Kelly, C., Juurlink, D., Gomes, T., Duong-Hua, M., Pritchard, K., Austin, P., & Paszat, L. (2010). Selective serotonin reuptake inhibitors and breast cancer mortality in women. BMJ, 340, c693.
Researchers sought to show that some SSRI antidepressants reduce tamoxifen’s effectiveness by inhibiting its bioactivation by cytochrome P450 2D6 (CYP2D6).
The study enrolled postmenopausal women with breast cancer using tamoxifen therapy and a single SSRI antidepressant (paroxetine fluoxetine, sertraline, citalopram, fluvoxamine, or venlafaxine.)
The study included women living in Ontariowho were 66 years or olderand treated with tamoxifen for breast cancer between 1993 and 2005 and with a single SSRI. (24,430 women were identified; 2,430 entered into study; mean age was 74 years).
Inclusion criteria: Postmenopausal women with breast cancer newly treated with tamoxifen (defined as no tamoxifen prescription in the preceding year) and a single SSRI antidepressant (paroxetine fluoxetine, sertraline, citalopram, fluvoxamine, or venlafaxine)
Exclusion criteria: Antidepressant use of duloxetine or escitalopram
Ontario Cancer Registry provided the data.
This was a retrospective cohort study.
The study examines the total duration of tamoxifen therapy (index date: date tamoxifen was last dispensed plus an additional 60 days) and the extent to which co-prescription of potentially interacting medications occurred during the course of treatment. The primary outcome was death from breast cancer
Of 2,430 women treated with tamoxifen and single SSRI, 374 (15%) died of breast cancer during follow up. Absolute increases of 25%, 50%, and 75% in the proportion of time on tamoxifen overlappingthe use of paroxetine were associated with 24%, 54%, & 91% increases in the risk of death from breast cancer. (p < 0.05) No such risk was seen with other antidepressants
Reported study limitations included lack of information on breast cancer stage and lack of information on indication for antidepressant use.
Kelly, A.E., Sullivan, P., Fawcett, J., & Samarel, N. (2004). Therapeutic touch, quiet time, and dialogue: Perceptions of women with breast cancer. Oncology Nursing Forum, 31, 625–631.
This intervention was therapeutic touch (TT). The experimental group received 10 minutes of TT and 20 minutes of dialogue, and the control group received 10 minutes of quiet time and 20 minutes of dialogue. Data were collected as part of a larger experimental study of the effects of TT on pre- and postoperative anxiety and mood and pain in women with breast cancer. Telephone interviews were conducted at the completion of an experimental or control nursing intervention administered in the women’s homes before and after breast cancer surgery. The interview consisted of six open-ended questions.
The study reported on a sample of 18 women with early-stage breast cancer.
Mixed methods of qualitative and quantitative study were used.
Telephone interviews consisting of six open-ended questions
Regardless of experimental or control intervention, women expressed feelings of calmness, relaxation, security, and comfort. No objective measures were reported.
Kehrer, D.F., Sparreboom, A., Verweij, J., de Bruijn, P., Nierop, C.A., van de Schraaf, J., … De Jonge, M.J. (2001). Modulation of irinotecan-induced diarrhea by cotreatment with neomycin in cancer patients. Clinical Cancer Research, 7(5), 1136–1141.
To evaluate irinotecan disposition and pharmacodynamics in the presence and absence of the broad-spectrum antibiotic neomycin
Patients experiencing grade 2 or higher diarrhea after receiving irinotecan alone (350 mg/m2 every 3 weeks) received the same dose combined with 1,000 mg oral neomycin three times per day continuously from 2 days prior to 5 days after the second course.
The study reported on 20 patients with advanced colorectal cancer receiving CPT-11 (350 mg/m2 every 3 weeks).
This was a nonrandomized trial. Patients acted as their own controls.
Presence of more than 4 stools per day and duration (measured in days) of diarrhea were recorded.
Findings indicate that bacterial B-glucorinidase plays a crucial role in irinotecan-induced diarrhea without affecting enterocycling and systemic SN-38 levels.
This was an extremely small pilot study.
Keenan, A., & Keithley, J.K. (2015). Integrative review: Effects of music on cancer pain in adults. Oncology Nursing Forum, 42, E368–E675.
STUDY PURPOSE: To evaluate published evidence regarding the effects of music on cancer-related pain
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Palliative care
Out of the five studies included, two showed significant differences in self-reported pain scores associated with the music intervention. Most studies were done outside of the United States, and in most studies, patients were offered a limited variety of prerecorded music for listening.
This review showed mixed results regarding the effects of listening to music on pain among patients with cancer in various phases of care.
This review did not add substantially to the body of evidence regarding the use of music for cancer-related pain. There are a number of more recent studies that have shown greater efficacy and are of higher quality than those reviewed here.
Keeley, P.W. (2009). Nausea and vomiting in people with cancer and other chronic diseases. BMJ Clinical Evidence, 2406.
To determine the effects of treatments for nausea and vomiting either as a result of the disease or its treatment in adults with cancer and other chronic diseases
Databases reviewed searched were MEDLINE, Embase, and the Cochrane database. Harm alerts from the Food and Drug Administration (FDA) and the United Kingdom regulatory agency also were reviewed.
No separate description of the volume of literature evaluated or the specific evaluation process was provided. The Grading of Recommendations Assessment, Development and Evaluation (GRADES) system was used for rating the evidence, and these results were provided. The literature review was completed as of April 2008.
The study reported on 13 randomized, controlled trials (RCTs), representing more than 14,000 patients with cancer. These included studies of nausea and vomiting as a result of disease or treatment.
Results indicated that 5-HT3 RAs + dexamethasone was beneficial.
The following were identified as likely to be beneficial.
Cannabinoids were identified as being a tradeoff between benefit and harm.
The following were determined to have unknown effectiveness.
Keefe, F.J., Ahles, T.A., Sutton, L., Dalton, J., Baucom, D., Pope, M.S., . . . Scipio, C. (2005). Partner-guided cancer pain management at the end of life: A preliminary study. Journal of Pain and Symptom Management, 29, 263–272.
Intervention goals were to
Three 45- to 60-minute face-to-face sessions with an RN educator for training in pain management strategies were delivered over one to two weeks. Educators were knowledgeable about cancer pain and skilled in coping skills training interventions. Four educators were used, and quality assurance plans were described.
For sessions 2 and 3, the educator guided participants through skills, partners were asked to serve as coach, and the educator provided feedback.
Following completion of the three sessions, the educator reviewed the coping skills found most useful and developed a maintenance plan.
Home setting
A properly randomized, controlled trial design was used (with small sample size). Power analysis was not reported.
A trend toward reporting lower levels of caregiver strain (p = 0.06) existed.
Partners receiving the intervention reported significantly higher levels of self-efficacy for helping patients control pain and significantly higher levels of self-efficacy for helping patients control other symptoms.
No significant difference was found in positive or negative mood.
Kee, B.K., Morris, J.S., Slack, R., Crocenzi, T., Wong, L., Esparaz, B., . . . Fisch, M.J. (2015). A phase II, randomized, double blind trial of calcium aluminosilicate clay versus placebo for the prevention of diarrhea in patients with metastatic colorectal cancer treated with irinotecan. Supportive Care in Cancer, 23, 661–670.
To determine whether the oral administration of calcium aluminosilicate clay (CASAD) reduces the rate of grade 3 diarrhea associated with irinotecan administration in patients with colorectal cancer
Patients were provided with CASAD or placebo capsules. The treatment arm received capsules containing 500 mg of the active compound taken as two tablets four times daily. Treatment lasted for six weeks or until treatment criteria were met. After six weeks, all patients were offered off-label CASAD for an additional six weeks. Patients who developed diarrhea were provided standard-of-care antidiarrheal medication. Patients completed baseline assessments of bowel statuses and additional assessments at three, five, and six weeks. Daily bowel logs were completed by patients and reviewed at the third, fifth, and sixth provider visits.
This was a phase II, randomized, double-blinded, multicenter study. Patients were randomized on a 1:1 ratio to receive CASAD or a placebo. Patients were stratified according to irinotecan therapy, no concurrent therapy, or concurrent therapy in addition to irinotecan.
There were no differences between groups. In the CASAD arm, seven out of 49 patients in the CASAD arm versus three out of 46 patients in the placebo arm developed grade 3 diarrhea during the first six weeks (PR = 0.10). The incidence of any grade of diarrhea was similar in both arms. There was no difference in gastrointestinal (GI) toxicities between the two groups.
CASAD was ineffective in preventing diarrhea in this patient population. There were no issues with GI toxicities, indicating that CASAD was clinically safe.
CASAD is not indicated as a preventive measure for diarrhea associated with irinotecan administration.
Kedge, E.M. (2009). A systematic review to investigate the effectiveness and acceptability of interventions for moist desquamation in radiotherapy patients. Radiography, 15, 247–257.
To systematically review the currently available high-quality evidence evaluating treatments for moist desquamation in patients receiving radiotherapy
Databases used were AMED, BIOMED, BIOSIS, BNI, British Library Integrated Catalogue, CINAHL, Cochrane, Current Controlled Trials, DARE, Dissertation Abstracts, DoH Research Findings Register, EMBASE, HSRProj, IBSS, Index to Theses, ISI Wok, Medline, National Cancer Research Network, National Register of Cancer Trials, National Research Register, PROQUEST, and ZETOC. Keywords searched were radiotherapy, radiation therapy, deep x-ray therapy, irradiation, wounds, moist desquamation, desquamation burns, radiation burns, radiotherapy burns, broken skin, ulcers, wound healing, skin care, wound care, and epithelial. Studies were included if they
Studies were excluded if they
The search returned 166 articles. Of these, 20 were relevant. Only 10 were included in the review. Studies were evaluated for quality using the CASP guidelines for clinical trials. Of the 10 studies that met inclusion criteria, none were judged to be of very poor quality, so all were included in the review. Studies were not homogenous in interventions or variables examined, so no meta-analysis was undertaken. A qualitative overview of results is presented.
No convincing evidence for any intervention was found. Evidence was mixed concerning the use of hydrogel and hydrocolloid dressings; however, improved patient comfort was sometimes seen with these. Other dressings studied did not show positive results and comparison dry dressings may cause injury of granulating tissue with daily removal for treatment. A number of other types of dressings that might be useful were briefly identified, but there are no reports of research using these yet. Limited evidence supports other interventions. Most findings with topical agents were equivocal. In one study, hydrocortisone cream appeared to reduce healing time (abstract only).
Although the author states that the 10 studies included were all of sufficient quality for use according to the guidelines used, results reported per study indicate that one study may have reported information that was untrue, one study was identified as being poorly reported with insufficient information, and one study was identified as fairly low quality.
Well-designed research in this area is urgently needed.
Keat, C.H., Phua, G., Abdul Kassim, M.S., Poh, W.K., & Sriraman, M. (2013). Can granisetron injection used as primary prophylaxis improve the control of nausea and vomiting with low- emetogenic chemotherapy? Asian Pacific Journal of Cancer Prevention: APJCP, 14, 469–473.
To examine differences in incidence and risk of chemotherapy-induced nausea and vomiting (CINV) among patients receiving low emetogenic chemotherapy (LEC) with or without prophylactic granisetron
The first cohort of patients received 8 mg IV bolus dexamethasone or 10 mg metachloepramide. The second cohort also was given 3 mg IV bolus of granisetron. Both groups were given dexamethasone (2-4 mg twice daily) or metochlopramide (10 mg three times daily) tablets to be taken for three days after chemotherapy. CINV was evaluated for 120 hours, days 1–5 after chemotherapy.
The study was conducted at a single outpatient site in Malaysia.
All patients were in active, antitumor treatment.
This was a two-group cohort, observational trial.
Those who received granisetron had lower rates of acute and delayed nausea and emesis. The only significant difference between groups was in the prevalence of acute emesis; 3.9% of those who received granisetron experienced acute emesis versus 19% of those who did not receive granisetron (p = 0.017). No differences were found between groups in complete control rates in either the acute or delayed phases. With analysis controlling for covariates influencing CINV, those receiving granisetron had a lower risk of CINV (overall response [OR] = 0.1, 95% confidence interval [CI] = 0.02–0.85, p = 0.034).
Patients receiving granisetron in addition to antiemtic regimens recommended for LEC had a lower incidence of acute emesis, but no effect was found on delayed phase symptoms or acute nausea.
Common recommendations for CINV prophylaxis with LEC do not include the use of neurokinin 1 (NK1) or 5-HT3 medications but, rather, rely primarily on the use of increased dexamethasone dosage for control. This study examined the addition of a 5-HT3 to an LEC antiemetic regimen and demonstrated a significant improvement in acute emesis. Granisetron is more costly than a single-agent antiemetic regimen such as dexamethasone, so additional antiemetic use is seen as controversial or “overtreatment.” Nurses can advocate for consideration of aggressive prevention of CINV to minimize the adverse patient experience with chemotherapy, balanced with recognition of potential cost burdens to the patient. As shown in many other studies, control of nausea (rather than emesis) remains challenging. The strength of findings in this study are limited by the study design. Further well-designed research in this area is warranted.
Kearney, N., Miller, M., Maguire, R., Dolan, S., MacDonald, R., McLeod, J., . . . Wengström, Y. (2008). WISECARE+: results of a European study of a nursing intervention for the management of chemotherapy-related symptoms. European Journal of Oncology Nursing, 12, 443–448.
To evaluate the impact of a nursing intervention incorporating structured symptom assessment and management of the chemotherapy-related symptoms of nausea, vomiting, fatigue, and mucositis.
A consecutive sample of 249 patients, who were scheduled to receive first-line chemotherapy, received structured symptom assessment and management, facilitated by WISECARE+, an information technology–based program. Symptom data was self-report by patients using a paper questionnaire for 14 consecutive days following each cycle of chemotherapy, starting on the first day of treatment.
Patients were undergoing the active treatment phase of care.
The study used a pre- and postintervention design.
Patients experienced less nausea postintervention, but pre/post differences were only significant at days 0 to 4 (p = 0.025). Similarly, patients had less vomiting after the intervention but pre and post differences were only significant at days 0 to 4 (p < 0.001). Although changes in oral problems varied at different time points in the study, overall repeated measures analysis showed reduction in oral problems over the course of the study (p = 0.016). There was no effect of the intervention on fatigue.
Structured nursing symptom assessment and management of chemotherapy-related symptoms improved the symptoms of nausea, vomiting, and oral problems (mucositis) related to chemotherapy.
The study used patient-assessed symptom data that was collected in real time. The data measured the incidence, severity, and associated distress of the symptoms. Additional research is needed to evaluate the effectiveness of the structured symptom assessment and management of chemotherapy-related symptoms.