The hypothesis was that micafungin (150 mg) is a safe and effective alternative to fluconazole (400 mg) for the use of antifungal prophylaxis during neutropenia.

Patients were randomly assigned to receive either micafungin or fluconazole treatment using a 1:1 schedule.  Randomization was stratified according to the risk or transplant-related mortality.  High risk included acute leukemia in relapse or in complete remission for at least the third time, chronic myelogenous leukemia other than the first chronic phase, Hodgkin lymphoma or non-Hodgkin lymphoma in relapse or greater than or equal to the second complete or partial remission, myelodysplastic syndrome, or myeloproliferative syndrome.  Low risk included all factors not classified as high risk and any type of transplant (i.e., autologous, allogeneic using peripheral blood stem cells or bone marrow, or allogeneic using cord blood).  Groups received either 150 mg of micafungin or 400 mg of fluconazole daily by infusion until the earliest of: (1) absolute neutrophil count (ANC) of 500 cells/mm³ or greater, (2) 42 days after hematopoietic stem cell transplantation (HSCT), (3) development of proven, probable, or suspected invasive fungal infection, (4) development of unacceptable drug toxicity, or (5) other reason for withdrawal or discontinuation of treatment.  Antifungals were given within 48 hours of initiation of the transplant conditioning treatment.

• One hundred four patients were evaluable (52 patients in each arm).  
• Mean age was 46.5 years (range 16–67) in the micafungin arm and 47.3 years (range 18–65) in the fluconazole arm.
• In the micafungin arm, 64% of patients were male and 36% were female.  In the fluconazole arm, 68% of patients were male and 32% were female.
• Key disease characteristics were malignant lymphoma (46% in the micafungin arm, 44% in the fluconazole arm), multiple myeloma (18% in the micafungin arm, 26% in the fluconazole arm), acute myeloid leukemia (AML) (14% in the micafungin arm, 12% in the fluconazole arm); myelodysplastic syndrome (MDS) (10% in the micafungin arm, 8% in the fluconazole arm); acute lymphoblastic leukemia (ALL) (6% in both arms), and other hematologic malignancy/nonmalignant disease (6% in the micafungin arm, 4% in the fluconazole arm).  
• Transplant type included autologous HSCT in 48% of patients in both arms and allogeneic HSCT in 52% of patients in both arms.  Peripheral blood was used in all autologous HSCTs, allogeneic bone marrow or peripheral blood was used in 38% of patients in the micafungin arm and 44% in the fluconazole arm, and cord blood was used in 14% of patients in the micafungin arm and 8% in the fluconazole arm.

• Mutli-site  
• Inpatient
• Patients were hospitalized at the hematology departments of six study sites in Japan.

Patients were undergoing the active treatment phase of care.

This was a prospective, randomized, open-label comparative trial.

• Treatment success was defined as an absence of proven, probable, or suspected systemic fungal infection through a four-week period.     
• Definitions of the Fungal Infections Cooperative Group of the Suropena Organization for Research and Treatment of Cancer, National Institute of Allergy and Infectious Diseases Mycoses Study Group were used.
   

Neutrophil recovery was seen in an average of 13.7 days in both arms.  Graft-versus-host disease was present in 24% of patients in the micafungin arm and 30% in the fluconazole arm.  Overall treatment success, defined as the absence of proven, probable, or suspected systemic fungal infection through the end of prophylaxis therapy and as the absence of a proven or probable systemic fungal infection through the end of the four-week posttreatment period, was comparable in both arms, with 94% in the micafungin arm and 88% in the fluconazole arm.  This was not a significant difference.

The study showed that another class of medications, the echinocandins, can be effective in preventing fungal infections.  Its effectiveness is comparable to that of fluconazole, which is considered the gold standard for antifungal prophylaxis.  Neither drug had significant side effects, although the incidence was slightly higher with the use of micafungin.

This was an open-label study and was not powered to measure success rate differences.

Patients should be educated regarding the use, effectiveness, side effects of the medications, and need for continued antifungal prophylaxis based on risk.

To determine the effectiveness of a care bundle completed by patients with esophageal cancer before surgery to reduce the risk of postoperative pneumonia

• N = 240  
• MEDIAN AGE = 64 years (range = 36–86 years)
• MALES: 83.3%, FEMALES: 16.7%
• KEY DISEASE CHARACTERISTICS: Esophageal cancer
• OTHER KEY SAMPLE CHARACTERISTICS: The comparison groups were significantly different based types of surgery. The care bundle group was 65.4% thoracotomy and 34.6% thoracoscopic versus the non-care bundle group, which was 96.7% thoracotomy and 3.3% thoracoscopic.

• SITE: Single site    
• SETTING TYPE: Multiple settings  
• LOCATION: Japan

• PHASE OF CARE: Active antitumor treatment

Retrospective, case-controlled study comparing two groups of patients, each from a different time period in the past.

The definition of postoperative pneumonia was based on the Centers for Disease Control and Prevention criteria. The detection of postoperative pneumonia was based on bacteria collected from a bronchoscope within 30 days of surgery. An analysis between groups was completed using logistic regression.

Completing daily care bundle activities before surgery for esophageal cancer may lower the risk of postoperative pneumonia. The study design and underadherence to care bundle activities limit stronger conclusions. However, most care bundle activities were inexpensive with little risk to patients, so the use of this intervention may still be warranted.

• Small sample (< 30): Not for study as a whole, but for the intervention group
• Baseline sample/group differences of import: Significant difference in surgical approach (p < 0.001) and operative time (p = 0.002) between the comparison groups; variation in adherence to care bundles
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Other limitations/explanation: Although compliance rates with the care bundle activities reflect real-world applications, it makes the conclusions based on care bundle activities difficult to discern. Also, it was unclear how many days preoperatively a patient should complete the care bundle activities.

Preoperative nursing interventions and patient education may influence postoperative health outcomes. Nurses can promote smoking cessation, deep breathing, breathing exercises, oral care, and adherence to nutritional guidelines before surgery for esophageal cancer as a potential strategy to decrease the risk of postoperative pneumonia.

To examine the feasibility and effectiveness of problem-solving therapy for psychological distress among patients with early-stage breast cancer

The problem-solving therapy involved five weekly sessions aimed at assessing problems, setting goals, generating solutions, choosing a solution, and implementing the solution and evaluating results. The therapy included a manual and worksheet for patients to use. Authors collected self-report data prior to the intervention, after the final sessions, and three months after the final sessions.

• Mean patient age was 50.21 years (SD = 11.09 years).
• The sample was 100% female.
• The majority of participants had stage II disease. All had had prior surgery; 89% were on hormone therapy.
• Of all participants, 43% were employed full- or part-time, 79% were married, and 21% had a college education.

• Single site
• Outpatient setting
• Japan

Patients were undergoing active antitumor treatment.

A pre/post-test design was used.

• Two-item 11-point Likert-type distress scale
• Hospital Anxiety and Depression Scale (HADS), Japanese version
• Scale that measured self-efficacy of patients with advanced cancer
• Brief Cancer-Related Worry Inventory
• European Organization for Research and Treatment Cancer Core Quality-of-Life Questionnaire (QLC-C30), Japanese version

Four patients dropped out of the study after starting treatment. Analysis showed a significant effect of time on anxiety and depression scores (p < 0.01).  Over time scores for global health status, physical functioning, emotional functioning, and role functioning improved significantly.

The study shows that symptoms of anxiety and depression and some aspects of quality of life improved over time. The effect of the intervention cannot be evaluated from these study results. Though authors state that the intervention was feasible, the fact that 17% of the initial sample did not complete the study suggests that the intervention was not of interest to a substantial proportion of the patients.

• The study had a small sample size, with fewer than 30 participants.
• The study had risks of bias due to the lack of a control group, blinding, and random assignment.

Study results are insufficient to allow evaluation of the acceptability and efficacy of the problem-solving intervention.

To assess the safety and efficacy of aprepitant for chemotherapy-induced nausea and vomiting (CINV) prophylaxis with highly emetogenic cheomtherapy (HEC) or moderately emetogenic chemotherapy (MEC) regimens

Patients received 125 mg aprepitant on day 1 and 80 mg along with palonosetron and dexamethasone

• N = 75   
• AGE RANGE = 18-71 years
• MALES: 10.3%, FEMALES: 89.7%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Multiple tumor types 
• OTHER KEY SAMPLE CHARACTERISTICS: Sixty percent were receiving HEC therapy.

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: India

PHASE OF CARE: Active antitumor treatment

Open-label, prospective, observational

• Complete response (CR) defined as no emesis and no use of rescue medicatiton
• Common Terminology Criteria for Adverse Events (CTCAE), version 4

For all regimens, CR rates were 96.8%, 93.7%, and 92% for acute, delayed, and overall phases. Nine percent reported side effects; the most common was hiccoughs.

Triple drug antiemetic prophylaxis was effective to manage CINV in most patients.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)

This study adds to the substantial body of evidence for the efficacy of triple drug antiemetic regimens for the prevention of CINV.

• FINAL NUMBER STUDIES INCLUDED = 6
• TOTAL PATIENTS INCLUDED IN REVIEW = 812
• KEY SAMPLE CHARACTERISTICS: Five studies (two ongoing at the time of publication) were designed to investigate cognitive behavioral training (CBT). One study involved an intervention based on CBT. A meta-analyses was conducted for two of the studies for which the authors provided additional data. Participants were primarily female, and the mean age range was 49.2–60.4 years.

PHASE OF CARE: Late effects and survivorship

The authors indicated that there was insufficient evidence to recommend these interventions and concluded that future research involving CBT interventions for CRCD are unlikely to yield different findings. However, this systematic review and meta-analysis is limited because CBT and neuropsychological interventions and instruments differed, resulting in the inability to pool results.

• The meta-analysis was conducted on only two studies.
• More studies with long-term follow-up periods are needed to draw conclusions about the efficacy of CBT. Additional information regarding intervention descriptions, subject characteristics, and the instruments used for outcome measures are necessary to complete this review for comparison.

The authors indicated that additional research using CBT for CRCD is unlikely to indicate efficacy. However, this review was limited by the limited number of studies reviewed, its lack of longitudinal timepoints, and the differences between the CRCD interventions.  

To demonstrate the potential benefits of topical mometasone furoate (MF) for the prevention of acute radiation reactions with a primary measure/endpoint being the mean modified Radiation Therapy Oncology Group (RTOG) score

• MF and diprobase were applied daily to the irradiated sites from day 1 for five weeks during breast radiation therapy (three weeks radiation therapy [RT], two weeks post-RT).

• Patients received 40 Gy of radiation therapy in 15 fractions in three weeks.
• Some patients received an electron boost of 10 Gy in five fractions.

• Assessments occurred at baseline and on days 8, 15, 21, 29, 36, and 43.

• N = 99
• MEAN AGE = 59.5 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All patients had breast cancer.
• OTHER KEY SAMPLE CHARACTERISTICS: Included nonsmokers, ex-smokers, and smokers; bra cup sizes A–E were included; 72% also received chemotherapy

• SITE: Multi-site
• SETTING TYPE: Outpatient
• LOCATION: United Kingdom

• PHASE OF CARE: Active antitumor treatment

Double-blinded, randomized, controlled trial

• Modified RTOG for skin dermatitis
• Dermatology Life Quality Index (DLQI)
• Hospital Anxiety and Depression Scale (HADS)
• Erythema measurement by reflectance spectrophotometry

• Mean RTOG scores were lower for patients using MF than for those using diprobase (p = 0.046).
• Patients using MF experienced lower scores than those using diprobase for the time till maximum RTOG score (statistically insignificant).
• 4.8% of the patients using MF reached an RTOG of 2.5 versus the 15.5% of patients using diprobase who reached the same score. On a week-to-week basis, the difference in average scores between the groups in was not significantly different.
• The odds ratio of having a lower RTOG score associated with MF use was 2.38 (p = 0.18).

• Higher erythema values were seen in patients using diprobase versus MF. Over the course of the study period, the average treatment difference between groups was significantly better for those using MF (p = 0.012).

• Patients in the MF group experienced higher anxiety and depression scores at baseline than those in the diprobase group.

• Diprobase was associated with increased DLQI scores between weeks 2 and 3, but these scores gradually fell.
• MF was associated with increased DLQI scores till week 5, but this score fell thereafter.
• DLQI scores were worse for those using diprobase.

This study demonstrated that MF cream may be beneficial in reducing the severity of acute radiation skin reactions when compared to diprobase cream applied daily to the irradiated area on the breast during three weeks of RT and two weeks post-RT.

• Small sample (< 100)
• Baseline sample/group differences of import
• Measurement validity/reliability questionable
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%
• Other limitations/explanation: It is not clear whether intensity-modulated radiation therapy was used, which impacts the development of radiodermatitis. A slightly higher percentage of participants in the diprobase group also received chemotherapy, which could have affected the results in this group negatively. The chemotherapy agents that participants received were not described.

The findings of this study demonstrated that the use of MF cream was more effective than an aqueous cream for the prevention of severe radiodermatitis in women receiving radiation therapy for breast cancer. Mixed results have been seen in various studies using different topical corticosteroids, suggesting that specific steroid selection is important. Overall findings suggest that it may be important to begin topical treatment use prior to radiation rather than using steroids for the treatment of radiodermatitis after it has developed. The optimal schedule for the use of such treatments has not been determined, and it has varied across studies.

Women with ovarian cancer scheduled for treatment with carboplatin or paclitaxel-based chemotherapy were randomized to receive either IV premedication with amifostine 740 mg/m² or placebo for 30 minutes. Data were collected at baseline, after each cycle of chemotherapy, and at three and six months after completion of chemotherapy.

The sample consisted of 71 women with advanced ovarian cancer.

The study was a double-blind, randomized, placebo-controlled study.

• Measurements included vibration perception thresholds and vibration disappearance thresholds before cycle 4 and after the end of treatment. Secondary objectives were patella and Achilles tendon reflexes and two-point discrimination.
• Sensory symptoms, fine global motor activities, and quality of life were collected via questionnaire.
• Toxicity was reported according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI-CTCAE).

Thirty-seven women received amifostine and 34 received the placebo infusion. A significant protective effect of amifostine was found in vibration, two-point discrimination, and deep tendon reflexes. No significant differences were observed for single sensory or motor symptoms; however, amifostine improved sensory neuropathy according to the NCI-CTCAE criteria. Inconsistent results were reported in regard to quality of life.

• The study sample size may have been too small to detect group differences.
• Inconsistencies were present regarding the assessment of sensory neurotoxicity, the neurologic assessment of vibration thresholds, and quality of life.
• There were inter-observer variances with vibration sense measurement.

To assess the effectiveness of a short-term breathlessness support service in facilitating breathlessness mastery in patients with advanced disease

• N = 105 (53 assigned to the breathlessness support service, and 52 assigned to the standard care group)  
• AVERAGE AGE = 67 years
• MALES: 58%, FEMALES: 42%
• KEY DISEASE CHARACTERISTICS: Patients were included if they experienced refractory breathlessness on exertion or rest despite optimum treatment of their underlying disease; advanced diseases including cancer, chronic obstructive pulmonary disease (COPD), chronic heart failure, interstitial lung disease, and motor neuron disease were included; willing to participate in home physiotherapy and occupational therapy; able to provide informed consent
• OTHER KEY SAMPLE CHARACTERISTICS: Patients were excluded if they experienced breathlessness of unknown etiology, had a primary diagnosis of chronic hyperventilation syndrome, were completely homebound despite the offer of free clinic transport, or were within two weeks of treatment for an acute exacerbation.

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: South London

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care 

This was a single-blinded, randomized, controlled trial. Research nurses and interviewers were blinded to the treatment allocation. Participants, the trial coordinator, and the trial administrator were aware of the treatment allocation.

• Chronic Respiratory Disease Questionnaire (CRDQ)
• London Chest Activity of Daily Living (LCADL) scale
• EQ-5D and EQ Visual Analog Scale (VAS)
• Palliative Care Outcome Scale (PCOS)
• Hospital Anxiety and Depression Scale (HADS)
• Spirometry to assess pulmonary function
• Pulse oximetry to assess oxygen saturation
• Severity of breathlessness in the previous 24 hours on a numeric scale (0–10)

An integrative approach to managing breathlessness within a support service improves patient mastery of breathlessness.

• Findings not generalizable
• Other limitations/explanation: One limitation of the study was a possible placebo effect because participants were not blinded to their specific treatment groups. The authors also suggested that although nurse researchers were blinded to the intervention groups, they may have been able to determine which treatment group participants were assigned based on the existence of breathlessness equipment in their homes (thereby potentially biasing their interviews). In addition, the authors noted that their inclusion and exclusion criteria prevented the inference of study results to patients in the last month of life. Finally, the authors noted that the short-term nature of outcome follow-up restricted their assessment of care costs and long-term survival.

Additional research and education on the structure and process of an integrative breathlessness support service for patients with advanced cancer is warranted.

To evaluate the effects of yogurts made with different types of lactic acid bacteria (LAB) on the gastrointestinal system.

Participants were recruited via advertisement. Consenting patients were assigned using stratified randomization by defecation frequencies to receive one of three types of yogurt.

• Type A: plant-derived LAB—Lactobacillus plantarum—SN35N (95%) with SN13T (5%)
• Type B: plant-derived LAB—Lb. plantarum—SN13T (98%) with SN35N (2%)
• Type C: animal-derived LAB—Lb. lactis A6 (86.1%), Streptococcus thermophilus 510 (13.8%), and Lb. bulgaricus C6 (0.1%)

Participants consumed 100 g of yogurt daily for a six-week period. Data were collected from clinic visits at two-week intervals.

• The study reported on a sample of 68 patients aged 21 to 65 years.
• The sample comprised 49 women and 19 men.
• Patients were healthy adults with some complaints of intestinal health, such as constipation, diarrhea, abdominal pain, and bloating.

Hiroshima, Japan

This was a randomized, double-blind study.

Bristol Stool Form Scale

• No statistical difference existed between the study types (groups A and B) and the control (group C).
• Total cholesterol decreased significantly in all individuals from 214.3 mg/dl at baseline to 203.2 mg/dl at six weeks (p = 0.012) in group B, but not in groups A and C.
• No participants reported any significant adverse events resulting from yogurt intake during the trial.
• No abnormal changes in urine analysis or serum biochemical parameters were observed during the study.

In healthy adults, Lb. plantarum SN13T may improve serum lipid levels and liver function. Actual effects in relieving constipation are unclear.

• The sample size was small (fewer than 100).
• The study did not include patients with cancer.

Effects in relieving constipation are unclear in healthy adults. Additional studies are warranted that include a larger sample and patients with cancer.

The intervention was autogenic training (AT), a type of meditation, with mental exercises:

• Heaviness of limbs
• Warmth of limbs
• Calm regular heartbeat
• Easy breathing
• Abdominal warmth
• Cooling of forehead

Measurements were taken at baseline and at the end of two monthly periods. Patients were observed for evidence of meditative state. Group 1 (control) received one home visit, and group II (intervention) received one home visit plus two months of AT intervention.

The study reported on a sample of 31 women with early-stage breast cancer.

A randomized controlled trial design was used.

• Hospital Anxiety and Depression Scale (HADS)
• T and B cell markers
• Unpaired t tests
• Calculations of blood results and HADS scores were made of mean and standard deviation.

Results showed a p value of 0.0027 between groups for anxiety. T and B cell markers remained similar in both groups. The AT group reported improved HADS anxiety levels (t = 2.00, p = 0.092). There was no statistical difference in HADS scores for patients within the group.

• The study had a small sample of women with early-stage breast cancer.
• Specialized education was needed to provide the AT.
• The authors state a limitation may be that only 7 of 16 patients in the experimental group achieved a meditative state.