Hershman, D.L., Unger, J.M., Crew, K.D., Till, C., Greenlee, H., Minasian, L.M., . . . Albain, K.S. (2018). Two-year trends of taxane-induced neuropathy in women enrolled in a randomized trial of acetyl-l-carnitine (SWOG S0715). Journal of the National Cancer Institute, 110, 669–676.
To investigate the clinical phenotype of CIPN and longitudinal patterns of CIPN over 24 month period in patients on the SWOG S0715 trial (double-blind RCT of stage I-III patients with breast cancer who received an adjuvant taxane-based regimen and compared CIPN between those in the treatment group - acetyl-L-carnitine (ALC) versus the placebo control group x 24 weeks)
Multi-site double-blind randomized-controlled trial
Peripheral neuropathy measured by the 11-item neurotoxicity section of the Functional Assessment of Cancer Therapy-Taxane (FACT-NTX). A lower score indicates worse CIPN and more than 10% (or 5 points) is considered clinically significant. Sensitivity analysis done to evaluate a 10-point decrease in the FACT-NTX scores from baseline; other measurements were secondary outcomes: FACT-Taxane Trial Outcome Index; fatigue measured by 13-item Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale. All patient measurements taken at baseline and weeks 12, 24, 36, 52, and 104.
Linear mixed model results showed the average difference of NTX between the ALC group and placebo control group was statistically significant (p = 0.01) with worsened CIPN in the ALC group, at 24 weeks (p = 0.02); 36 weeks (p = 0.04); and 52 weeks (p = 0.02) compared to the placebo control group. Functional status (FACT TOI) scores worsened at weeks 24 (p = 0.04) and week 52 (p = 0.05), but was not significantly different at week 104 (p = 0.09). No difference between ALC group and placebo control group for FACIT-Fatigue. No differences observed between groups for medications taken to treat CIPN. At one year, women aged 60 or older had a higher risk of worsening peripheral neuropathy compared with women 60 years or younger at one year (OR = 1.74, p = 0.02) and at two years (OR = 1.67, p = 0.04).
In women receiving a taxane-based chemotherapy, 24 weeks of ALC therapy to reduce symptoms of CIPN caused a statistically significant worsening of short- and long-term CIPN over two years compared to placebo. Age was a risk factor for long-term CIPN. Women 60 years or older were 1.5 times more likely to have clinically significant long-term CIPN.
Exploratory statistical plots showed a non-linear relationship requiring statistical transformation procedures; no quantifiable neuro-diagnostic tests, such as balance/nerve conduction/TNS; no differentiation between sensory, motor, or autonomic neuropathy; no reports of comorbidities developing over course of study; no cumulative taxane dose or number of cycles received
Acetyl-L-carnitine (ALC) has previously been identified as a potential pharmacotherapeutic option for CIPN; however, based on the study results, ALC is not recommended as therapy for CIPN because it can cause harm in worsening CIPN. This study points to the necessity for further research into the mechanisms of CIPN, toxicities, and preventive interventions.
Izgu, N., Ozdemir, L., & Bugdayci Basal, F. (2017). Effect of aromatherapy massage on chemotherapy-induced peripheral neuropathic pain and fatigue in patients receiving oxaliplatin: An open label quasi-randomized controlled pilot study. Cancer Nursing, 42, 139-147.
To explore the effects of aromatherapy hand/foot massage on chemotherapy-induced peripheral neuropathy (CIPN), pain incidence and severity, and fatigue severity, compared to standard care in GI cancer survivors who are actively receiving oxaliplatin
Pilot, open-label, repeated measures, non-randomized, standard care-controlled quasi-experiment.
Aromatherapy hand/foot massage, using chamomile, rosemary, and peppermint oil, given 3 times per week for 40 minutes (10 minutes each hand/foot) during FOLFOX treatment may:
However, more rigorous RCTs with blinded assessors, utilizing larger sample sizes, are needed to evaluate the preventative and treatment effectiveness, necessary dosage, physiological mechanisms, and long-term effects of aromatherapy hand/foot massage on FOLFOX-induced CIPN pain.
Aromatherapy hand/foot massage during oxaliplatin treatment may be a safe and promising nonpharmacologic therapy for CIPN pain and fatigue. Further investigation of this therapy is warranted.
Kyphoplasty involves the use of a balloon to help restore the shape of a damaged vertebra and the injection of cement. The procedure can re-establish the vertebra’s height and may relieve pain. (Johns Hopkins Medicine, 2019).
Johns Hopkins Medicine. (2019). Health: Kyphoplasty. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ky…
Doxycycline is a tetracycline antibiotic that prevents the growth and spread of bacteria. It is used to treat a variety of infections; for example, pneumonia; infections spread by ticks, infected animals, or contaminated water or food; anthrax; and plague. Doxycycline is used with other medications to treat acne (American Society of Health-System Pharmacists, 2019).
American Society of Health-System Pharmacists. (2019). Doxycycline. Retrieved from https://medlineplus.gov/druginfo/meds/a682063.html
Yun, Y.H., Kim, Y.A., Lee, M.K., Sim, J.A., Nam, B.H., Kim, S., . . . Park, S. (2017). A randomized controlled trial of physical activity, dietary habit, and distress management with the Leadership and Coaching for Health (LEACH) program for disease-free cancer survivors. BMC Cancer, 17, 298-017-3290-9.
To assess if cancer survivors’ physical activity, dietary habits, and distress management would benefit from a Leadership and Coaching for Health (LEACH) program
Participants were randomly assigned to the LEACH Program (LP) intervention group or the usual care (UC) control group.
LP group received a one-hour health education workshop (topics covered included physical activity, dietary habits, and distress management), a three-hour leadership workshop, and individual telephone coaching for 24 weeks. A total of 16 tele-coaching sessions were held: 30 minutes per week for 12 sessions, 30 minutes per 2 weeks for 2 sessions, and 30 minutes per month for 2 sessions.
The UC group was asked to continue their usual care and received a health education booklet on dietary habits, physical activity, and distress management, as well as a four-hour lecture on physical activity, dietary habits, distress management, and a screening for a second cancer.
Patient evaluations took place at baseline, 3 months, 6 months, and 12 months.
PHASE OF CARE: Survivorship
12 month randomized control trial, patients evaluated at 0, 3, 6, and 12 months.
Cancer registry from 10 South Korean teaching hospitals; questionnaire based on the “Rules for National Cancer Prevention: Dietary Practice Guideline” and the Korean National Health and Nutrition Examination Survey data; METs (kcal/kg per week) for physical activity; Post-Traumatic Growth Inventory; Seven Habit Profile; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; Diener’s Satisfaction With Life Scale; Hospital Anxiety and Depression Scale; Impact of Events Scale-Revised; Medical Outcomes Study Social Support Survey; Ten Rules for Highly Effective Health Behavior
There was no significant difference between the two groups; UC and LP for primary or secondary outcomes.
For primary outcome, UC and LP groups did not significantly differ in intake of fruit and vegetable intake, and physical activity, but differed at 12 months in post-traumatic positive growth (p = 0.065).
For secondary outcomes, from baseline to 3 months, the LP group showed a greater decrease in the anxiety score (p = 0.025), a greater increase in social functioning score (p = 0.018), and a greater decrease in appetite loss (p = 0.048) and financial difficulties (p = 0.036).
From baseline to 12 months, the LP group showed a decrease in fatigue (p = 0.065) and an increase in number of 10 Rules for Highly Effective Health Behavior adhered to by patients. Patient subjective cancer-induced stress in response to specific traumatic events, scored between UC and LP groups, were marginally significant from baseline to 12 months (p = 0.068).
Participants’ primary behaviors of physical activity and dietary habits did not change due to this program. Participants’ management of their anxiety, social functioning, and symptoms did somewhat improve.
Long-term cancer survivors partnering with healthcare professionals may be helpful in reducing distress and anxiety in cancer survivors who recently completed cancer treatment. Increased education and training is needed for the long-term cancer survivors to coach.
Sun, F.K., Hung, C.M., Yao, Y., Lu, C.Y., & Chiang, C.Y. (2017). The effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy. Cancer Nursing, 40, E39-E48.
To measure the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in patients with breast cancer receiving chemotherapy
Two interventions. (a) muscle relaxation techniques using CD at least two times daily for 12 weeks, three visits in the hospital by the researcher who trained them in the practice of the MRT, and understood the techniques. (b) Therapeutic walking with a pedometer provided to patients. Walking technique and pedometer use taught by researcher. Asked to walk 90-120 minutes per week or three times per week for at least 30 minutes per session. Record steps, walking time, strength for 12 weeks. Control group: no intervention.
Randomized control study
The results showed no significant difference in any outcome variable in the pretest. The results of the post-test indicated that the two groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638, p < 0.05). The patients with breast cancer who participated in the three-month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE = 37) than those who did not (RC = 51.16).
No difference in groups on pretesting (initially). After intervention, the group with the intervention scored significantly differently only on the depression scale.
Nursing staff could teach and encourage the use of muscle relaxation techniques, as well as therapeutic walking to reduce depressive symptoms for patients undergoing chemotherapy.
Cheng, K.K.F., Lim, Y.T.E., Koh, Z.M., & Tam, W.W.S. (2017). Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database of Systematic Reviews, 8, CD011152.
PHASE OF CARE: Survivorship
HBMS programs in breast cancer survivors were found to provide beneficial short-term improvement of breast cancer-specific quality of life and global quality of life. Also, immediately after the intervention, a reduction in anxiety, fatigue, and insomnia was assessed.
Group-based intervention was shown to be the most effective mode of delivery toward improving physical, emotional, and functional quality of life