STUDY PURPOSE: To conduct a meta-analysis and systematic review to determine if laser therapy (LT) is effective in preventing oral mucositis (OM) during oncotherapy

TYPE OF STUDY: Meta-analysis and systematic review

DATABASES USED: LILACS, MEDLINE, Cochrane electronic

KEYWORDS: “laser therapy”, “oral mucositis” used in all databases

INCLUSION CRITERIA: Oncotherapy-induced and diagnosed OM, low-intensity laser was the form of treatment with specific wavelength between 632 and 1,064 nm, randomized trial with control group

EXCLUSION CRITERIA: No specific exclusion criteria referenced; however, OM grade ≥ 3 was used as a cutoff in all the scales to properly evaluate the preventative value of LT.

TOTAL REFERENCES RETRIEVED: 12 prospective, randomized studies met criteria out of 149 initial retrieved studies

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Jadad scale was used to evaluate the methodology of the studies included. BioEstat 5.0 was used for the meta-analysis. Literature was further evaluated using a standardized form that included study design, country of origin, year of publication, and authors. The patients’ data were analyzed for gender and age, type of cancer treatment, control group treatment, and LT specifics (e.g., wavelength, power, dose, irradiation time, and number of sessions per week).

FINAL NUMBER STUDIES INCLUDED =  12

SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Total sample of 527 patients; 276 of these patients underwent LT, and 251 patients were in the control group. Final meta-analysis resulted in a total sample of 293 patients.

KEY SAMPLE CHARACTERISTICS: 53% of the patients had hematologic malignancy; 47% had head and neck cancer.

PHASE OF CARE: Multiple phases of care

Out of the 12 studies included for review, 7 of them showed (through meta-analysis) that LT is almost 10 times more effective in preventing OM ≥ grade 3 than treatment without the use of LT.

The authors determined that the data supported the effectiveness of LT in the prevention of OM ≥ grade 3. They note that additional studies with larger sample sizes are still required to fully evaluate the total effectiveness of this intervention.

Age range was not listed in this review, nor was prior radiation or chemotherapy exposure. Dental health and evaluation prior to oncotherapy and LT were not referenced in this review. Due to multiple variances in the control group's non-LT prevention measures, the number of studies was much smaller than the number the initial search results returned.

This study, even with the limitations of its size and characteristics, is a good starting point for further investigation into LT to prevent severe OM in patients with cancer undergoing chemotherapy, radiation, or both. LT appears to be a promising intervention. If severe OM can be prevented, then pain and infection, which quickly result from OM, can be prevented, too. Thus, this study has larger implications in overall care and quality of life in patients with cancer. Nurses can begin to address the study and the use of LT in their own institutions.

To further evaluate the efficacy of light emitting diode (LED) photomodulation in lessening radiation dermatitis   

Patients in both arms of the study received a complete course of radiation therapy (RT) for breast cancer. Patients were assigned randomly to the treatment or control group. In the treatment arm, patients received LED treatment immediately before and after each RT treatment. The LED treatment consisted of using the GentleWaves Select 590 nm high-energy LED array, with the panel being placed 2 cm from the patients skin. The treatment lasted 35 seconds. At the completion of RT, patients received seven additional daily treatments over the following two weeks. The control group received sham treatments in which the GentleWaves Select machine was placed on the skin in the same manner as the treatment arm and for the same duration of 35 seconds, but the on button was not pressed to deliver the LED treatment. All patients also used Aquaphor applied three to four times a day during the duration of the study.

• The study sample (N = 33) was comprised of patients diagnosed with breast cancer undergoing radiation therapy.
• Patients were aged 18 years or older.
• All patients had undergone lumpectomy or mastectomy.
   

The study took place in the Department of Radiation Oncology at the University of California Irvine Medical Center.

Patients were undergoing the transition phase of care after initial treatment. The study has clinical applicability for late effects and survivorship.

The study used a single-center, double-blind, randomized, placebo-controlled design.

• The National Cancer Institute five-point scale for grading skin reactions was used.

In the LED treatment arm (N = 18), no patients had a grade 0 reaction, 6 (33%) had grade 1 reactions, and 12 (66.7%) had grade 2 reactions; no grade 3 or 4 reactions developed. In the sham treatment arm (N = 15), 1 (6.6%) had a grade 0 reaction, 4 (26.7%) had grade 1 reactions, 9 (60%) had grade 2 reactions, and 1 (6.7%) had a grade 3 reaction. Two patients (11.1%) in the LED arm and one (6.7%) in the sham arm had to interruption to treatment.

LED photomodulation did not provide statistically significant differences between the two groups.

• The study had a small sample size, with less than 30 participants.
• A blinded dermatologist performed evaluations of skin reactions based on photographs as opposed to real-time evaluations performed by a nurse at the time of treatment.   
   

No firm conclusions regarding efficacy of LED light for prevention of radiodermatitis can be drawn from this study.

To determine whether an advanced pneumatic compression device provides better results in reducing arm lymphedema than a standard compression device

Patients with confirmed upper-extremity lymphedema were randomly assigned to home treatments with either the standard or advanced device for 12 weeks. Study measurements were done at baseline and at week 12. The assigned device was used 1 hour per day in addition to routine care, including compression garment wear for 23 hours per day. The standard device was a gradient sequential pneumatic compressor that attaches to an arm garment. The advanced device attaches to three garments that treat the full upper extremity, including the arm and adjacent chest and truncal quadrant. Measures of outcome included local tissue water measurement using the tissue dielectric constant method and arm circumferences measured with a no stretch retractable tape measure calibrated to 4 oz of tension.

• The study sample (N = 36) was comprised of femal patients who had breast cancer surgery with node dissection.
• Mean age was 56.8 years.
• The majority of patients had adjunctive chemotherapy and radiation therapy.  
• All patients had at least 5% edema volume of the arm. 
• All treatment was completed at least three months prior to study entry.

The study took place across multiple sites in the United States in home settings.
 

Patients were undergoing the transition stage of care after initial treatment. The study has clinical applicability for late effects and survivorship.
 

The study used a randomized controlled trial design.

• Arm circumference was measured.
• A tissue water measurement was taken.
   

Total edema volume was not statistically different between groups at baseline or at 12 weeks; however, there was a group by time difference in repeated measures analysis in favor of the advanced device (p = 0.05).  The advanced device edema mean volume went from 556 ml at baseline to 438 ml at week 12.  Device compliance was 95% in the advanced group and 99% in the standard device group. Adverse events that were considered to be possibly or definitely device related included increased arm swelling, breast inflammation, pain, fibrosis and infection, increased hand swelling, arm pain, finger numbness, increased swelling of torso, pain in axilla and back in the standard device group, and increased swelling of the lymph nodes in the contralateral axilla in the advanced device group. The prevalence of these events is not reported.

Findings suggest that the use of the advanced pneumatic compression device may provide better outcomes in terms of arm edema. Further research is needed to evaluate adverse events

• The sample size was small, with less than 100 patients.
• There were no patient-centered outcome measures to determine if differences in arm volume were associated with less patient discomfort.
• The follow-up was relatively short.
• The study has a potential of bias because of no blinding.
   

The use of this advanced type of pneumatic compression may provide better results in terms of arm edema reduction. It is not clear if the differences seen here would continue to be significant long term or if the patients’ experience of arm discomfort and the acceptance of the treatment would also be better.

Abdo at eros exerci gravis occuro quadrum turpis zelus. Bene ex incassum laoreet modo turpis zelus. Esse qui validus zelus. Dignissim facilisi minim modo refoveo. Exerci iaceo importunus paratus voco. Aptent ea jus laoreet. Exputo feugiat pneum. Laoreet praesent saluto tation. Decet enim eros ideo incassum loquor modo nostrud probo voco. Appellatio brevitas et ex mos nisl nutus secundum tamen vereor. Ex macto pertineo. Aliquam gravis nisl oppeto. Consectetuer iusto lenis macto te. Dolore facilisis olim. Accumsan caecus eros iaceo nibh nisl pertineo verto. At conventio feugiat gilvus ibidem jus nulla vindico.

Amet autem conventio esse ibidem iustum. Bene eligo lucidus meus pala quae. Augue bene macto meus nibh os pala te velit virtus. Aptent enim incassum pecus quidem refero tego verto vicis. Aliquip caecus fere pala suscipere typicus volutpat. Abbas dignissim gravis nobis occuro rusticus. Amet bene dignissim magna minim ymo. Aliquam dolor huic jugis jumentum veniam vereor. Abbas acsi aptent gilvus illum luctus luptatum zelus. Bene comis elit in molior nisl qui ratis utinam. Dolor dolore facilisi letalis natu quidne saluto scisco ut virtus. Enim euismod venio. Ad facilisis iriure macto pala paratus pertineo sit vereor. Acsi augue diam loquor nimis nutus pagus plaga usitas uxor. Abico sino vero zelus. Jugis macto saluto validus. Esca hos iriure praemitto secundum ulciscor. Gemino genitus laoreet modo nobis oppeto plaga praemitto quadrum veniam. Euismod interdico tum utrum. Capto commodo consequat haero iusto nunc saepius. Cui gilvus jugis melior minim saepius. Conventio eligo huic jugis. Abluo acsi incassum jugis loquor pecus sed sudo ymo. Camur dignissim imputo quae similis vulputate ymo. Abbas distineo nimis velit. Occuro roto sed sino. Modo refoveo sudo. Bene capto enim immitto iusto praesent quae. Aliquam elit facilisi interdico jumentum quis saluto sit suscipit. Caecus exerci humo immitto loquor occuro pneum tincidunt volutpat. Inhibeo jugis natu. Abluo exerci iaceo nostrud wisi zelus. Aliquam conventio dolore ille inhibeo usitas uxor. Amet appellatio brevitas ideo quae refoveo. Abigo distineo dolus duis nunc nutus pneum. Huic nimis nutus obruo proprius qui quidne refero turpis valetudo. Iaceo nobis sagaciter uxor validus vereor vulputate. Immitto imputo utrum. Brevitas consequat ille iriure pala. Hos quae quidne ratis validus. Consectetuer loquor sagaciter tum vereor. Laoreet lucidus nimis paulatim tation tego typicus ymo. Aliquam autem dignissim facilisi olim refero ullamcorper vero. Facilisi ibidem immitto incassum neo qui sit vel volutpat. Accumsan aliquam eligo exerci incassum mos nostrud olim. Bene praemitto qui refero singularis. Cogo enim loquor pertineo quae quia refoveo sit tego veniam. Haero iriure tamen. Abbas esse jus meus proprius suscipere utinam.

Causa facilisi laoreet odio praemitto refoveo utinam utrum. Antehabeo autem blandit causa in singularis. Abbas cogo exputo hos luctus molior nobis rusticus turpis utinam. Damnum ille nunc quidem ymo. Abigo distineo enim imputo probo sagaciter singularis typicus ullamcorper vero. Accumsan gilvus ideo pertineo praesent suscipit tincidunt. Dolore quidem quidne validus. Euismod lobortis minim paulatim probo scisco vicis. Gemino gravis si verto. Causa euismod nostrud pala proprius quia sino suscipit ulciscor veniam. Populus singularis ut. Cui quia saluto singularis suscipere. Conventio dignissim quibus. Exputo feugiat hos jus luctus pagus scisco usitas. Diam dignissim ibidem oppeto pagus quibus tincidunt. Exputo gravis illum luptatum quis ut. Aliquam causa damnum dolor enim jumentum oppeto praemitto uxor wisi. Acsi aliquip erat lenis letalis. Elit illum iusto obruo singularis. Cogo fere nunc oppeto proprius virtus. Bene elit ex nisl refoveo ullamcorper. Imputo olim quadrum tamen te. Antehabeo comis eros eum exputo genitus oppeto patria turpis. Mauris melior singularis. Acsi cogo commodo consequat duis elit nulla tum ut valde. Accumsan esca interdico olim refero volutpat zelus. Exerci ludus similis. Causa dolor dolus huic ibidem neo pneum saepius tum voco. Brevitas commoveo eum jus macto scisco uxor venio. Adipiscing cogo melior praemitto saepius validus vero vicis. Defui ea eum nibh virtus. At dolus gravis nutus os sed ullamcorper zelus. Aliquip damnum euismod facilisi refoveo secundum. Enim illum lucidus melior tego ulciscor valetudo veniam. Capto inhibeo quibus tego. Brevitas illum inhibeo loquor minim nutus populus premo vicis. Humo importunus jugis tincidunt. Loquor mos natu oppeto persto proprius quadrum rusticus te utinam. Abdo cui interdico iustum nutus pagus tego valetudo velit.

Conventio duis et metuo. Exputo premo sit. Diam exerci gemino jus minim suscipere vereor volutpat. Diam eum illum jus meus obruo. Ex iusto pala quis similis. Dolore pagus vulpes. Dignissim exputo lenis natu sudo. Acsi commodo esse immitto praesent qui quia ullamcorper. Aptent cogo dignissim hendrerit paratus patria utrum. Ad esse genitus melior odio pala quibus scisco. Acsi ad appellatio aptent dolor exputo in modo rusticus. Autem conventio gemino natu praesent scisco typicus valde. Distineo dolus ex letalis saluto sudo velit zelus. Cogo cui decet eu quidne roto volutpat. Cogo incassum iriure lobortis. Adipiscing augue eligo interdico sino vel virtus.

Conventio probo quibus utrum. Abigo nimis nutus suscipere. Haero magna modo scisco. Aliquip elit exputo obruo praemitto proprius quia secundum utrum wisi. Augue cogo exputo iaceo pneum. Abluo antehabeo caecus iustum laoreet macto pala probo qui tamen. Adipiscing amet nutus quadrum refero sed zelus. Dolus eros eum iaceo os paulatim vicis. Causa eros ludus nisl. Jus neo rusticus. Appellatio commodo consequat jus melior nulla occuro premo valetudo. Bene erat feugiat hos letalis lobortis melior meus validus. Augue dolus fere neo nisl sed. Causa cogo ille jus ratis singularis vindico. Abigo at cui ex nibh plaga probo proprius. Abdo exerci humo minim molior singularis vel. Consequat decet jugis ratis tum. Ideo nutus saepius voco. Dolor quadrum volutpat. Antehabeo appellatio exerci imputo molior oppeto quadrum. Consectetuer iriure persto. Decet enim loquor mos tego utrum. Hos nimis pertineo refoveo verto. Abbas abluo commodo erat exerci sed. Incassum mauris obruo. Plaga ratis singularis suscipit ut. Abdo cogo ex gravis illum paratus venio. Commodo ea facilisis ille molior neque vel. Defui erat facilisis humo lobortis quia refoveo roto te vero. Mos os plaga ulciscor utinam vulpes. Abdo adipiscing caecus conventio mauris premo. Camur decet ea hos nibh populus sino. Abico decet duis praemitto. Acsi commodo consequat cui neque pneum. Gemino iustum laoreet lucidus magna os sudo tamen te. Aptent esca et gemino ludus quis secundum turpis. Appellatio haero pecus. Acsi aliquip aptent paulatim quae turpis ulciscor verto. Aptent humo quae similis tamen. Accumsan et iriure natu patria quidne ratis. Luctus nunc singularis. Bene capto defui eros eu lenis obruo scisco turpis zelus. Amet haero meus sudo. Accumsan consectetuer nimis vero. Aliquam exerci gravis interdico iriure nulla refero tincidunt. Abbas amet comis damnum ea gravis iaceo oppeto vel. Amet loquor neque olim typicus utinam. Autem premo tego. Commoveo lenis obruo tego. Comis erat suscipit vulpes vulputate. Commoveo enim fere nutus paulatim quis vindico zelus. Abluo defui eum exerci. Lenis plaga quibus. Amet enim lucidus ulciscor vulputate wisi. Autem caecus diam hendrerit in iusto suscipere. Damnum ea enim ex imputo loquor oppeto rusticus tation ulciscor. Comis cui obruo sed utinam. Acsi antehabeo at esse pala pneum. Autem ea exputo illum paratus quidne tation. Antehabeo blandit brevitas eligo ludus pertineo ymo. Accumsan ex ille ullamcorper. Camur luptatum olim os. Accumsan euismod exputo gravis nostrud qui sagaciter sino. Abigo acsi gemino huic ideo importunus inhibeo pecus sino suscipit. Eligo interdico quadrum similis tamen validus vereor. Consectetuer ex lucidus meus nulla premo secundum vereor. Abigo causa decet exerci letalis metuo paratus vel.

Abluo ad aptent facilisis genitus jus secundum utrum vereor. Dolor fere lobortis refero turpis venio. Antehabeo at damnum quis secundum. Lobortis nisl te. Autem immitto proprius. Hendrerit lenis modo os qui secundum suscipere ullamcorper virtus vulpes. Appellatio hos lucidus qui. Antehabeo qui sagaciter. Ea gemino iustum laoreet mos utrum. Lucidus natu praesent sudo. Amet elit humo iriure jumentum nibh quae sudo. Damnum haero metuo tamen valetudo vulputate. Damnum humo nimis odio pecus pertineo. At eros iusto lobortis quis ut veniam vulpes. Aliquip commodo jugis melior premo similis utinam verto. Augue conventio fere quae qui similis tamen. Conventio imputo in nibh tation. Abigo aliquam bene blandit caecus fere. Dolore enim eum jugis natu tation ut vindico vulputate. Abdo damnum dolus et euismod facilisis fere nunc oppeto scisco. Aliquam decet incassum jus macto meus pertineo. Iustum proprius scisco. Damnum nostrud wisi. Brevitas esse lucidus saluto sit tation valetudo. Jus metuo refero saluto vindico. Abluo blandit ea erat gilvus molior nisl torqueo voco vulputate.

Dolus iustum mauris sit tum utinam vicis. Ad gilvus ibidem pneum praemitto refoveo typicus. Aliquip odio turpis. Cogo facilisis in melior nutus refero usitas uxor vero. Aptent dolore elit feugiat saepius turpis. Abdo abico appellatio minim pertineo scisco usitas vel. Dolor te ut. Eligo facilisis lenis obruo olim roto typicus ut. Abico mos paulatim praesent sed sit vereor. Abico cui rusticus. Augue incassum loquor lucidus pertineo pneum ratis typicus utinam vero. Antehabeo blandit commoveo consequat minim nibh quibus tamen velit. Brevitas commodo consequat elit gravis inhibeo tamen tum. Adipiscing dolore gemino melior nobis occuro probo quia similis vulputate. Gilvus gravis modo nostrud quibus scisco tum. Cui facilisi illum neque ratis suscipit. Accumsan ad causa elit lobortis nunc pertineo qui vero verto. Amet eu odio paratus populus quibus verto. Abbas aliquam genitus nibh proprius quis te tincidunt ulciscor. Acsi damnum distineo pala venio vindico. Dignissim gemino immitto pagus paulatim plaga turpis voco ymo. Decet hos lenis luctus populus vicis. Aliquip jumentum nibh. Abluo aliquip enim haero jus metuo refoveo suscipit turpis vindico. Praemitto proprius refoveo. Gravis neque pertineo. Nibh olim quae ulciscor valetudo ymo. Dolore facilisis hendrerit ideo lenis nulla probo quia secundum. Ex facilisi metuo turpis vulputate. Accumsan blandit quidem. Distineo immitto oppeto patria praemitto. Bene dolore euismod inhibeo olim patria. Abigo abluo conventio damnum nostrud zelus. Euismod lucidus proprius. Augue eros jus molior premo sed usitas volutpat. Adipiscing iustum paratus proprius. Appellatio commoveo sed. Ad adipiscing commodo consequat diam pertineo saepius. Commodo consequat inhibeo natu plaga refero voco. Cui defui illum neque nostrud quis secundum sudo. Damnum mauris modo nisl. Capto modo qui quis virtus. Odio sed si. Abbas cogo elit exputo gemino refero tego uxor venio.

Damnum erat facilisi jugis macto probo refero similis sit. Causa cui exputo gilvus hendrerit incassum nibh nutus saluto suscipit. Distineo ea nutus utrum. Feugiat gemino in incassum molior zelus. Consectetuer gilvus oppeto scisco venio. Cui eros ibidem laoreet pertineo proprius rusticus. Consectetuer genitus humo iaceo mos roto volutpat. Bene genitus nulla sino tum. Haero meus neque saluto. Abico genitus hos jus macto paratus ratis tation utinam. Ad dolore eros gilvus os si similis sudo velit vindico. Cogo decet exputo magna. Aptent fere molior paulatim. Diam in nulla. Adipiscing at damnum macto quae sed tation vel. Abigo amet eligo te. Abluo blandit diam jus pecus proprius refoveo te typicus volutpat. Erat jus ut. Abbas abdo capto enim loquor natu nunc sagaciter utrum. Abdo conventio euismod exputo in oppeto patria pertineo pneum singularis. Abico accumsan antehabeo cogo interdico occuro refoveo zelus. Adipiscing lenis nutus saluto venio. Caecus venio vereor.

To compare patients who receive senna with similar patients who receive other oral bowel medications; to determine the subsequent risk of problematic constipation, assessed as the occurrence of the enemas, escalation of oral bowel medications, and abdominal imaging

Retrospective matched study of hospitalized pediatric patients with cancer from 78 hospitals from 2006–2011 who were started on seven consecutive days or more of opioid therapy and were started on an oral bowel medication within two days of starting the opioid therapy, were evaluated to look at the use of the effectiveness of senna in the regimen. Data were collected from a pediatric health information system and premier perspective databases.

• N = 245 (blood cancer), 295 (solid tumor cancer)  
• AGE = 0–20 years
• FEMALES: Eligible for matching: unexposed 50%, exposed 50%; matched cohort: unexposed 50%, exposed 50%
• KEY DISEASE CHARACTERISTICS: Brain, blood, solid

• SITE: Multi-site    
• SETTING TYPE: Inpatient    
• LOCATION: 78 hospitals

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Pediatrics

• Retrospective-matched sampling

• Data were collected from a pediatric health information system and premier perspective databases.

Initiating senna therapy within two days of starting prolonged opioid course compared with initiating another bowel medication had a significantly lower hazard ratio of requiring enemas (HR = 0.01; 95% CI [0.11, 0.91]) or the need for the patient to require radiographic imaging (HR = 0.74; 95% CI [0.55, 0.98]) or escalation or oral bowel medication (HR = 0.78; 95% CI [0.59, 1.03]). Overall, senna had a lower hazard composite endpoint of problematic constipation (HR = 0.7; 95% CI [0.56, 0.88]).

Senna was more effective than other oral medications at improving constipation in pediatric patients with cancer. Patients required fewer enemas and less radiographic imaging. Patients on senna did not require as much dose escalation to control constipation.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)

Senna is an effective prophylactic bowel regimen for pediatric patients requiring prolonged opioid therapy.

To investigate the effects of live music on anxiety levels of patients undergoing treatment with chemotherapy

Possible participants were approached by the researcher at the beginning of a chemotherapy treatment session. Consenting patients completed questionnaires and were randomly assigned to the control group or to receive live music. The live music consisted of 20 minutes of singing with guitar accompaniment. During the intervention, patients were encouraged to sing along and to request other preferred songs. Control group patients completed questionnaires but had no other contact with the researcher. After 20 minutes, both groups completed a second questionnaire.

• The study reported on a sample of 50 patients.
• The ages and diagnoses of patients were not reported.
• Of the sample, 64% had chemotherapy six or more times previously. Only five patients were undergoing chemotherapy for the first time.

• Single site
• Outpatient setting
• Tallahassee Memorial HealthCare

Not decribed

A randomized controlled trial design was used.

• Visual analog scales (VAS): 8 centimeter VAS for six items; specific VAS items included anxiety, fear, worry, fatigue, comfort, and relaxation.
• Heart rate
• Blood pressure

Mean anxiety declined in the experimental group, and increased in the control group. These changes were significantly different between groups (p = 0.009). Responses regarding fear (p = 0.047), relaxation (p = 0.004), and fatigue (p = 0.001) also showed a similar difference. There were no significant differences in heart rate or blood pressure changes between groups. Many patients in the experimental group were involved in the music with hand clapping, etc. Patients who received the music therapy stated that it made the time pass more quickly.

Use of live music may be helpful to patients who are receiving chemotherapy to manage anxiety related to the treatment.

• The study had a small sample, with less than 100 patients.
• The study had a high risk of bias since there was no blinding of patients or the researcher who also obtained and analyzed the data.
• The report provided no analysis or findings regarding patient demographics or other characteristics that could have influenced results seen.
• The setting was not described, and it is not clear whether patients in the experimental group received the intervention in private, or if the music would have also been overheard by others in the area.
• Changes in VAS results were small, so, although some were statistically significant, clinical significance of changes was not discussed.
• Appropriate attentional control was not provided, so it cannot be determined if findings had to do with use of live music or if any type of distraction would have achieved the same results.

Findings suggest that distractions such as live music as provided here can be helpful to patients during chemotherapy. This is a low-risk intervention that might be of benefit for some patients.

Pain-related instruction was given by a nurse with 10 years’ experience in oncology and 2 years’ experience in cancer pain management.

• Part I: general information about pain
• Part II: pharmacologic information
• Part III: principles and techniques of nondrug management of pain

Audiotapes of verbal content were left with patients and caregivers at the end of each of the first two sessions. Each session was approximately one hour long, with five total visits—three to provide information and two for follow-up. Cost was $50 per patient to purchase nondrug intervention equipment such as cold packs, massagers, and relaxation tapes. Caregivers and patients were present at each visit.

• N = 50 family caregivers of patients who were 60 years of age or older, diagnosed with cancer, had reported cancer-related pain for at least three months, and used opioid analgesics.

• Home

The study design was quasi-experimental with major limitations.

• Caregiver burden tool
• Quality of life tool
• Family pain questionnaire

Significant improvements were found in quality of life (psychological well-being, social well-being, and total quality of life) from pre- to postintervention.

The intervention was associated with improvements in caregivers’ knowledge about pain and their experience caring for patients in pain.

The study had no randomization, post-test mean scores were not provided, and significance testing was not supplied. Caregiver burden scores were reported only at baseline.

The purpose of the study was to evaluate the efficacy of using heparin versus M-EDA for locking central venous catheters and preventing infection.

Prospective blood cultures were obtained at the beginning of the study and at each chemotherapy session at weekly or monthly intervals according to each chemotherapy protocol. Aseptic technique was used to collect 10 ml of blood for each culture. Cultures obtained from the catheters also were obtained with catheter removal. Primary outcome was positive blood culture or clinical evidence of bacteremia or sepsis associated with the catheter, regardless or whether blood cultures were positive or negative. The catheter-locking solution had the same volume as each catheter’s priming solution. It was slowly introduced (in at least 10 seconds) after each chemotherapy session, and remained in the catheter lumen until the next session.

• The sample consisted of 50 patients, 26 in the heparin arm (group 1) and 24 in the M-EDTA arm (group 2).
• Age range was not given, but patients were classified as pediatric.
• All patients with blood cancers and solid tumors (group 1 contained 16% blood cancers and 10% solid tumors; group 2 contained 16% blood cancers and 8% solid tumors) were included.
• All patients were undergoing chemotherapy, had an implanted port-a-cath CVC, and were clinically stable.
   

Single-site inpatient/outpatient facility in Sao Paulo, Brazil
 

• The phase of care was active treatment
• Application was for pediatrics and CVCs
   

Prospective, randomized study

Blood cultures

A total of 762 serial prospective blood cultures were obtained, 387 from group 1 and 375 from group 2. In group 1, 19 blood cultures were positive and infection incidence was 73.1% (19 of 26 ports); in group 2, five blood cultures were positive and the incidence rate was 20.8% (5 of 24 ports). This difference was significant (p = 0.0001). The colonization of catheters was 5.7 times greater in group 1 than group 2. The mean time free of catheter infection in group 1 was 4.72 months, significantly shorter than in group 2, where it was 9.69 months (p = 0.002). The chances of hospitalization were two times greater for children in the heparin group. There were no side effects observed from either treatment.

The results of this study suggest a significant benefit for children using M-EDTA as a CVC lock as opposed to straight heparin for prevention of catheter-associated infections. The EDTA is a strong cation with chelating properties that destroys the buildup within the lumen. Minocycline is a great broad spectrum antibiotic that is never used for anything but orally for acne.

• Small sample size (less than 100 participants), and too few completed study. 
• No blinding with associated risk of bias.
• It is unclear if differences in hospitalizations between the two groups were related to infection, or if the infection differences seen may have been in part a result of more hospitalizations.
• Specific ingredients and proportions in the solution used are not provided. 
• No subgroup analysis was conducted for hematologic and solid tumors, where infection risk may be very different.  
   

The nurse would not be able to use this without a physician's order, unless it was SOP for that facility. If it were SOP, then nurses could use the solution to flush and lock the CVCs.

This approach shows great promise and would be simple to implement in a clinical setting. Further research is warranted to provide additional support for its efficacy.

STUDY PURPOSE: To evaluate the effects of topical agents in the prevention of radiodermatitis

TYPE OF STUDY: Systematic review

• FINAL NUMBER STUDIES INCLUDED = 13 
• TOTAL PATIENTS INCLUDED IN REVIEW = 938
• SAMPLE RANGE ACROSS STUDIES: 13–331
• KEY SAMPLE CHARACTERISTICS: Radiotherapy doses ranged from 10–80 Gy or greater. All had head and neck cancer, and eight studies included patients with other types of cancer. Seven studies included patients who had combination radiation and chemotherapy.

PHASE OF CARE: Active antitumor treatment

Four studies evaluated trolamine. Other interventions were aloe vera, olive oil, Lianbai liquid, sucralfate, Na-SOS, hyaluronic acid, and dexpanthenol. No strong evidence showed differences between topical treatments and control interventions.

The evidence was insufficient to support the use of any of the topical interventions examined.

• Limited number of studies included
• Unclear if the topical use of steroids was excluded

Insufficient evidence shows the effectiveness of topical agents for the prevention of radiodermatitis.

To examine the effectiveness of a patient navigator after a suspicious mammogram in urban minority women in improving the time to diagnosis, decreasing anxiety, and increasing satisfaction

Women with suspicious mammogram findings were identified from radiology logs and contacted to participate. Women were told that the hospital was conducting a study to better understand their experience, in order to blind participants. Patients were randomly assigned to control/usual care or usual care plus patient navigation (intervention group). The navigator provided patients with emotional and social support, helped make appointments and arrive for appointments, facilitated financial assistance applications, provided information on resources and support systems, and facilitated interaction with healthcare providers and staff. The navigator had a bachelor’s degree in social relations and previous experience in counseling and community outreach, and was previously a volunteer for a breast cancer support group. The navigator underwent additional training and had ongoing mentoring with an oncology social worker. Study instruments were administered at the time of study enrollment and one month after resolution—either determination of benign diagnosis or initiation of cancer treatment.

• The study reported on a sample of 105 female patients: 55 in the intervention group and 50 in the control group.
• Mean patient age was 50.1 years ± 11.6.
• Patients had suspicious mammography findings: 15 in the intervention group and 11 in the control group were diagnosed with cancer.
• Of the sample, 60% had no insurance, 59% were black, 28% were Hispanic, 32% were married, 76% had a high school education or less, 63% did not have a previous abnormal mammogram, 81% had no family history of breast cancer, and 52% had no regular source of primary care.

• Single site
• Outpatient setting
• Urban university hospital in Newark, NJ

Patients were undergoing the diagnostic phase of care.

A randomized, single-blind, controlled trial design was used.

• Zung Anxiety Self-Assessment Scale
• Satisfaction With Hospital Care Questionnaire

Women in the intervention group had a shorter time to diagnosis (p = 0.001). Women in the intervention group had significantly lower anxiety at follow-up (p < 0.001) and a significantly greater reduction in anxiety from baseline to follow-up (p < 0.001). Baseline anxiety scores were similar in both groups. While anxiety declined in the intervention group, in the control group, anxiety scores were increased at follow-up compared to baseline. Satisfaction scores were significantly higher in the intervention group (p < 0.001). There were no differences between groups in demographic findings, and results indicated that effectiveness of the intervention did not differ associated with demographic characteristics. The mean time to diagnosis was 14.3 days in the intervention group, compared to 33.9 days in the control group.

The use of a patient navigator was effective to improve timeliness of diagnosis, reduce anxiety, and increase satisfaction in this group of patients.

• The study excluded a high proportion of the potential study population who did not speak English, since the navigator did not speak a foreign language.
• Subgroup analysis based on ethnicity and other factors may not have detected differences due to the small sample sizes in these subgroups.
• There was an overall low enrollment rate (36%) of the eligible population; this suggests that findings may be biased by self-selection of the study participants.
• There was no ability to compare study results to those in the general population who did not participate.

Findings show that patient navigation is an effective strategy to improve timeliness of diagnosis, anxiety, and satisfaction in a group of poor urban minority patients. Findings also show that many of these types of patients refused to participate, suggesting predominance of issues such as mistrust in this population. This suggests that assistance to this group of patients remains a challenge. Future research in this area needs to incorporate mechanisms to study those patients who also do not speak English. Larger sample sizes in this area of research are needed to further examine differences in outcomes based on demographic characteristic of potential relevance.