Cauwels, R.G., & Martens, L.C. (2011). Low level laser therapy in oral mucositis: A pilot study. European Archives of Paediatric Dentistry, 12, 118–123.
To study the capacity of pain relief and wound healing of low-level laser therapy (LLLT) in chemotherapy-induced oral mucositis in a pediatric population
Children were treated using a GaAIAs diode laser with 830 nm continuous wavelength an output of 150 mW. Laser was applied every 48 hours until complete healing of the lesion occurred.
The study was conducted at a single site in Belgium.
The study used a convenience sample.
Fifty episodes of oral mucositis were included. Pain scores improved after each session with only one exception.
The LLLT appeared to be effective for pain relief in this population.
Castaman, G., Bona, E.D., Schiavotto, C., Trentin, L., D'Emilio, A., & Rodeghiero, F. (1997). Pilot study on the safety and efficacy of desmopressin for the treatment or prevention of bleeding in patients with hematologic malignancies. Haematologica, 82, 584–587.
To determine if desmopressin use is effective to prevent bleeding episodes for patients with thrombocytopenia due to bone marrow failure or idiopathic thrombocytopenic purpura (ITP)
Desmopressin was delivered as 0.4 microgram/kg diluted in 100 mL of NS infused over 30 minutes. Bleeding time was assessed (using standard procedure) before the start of infusion and at one and four hours postinfusion. It is not clear how patients were chosen for inclusion in this study but all had a bleeding event.
All of the patients had a favorable response after one infusion of desmopressin. Bleeding time slowed during infusion and stopped usually within one hour. No nasal packing was required. Patients were able to have scheduled dental procedures, none required platelet transfusions, and no significant side effects were noted from the desmopressin. None of the patients had evidence of disseminated intravascular coagulation.
The findings of this pilot study are interesting to consider for hematologic malignancy groups of patients who receive multiple platelet transfusions and are at risk to become refractory to platelets. Further experimentation is needed to validate the results found here, but on a case-by-case basis, desmopressin infusion could be helpful to decrease bleeding time in thrombocytopenic patients.
At this time, this pilot study does not warrant a change in practice due to its severe limitations of generalizability. There needs to be randomized, clinical trials before a change in practice can be endorsed.
Castagna, L., Bramanti, S., Levis, A., Michieli, M. G., Anastasia, A., Mazza, R., . . . Santoro, A. (2010). Pegfilgrastim versus filgrastim after high-dose chemotherapy and autologous peripheral blood stem cell support. Annals of Oncology, 21, 1482–1485.
To demonstrate that one single fixed dose of pegfilgrastim (PEG) was not inferior compared to daily doses of filgrastim after high-dose chemotherapy (HDC) and autologous peripheral stem cell transplant.
Comparisons between two different granulocyte colony-stimulating factors (G-CSFs) (i.e., PEG and filgrastim) were highlighted in this article. The researcher wanted to reveal that PEG is the same high quality as filgrastim after receiving HDC and peripheral blood stem cells starting from day 1. A single fixed dose of PEG was given 24 hours after stem cell infusion. In the control arm, 5 mcg/kg/day of filgrastim was given from day 1 until absolute neutrophil count (ANC) recovered to greater than .5x 109/l. Each setting followed its own supportive care and prophylaxis guidelines; however, all patients received quinolone prophylaxis.
This was an open-label, randomized study with a noninferiority design.
This study illustrated that the use of a single fixed dose of PEG was not inferior to the use of daily filgrastim. There were no significant differences in measured outcomes between the two groups and no differences in treatment side effects.
PEG can be use alternately to filgrastim as it is only given as one single fixed dose of 6 mg as compared to daily doses of filgrastim. Infection-related outcomes studied were not different between these two treatment approaches.
Use of a single dose of PEG rather than daily injections of filgrastim may be a useful alternative for these types of patients in order to avoid multiple injections. Findings of this study were limited by sample size, study design issues, and the fact that other prophylactic treatment was not consistent throughout the sample. Further research in this area will be helpful to confirm differences in the relative equivalency of these two approaches.
Castagna, L., Benhamou, E., Pedraza, E., Luboinski, M., Forni, M., Brandes, I., … Dietrich, P.-Y. (2001). Prevention of mucositis in bone marrow transplantation: A double blind randomised controlled trial of sucralfate. Annals of Oncology, 12, 953–955.
To compare placebo to sucralfate for prevention of mucositis in high-dose chemotherapy and bone marrow transplant (BMT)
Treatment was started one day before the regimen. Patients received one 2 g dose pack every three hours during the day and once during the night if awakened for a maximum of 7 per 24 hours until bone marrow (BM) recovery or end of mucositis.
The study reported on 102 patients hospitalized for allogeneic or autologous BMT.
The study was conducted between April 1991 and November 1993.
This was a prospective, randomized, double-blind study.
Patients were examined twice weekly by two physicians only, recorded prospectively, according to adapted Oral and Maxillofacial Surgeon (OMS) criteria for grafted patients.
Cassileth, B.R., Van Zee, K.J., Yeung, K.S., Coleton, M.I., Cohen, S., Chan, Y.H., … Hudis, C.A. (2013). Acupuncture in the treatment of upper-limb lymphedema: Results of a pilot study. Cancer, 119, 2455–2461.
To evaluate the safety and potential efficacy of acupuncture in the treatment of arm lymphedema in women with breast cancer-related lymphedema
Each patient was given acupuncture treatment twice weekly for four weeks. Treatments lasted 30 minutes, as 14 needles were inserted at apecific points determined on the basis of history and consensus of experienced acupuncturists. Arm circumference was measured before and after each treatment.
This was a single-site, outpatient study conducted at Memorial Sloan-Kettering Cancer Center in New York.
This study has clinical applicability for late effects and survivorship.
This was a prospective trial.
Findings suggest that acupuncture can be safely provided to patients with arm lymphedema. However, the benefit is unclear because of study design limitations and the fact that the mean change in lymphedema was very small.
This study provides insufficient evidence to support efficacy of acupuncture for lymphedema management.
Cassileth, B.R., Van Zee, K.J., Chan, Y., Coleton, M.I., Hudis, C.A., Cohen, S., . . . Vickers, A.J. (2011). A safety and efficacy pilot study of acupuncture for the treatment of chronic lymphoedema. Acupuncture in Medicine: Journal of the British Medical Acupuncture Society, 29(3),170–172.
To evaluate the safety and effectiveness of acupuncture in women diagnosed with chronic lymphedema
Women with chronic lymphedema after breast cancer surgery received acupuncture twice a week for four weeks using Acupoint prescription, chosen by consensus from members of the Memorial Sloan Kettering Cancer Center Integrative Medicine Service certified acupuncturists.
The study took place at the Integrative Medicine Service and Department of Epidemiology and Biostatistics at the Memorial Sloan-Kettering Cancer Center in New York.
The study has clinical applicability for late effects and survivorship.
The study used a prospective pilot design.
After nine subjects were treated, four women demonstrated a 30% reduction in limb volume after four weeks of treatment, with no significant adverse events occurring. Some patients did experience minor toxicities, such as slight bruising or minor pain at acupuncture site shortly after treatment.
The pilot study suggests that acupuncture for women with arm lymphedema may be practical and was not associated with significant adverse effects. Further research in this area to establish safety and begin to evaluate effectiveness is planned.
Additional robust randomized controlled trials are needed to evaluate the use of acupuncture for the treatment of lymphedema.
Cassileth, B.R., & Vickers, A.J. (2004). Massage therapy for symptom control: Outcome study at a major cancer center. Journal of Pain and Symptom Management, 28, 244–249.
Promising results warrant a controlled trial.
Cassileth, B. R., & Vickers, A. J. (2004). Massage therapy for symptom control: outcome study at a major cancer center. Journal of Pain and Symptom Management, 28, 244–249.
Patients received one of three types of massage therapy and were asked to report their symptoms posttherapy. Massages were provided by 12 licensed massage therapists. Patients were referred by physicians, nurses, or self. Patients received Swedish, light touch, or foot massage according to their preference. On average, sessions lasted 20 minutes for inpatients and 60 minutes for outpatients.
In total, 1,290 patients were included.
Inpatient and outpatient
Patients reported the level of symptom distress (0–10) on a card prior to and following massage therapy. Comparisons were analyzed by analysis of covariance, with the baseline score as the covariate.
The effect of massage on symptom relief was demonstrated as a positive response with respect to depression.
Cassileth, B.R., & Vickers, A.J. (2004). Massage therapy for symptom control: Outcome study at a major cancer center. Journal of Pain and Symptom Management, 28, 244-249.
Patients with cancer received light touch, Swedish, or foot massage. No control group was included.
The study was conducted in Inpatient and outpatient settings.
A visual analog scale (VAS) was used to measure nausea and vomiting, pain, fatigue, stress, anxiety, and depression.
Just more than half (51%) experienced a decrease in nausea.
A risk of bias exists for nontraditional treatment.
Casley-Smith, J.R. & Casley-Smith, J.R. (1996). Lymphedema initiated by aircraft flights. Aviation, Space and Environmental Medicine, 67(1), 52–56.
To describe reported incidence and triggering factors related to development of lymphedema in patients with lymphedema
Questionnaires were sent to 1,020 patients with lymphedema. The names were taken from the Lymphedema Association of Australia. The questionnaire asked about many aspects of their disease. One of the questions was “What triggered your lymphedema?\" Answer choices were infection, insect bite, plane flight, burn, other, or unknown.
Questionnaires were sent to 1,020 patients with lymphedema. A total of 749 responded to the survey, and 531 of these answered the question about what triggered the lymphedema. Responses were as follows: 41 had the condition since birth, 163 had postmastectomy lymphedemas, 136 had primary and 191 had secondary leg lymphedemas. Of those who did not have the condition since birth (n = 490), 27 claimed that it started during an aircraft flight (15 legs and 12 arms). In addition, flying was the identified cause of existing lymphedema to permanently worsen in 23 arms and 44 legs.