Intraspinal Analgesia
Intraspinal analgesia includes various approaches for medication administration directly into the spinal canal to diffuse throughout the spinal fluid, including intrathecal injections and implanted devices such as reservoirs or pumps. Intraspinal analgesics have been used for the prevention of procedure-related acute pain. These approaches have been evaluated for their efficacy in the management of intractable pain in patients with cancer. The risk of infection with the long-term use and functioning of indwelling devices and catheters requires consideration.
Intraoperative Dexmedetomidine for Bladder Spasm
Dexmedetomidine is an alpha-2 adrenoceptor agonist that has sympatholytic, sedative, and analgesic effects. It has been used in postoperative sedation and analgesia, and appears to have opioid-sparing effects in analgesia. Administration of dexmedetomidine during surgery has been examined for its effect on postoperative pain from bladder spasms in patients undergoing cancer-related surgery.
Intranasal Sufentanil
Sufentanil is a strong synthetic opioid analgesic that has been used as an anesthetic agent. Research has evaluated the effects of an intranasal formulation of sufentanil as a treatment for cancer-related breakthrough pain. At the time of this writing, this formulation is not yet FDA-approved for use in the United States. Sufentanil for injection is also available.
Intensity Modulated Radiation Therapy
Intensity modulated radiation therapy (IMRT) combines tumor imaging techniques with special linear accelerators that can deliver hundreds of thin beams of radiation from any angle. Information fed into the linear accelerator allows it to revolve around the patient, delivering radiation in a three-dimensional pattern that corresponds to the exact tumor location.
Integrated or Collaborative Behavioral Health Care Model
An integrated or collaborative behavioral healthcare model involves the incorporation of intensive psychological patient assessment and management into routine cancer care. This care model is delivered through a multidisciplinary team approach, which includes mental health professionals, or through the provision of psychological assessment and care by trained nurses working under the supervision of a psychiatrist. In this type of model, mental healthcare providers work in direct collaboration with the patient's oncology team and primary physician.
Institutional Initiatives
Institutional initiatives are interventions done by an organization to facilitate uptake and implementation of new knowledge by healthcare providers, patients, and caregivers to improve care. Interventions include provision of education and distribution of printed materials, and may include development of organizational protocols, procedures, and activities to standardize care. Institutional interventions were evaluated in terms of effect on chronic pain and prevention of infection in patients with cancer.
Inspiratory Muscle Training
Inspiratory muscle training involves inhalation against a consistent resistance to build muscles used for inspiration for increased strength and endurance. The use of inspiratory muscle training was studied for its effect on dyspnea in patients with cancer. The patients used a device for breathing with a one-way valve that provided resistance when they inhaled through the device. They did this 15 minutes twice daily, five days a week.
Infrared Phototherapy
Near infrared or infrared phototherapy involves the application of near infrared wavelength light. This approach was studied for its effect on oral mucositis in patients with cancer.
Influenza Vaccination
Influenza vaccination is the provision of annual vaccine against influenza with inactivated influenza virus. Several organizations have published guidelines on vaccination of hematopoietic stem cell transplantation (HSCT) recipients (see Center for Disease Control and the European Bone Marrow Transplant Group), and National Comprehensive Cancer Network (NCCN) guidelines provide general principles regarding vaccination use in patients with cancer. Live attenuated vaccines have the potential to cause disease in compromised patients, however other vaccines are safe.
Infliximab
Infliximab is a monoclonal antibody that can counter tumor necrosis factor. Infliximab has been used to treat autoimmune diseases. Researchers have studied the effect of infliximab on depression in patients with cancer, because some depressed patients have an elevated level of inflammatory cytokines.