Moreno, V.V., Vidal, J.B., Alemany, H.M., Salvia, A.S., Serentill, M.L., Montero, I.C., . . . Padró, J.G. (2006). Prevention of irinotecan associated diarrhea by intestinal alkalization. A pilot study in gastrointestinal cancer patients. Clinical and Translational Oncology, 8, 208–212.
Two grams of powdered NaHCO3 diluted in 250 ml water was sipped during the days of irinotecan administration, starting in the morning. Other fluids were taken ad lib.
Four of 24 patients (16%) had grade III–IV diarrhea (8 had prior pelvic radiation therapy, a risk factor associated with diarrhea). Comparison was made to incidence of grade II–IV diarrhea in previous colorectal cancer studies. The researchers’ conclusion was that intestinal alkalization may be effective in preventing diarrhea with patients with gastrointestinal cancer receiving irinotecan.
Morel, V., Joly, D., Villatte, C., Dubray, C., Durando, X., Daulhac, L., . . . Pickering, G. (2016). Memantine before mastectomy prevents post-surgery pain: A randomized, blinded clinical trial in surgical patients. PLOS One,11(4), e0152741.
To determine if pre- and postmastectomy treatment with memantine can prevent neuropathic pain, impaired cognition, and decreased quality of life (QOL)
Memantine 5–20 mg or placebo was given daily for four weeks starting two weeks prior to mastectomy, with increasing doses during the first two weeks prior to mastectomy and maintained at 20 mg during two weeks after surgery. The control received placebo daily for four weeks starting two weeks prior to mastectomy. Assessment was baseline, two weeks prior to surgery, two weeks after surgery, and three and six months postop.
A significant reduction in pain at three months postoperatively was noted (p = 0.017) and better ability to cope with pain was demonstrated (p = 0.032). No significant difference was noted at six months. Secondary outcomes for pain intensity showed no significant difference. A significant difference existed in use of antiepileptics for pain at M3 which was maintained up to M6 (M3, p = 0.04; M6, p = 0.04) with overall significant time difference (p = 0.041). Pain was significantly less for those receiving chemotherapy at M3 (p = 0.04) and M6 (p = 0.009). In addition, chemotherapy-induced paresthesias/dysesthsias was significantly reduced at M3 compared to the day of inclusion (p = 0.01). No significant difference was noted in cognitive function or QOL. No significant difference was noted in regards to LSEQ; however, significance was noted for behavior following wakefulness at M6 (p = 0.038).
Memantine can potentially reduce post-mastectomy and chemotherapy-induced nerve pain while limiting polypharmacy and comorbidity associated with the current treatment approach. This approach would need to be demonstrated in a larger population, with a longer term follow-up and potential dosing change.
Nurses would need to be educated on use of memantine for pain control and the potential side effects. Patient education would be required to help the patients understand the use of this medication for treatment of pain. Results of the effects of this approach may be limited.
Morean, D.F., O'Dwyer, L., & Cherney, L.R. (2015). Therapies for cognitive deficits associated with chemotherapy for breast cancer: A systematic review of objective outcomes. Archives of Physical Medicine and Rehabilitation, 96, 1880–1897.
PHASE OF CARE: Late effects and survivorship
Studies of pharmacologic interventions were not found to be effective in improving cognitive function. Medications reviewed included d-methylphenidate (n = 1), epoetin alfa (n = 2), and ginkgo biloba (n = 1). Evidence for nonpharmacologic interventions was mixed. No improvements in cognitive function were found with Tibetan sound meditation (n = 1). Natural restorative therapy (n = 1) improved attention only when comparing the baseline with the final 90-day evaluation (p = 0.01). Exercise (n = 1) improved attention (p = 0.019) and verbal memory (p = 0.048) but not working memory. Cognitive rehabilitation (n = 1) improved four out of six measures of information processing speed (p < 0.05) but not attention, verbal memory, or executive function. Cognitive behavioral training (n = 2) improved verbal memory (p < 0.05) in both studies and was effective in improving in information processing speed when compared to baseline scores in one study (p ≤ 0.01) but not the other. Computerized cognitive training was effective in one study in improving processing speed (p = 0.009), executive function (p = 0.008), and a measure of executive function and language (p = 0.003) but not verbal memory. However, in another study, there was no difference in verbal memory or information processing speed between the intervention and control groups.
Nonpharmacologic interventions, especially cognitive training, may have a role for improving attention, information processing speed, and verbal memory. Exercise and computerized cognitive training may be effective for improving executive function. However, additional research validating these findings with larger sample sizes and evaluating other cognitive domains is needed. In addition, studies determining the dose or duration of interventions is required for a durable response.
These findings suggest that nonpharmacologic, not pharmacologic, interventions may be helpful in managing chemotherapy-induced cognitive impairment in patients with breast cancer. However, these findings were based on a small number of studies per intervention. Additional research validating which interventions might be useful in improving cognitive impairments in women receiving chemotherapy for breast cancer is needed.
Morasso, G., Caruso, A., Belbusti, V., Carucci, T., Chiorri, C., Clavarezza, V., . . . Di Leo, S. (2015). Improving physicians' communication skills and reducing cancer patients' anxiety: A quasi-experimental study. Tumori, 101, 131–137.
To determine the effectiveness of a physician-centered communication skills training program on anxiety levels in patients with cancer. A three-phrase, multicenter, quasi-experimental study was used.
The intervention phase of the study invited physician participants in the treatment group to attend a skills program to improve communications knowledge and strategies. The intent of the communications training was to improve communication with patients with cancer and families. The training sessions, taught by psycho-oncologists, were held at each study center and were scheduled in three-hour sessions for three weeks to total nine hours of training. Each physician participant was emailed relevant scientific papers (two published, one unpublished) five days in advance of each three-hour session. The treatment group physician participants were asked to read the materials in preparation for sharing during the training. Each session included didactic, experiential learning, and group discussion including clinical cases and role play. There was no communications training for physician participants from the control group.
Multi-center, quasi-experimental, three-phase study. Of note, the phases of the study, as described, are not phases as used in North American scientific study. Rather, they are components of the methodology. Specifically, the authors describe phase 1 as recruitment, phase 2 as intervention, and phase 3 is evaluation.
Suggestion of effectiveness of a communication skills training program with reference to patient anxiety levels. Further research needed.
Implications were difficult to ascertain because the intervention was physician-based. The authors indicated a need to explore if nurse training in communication would be beneficial. Also discussed was the difference in communication styles between oncologists and oncology nurses and the effect on anxiety.
Moraska, A. R., Atherton, P. J., Szydlo, D. W., Barton, D. L., Stella, P. J., Rowland, K. M.,Jr, . . . Loprinzi, C. L. (2010). Gabapentin for the management of hot flashes in prostate cancer survivors: a longitudinal continuation Study-NCCTG Trial N00CB. The Journal of Supportive Oncology, 8(3), 128-132.
Examined efficacy and toxicity of gabapentin when taken for additional 8 weeks after previous study, where it was compared 3 different doses of gabapentin with placebo for treatment of hot flashes due to androgen deprivation therapy
Self completed report by participants
SITE: Mutli-site
PHASE OF CARE: Transition phase after initial treatment
APPLICATIONS: Late Effects & Survivorship; End of Life and Palliative Care
Observational, open label, and uncontrolled design continuation of randomized study
600 mg/d of gabapentin moderately decreased the hot flash score without substantial toxicities. All groups decreased hot flash scores and frequency at similar levels. Appetite loss and constipation were not increased. Troubled sleeping and nervousness scores were better in the placebo group.
Moraska, A. R., Sood, A., Dakhil, S. R., Sloan, J. A., Barton, D., Atherton, P. J., . . . Loprinzi, C. L. (2010). Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial. Journal of Clinical Oncology, 28, 3673–3679.
To evaluate the efficacy of long-acting methylphenidate in alleviating cancer-related fatigue (CRF), assess tolerability, and determine the effects on quality of life (QOL) in patients with CRF. Prior studies of methylphenidate have yielded mixed results. The drug used here was a mixture of d and l isomers of methylphenidate.
Patients were stratified according to disease stage, baseline fatigue scores, and whether they were receiving concomitant cancer treatment. They were then randomized to receive methylphenidate or placebo for four weeks. Patients took one tablet (18 mg of long-acting methylphenidate) on days 1 to 7, two tablets (36 mg) on days 8 to 14, and three tablets (54 mg) on days 15 to 28. Tablets were to be taken in the morning. A standard dose modification procedure was used in case of adverse effects attributed to the study drug.
The study was a double-blind, randomized, placebo-controlled trial.
In advanced stage disease (stage III–IV), mean improvement in fatigue was 19.7 with methylphenidate and 2.1 with placebo (p = 0.02) Early stage patients had less improvement with methylphenidate than those receiving placebo. Similar trends were seen in SF-36 measures; however, differences between groups were not statistically significant. Self-reported adverse events showed a significant increase in nervousness (p = 0.003) and appetite loss (p = 0.034) in the methylphenidate arm. Individuals in the placebo arm reported improvements in self-reported adverse effects in nervousness, shakiness, appetite loss, abdominal pain, and sex drive. Both study groups were similar in terms of gender distribution, age, disease stage, and other baseline measures.
The study demonstrated benefit for d-methylphenidate compared with placebo in alleviating CRF. Methylphenidate appeared to have some benefit in patients with advanced stage of disease.
There appeared to be some benefit of long-acting methylphenidate in patients with more advanced disease; however, these patients also experienced adverse effects. For use in these patients, benefits in terms of fatigue would need to be weighed against the adverse effects for individual patients from the patient's perspective.
The study findings suggest that further research on effectiveness, particularly in patients with more advanced disease, is warranted.
Moran, M., Browning, M., & Buckby, E. (2007). Nursing guidelines for managing infections in patients with chronic lymphocytic leukemia. Clinical Journal of Oncology Nursing, 11, 914–924.
Patients with chronic lymphocytic leukemia (CLL) were assessed.
No process development or search strategy were stated.
Information was provided by the authors in regards to current trends in CLL treatment and the risk of infection that is present with the most common current treatments, such as fludarabine, rituximab, alemtuzumab, and steroids. Specific bacterial and fungal infections that are most commonly associated with treatment were discussed as well as the prevention and management of these infections. A table was provided that had the most commonly occurring infections; chemotherapy treatment most commonly associated with each infection, prophylaxis, treatment options for the infection with duration and side effects; and nursing interventions. Discussion also was included on monoclonal antibodies and risk of opportunistic infection due to immune incompetency from these agents.
No conflicts of interest were identified.
Combinations of antibacterial, antiviral, and antifungal prophylactic medications may be appropriate in patients with CLL being treated with various chemotherapy regimens to prevent a life threatening infection from occurring and the type and duration is dependent on the agents they are receiving.
Moradian, S., Walshe, C., Shahidsales, S., Ghavam Nasiri, M.R., Pilling, M., & Molassiotis, A. (2014). Nevasic audio program for the prevention of chemotherapy induced nausea and vomiting: A feasibility study using a randomized controlled trial design. European Journal of Oncology Nursing, 19, 282–291.
Nevasic, a medical device, is an audio program that generates an antiemetic reaction. Nevasic is thought to work by emitting specific constructed tones, frequencies, and pulses that disrupt the normal auditory signal chain at the vestibular level, affecting the experience of nausea and vomiting.
This study was a pilot, multicenter, randomized, controlled trial with three parallel arms (intervention, attention, and control) in Mashhad, Iran. After randomization, all participants were given the treatment progression questionnaire. Those in the intervention and attention groups also were issued a CD player and headphones with the Nevasic program or music files. Patients could keep the equipment at the end of the study. The procedure for the intervention and attention groups were identical except that those in the Nevasic intervention group listened to the active intervention of Nevasic, and those in the attention group listened to preselected music. Participants were given clear instructions on the use of the Nevasic program or the music, which included: only listening through the headphones provided; listening to Nevasic or the music immediately once they started feeling nauseous or vomiting during or after chemotherapy administration; listening to the Nevasic or music program all the way through the 27 minutes or till they felt symptoms diminished; and not skipping any part of the Nevasic or music program. They were instructed to repeat these stages if their symptoms returned. The duration of the intervention or attention was six days. Participants in all three groups were told to take their antiemetics after chemotherapy as prescribed. The participants were instructed in the completion of the measures and follow-up questionnaire. They were asked to return the measures and questionnaires using prepaid, selfaddressed envelopes.
Pilot, multicenter, randomized, controlled trial with three parallel arms (intervention, attention, and control)
Based on these study results, Nevasic is not an effective treatment in the management of CINV. The researchers stated that the findings from the trial highlight the need for several modifications to the design and the mode of intervention delivery.
Based on these study results, Nevasic is not an effective nonpharmacologic treatment technique to control or manage CINV.
Moore, D.H., Donnelly, J., McGuire, W.P., Almadrones, L., Cella, D.F., Herzog, T.J., & Waggoner, S.E. (2003). Limited access trial using amifostine for protection against cisplatin and three hour paclitaxel-induced neurotoxicity: A phase II study of the Gynecologic Oncology Group. Journal of Clinical Oncology, 21(22), 4207–4213.
To determine the proportion of women who experience significant treatment-induced peripheral neuropathy
Women with gynecologic cancer received combination chemotherapy consisting of cisplatin and paclitaxel via IV 175 mg/m2 over three hours, followed by amifostine 740 mg/m2 and cisplatin 75 mg/m2 administered over 90 minutes beginning 15 minutes after amifostine administration.
Four of 27 assessable patients experienced dose-limiting toxicity grade 2 or higher CIPN as measured by clinical assessment and NCI CTCAE grading. The number of neuropathic events exceeded the predetermined threshold level for a second stage of accrual and the study was closed.
Amifostine’s level of activity was insufficient to warrant further study in a phase III trial.
Moore, D., Donnelly, J., McGuire, W.P., Almadrones, L., Cella, D.F., Herzog, T.J., & Waggoner, S.E. (2003). Limited access trial using amifostine for protection against cisplatin and three hour paclitaxel-induced neurotoxicity: A phase II study of the Gynecologic Oncology Group. Journal of Clinical Oncology, 21, 4207–4213.
The researchers' aim was to determine the proportion of women who experience significant treatment-induced peripheral neuropathy.
Women with gynecologic cancer received combination chemotherapy consisting of cisplatin and paclitaxel via IV 175 mg/m2 over three hours followed by amifostine 740 mg/m2 and cisplatin 75 mg/m2 administered over 90 minutes beginning 15 minutes after amifostine administration.
Twenty-nine women enrolled in the limited-access study and 21 completed all six cycles of therapy plus the three-month evaluations. The eligibility criteria for this phase II study included having ovarian cancer and primary peritoneal, fallopian tube, endometrial, cervical, or uterine sarcoma. Exclusion criteria include prior chemotherapy or radiation therapy and having a history of neuropathy.
Measures were conducted at baseline, before each chemotherapy cycle, and three months after completion of treatment. Chemotherapy-induced peripheral neuropathy (CIPN) was measured using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE) toxicity scale, the neurotoxicity subscale of the Functional Assessment of Cancer Therapy–Gynecologic Oncology Group (FACT-GOG), and vibration perception threshold (VPT) was tested using the Vibratron II device.
Four of the 27 assessable patients experienced dose-limiting toxicity (greater than grade 2 CIPN) as measured by clinical assessment and the NCI-CTCAE. The number of neuropathic events exceeded the predetermined threshold level for a second stage of accrual and the study was closed. The level of activity for amifostine was insufficient to warrant additional study in a phase III trial.
The study contained a relatively small sample size (29 participants) and used a one-group design. Frequent evaluations of CIPN were performed by different professionals, but a detection bias may have been present. Although VPT testing is considered to be the gold standard, it can be inaccurate if the same digits are not used at each assessment. Low interobserver agreement (46%) was found using the NCI-CTCAE.