Lambertini, M., Del Mastro, L., Bellodi, A., & Pronzato, P. (2014). The five “Ws” for bone pain due to the administration of granulocyte-colony stimulating factors (G-CSFs). Critical Reviews in Oncology/Hematology, 89, 112–128.

DOI Link

Purpose & Patient Population

PURPOSE: To determine the effectiveness of antihistamine use with ​granulocyte-colony stimulating factors (GCSFs)
 
TYPES OF PATIENTS ADDRESSED: Oncology patients receiving chemotherapy and stem cell donors

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Consensus-based guideline
 
SEARCH STRATEGY: None identified
 
DATABASES USED: None identified 
 
KEYWORDS: None identified
 
INCLUSION CRITERIA: Patients receiving chemotherapy with a moderate to high risk for neutropenia; stem cell donors
 
EXCLUSION CRITERIA: None identified

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Elder care 

Results Provided in the Reference

  • Six studies looking at the incidence of bone pain associated with GCSFs in cancer patients evaluating diagnosis, dosing, and incidence
  • Five studies looking at incidence of bone pain associated with GCSFs in healthy people evaluating dose and incidence
  • Three studies involving elderly patients with lymphoma who received GCSFs evaluating chemotherapy regimens with or without GCSFs and incidence
  • Six studies evaluating the prevention and treatment of bone pain with GCSFs in varying forms of interventions with a maximum of two studies looking at opioids, one with no reported relief of pain

Guidelines & Recommendations

There was no real difference between pegfilgrastim and daily GCSFs in terms of incidence of bone pain, and most patients will benefit from the use of NSAIDs to control pain. The authors suggest that patients who do not respond to NSAIDs should consider second-line treatment with antihistamines. The study cites a series of four patients and one case study in which this was effective.

Limitations

Only one study was cited that evaluated the efficacy of antihistamines in relieving or decreasing bone pain associated with GCSFs from 2005. Main evidence is case reports only.

Nursing Implications

More studies are needed to evaluate the efficacy of antihistamines versus NSAIDs or acetaminophen in relieving bone pain.