Katz, M.R., Irish, J.C., & Devins, G.M. (2004). Development and pilot testing of a psychoeducational intervention for oral cancer patients. Psycho-Oncology, 13, 642–653.
The intervention involved a 95-page teaching booklet, What to Expect From Your Oral Cancer Surgery: A Guide for Patients and Families. The booklet included information about oral cancer, treatments, and effective coping strategies. Contents were divided into preparing for surgery, postoperative care, and returning home.
In the intervention group, the booklet was given to patients pre- and postoperatively by a nurse experienced in caring for patients with head and neck cancers. The preop session was 60–90 minutes of individual teaching before admission to the hospital for surgery. The predischarge session was 60–90 minutes of individual teaching several days prior to expected discharge from the hospital.
In the control group, patients received standard level of care, which included a preop meeting with the surgeon for consent to treatment as well as a brief description of the illness and treatment. Also included in the preadmission information was a tour of the ward and a team visit from the physician, dietitian, social worker, speech therapist, and enterostomal nurse. No information about coping or emotional difficulties was provided routinely. Measurements were taken at baseline, predischarge, and three months follow-up.
A randomized controlled trial design was used.
The authors reported significant improvement in anxiety scores within the intervention group from time 1 to time 3 (t = 2.88, df = 9, p = 0.018).
Katranci, N., Ovayolu, N., Ovayolu, O., & Sevinc, A. (2012). Evaluation of the effect of cryotherapy in preventing oral mucositis associated with chemotherapy: A randomized controlled trial. European Journal of Oncology Nursing, 16, 339–344.
To assess the effect of oral cryotherapy on development of oral mucositis associated with infusion of fluorouracil (5-FU) with leucovorin
Patients were randomized to cryotherapy or usual care. Prior to randomization, patients completed a study questionnaire, and 60 patients, who had similar characteristics, were selected for randomization. Ice chips were given to patients in the treatment group 5 minutes before and throughout treatment for a total of 30 minutes of continuous use. Mucositis assessment was done on days 7,14, and 21 after chemotherapy.
This was a single-site study conducted in an outpatient setting in Turkey.
Patients were undergoing the active antitumor treatment phase of care.
This was a randomized controlled trial (RCT).
The World Health Organization (WHO) mucositis grading scale was used to assess mucositis severity.
On days 7 and 14, more patients in the experimental group did not have mucositis (p < 0.05). On day 21, patients in the experimental group tended to have lower-grade or grade 0 mucositis, but the difference was not significant.
Findings demonstrated a short-term benefit of cryotherapy in patients receiving 5-FU.
Findings suggest that short-term cryotherapy may be beneficial for patients receiving bolus 5-FU; however, longer-term effectiveness may not be seen.
Kastler, A., Alnassan, H., Pereira, P.L., Alemann, G., Barbe, D.A., Aubry, S., . . . Kastler, B. (2013). Analgesic effects of microwave ablation of bone and soft tissue tumors under local anesthesia. Pain Medicine, 14, 1873–1881.
To evaluate the probability and usefulness of ablation on pain when performed via local anesthesia
Lesions targeted included spinal, sacral, and extraspinal. A visual analog scale was used to evaluate pain from 0–10 pre- and post-procedure, after one week, at 3 months, at 6 months, and at 12 months. Only three patients had data at 12 months.
The mean ablation time was 4.09 minutes, with an average of 4.2 cycles and mean ablation power of 60 W. Pre-procedure pain score was 7.2 (SD = 0.97). Post-procedure, mean visual analog scale scores were 1.64 on day 0, 1.82 on day 7, and 2.05 by the end of one month. At three months, the mean pain score was 2.13, and at six months, it was 2.36. One patient had no pain relief by one month, and follow-up was discontinued. One patient had a soft tissue abscess at the ablation site, which was drained. No other major or minor complications were found.
Microwave ablation of bone lesions may have some promise for relief of bone pain in patients with cancer.
This study suggests that microwave ablation of painful bone lesions may be feasible and may substantially reduce bone pain. This was an extremely small sample. Further well-designed studies are warranted.
Kasseroller, R.G., & Brenner, E. (2010). A prospective randomised study of alginate-drenched low stretch bandages as an alternative to conventional lymphologic compression bandaging. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 18(3), 343–350.
To determine whether a difference exists between conventional and alginate bandaging in regard to lower-volume increase or re-filling of the lymphedema when the bandages are applied in periods with reduced decongestive therapy.
The study included an A group and a B group who received 22 days of treatment with manual lymphatic drainage (MLD) including three inpatient weekends. On inpatient weekends low-stretch compression dressing and alginate semi-rigid bandaging were compared. Patients using low-stretch compression dressings (Group A) had bandages applied Friday evening after MLD and then again on Saturday and Sunday after receiving intermittent pneumatic compression (IPC); patients were instructed to not remove bandaging during sleep. Group B used alginate semi-rigid bandages and also were bandaged after MLD on Friday. Patients were instructed to not remove this bandage for the entire weekend. IPC took place in this group with the bandage remaining in place. Volumes were measured prior to bandaging on Friday and then again on Monday prior to MLD.
The study used a randomized controlled trial design.
There was a statistical difference between the two groups in terms of volume depletion on days 1–5 (p = 0.010). Days 5–8 had a significantly smaller difference (p = 0.001) and days 8-12 was insignificant. Days 12–15 had a significant statistical difference (p=0.001), days 15–19 not significant, and days 19–22 significant (p = 0.003). All significance was in favor of Group B, although the overall statistics were not significant. In terms of tolerance, Group B using the alginate semi-rigid bandage had a statistically significant difference in comfort on the second (p = 0.0004) and third (p = 0.024) weekends.
Although there was no significant difference in volume depletion for women from Group A to Group B, there was a statistically significant difference in the overall comfort of patients in Group B with the semi-rigid bandaging, which can directly impact the women’s quality of life during treatment for lymphedema.
The sample size was small (N < 100).
Some positive changes in women with lympedema rely solely on patient education and compliance with exercise. Patient education and physical therapy must be included in after surgery.
Kashiwazaki, H., Matsushita, T., Sugita, J., Shigematsu, A., Kasashi, K., Yamazaki, Y., et al. (2011). Professional oral health care reduces oral mucositis and febrile neutropenia in patients treated with allogeneic bone marrow transplantation. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 20(2),367-373.
To evaluate the effects of professional oral health care (POHC) given by dentists and dental hygienists on the development of oral mucositis and FN after allogeneic BMT.
1. Pre-BMT, two dentists examined patient’s oral health, including x-rays, baseline hygiene, and clinical exam of hard and soft palate, looking for risk factors for oral infection.
2. All dental problems were treated up until HSCT.
3. Dental hygienist gave mechanical cleaning of the mouth and instructed patients on how to properly clean the mouth and teeth.
4. During HSCT period, all patients had to be able to perform proper oral hygiene themselves, which included brushing their teeth after every meal and before going to bed and oral rinsing with normal saline solution every three hours during the day.
5. When xerostomia developed, a mouth-wetting agent containing baking soda was applied locally several times a day.
6. Dentists and hygienists performed weekly oral exams and POHC on all patients and monitored compliance.
7. When OM developed, extra-soft toothbrushes were used, and patients gargled with a saline rinse containing lidocaine. Opioids were used for severe OM pain.
The sample was comprised of 140 patients. The median age for non-POHC was 43 (with a range of 15-66 years), n = 62. The median age for POHC was 47 (with a range of 18-77 years), n = 78.
Males (%): 54; Females (%): 46
Key Disease Characteristics: Adult patients with ALL, AML, MDS, CML, malignant lymphoma, adult T-cell leukemia/lymphoma, MM, and other (6.7%)
Other Key Sample Characteristics:
1. BMT was done by conventional or reduced-intensity stem cell transplantation.
2. Conditioning regimens included Fludarbine/Busulfan, Fludarabine/Melphalan, Cytoxan/VP-16/total body radiation, Cytoxan/total body radiation, and others (8.6%).
3. Cyclosporine A or tacrolimus and short-course methotrexate were given for GVHD prophylaxis.
4. Median age, administration of Cytoxan/VP16/TBI and GVHD prophylaxis were significantly different between groups.
5. The number of reduced-intensity stem cell transplant (RIST) was higher in the POHC group.
Site: Inpatient
Location: Hokkaido University Hospital, Sapporo, Japan
Phase of Care: Active treatment
Retrospective study from February 2002 until December 2009. Data collected from clinical records.
1. OM was graded using the WHO scale.
2. Daily exams by nurses and physicians per instructions of the dentist in charge and at least weekly confirmation of assessments by dentists. (It is not stated if this is only in the POHC arm, but it is likely only in the POHC group.)
3. FN was defined as a single axillary temperature of >37.5°C with a peripheral neutrophil count of <0.5 X 109/L.
1. The incidence of OM was significantly lower in the POHC group (66.7% versus 93.5%).
2. The incidence of FN and maximal level of CRP were both significantly lower in the POHC group (P < 0.035).
3. The conditioning regimen and POHC were significantly associated with the incidence of OM in the univariate analysis.
4. Only POHC remained significant in the multivariate analysis.
The incidence of OM in patients with POHC was significantly lower than in those without POHC.
Retrospective study
Higher number of RIST patients in the POHC group, which may account for the lower number o f cases of OM seen.
Long time from the non-POHC group and POHC make comparison to historical control less accurate. Additional intervening variables could be responsible for changes seen.
1. This retrospective study helps to support the need for diligent oral hygiene prior to and during OM in high-risk patients.
2. The intervention in this study is not expensive and does not introduce additional medications to patients, which put the patient at risk for additional side effects.
3. This study reinforces the use of saline rinses.
4. FN was lower in the study group, and interventions that can help decrease the incidence of this significant and sometimes deadly side effect of chemotherapy are worth considering (perhaps the risk of infection via the oral cavity was reduced through the use of meticulous mouth care).
5. This intervention would require education to the patient and the caregivers prior to treatment and monitored during treatment, which oncology nurses are well positioned to do.
6. This study was done inpatient, and it would be nice to see an outpatient prospective study done to see if the results are the same.
Kashani, F., & Kashani, P. (2014). The effect of massage therapy on the quality of sleep in breast cancer patients. Iranian Journal of Nursing and Midwifery Research, 19, 113–118.
To determine the effects of massage on sleep quality in patients with breast cancer
A random sample of women in a chemotherapy clinic was obtained, and individuals randomly were assigned to control and experimental groups. Those in the experimental group received effleurage style massage therapy by a certified practitioner for 20 minutes three times a week for four weeks in the clinic. Patients in the control group received usual care. Study measures were obtained at baseline and at four weeks.
In the experimental group, sleep latency, use of hypnotics, and sleep time improved (p < .001) from baseline. In the control group, sleep adequacy and use of hypnotics also improved (p < .05). No differences were seen in quality of life between groups.
Massage therapy may improve some aspects of sleep in women with breast cancer during active treatment.
Although this study does not provide strong support for the effectiveness of massage to improve sleep quality among women during therapy, massage is a low-risk intervention and these findings suggest that it might be helpful. For patients with sleep disturbance, massage may be an alternative that is helpful and preferred by some patients.
Kashani, F., Kashani, P., Moghimian, M., & Shakour, M. (2015). Effect of stress inoculation training on the levels of stress, anxiety, and depression in cancer patients. Iranian Journal of Nursing and Midwifery Research, 20, 359–364.
To investigate the effects of inoculation training on stress, anxiety, and depression
Forty patients were randomly selected and randomly assigned to study and control groups. Study group patients had weekly group education sessions for eight weeks. Sessions were aimed at understanding stress, relaxation, education, concepts of cognition, feelings and behaviors, role of negative self-talk, concentration and distraction techniques, and problem solving skills. Data were obtained before and after the intervention period.
Anxiety and depression declined after the intervention, but did not decline in the control group. After eight weeks, anxiety was significantly lower in the intervention group (p = 0.00) and depression was significantly lower than controls (p = 0.04). Stress increased in the control group, but declined in the intervention group (p = 0.01).
The psychoeducational intervention tested here was associated with significantly less anxiety and depression compared to patients who did not receive this intervention.
Findings suggest that the type of psychoeducational intervention provided here was helpful to manage anxiety and depression. Study design limitations affect the strength of evidence from this particular study; however, findings are in general concert with the body of evidence regarding effectiveness of psychoeducational interventions. Various psychoeducational interventions have been shown to be effective for anxiety and depression. These interventions can be incorporated into usual nursing practice.
Kartin, P., Tekinsoy, Tasci, S., Soyuer, S., & Elmali, F. (2014). Effect of an oral mucositis protocol on quality of life of patients with head and neck cancer treated with radiation therapy. Clinical Journal of Oncology Nursing, 18, E118–E125.
To determine the effect of an oral mucositis prevention protocol on nutritional status and quality of life in patients receiving radiation therapy for head and neck cancers
The intervention group received an oral care protocol that included tooth brushing, features of the tooth brush, and a sodium bicarbonate mouth rinse. It also included an oral evaluation, precautions for oral mucositis, and a nutrition protocol. The nutrition protocol consisted of recommendations for wounds, irritation, intensive secretion, xerostomia, smell or taste changes, nausea, vomiting, and nutritional principles after radiation therapy (RT). The protocols were used for preventing oral mucositis and malnutrition, and interventions were used according to the grading of mucositis. Assessments were done weekly for seven weeks.
Randomized, controlled, experimental study
Oral mucositis severity was lower in the group receiving the oral care protocol compared to the control group. As the post-treatment period progressed, the prevalence of malnutrition in the intervention group was lower than the control group, and the intervention group experienced significantly less pain related to oral mucositis. A similar deterioration in quality of life was noted in each group.
Oral mucositis severity was lower in the two groups receiving the oral care protocol compared to the control group. This study demonstrated that oral mucositis rate may be reduced with an oral care protocol.
Nurses working in RT units should explain oral care protocols to patients before treatment and assess patients' mouths every week using evidence-based assessment criteria. Healthcare professionals should evaluate the nutritional status of individuals receiving RT before, during, and after treatment, and patients should be offered education and training. Nurses should use evidence-based protocols for patient care. This study added to the body of evidence pointing to the importance and effectiveness of standardized oral care for the reduction of mucositis severity.
Karthaus, M., Ballo, H., Abenhardt, W., Steinmetz, T., Geer, T., Schimke, J., … Kleeberg, U. (2005). Prospective, double-blind, placebo-controlled, multicenter, randomized phase III study with orally administered budesonide for prevention of irinotecan (CPT-11)-induced diarrhea in patients with advanced colorectal cancer. Oncology, 68(4–6), 326–332.
Participants were randomly assigned to receive either 3 mg oral budesonide three times per day for a total of eight weeks during two cycles of irinotecan or a placebo. Rescue medication was given at an initial dosage of 4 mg loperamide followed by 2 mg every two hours until free of diarrhea for 12 hours.
The study reported on 56 patients with advanced colorectal cancer receiving 125 mg/m2 irinotecan once per week.
This was a prospective, double-blind, placebo-controlled, multicenter, randomized phase III trial for prevention of diarrhea.
Patients recorded presence of diarrhea (defined as more than four stools per day), duration of diarrhea, and use of loperamide in patient diaries.
Diarrhea could be prevented in 58.3% of the budesonide-treated patients compared to 38.5% of the patients receiving the placebo (p = 0.257).
Budesonide provided superior prevention of diarrhea compared to placebo in the first cycle. However, the trial failed to show that budesonide provided a statistically significant benefit in preventing irinotecan-induced diarrhea.
In a previous study (Lenfers, 1999), budesonide was found to be effective in treatment chemotherapy-induced diarrhea in patients who had treatment failure with loperamide. Budesonide also has been proposed as a therapeutic approach for inflamed bowel. However, this study did not support that finding. Further research is warranted.
Karthaus, M., Tibor, C., Lorusso, V., Singh-Arora, R., Filippov, A., Rizzi, G., . . . Grunberg, S.M. (2015). Efficacy and safety of oral palonosetron compared with IV palonosetron administered with dexamethasone for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with solid tumors receiving cisplatin-based highly emetogenic chemotherapy (HEC). Supportive Care in Cancer, 23, 2917–2923.
To compare the safety and efficacy of oral and intravenous palonosetron when used to prevent chemotherapy-induced nausea and vomiting (CINV) in patients receiving cisplatin-based chemotherapy
On day 1 of chemotherapy, subjects were given either 0.50 mg oral palonosetron or 0.25 mg IV palonosetron in addition to oral dexamethasone at 20 mg on day 1 followed by 8 mg orally as needed on days 2–4. The use of rescue medication was considered a treatment failure. Metoclopramide tablets were available, the use of other 5HT3s was discouraged, and the use of palonosetron was not allowed.
Randomized, controlled, double-blinded, double-dummy, parallel-group, stratified study
The acute phase complete response (CR) rate was 89% in the oral palonosetron group and 86% in the IV group. The CR rate in the delayed phase was 76% for oral versus 75% for IV palonosetron. There was no difference in the percentage of patients with no emesis in the delayed (79% oral versus 78% IV) and overall phases (76% oral versus 73% IV). There was no overall statistical difference in nausea and the use of rescue medication between the oral and IV groups in the acute, delayed, and overall study phases. Study drug treatment-emergent adverse events were rare (3.2% oral versus 6.5% IV).
IV palonosetron was not superior to oral palonosetron in preventing CINV from platinum-based highly emetogenic chemotherapy. Both routes had similar efficacy in the acute, delayed, and overall phases.
Oral 0.50 mg and IV 0.25 mg palonosetron were effective in preventing CINV in highly emetogenic chemotherapy regimens containing cisplatin without increasing the risk of adverse events. The availability of oral antiemetics provides opportunities to decrease the amount of time patients spend in the clinic receiving IV premedications. This may decrease the cost of treatment because of the decrease in chair time.