Ost, D.E., Ernst, A., Grosu, H.B., Lei, X., Diaz-Mendoza, J., Slade, M., . . . AQuIRE Bronchoscopy Registry. (2015). Therapeutic bronchoscopy for malignant central airway obstruction: Success rates and impact on dyspnea and quality of life. Chest, 147, 1282–1298.
To measure the technical success of therapeutic bronchoscopy and its impact in improving dyspnea and quality of life among patients with malignant central airway obstruction
Data from the AQuIRE (American College of Chest Physicians Quality Improvement Registry) for 1,115 procedures on 947 patients undergoing therapeutic bronchoscopy from January 2009–February 2013 were used for this study. Primary outcome data were defined as greater than a 50% opening of airway lumen. A smaller subset (N = 187) of centers collected pre- and postprocedure (30 days) secondary outcome data looking at dyspnea improvement after bronchoscopy as measured via Borg scores and health-related quality of life (HRQOL) measured via the SF-6D.
The use of therapeutic bronchoscopy for the treatment of malignant central airway obstruction had a high technical success rate. More importantly, patients showed significant improvement in their subjective rating of dyspnea and in HRQOL. Having clinical outcome data assists in the process of weighing potential risks versus benefits of this procedure. Given that some of the patients with the worst dyspnea at baseline ultimately had the greatest benefit, these patients should be considered for therapeutic bronchoscopy and not assumed to be too sick to benefit.
To educate and advocate for patients undergoing therapeutic bronchoscopies, nurses must be knowledgeable about the different types, purpose, indications, and potential risks and benefits of each. The technical success of the procedure is not sufficient enough in measuring the overall benefit to the patient; quality of life and palliation of dyspnea outcomes must also be considered.
Ostuzzi, G., Benda, L., Costa, E., & Barbui, C. (2015). Efficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: Systematic review and meta-analysis. Cancer Treatment Reviews, 41, 714–724.
Antidepressants were effective in reducing distressing symptoms (SMD = -0.229, p = 0.018) and major depression or depressive symptoms (SMD = -0.285, p = 0.001). All types of antidepressants showed some efficacy, although tricyclic antidepressants did not show efficacy across two small studies. SSRIs and manserin were effective. Quality of life measures were also improved. There was significant heterogeneity. Analysis showed significant efficacy was correlated with length of follow up (p < 0.001). Antidepressants did not differ from placebo in terms of acceptability, using drop-out rate as a proxy of acceptability.
Antidepressants of all types demonstrated overall efficacy for improvement in depressive symptoms as well as other distressing symptoms. SSRIs and manserin showed the best results
Overall quality of reports was graded as low to moderate. Several studies included funding by drug companies, suggesting sponsorship bias as the funder role was not described. There was significant heterogeneity
Findings from this analysis show that antidepressants, particularly SSRIs and manserin, were tolerable and effective in reducing depressive symptoms in patients with cancer. Findings also suggest that efficacy may increase over time, pointing to the potential need for sufficient duration of treatment. It is important that nurses screen for symptoms of depression among patients with cancer, and facilitate relevant treatment.
Ostuzzi, G., Matcham, F., Dauchy, S., Barbui, C., & Hotopf, M. (2015). Antidepressants for the treatment of depression in people with cancer. Cochrane Database of Systematic Reviews, 6, CD011006.
STUDY PURPOSE: Assess effects of antidepressants among people with cancer for treatment of depression
There was no differences between antidepressants as a class and placebo in five RCTs, no difference between groups comparing different antidepressants, and no difference in drop-out rates between placebo and antidepressants
The findings did not provide strong evidence for efficacy of antidepressants.
Study quality was generally low with unclear risk of bias in multiple aspects of the study design and implementation. In five studies, risk of bias due to conflict of interest was questionable. There was no difference found between SSRIs and tricyclic antidepressants. Studies included were all conducted prior to 2009.
This particular analysis did not demonstrate efficacy of antidepressants in patients with cancer for management of depressive symptoms. There were multiple limitations in this analysis due to the low quality of the studies included.
Osterlund, P., Ruotsalainen, T., Korpela, R., Saxelin, M., Ollus, A., Valta, P., … Joensuu, H. (2007). Lactobacillus supplementation for diarrhoea related to chemotherapy of colorectal cancer: A randomised study. British Journal of Cancer, 97(8), 1028–1034.
To assess the effect of Lactobacillus and fiber supplementation on tolerability of treatment with chemotherapy containing 5-fluorouracil (5-FU) and to compare the tolerability and frequency of diarrhea with the Mayo regimen (bolus 5-FU) to that of the simplified de Gramont regiment (bolus plus continuous 5-FU)
Postoperative colorectal cancer (CRC) patients were randomly assigned to receive adjuvant chemotherapy monthly (Mayo regimen) or twice monthly (simplified de Gramont regimen) for 24 weeks. Further randomization determined whether patients received the probiotic Lactobacillus rhamnosus GG gelatin capsules twice daily and daily fiber on cycle days 7–14 for 8 days per month during the 24 weeks of chemotherapy. All patients received dietary counseling and kept nutrition diaries. Treatment-related adverse effects were assessed at every cycle.
The study was conducted at a single-site, outpatient setting in Finland.
All patients were undergoing the active treatment phase of care.
This was a prospective, randomized trial.
The National Cancer Institute of Canada Common Toxicity Criteria, version 2, was used.
The frequency of grade 3 or 4 diarrhea and the frequency of abdominal discomfort may be decreased with the use of Lactobacillus rhamnosus supplementation for patients receiving 5-FU-based chemotherapy.
The administration of Lactobacilus rhamnosus GG may decrease the frequency and severity of diarrhea and abdominal discomfort with 5-FU-based chemotherapy. Further placebo-controlled, blinded studies are needed.
Oshima, K., Takahashi, T., Mori, T., Matsuyama, T., Usuki, K., Asano-Mori, Y., . . . Kanda, Y. (2010). One-year low-dose valacyclovir as prophylaxis for varicella zoster virus disease after allogeneic hematopoietic stem cell transplantation. A prospective study of the Japan Hematology and Oncology Clinical Study Group. Transplant Infectious Disease, 12, 421–427.
To determine the cumulative incidence of varicella-zoster virus (VZV) two years after transplant.
Following allogeneic hematopoietic stem cell transplant (HSCT), patients received low-dose valacyclovir (VCV) for prophylaxis against VZV. Up to day 35, patients received oral acyclovir (ACV) 1,000 mg/day, and then from days 36 to 365, they received oral VCV 500 mg/day three days a week. Patients were monitored for VZV for two years after HSCT.
This was a prospective, nonrandomized study.
Breakthrough VZV occurred in two patients while receiving VCV. After stopping VCV prophylaxis, an additional five patients developed VZV disease. These seven patients had a favorable response to oral or intravenous VCV given at therapeutic doses. Univariate analysis revealed no factors that significantly associated patients with incidence of VZV.
For patients undergoing allogeneic HSCT, one year of low-dose VCV is safe and effective for preventing VZV.
Small sample size
Patients undergoing allogeneic HSCT may benefit from the safe use of low-dose prophylactic VCV (500 mg/day three times a week) for VZV in the posttransplant setting.
Osborn, R.L., Demoncada, A.C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. International Journal of Psychiatry in Medicine, 36, 13–34.
To investigate the effects of cognitive behavioral therapy (CBT) and patient education on depression, anxiety, pain, physical functioning, and quality of life (QOL) in adult cancer survivors
The study involved searching MEDLINE, PsycINFO, and the Cochrane Database for the period 1993–2004.
The literature evaluated included 15 randomized controlled trials (RCTs), five of which measured depression and all of which had been published 1993–2004. Authors assessed quality of the RCTs by means of the Jadad scale.
The sample size was 1,492.
CBT is related to short-term effects on depression; individual interventions were more effective than group interventions. Neither CBT nor patient education produced significant long-term effects on depression.
Osborn, R.L., Demoncada, A.C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analysis. International Journal of Psychiatry in Medicine, 36, 13–34.
To investigate the effects of cognitive behavioral therapy (CBT) and patient education (PE) on anxiety in adult cancer survivors
Databases searched were MEDLINE, PsycINFO, and the Cochrane Database (1993–2004).
Search keywords were cancer, anxiety, depression, quality of life (QOL), fatigue, stress, pain, physical function, social, self-management, evidence-based, interventions, and random/randomized.
Studies were included in the review if they
Studies were excluded if they were not randomized or controlled, had a score of less than four on checklist, did not report follow-up data, or did not report data on targeted outcomes.
Dissertations were excluded.
CBT is effective for short-term management (less than 8 months) of anxiety. Individually based interventions were more effective than those delivered in a group format. Various CBT approaches provided in an individual format can assist cancer survivors in reducing the emotional distress of anxiety.
Oren, I., Rowe, J. M., Sprecher, H., Tamir, A., Benyamini, N., Akria, L., . . . Dann, E. J. (2006). A prospective randomized trial of itraconazole vs fluconazole for the prevention of fungal infections in patients with acute leukemia and hematopoietic stem cell transplant recipients. Bone Marrow Transplantation, 38, 127–134.
To determine whether itraconazole is superior to fluconazole in the prevention of invasive fungal infections, particularly invasive aspergillosis, in hematopoietic stem cell transplant (HSCT) recipients and patients with acute leukemia (AL).
Patients were stratified to either high or low risk based on type of therapy or disease. High risk included patients undergoing allogeneic HSCT or patients with relapsed/resistant AL. Low risk included patients undergoing autologous HSCT or newly diagnosed patients with AL receiving induction. Patients were then randomized to receive either itraconazole or fluconazole prophylaxis in each risk stratum, using a random number generator, in blocks of four. Intravenous (IV) preparations were used only if the patient could not tolerate oral medications and was switched back to oral as soon as the patient tolerated oral medications. Antifungal prophylaxis was continued until the resolution of neutropenia, for a maximum of eight weeks. Antibacterial prophylaxis was not administered. Fluconazole was given in a dose of 400 mg once daily, and itraconazole was given at 200 mg twice daily.
Patients were undergoing the active treatment phase of care.
This was a randomized trial comparing oral and IV itraconazole with oral and IV fluconazole.
Toxicity was graded from 0 to 4 according to the National Cancer Institute Common Toxicity Criteria.
Itraconazole was not found to be more effective than fluconazole in preventing invasive fungal infections (IFIs) in neutropenic patients after chemotherapy for AL or after HSCT. Both drugs were successful in preventing invasive candidal infections. Invasive aspergillosis (IA) was not as decreased in the itraconazole arm as expected, although the mortality from IA was lower in the itraconazole arm.
Fungal prophylaxis is important in patients with AL and those undergoing HSCT. Both itraconazole and fluconazole seem to be effective in preventing IFIs and IA, but neither appeared to be superior to the other in this study. Itraconazole seems to be less well tolerated in the oral form due to gastrointestinal side effects, although none were significant. Neither drug completely prevented IA, which causes significant morbidity and mortality; therefore, more research is needed for drugs that have better prophylaxis against IA.
This was a nonblinded study leading to bias in the assessment of efficacy and adverse events, as well as the evaluation of response and causes for adverse events. There was a lack of itraconazole blood measurement. Antifungal prophylaxis was only used during the early period at risk (during the neutropenic period), the high-risk patients, especially, are at risk for significantly more time than just the neutropenic period. Antifungal prophylaxis should be continued for an extended period after engraftment, especially in patients undergoing allogeneic HSCT. This information is useful for most hematologic malignancy but may not be generalizable for patients with solid tumors.
Education related to antifungal prophylaxis and the necessity of taking these medications is important. Nurses can educate about the expected side effects, especially the GI side effects of itraconazole when given orally.
Oremus, M., Dayes, I., Walker, K., & Raina, P. (2012). Systematic review: Conservative treatments for secondary lymphedema. BMC Cancer, 12, 6.
STUDY PURPOSE: To examine the effectiveness of conservative treatments for lymphedema
TYPE OF STUDY: Systematic review
DATABASES USED: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and CINAHL 1990–January 2010
KEYWORDS: Search terms provided in online file
INCLUSION CRITERIA: RCT or observational study with comparison group, pediatric and adult patients with secondary lymphedema for any reason except filariasis infection
EXCLUSION CRITERIA: Pharmacologic or surgical treatment for lymphedema
TOTAL REFERENCES RETRIEVED: 6,814 articles were evaluated.
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale used for RCTs; Newcastle-Ottawa Scale used for observational studies
PHASE OF CARE: Not provided
Six RCTs involving intermittent pneumatic compression (IPC) were used. Two showed IPC had benefit over CDT or self-massage, and three did not show IPC to be any better than massage, skin care, or elastic sleeve; one compared different IPC devices. Six RCTs using massage-based treatments were used, and five showed no benefit. Four studies of low-level laser were used. Three showed low-level laser was superior to exercise, sham laser, or usual care, and one shows that low-level laser was better than sham laser at some time points in the study. Dieting yielded conflicting findings. Equivocal results were seen for ultrasound, modified manual lymph drainage, and compression stockings.
This review provides limited evidence of effects of conservative treatments for lymphedema, and no conclusions about the most effective conservative approach are possible from this review.
Most studies had “fair” quality. Follow-up time frames in studies varied considerably. The majority of studies were among breast cancer patients only. It is surprising that this review did not include any studies involving CDT.
Findings from this review showed that most interventions reduced limb volume and were not associated with any significant patient harms. Dieting alone does not appear to be particularly effective for limb volume reduction. Patients may benefit from a variety of conservative approaches to manage lymphedema. Ongoing research is needed to determine comparative effects of various approaches.