Chanwimalueang, N., Ekataksin, W., Piyaman, P., Pattanapen, G., & Hanboon, B.K. (2015). Twisting Tourniquet® technique: Introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities. Cancer Medicine, 4, 1514–1524.
To describe the clinical effectiveness of a particular device in decongestive therapy
The Schnogh device consists of fabric and other parts that enable a spiral twisting that delivers sequential compression for 15 minutes followed by decompression for five minutes over the course of an hour. Patients analyzed in this study completed five days of treatment over one week.
Prospective, descriptive study
The average percent limb volume reduction was 50.2% for upper extremities and 55.6% for lower extremities.
Decompression therapy as provided with the device described here was effective in reducing lymphedema volume.
Complete decongestive therapy is effective for lymphedema reduction with most evidence describing its use in upper extremities. The findings in this study suggested that this device can provide similar results with no manual decongestive component. Additional well-designed studies are needed to confirm that this approach yields comparable or better results than current treatments.
Chanthawong, S., Subongkot, S., & Sookprasert, A. (2014). Effectiveness of olanzapine for the treatment of breakthrough chemotherapy induced nausea and vomiting. Journal of the Medical Association of Thailand = Chotmaihet Thangphaet, 97, 349–355.
To evaluate the safety and efficacy of olanzapine for breakthrough emesis in addition to standard antiemetic regimen in patients with cancer receiving highly emetogenic chemotherapy
All patients were treated with the institutional standard for HEC: ondansetron 24 mg IV BID and dexamethasone 10 mg IV BID on day 1. Oral metoclopramide 10 mg TID plus dexamethasone 10 mg po BID were given on days 2 and 3. Oral olanzapine 5 mg was given after the first vomiting episode. Twelve hours later, the second dose was given concurrently with the standard prevention regimen.
Complete response of breakthrough emesis was 60.9%, retching was 71.7%, and nausea was 50.0%. Adverse events were mild, including dizziness, fatigue, and dyspepsia.
The study demonstrated the effectiveness and safety of olanzapine in the treatment of nausea and vomiting in HEC patients. Olanzapine could be considered for treatment of patients at high risk for breakthrough emesis despite standard prevention. Olanzapine 5 mg every 12 hours for at least 24 hours could be recommended per the study.
Olanzapine is a drug that could be extremely helpful in treatment of CINV. Studies have shown olanzapine to be a safe and effective medication in acute and delayed CINV. The reviewed study attempted to show effectiveness in the breakthrough setting but many limitations were reported and are listed above. The researchers should not conduct CINV studies for “breakthrough” if the patient is given suboptimal treatment upfront.
Chang, J.T., Lin, C.Y., Lin, J.C., Lee, M.S., Chen, Y.J., & Wang, H.M. (2010). Transdermal fentanyl for pain caused by radiotherapy in head and neck cancer patients treated in an outpatient setting: A multicenter trial in Taiwan. Japanese Journal of Clinical Oncology, 40(4), 307–312.
To evaluate the effectiveness of transdermal fentanyl (TF) for pain management in patients with head and neck cancer receiving radiotherapy; to evaluate the effectiveness, safety, and long-term tolerability of TF after initial administration
Patients entered in the trial were instructed in the use of TF. Initial TF dose was 25 mcg/hour, and patches were replaced every three days. Dose was titrated upward as needed, in 25 mcg/hour increments. Patients requiring more than 50 mcg/hour were allowed to use multiple patches to achieve the required dose. Doses greater than 100 mcg/hour were used in exceptional circumstances only. As a treatment for breakthrough pain, patients received immediate-release morphine to be administered as needed, every 2–4 hours. Use of all rescue medications was recorded. Pain was measured by means of a questionnaire that was administered at study entry and after 7, 14, 28, 35, and 42 days. Amount of rescue analgesics and data about constipation, diarrhea, and use of laxatives and antidiarrheals were recorded by patients daily. Investigators summarized the data at each study visit.
Prospective trial
Data suggest that TF can be effective and relatively easy to use, in an outpatient setting, for patients receiving radiotherapy; however, TF was accompanied by a high rate of severe side effects.
Additional research regarding various approaches to pain management, in the cited population, is needed.
Chang, C.J., & Cormier, J.N. (2013). Lymphedema interventions: Exercise, surgery, and compression devices. Seminars in Oncology Nursing, 29, 28–40.
STUDY PURPOSE: To review the current literature regarding the treatment of lymphedema, providing applications of the evidence to the care of patients with cancer, with or at risk for, lymphedema
PHASE OF CARE: Multiple phases of care
The PAL trial provides the strongest evidence to date that progressive resistive exercises may reduce the risk of, and not exacerbate pre-existing, BCRL. However, no clear evidence-based recommendation regarding compression garment use during exercise can be made. Surgical treatment is associated with risk, and should not be considered a first line treatment. IPC devices may play a role in a multi-modality approach. There are no clear evidence-based guidelines for pressure setting use in lymphedema management.
CDT remains the standard in LE therapy, but there is some limited evidence supporting consideration of adjunctive therapies, such as exercise, surgery, and IPC. More RCTs looking at exercise and LE in populations other than those with breast cancer are needed, especially studies with LE of other areas of body, and role of compression garments during exercise. Surgical treatments are promising in LE not responsive to standard therapy. IPC in low to moderate pressure ranges appear to be a safe adjunctive treatment option for appropriate, selective patients, in conjunction with CDT.
Patients with LE need education regarding the benefits of exercise in general health and cancer prevention, tailored to their individual needs and comorbidities. Surgery for LE should not be considered a first-line treatment. Microvascular procedures should be treated by experienced surgeons offering ongoing care with support from certified lymphedema providers. IPC is potentially a valuable adjunctive therapy, and should be prescribed only by practitioners trained at a specialist level. With no clear guidelines for use, the authors recommend the current NLN recommendations for pump pressures from 30-60 mmHG. Additional research is essential in these categories to provide evidence based guidelines and safe, effective patient care for patients with lymphedema.
Chang, C.W., Mu, P.F., Jou, S.T., Wong, T.T., & Chen, Y.C. (2013). Systematic review and meta-analysis of nonpharmacological interventions for fatigue in children and adolescents with cancer. Worldviews on Evidence-Based Nursing/Sigma Theta Tau International, Honor Society of Nursing, 10, 208–217.
STUDY PURPOSE: To review the published evidence on non-pharmacologic interventions for fatigue in children and adolescents with cancer
TYPE OF STUDY: Meta-analysis and systematic review
DATABASES USED: Cochrane Library, Joanna Briggs Institute Library of Systematic Reviews, CINAHL, PsycINFO, Ovid, MEDLINE, ProQuest Dissertations and Theses, the Electronic Theses and Dissertations System, the Index to Taiwan Periodical Literature, Electronic Thesis and Dissertation System (Chinese)
KEYWORDS: experimental study, random study, quasi-experimental study, children, adolescents, pediatric, cancer, oncology, nonpharmacological interventions, massage, exercise, fitness, physical activity, cognitive-behavioral, stress management, energy conservation, sleep therapy, relaxation, distraction, psychoeducation, fatigue, cancer-related fatigue, loss of energy, levels of tiredness, tired, side effect, symptoms
INCLUSION CRITERIA: RCT or quasi-experimental studies; 1–18 years of age, experiencing cancer-related fatigue; maintenance stage or survivor stage; hospitalized or home; acute lymphoblastic leukemia (ALL)/acute myeloid leukemia (AML)/lymphoma/solid tumor; interventions with descriptions of length, frequency setting, and provider, and including activity enhancement, psychosocial interventions, cognitive behavioral therapy, stress management, relaxation, nutrition consultation, massage, or educational interventions; use of validated scales for cancer-related fatigue in outcomes
EXCLUSION CRITERIA: Written in languages other than English or Chinese
TOTAL REFERENCES RETRIEVED = 76
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Retrieved papers reviewed by two independent reviewers with a third for disagreements about methodologic validity
PHASE OF CARE: Multiple phases of care
APPLICATIONS: Pediatrics
Two studies showed no significance in decreasing total fatigue with exercise. Two studies suggested exercise reduced general fatigue (p < .01). No significance was found for sleep/rest fatigue or cognitive fatigue. Study of massage showed no effect on fatigue. Final study used nurse education session on fatigue versus UC with reports that interventions were “effective.”
No study reduced total fatigue in any population. General fatigue was the only fatigue measure with significant improvement in some studies.
The phases of care, tumor type, and age varied. Children may not have had an ability to differentiate fatigue and relaxation, making fatigue perhaps difficult to measure.
Exercise may be a safe intervention for improving general fatigue in children and adolescents experiencing cancer-related fatigue.
Chang, J., Couture, F.A., Young, S.D., Lau, C.Y., & McWatters, K.L. (2004). Weekly administration of epoetin alfa improves cognition and quality of life in patients with breast cancer receiving chemotherapy. Supportive Cancer Therapy, 2, 52–58.
The study's primary aim was to evaluate the effect of epoetin alfa on changes in quality of life and utility scale scores at week 12. Its secondary aim was to evaluate transfusion reduction and hemoglobulin level increase.
Participants were screened at the initiation of chemotherapy with hemoglobin (Hgb) levels ≤ 15.0 grams per deciliter (g/dL). Randomization occurred when the Hgb level was decreased to 12.0 g/dL. They received 40,000 IU of erythropoietin subcutaneously each week for 16 weeks or for 4 weeks after the completion of chemotherapy, whichever was longer (the maximum amount of time participants could receive erythropoietin was 28 weeks).
This multi-site study was conducted in Canada.
The study was a phrase III, randomized, open-label, multi-center trial.
Based on the subscale HUI survey, significant improvement in cognition (p = 0.02) was found in participants who received erythropoietin.
No objective measure for cognitive function was used.
Chandwani, K.D., Perkins, G., Nagendra, H.R., Raghuram, N.V., Spelman, A., Nagarathna, R., . . . Cohen, L. (2014). Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. Journal of Clinical Oncology, 32, 1058–1065.
To test whether participation in yoga during radiation therapy would have long-term effects on fatigue, depression, and sleep disturbances
Patients were randomly assigned to one of three groups: a yoga group, an exercise group, and a wait list control group. Yoga and exercise groups attended up to three 60-minute sessions per week during six weeks of radiation therapy. These were given one-on-one or in groups according to the patient’s convenience and schedule. Each received a CD and written program manual to encourage at-home practice. The yoga program included warm-up breathing, postures, deep relaxation, alternate nostril breathing, and meditation. The exercise program included exercises specifically recommended for women recovering from breast cancer treatment involving multiple positions and stretching. Study assessments were done at baseline, during the last week of treatment, and at one, three, and six months after treatment.
Greater increases in physical component scores of the SF-36 were seen in the yoga group compared to both other groups at one and three months (p = .01). The yoga group (p = .04) and exercise group (p = .02) had greater reduction in fatigue compared to wait list controls at the end of treatment. These differences were not significant at other time points. Fatigue consistently declined over time in all patient groups. Sleep quality improved in all groups over time with no significant differences between groups.
Both yoga and exercise were associated with reduced fatigue by the end of radiation treatment; however, these effects were not maintained over the following six months.
Findings showed that both yoga and exercise programs during radiation therapy were beneficial in reducing fatigue. Fatigue declined over time in all patients, and effects seen by the end of treatment did not appear to last. The follow-up information here is limited by the high number lost to follow-up, showing the difficulty of conducting longitudinal examination of intervention effects. Nurses can recommend that patients participate in programs such as yoga and exercise during active cancer therapy.
Chan, R.J., Webster, J., Chung, B., Marquart, L., Ahmed, M., & Garantziotis, S. (2014). Prevention and treatment of acute radiation-induced skin reactions: A systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 14, 53-2407-14-53.
TOTAL REFERENCES RETRIEVED: 8,599
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Risk of bias was assessed according to the Cochrane handbook
PHASE OF CARE: Active antitumor treatment
Forty-seven studies on the six types of interventions for managing RISR were reviewed (oral systemic medications, skin care practice [washing and deodorant], steroidal topical ointment/cream, dressings, nonsteroidal cream/ointment, and LED vs sham treatment). The results of a meta-analysis of Wobe Mugos versus a control showed an odds ratio of 0.13 (p < 0.0004) in favor of Wobe Mugos. There was a mean difference of -09/92 (p < 0.0001) for Wobe Mugos treatment across two studies including 219 patients. Pentoxifylline was not shown to have an effect. Oral sucralfate and oral antioxidants did not show an effect. Various topical steroids showed mixed results. A meta-analysis of trolamine showed no significant benefit. Washing the skin and using deodorants did not affect skin toxicity scores. Evidence was restricted because of the variation of interventions as it was not easily detectable which products would be most effective. There was no strong evidence for any of the products included in the study. The study quality of most of the included RCTs was only fair, and there were few interventions that were examined in multiple studies.
Additional research studies establishing the effectiveness of multiple skin care products is needed. The findings of this meta-analysis in regard to Wobe Mugos were positive, suggesting that additional, well designed research is warranted.
Additional research on skin care products used to manage RISR is needed.
Chan, R. J., Larsen, E., & Chan, P. (2012). Re-examining the evidence in radiation dermatitis management literature: an overview and a critical appraisal of systematic reviews. International Journal of Radiation Oncology, Biology, Physics, 84, e357–e362.
To review the evidence for interventions to prevent and manage radiodermatitis.
Databases searched were MEDLINE, CIHANL, EMBASE, and Cochrane. Key journals were manually searched.
The primary aim was to review the efficacy of interventions for preventing and managing radiodermatitis. The article was published in a peer-reviewed publication.
The following were excluded from the review: unpublished work, abstracts, letters, and conference proceedings.
In total, 1,837 references were retrieved. Assessment of multiple systematic reviews (AMSTAR) was used.
There is insufficient evidence to support the use of any particular intervention for preventing or managing radiodermatitis. There were several shortfalls identified in these systematic reviews. It was noted that the outcomes of pain, itching, and quality of life should be incorporated into the research in this area.
There was high variability in the quality of the systematic reviews concerning management and prevention of radiodermatitis.
The study was limited to discussing systematic reviews.
The study points to the continuing issue of insufficient evidence regarding effective interventions to prevent or manage radiodermatitis, as well as design and reporting limitations of many of the studies in this area. Further research is needed in this area.
Chan, R.J., Mann, J., Tripcony, L., Keller, J., Cheuk, R., Blades, R., . . . Walsh, C. (2014). Natural oil-based emulsion containing allantoin versus aqueous cream for managing radiation-induced skin reactions in patients with cancer: A phase 3, double-blind, randomized, controlled trial. International Journal of Radiation Oncology, Biology, Physics, 90, 756–764.
To investigate the effects of a natural, oil-based emulsion containing allantoin versus aqueous cream for preventing and managing radiation-induced skin reactions
Patients received either cream 1 (the natural, oil-based emulsion containing allantoin [Moogoo Udder Cream]) or cream 2 (aqueous cream). The allantoin emulsion contained multiple other ingredients, including aloe. Patients were stratified by irradiated site, body mass index, and smoking status, and they randomly were assigned to the intervention. Patients applied the cream to irradiated skin twice daily or more as needed. If moist desquamation occurred, the treatment was discontinued until healing occurred. Study assessments were completed weekly. The creams for both arms had a similar appearance and were manufactured in a plain tube. The participants and researchers remained blinded until the end of the study when codes on the tubes revealed the study arm. Inter-rater reliability was measured and resulted in an intraclass correlation of 1.0 (perfect agreement). A sample size calculation was conducted; 81 participants were required for each arm, and ≥ 81 participants completed each arm.
Double-blinded, blocked, randomly assigned, controlled, phase III clinical trial
Patients who received cream 1 had a significantly lower average CTCAE score at week 3 (p < 0.05) but had statistically higher average levels of skin toxicity at weeks 7, 8, and 9 (all p < 0.001). Similar results were observed when skin toxicity was analyzed by grades. In regard to pain, patients in the cream 2 group had significantly higher average worst-pain scores (p < 0.05) and itching (p = 0.046) compared to the cream 1 group at week 3; however, these differences were not observed during other weeks. In addition, there was a strong trend for cream 2 to reduce the incidence of grade 2 or more skin toxicity in comparison with cream 1 (p = 0.056). Overall, more participants in the cream 1 group were required to use another topical treatment at weeks 8 (p = 0.049) and 9 (p = 0.01).
Overall, this was a well designed study. However, some participants used prescribed creams in addition to the assigned study cream, making it difficult to know the true effects of the study creams. The cream containing allantoin performed better during the first five weeks of treatment but worse thereafter.
Additional studies with improved “buy-in” from participant healthcare providers to reduce the use of non-study creams are needed. This study does not provide strong evidence for the effectiveness of this intervention as findings varied at different time points and there were several study limitations. Nurses' awareness of the importance of using the CTCAE for grading skin toxicities related to topical treatments is vital in standardizing assessments. Moogoo Udder Cream is available in the United States (http://moogoousa.com/udder-cream-skin-milk.html), but not in stores.