.
The sign test was used to show the pre- and post-treatment significance of differences, and these were shown for all symptoms (p < 0.001). However, the pretreatment score for insomnia was equal to one before and after treatment, and a larger proportion of patients did not improve (57.8%) than improved (42.2%) in terms of sleep quality. In other symptoms, the percentage that improved was similar to the percentage that did not improve. The intervention group appeared to have the greatest number of patients whose nausea improved.
Acupuncture may be a useful adjunctive therapy for the management of pain, CINV, anxiety, and insomnia in hospitalized patients receiving chemotherapy. The design of this study limits the strength of its findings.
Acupuncture is a complementary therapy that may be beneficial as an adjunct treatment for symptom management in patients with cancer. This individual study has multiple limitations, and additional evidence is needed to evaluate the effectiveness of acupuncture.
Tarumi, Y., Wilson, M.P., Szafran, O., & Spooner, G.R. (2013). Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. Journal of Pain and Symptom Management, 45(1), 2–13.
To determine the efficacy of docusate in patients in hospice
Patients were randomly assigned via a code generated by a public domain computer. Randomization was assigned by a pharmacist, and the research assistant, patient, proxy, attending physician, and nurses were blinded to study treatment. The intervention group received two 100 mg docusate tablets in the morning and late afternoon plus one to three sennoside tablets (8.6 mg per tablet) one to three times per day. The placebo group received two cornstarch tablets in the morning and afternoon in addition to one to three sennoside tablets (8.6 mg per tablet) one to three times per day. All medications were administered by hospice nursing staff for a period of 10 days. Docusate pills were rolled in cornstarch and placed into nontransparent blue capsules, and the placebo pills were only cornstarch in blue capsules so that both the intervention and placebo pills looked the same. All patients were allowed to take laxatives and receive other bowel interventions as needed throughout the study. Nurses received multiple education sessions on stool consistency and volume to ensure inter-rater reliability. Nurses recorded data daily for 10 days.
Randomized, double-blind, placebo-controlled study
The results revealed no significant difference in stool frequency, volume, or consistency between the two groups. Data showed no significant differences in patients’ perception of the difficulty or completeness of defecation. ESAS scores showed no difference in symptoms experienced between the two groups. No difference was seen in the number of additional bowel-care interventions provided to patients in this study.
There were no significant differences between the docusate group and the placebo group, suggesting that the use of docusate should be considered on a patient-by-patient basis.
Nurses must assess patient needs versus what is actually happening. Frequent abdominal inspections should be made with or without the use of docusate. Other things that should be assessed include bowel sounds and pattern of bowel function as well as the color, consistency, and amount of stool produced without regard to docusate use.
Tarhini, A. (2013). Immune-mediated adverse events associated with ipilimumab CTLA-4 blockade therapy: The underlying mechanisms and clinical management. Scientifica, 2013, 857519.
RESOURCE TYPE: Expert opinion
PHASE OF CARE: Active antitumor treatment
N/A
Expert opinion level evidence only
Patients receiving immunotherapy need to be monitored for immune-related adverse events, and quickly managed appropriately to prevent more severe complications. In addition, nurses should be aware of potential side effects of systemic steroid therapy if initiated.
Targ, E.F., & Levine, E.G. (2002). The efficacy of a mind–body–spirit group for women with breast cancer: A randomized controlled trial. General Hospital Psychiatry, 24, 238–248.
The study compared a complementary and alternative medicine (CAM) group intervention to a standard psychosocial support group.
The 12-week standard psychosocial support group meeting was offered weekly. A trained clinical psychologist taught cognitive behavioral therapy using group sharing and supportive therapies. Topics included coping with real-life issues, communication, body image, sexuality, grief, anger, anxiety management, and problem solving.
The 12-week CAM group meeting was offered twice a week. This group was taught meditation, affirmation, imagery, and ritual. Each session was two and one-half hours. The Tuesday session was a one-hour, RN-run, health-series discussion group, with topics including nutrition, exercise, menopause, lymphedema, pain management, sexuality, and others as requested by the group. The next 90 minutes were spent in six yoga classes and six dance therapy sessions. The Thursday session was one hour of experiential work using silent meditation, guided imagery, and writing and drawing exercises. The final 90 minutes was devoted to a discussion group led by a licensed clinical social worker exploring themes of experiential work as well as general support by the group. Topics included relationship with cancer, views of healing, sexuality, body image, death and dying, compassion, anger, forgiveness, and healing.
A randomized controlled trial design was used.
Taradaj, J., Halski, T., Rosinczuk, J., Dymarek, R., Laurowski, A., & Smykla, A. (2015). The influence of kinesiology taping on the volume of lymphoedema and manual dexterity of the upper limb in women after breast cancer treatment. European Journal of Cancer Care. Advance online publication.
To evaluate the effects of Kinesiology® taping (KT) on upper extremity lymphedema and manual dexterity
Patients were randomized to one of three groups, (1) KT, pneumatic compression, and manual lymphatic drainage (MLD), (2) quasi-KT, pneumatic compression, and MLD, or (3) standard pneumatic compression, MLD, and multilayered bandaging. The groups received treatment once per day, three times per week, for four weeks. The same provider administered all sessions of MLD. KT was worn for four days.
Randomized, placebo-controlled, single-blinded study
A statistically significant decrease in limb volume occurred in comparison to initial size in all comparison groups (p < 0.001). However, a significant advantage was seen in group 3 treated with standard pneumatic compression, MLD, and multilayered bandaging. Shoulder range of motion was initially similar and statistically significance in all groups.
More research on when KT may be effective is needed. KT was not shown to be an effective intervention to reduce limb volume in patients with breast cancer.
KT is effective in increasing joint mobility, but it should not be used as a replacement for standard multilayered bandaging in the treatment of lymphedema. This study's participants had more extensive surgery than standard of care in the United States. Additional research to identify application with less swelling is needed.