Chow, K.M., Chan, C.W., Chan, J.C., Choi, K.K., & Siu, K.Y. (2014). A feasibility study of a psychoeducational intervention program for gynecological cancer patients. European Journal of Oncology Nursing, 18, 385–392.
To test the feasibility of the implementation of a psychoeducational intervention program for patients with gynecologic cancer
This study consisted of a series of interventions consisting of multiple components based on a thematic counseling model for patients with newly diagnosed gynecologic cancers. Blinding was performed at randomization. Quantitative data on sexual functioning, uncertainty, quality of life, anxiety, depression, and support systems were collected at recruitment, following surgery, during hospitalization, and eight weeks following surgery. Both quantitative and qualitative methods were used in the data analysis. The intervention consisted of four psychoeducational sessions. An individual format was used for the first three sessions and a group format was used for the last session. All intervention sessions were conducted by the researcher. The researcher also met with the control group on four occasions during the same period: at recruitment, after surgery, once in-hospital, and once via telephone four weeks following surgery during which participants were invited to attend a support group. The researcher was a registered nurse experienced in gynecologic cancer care.
Single-blinded, randomized trial with a mixed-methods design
Thirteen patients were in the intervention group and 13 were in the control group. There were no statistical differences between the populations of the two groups. The compliance rate was 69.2% in the intervention group with the greatest lack of compliance occurring during the final session. The compliance rate for the control group was 46.2%. Statistic significance regarding trends of change in the outcome variables was not obtained. There was no statistic significance in the comparison of baseline outcome variables of the two groups. There was no statistic significance of intervention effects between the two groups, except in the area of uncertainty. The inconsistency subscale showed a statistic significance between the two groups with the intervention group receiving less inconsistent information regarding their illnesses. The intervention group demonstrated better trends for improvement than the control group in all categories although there were contradictory results in the scales measuring quality of life, perceived social support, anxiety, and depression.
This patient population has healthcare needs that currently are not being met. This particular study did not show statistically significant results regarding anxiety, depression, quality of life, and sexual functioning in patients with gynecologic cancer. Further research is indicated.
Further research is indicated regarding anxiety, depression, quality of life, and sexual functioning in patients with gynecologic cancer, particularly during the postoperative period. This study showed trends for overall improvement, indicating the importance of nursing in this population. Understanding the implications of cultural differences regarding the effects of gynecologic therapies is an important nursing responsibility.
Choo, S.P., Kong, K.H., Lim, W.T., Gao, F., Chua, K., & Leong, S.S. (2006). Electroacupuncture for refractory acute emesis caused by chemotherapy. The Journal of Alternative and Complementary Medicine, 12, 963-969.
To evaluate the use of electroacupuncture in preventing anthracycline-based chemotherapy-related nausea and vomiting (CINV) refractory to combination 5-HT3-antagonist and dexamethasone
Patients received electroacupuncture in addition to standard antiemetic prophylaxis. Acupuncture was started 10 minutes prior to start of chemotherapy infusion and then continued for an additional 20 minutes. The P6 acupuncture point was used, a second needle was inserted at a different point, and electrical stimulation was delivered.
This was a prospective trial.
Choi, T.Y., Lee, M.S., Kim, T.H., Zaslawski, C., & Ernst, E. (2012). Acupuncture for the treatment of cancer pain: A systematic review of randomised clinical trials. Supportive Care in Cancer, 20, 1147–1158.
To perform a combined systematic review and meta-analysis to assess the effectiveness of acupuncture for treating cancer pain
The study has clinical applicability for palliative care.
Most of the studies involved manual acupuncture based on traditional Chinese medicine. In regard to effect on cancer pain, the majority of the studies found the effects of acupuncture and conventional drug therapy to be comparable; however, equivalence of effects is unclear in those studies reporting no differences between acupuncture and conventional drug therapies.
Acupuncture may be an effective intervention for controlling pain; however, due to the small number of RCTs, low methodological quality, and small sample sizes, the results of the meta-analysis did not provide strong evidence of such effectiveness.
Further research is needed to evaluate this nonpharmacologic intervention for relieving cancer pain.
Choi, T.Y., Kim, J.I., Lim, H.J., & Lee, M.S. (2016). Acupuncture for managing cancer-related insomnia: A systematic review of randomized clinical trials. Integrative Cancer Therapies. Advance online publication.
STUDY PURPOSE: To evaluate the efficacy of acupuncture to relieve cancer-related insomnia
TYPE OF STUDY: Systematic review
PHASE OF CARE: Not specified or not applicable
Two trials compared acupuncture to sham acupuncture in patients with breast cancer: one trial showed positive effects as reported in a sleep diary, and one trial did not show that acupuncture was beneficial as measured by the Pittsburgh Sleep Quality Index (PSQI). Three trials compared acupuncture to sleeping medications: two trials showed improved sleep with acupuncture as measured by PSQI when compared to drugs, and one trial did not show a benefit. One trial that compared acupuncture to hormone therapy in patients with breast cancer showed improved sleep with acupuncture. Overall, the trials had a low risk of bias, except for participant and personnel blinding, because of the nature of acupuncture. Few adverse events were reported with acupuncture but included fatigue, pruritis, and nausea.
Mixed evidence about the effectiveness of acupuncture to relieve cancer-related insomnia compared to medications exists. In the current review, acupuncture may be superior to sham acupuncture, conventional drug therapy, and hormone therapy for the management of cancer-related insomnia. The level of evidence is low because of a limited number of trials and total sample size.
Acupuncture has been examined as an intervention to relieve cancer-related insomnia, and a small number of studies show mixed evidence about its effectiveness. Additional trials that report standard acupuncture methodology and use objective sleep outcome measures are needed before nurses can recommend acupuncture as an effective treatment to relieve insomnia.
Choi, M.R., Jiles, C., & Seibel, N.L. (2010). Aprepitant use in children, adolescents, and young adults for the control of chemotherapy-induced nausea and vomiting (CINV). Journal of Pediatric hematology/oncology, 32(7), 268-271.
To describe one institution’s experience with using aprepitant to control chemotherapy-induced nausea and vomiting (CINV) in children with cancer who were receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) by conducting a retrospective chart review
This was a retrospective review of charts from Aug 2005 until May 2007 in the authors’ institution. The authors divided children into two groups based on whether they were given two or three antiemetic agents. Children in regimen 1 (n = 20) received 0.15 mg/kg ondansetron three times per day, 0.15 mg/kg (maximum of 20 mg) dexamethasone, and 125 mg aprepitant on day 1 followed by 80 mg aprepitant on days 2 and 3. Children in regimen 2 (n=12) received only ondansetron and aprepitant. Aprepitant was given to 24 out of 32 children whose weight was more than 20 kg at the above mentioned dosing. Children weighing less than 20 kg received 80 mg days 1–3. One child whose weight was less than 15 kg received 80 mg on day 1 and 40 mg on day 2 and 3.
The study was conducted at a single inpatient setting in the United States.
All patients were undergoing the active phase of treatment care.
This was a retrospective chart review.
The authors reported that children younger than 12 years or weighing less than 40 kg received reduced aprepitant doses. However, they did not report how many children fell into this group, only that the mean age was 10.
Based on this report, we know that 19 children in the regimen 1 (dexamethasone, ondansetron, and aprepitant) group did very well compared to the younger children in the regimen 2 group (ondansetron and aprepitant). In this report, dexamethasone was not reduced as suggested (12 mg on day 1 followed by 8 mg on days 2 and 3).
This retrospective study shows that aprepitant triple therapy, when combined with standard antiemetics, was well-tolerated in pediatric patients (mean age of 10 years) receiving HEC or MEC. Aprepitant was safe and well tolerated in patients age 18 or younger and improves control of CINV in children.
Aprepitant in combination with standard antiemetics is well tolerated in children. More prospective studies are needed to identify the most effective way to use aprepitant for children undergoing chemotherapy. Children with cancer who weigh more than 20 kg benefit if aprepitant is given at 125 mg on day 1 and 80 mg on days 2–3. Dexamethesone may need to be adjusted from standard dosing to 12 mg on day 1 and 8 mg on days 2 and 3 because of altered metabolism of corticosteroids by aprepitant’s inhibition of CYP3A4. Pediatric oncology nurses should be knowledgeable in cytochrome P450 enzymes and drug-drug interactions. Future research should focus on using aprepitant in very young children (less than 10 years of age or less than 40 kg weight).
Choi, H.S., Kim, K.O., Chun, H.J., Keum, B., Seo, Y.S., Kim, Y.S., . . . Ryu, H.S. (2012). The efficacy of transdermal fentanyl for pain relief after endoscopic submucosal dissection: A prospective, randomised controlled trial. Digestive and Liver Disease , 44, 925–929.
To investigate the efficacy and safety of fentanyl patches for pain relief after endoscopic submucosal dissection
Patients were randomized to a fentanyl patch or placebo control group. Patients in the patch group were instructed in the use of the patch, which they applied the night before the procedure. Pain was assessed immediately before and immediately after the endoscopy. Maximum pain during the 24 hours following the endoscopy was assessed at discharge. All patients received IV propofol and cimetropium bromide during the procedure. Fentanyl patches used were 12 mcg patches.
Phase of care: diagnostic
Randomized double-blind placebo-controlled trial
The study used a numeric rating scale to measure pain.
Findings show that fentanyl patches applied prior to endoscopic submucosal dissection are safe and effective in reducing postprocedural pain.
Usual treatment for endoscopy pain can involve frequent injections. Since fentanyl patches can be applied prior to a procedure, they may provide more comfort than injected as-needed pain medications can. This study showed that, compared to placebo, a low-dose fentanyl patch applied prior to endoscopic dissection was effective in reducing pain and was not associated with adverse effects. The approach the study outlines is novel and may be applicable to various groups of patients who could experience acute pain.
Choi, E., Nahm, F.S., & Lee, P.B. (2015). Sympathetic block as a new treatment for lymphedema. Pain Physician, 18, 365–372.
To study the effects of thoracic a sympathetic ganglion block (TSGB) in treating breast cancer-related lymphedema
The medical records of patients who received a TSGB were reviewed. Findings were compared between patients who were grouped according to therapeutic efficacy. TSGBs were performed under fluoroscopic guidance. An injection of contrast agent was used to confirm the proper positioning for the injection of lidocaine. Patients had arm circumference measurements and completed the Lymphedema and Breast Cancer Questionnaire two weeks and two months after the TSGB procedure. Arm circumference was measured at the axilla, upper arm, elbow, lower arm, and wrist.
Retrospective, descriptive study
The most frequent lymphedema severity was stage 2, which involved visible edema, usually with pitting and hardened, thickened skin and tissue (37.5% of cases). Arm circumference measures at all locations decreased significantly at two weeks after the procedure (p < 0.05). There was no significant additional decrease between two weeks and two months after the procedure. Questionnaire results also showed a significant reduction in symptoms at two weeks (p < 0.001) with no additional improvement between two weeks and two months. Overall, 65.7% of participants were deemed to have effective TSGB results. Those with more severe lymphedema tended to have the most improvement.
TSGBs may be a useful option for the management of breast cancer-related arm lymphedema. The mechanism by which this may be effective is unclear, and the duration of any improvement is not yet clear.
TSGBs may be an alternative option for patients with breast cancer-related arm lymphedema for whom conservative and standard treatments were unsuccessful. Additional research providing sufficient evidence for the effectiveness and identification of patients for whom the intervention is appropriate is needed.
Choi, S. W., Chang, L., Hanauer, D. A., Shaffer-Hartman, J., Teitelbaum, D., Lewis, I., . . . Niedner, M. F. (2013). Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods. Pediatric Blood and Cancer, 60, 262–269.
To investigate the effects of the implementation of a central line catheter care bundle on infection rates.
A working group comprised of physicians specializing in pediatric hematology-oncology, infectious diseases, anesthesiology, and surgery, as well as infection-control professionals, a phlebotomy service leader, and several nursing leaders, was formed to focus on improvement in central line-associated blood stream infection (CLABSI) rates. Team members were educated in quality improvement for a four-month period and developed techniques to improve the safety culture, identify best practices for insertion and line maintenance, and disseminate information to clinical care providers. A catheter care bundle was implemented, including proper hand hygiene, dressing change frequency, skin cleansing with chlorhexidine, tubing changes at least every 96 hours, chlorhexidine used for bathing, and standards for central line entry. Pre- and postimplementation data were analyzed at six months from the beginning of the effort and at 17 months.
This was a descriptive observational study.
Self-reported adherence to catheter bundle care was more than 90% in most areas. Lowest compliance areas were bathing practices and “all or none” (compliance with everything) areas in the first six months. These both improved to more than 85% at 17 months. The preintervention CLABSI rate was 5.55% in patients undergoing bone marrow transplantation (BMT) and 1.81% in non-BMT patients. Postintervention CLABSI rates were 2.96% in BMT patients and 1.04% in non-BMT patients (p < 0.04). Patient safety culture survey results reflected improvement; however, sample sizes were small with low response rates, and comparisons were not statistically significant.
Findings showed that the institutional initiative used here was effective in reducing CLABSI rates.
Comprehensive institutional initiatives can improve quality of care. Catheter care bundle implementation was effective in reducing overall CLABSI rates as measured here. Results showed that it took time to achieve improvement in compliance with all aspects of catheter care.
Choi, C.H., Kim, M.K., Park, J.Y., Yoon, A., Kim, H.J., Lee, Y.Y., . . . Bae, D.S. (2014). Safety and efficacy of aprepitant, ramosetron, and dexamethasone for chemotherapy-induced nausea and vomiting in patients with ovarian cancer treated with paclitaxel/carboplatin. Supportive Care in Cancer, 22(5), 1181–1187.
To evaluate the efficacy of aprepitant, ramosetron, and dexamethasone 20 mg on chemotherapy-induced nausea and vomiting (CINV) in women with ovarian cancer receiving paclitaxel/carboplatin
On day 1, one hour before chemotherapy, patients received 125 mg oral aprepitant, 0.6 mg IV ramosetron, and 20 mg IV dexamethasone (over 30 minutes). On days 2 and 3, patients received 80 mg aprepitant. Vomiting episodes and use of rescue therapy were recorded for 120 hours after chemotherapy was administered. A daily Visual Analog Scale was completed on the first five mornings after chemotherapy. Rescue medications were permitted throughout the study, and type of medication was at the treating physicians' discretion.
Prospective, nonrandomized trial
98.8% of patients had CR in the acute phase, 89.4% in the delayed phase, and 89.4% overall. Patients over age 55 had a significantly higher rate of CR (97.8%) than those younger than 55 (80%) (p = 0.011). 95.3% of patients experienced no vomiting in the overall phase, and 91.8% took no rescue medications in the overall phase. Overall CR (89.4%) achieved in cycle 1 was maintained in cycles 2–6. Four hundred and sixty cycles were analyzed for adverse events. Results are as follows: ≥ 1 adverse event occurred in 179 (38.9%) cycles, drug-related adverse events occurred in 35 (7.6%) cycles, and serious adverse events occurred in 10 (2.2%) cycles. No patients discontinued therapy due to adverse events.
The combination of aprepitant, ramosetron, and dexamethasone for CINV is highly effective in the acute and delayed phases after chemotherapy administration. CR is achieved by a high number of patients for the six days following chemotherapy.
Nurses can educate patients on the available pharmacologic options to control CINV, including the combination of aprepitant, ramosetron, and dexamethasone.
Cho, H.K., Jeong, Y.M., Lee, H.S., Lee, Y.J., & Hwang, S.H. (2015). Effects of honey on oral mucositis in patients with head and neck cancer: A meta-analysis. The Laryngoscope, 125, 2085–2092.
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: None stated
Administration of Honey Versus Control (Mucositis-Related Adverse Effects)
This study demonstrated the potential efficacy of honey administration in the prevention of oral mucositis and weight loss during radiotherapy and chemotherapy in patients with head and neck cancer.