Graham, P., Browne, L., Capp, A., Fox, C., Graham, J., Hollis, J., & Nasser, E. (2004). Randomized, paired comparison of no-sting barrier film versus sorbolene cream (10%
glycerine) skin care during post mastectomy irradiation. International Journal of Radiation Oncology, Biology, Physics, 58, 241–246.
To test the effect of prophylactic 3M Cavilon no-sting barrier film (no-sting) on the rates of moist desquamation compared with sorbolene cream (10% glycerin).
The chest wall was divided into medial and lateral halves, with one half treated with no-sting and the other with sorbolene. No-sting was applied by the nursing staff. Administration began at the start of radiation therapy until two weeks after completion. When a moist desquamation occured, the skin care changed to hydrocolloid dressing.
The study took place across multiple sites in Sydney, Australia.
The study used a quasi-experimental design with patients as their own control.
No-sting may be beneficial in the mitigation of skin toxicity with radiation therapy.
Graham, P.H., Plant, N., Graham, J.L., Browne, L., Borg, M., Capp, A., . . . Zissiadis, Y. (2013). A paired, double-blind, randomized comparison of a moisturizing durable barrier cream to 10% glycerine cream in the prophylactic management of postmastectomy irradiation skin care: Trans Tasman Radiation Oncology Group (TROG) 04.01. International Journal of Radiation Oncology, Biology, Physics, 86, 45–50.
A previous unblinded study demonstrated that an alcohol-free barrier film containing an acrylate terpolymer (ATP) was effective in reducing skin reactions compared with a 10% glycerine (sorbolene) cream. The different appearances of these products precluded a blinded comparison. To test the ATP principle in a double-blind manner required use of an alternative cream formulation, a moisturizing durable barrier cream (MDBC). This study tested the hypothesis that an ATP alcohol-free barrier film reduces the degree of radiation skin reaction compared with the 10% glycerine cream most commonly used for this purpose in women receiving postmastectomy radiation therapy in Australia.
The chest wall was divided into medial and lateral compartments, and patients were randomized to receive MDBC applied daily to the medial or lateral side and sorbolene to the other side. Patients were instructed to apply the separate creams daily at the start of radiation to each half of the area on the chest wall receiving radiation therapy and to continue until two weeks after radiation completion. Weekly observations, photographs, and symptom scores (pain and pruritus) were collected until week 12, or resolution of skin reactions if earlier. Skin dose was confirmed by centrally calibrated thermoluminescent dosimeters (TLDs).
The MDBC did not reduce peak skin reaction compared to sorbolene. It is possible that this is related to the difference in formulation of the cream compared with film formulation.
This study emphasizes the requirement for well-designed, appropriately powered, and controlled studies for skin care products. This study also potentially emphasizes that skin care products can vary in effectiveness based on formulation.
Graham, P.H. (2002). Compression prophylaxis may increase the potential for flight-associated lymphoedema after breast cancer treatment. Breast, 11 (1), 66–71.
Researchers conducted a survey to elicit information that would aid in the evaluation of the potential connection between flying and lymphedema. The study reported on 287 women with relapse-free breast cancer with known pathology/treatment and prospectively measured arm circumferences. Patient and treatment factors were age, type of surgery, number of nodes sampled and number positive, and radiotherapy technique.
Subjects were surveyed by phone and mail regarding flight history, precautions taken, and incidences of arm swelling subsequent to flying.
Gradalski, T., Ochalek, K., & Kurpiewska, J. (2015). Complex decongestive lymphatic therapy with or without Vodder II manual lymph drainage in more severe chronic postmastectomy upper limb lymphedema: A randomized non-inferiority prospective study. Journal of Pain and Symptom Management, 50, 750–757.
To compare the effects of compression bandaging and physical exercises versus the same management augmented by an additional 30 minutes of manual lymph drainage
Sixty women post mastectomy were randomly assigned to either a compression bandage group or a manual lymph drainage group. Fifty-one women then completed two weeks of intensive therapy and six months of maintenance therapy (26 weeks total).
Summed truncated cone method was used to measures limb segment volume. Limb relative volume change (RVC) was measured using the formula treatment (SLafter treatmentNLbefore)/(NLafter SLbefore), where SL is swollen limb volume and NL is normal limb volume. Edema-related quality of life was measured using the Lymphedema Questionnaire.
In both groups, a significant reduction in SL volume, LE volume, and RVC occurred after each day of the first week of therapy. Within the two-week intensive phase, a significant decrease in SL and LE volumes occured (p < 0.001). A rebound effect occurred in the CB-G group within the first month, but after six months, the SL and LE volumes in both groups were not statistically significant. Six months after finishing intensive therapy, no significant difference in lymph volumes existed between the two groups (p = 0.3).
Patients with postmastectomy LE may have a similar benefit of CDT without MLD on limb edema reduction. Compression bandaging combined with physical exercise may be considered a basic treatment option in limb LE.
The results of this study may help guide overall treatment in women post mastectomy with breast cancer–related lymphedema. However, the effect of manual lymph drainage remains unexplored because immediate lymph fluid draining images and long-term lymphatic changes were not investigated.
Gouvea de Lima, A., Villar, R.C., de Castro, G., Jr., Antequera, R., Gil, E., Rosalmeida, M.C., … Snitcovsky, I.M.L. (2012). Oral mucositis prevention by low-level laser therapy in head-and-neck cancer patients undergoing concurrent chemoradiotherapy: A phase III randomized study. International Journal of Radiation Oncology, Biology, Physics, 82, 270–275.
To evaluate the efficacy of low-level laser therapy (LLLT) to decrease severe oral mucositis and reduce radiation therapy (RT) interruptions
Patients received either gallium aluminum arsenide LLLT 2.5 J/cm2 or placebo laser before each radiation fraction.
This was a single-site, outpatient study conducted in Brazil.
Patients were undergoing the active treatment phase of care.
This was a randomized, double-blind, phase III study.
LLLT benefit was limited to fewer interruptions in RT.
LLLT dosage, schedule, specific laser type, and availability all need to be addressed.
Gøtzsche, P.C., & Johansen, H.K. (2014). Nystatin prophylaxis and treatment in severely immunodepressed patients. Cochrane Database of Systematic Reviews, 9, CD002033.
STUDY PURPOSE: To determine if nystatin prophylaxis or treatment for fungal infection decreases morbidity and mortality in immunocompromised patients
TYPE OF STUDY: Meta-analysis and systematic review
PHASE OF CARE: Active antitumor treatment
Nystatin cannot be recommended for prophylaxis or the treatment of Candida infections in immunodepressed patients.
Nystatin is no more effective than placebo for the prevention or treatment of fungal infections in immunocompromised patients.
Gottschling, S., Reindl, T.K., Meyer, S., Berrang, J., Henze, G., Graeber, S., … Graf, N. (2008). Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology—A randomized multicenter crossover pilot trial. Klinische Padiatrie, 220, 365–370.
To evaluate the efficacy and acceptance of acupuncture as an additive antiemetic treatment during highly emetogenic chemotherapy (HEC) in pediatric patients with cancer
Patients receiving chemotherapy were randomized to receive antiemetic medication plus acupuncture or antiemetic medication alone.
Acupuncture points were based on the acupuncturists’ decision, until the patient reported a “de Qi” sensation.
Antiemetic rescue medication, number of retching and vomiting episodes, and a short essay of the acupuncture experience were recorded.
This study was conducted in multiple inpatient settings in five German cancer centers.
This was a prospective, randomized, crossover clinical trial pilot study.
An open-form essay was used to document the subjective experience of acupuncture.
In evaluating chemotherapy courses, overall, no significant differences were found in retching or vomiting episodes. In evaluating differences between group 1 and group 2, no significant effect was found with dexamethasone (p = 0.145); however, the acupuncture group was associated with lower phenothiazine medication use (p = 0.001) and less retching and vomiting episodes (p = 0.01).
Acupuncture with baseline antiemetic medication was associated with less phenothiazine use and less retching and vomiting among children receiving HEC.
Acupuncture may provide some relief of retching or vomiting episodes associated with HEC, but the intervention should be used in combination with standard antiemetic treatment.
Gothard, L., Haviland, J., Bryson, P., Laden, G., Glover, M., Harrison, S., . . . Yarnold, J. (2010). Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer. Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology, 97(1), 101–107.
To assess the effectiveness of hyperbaric oxygen (HBO) therapy on reducing arm lymphedema in patients with early-stage breast cancer
Participants were divided into the control and the experimental group at a ratio of 1 to 2, respectively. The experimental group received HBO therapy and breathed 100% oxygen at 2.4 atmospheres absolute for 100 minutes with two five-minute air breaks. The sessions were conducted 30 times in a six-week period or five times a week. Both the control and experimental groups received patient education on standard care for lymphedema and hosiery when appropriate.
The study took place in multiple hospitals in the United Kingdom.
Patients were undergoing active lymphedema treatment.
The study used a randomized phase II study design.
There was not a statistically significant change in limb volume between the control group (p = 0.64) and the experimental group (p = 0.50) at 12 months after baseline. The investigators define a positive response as an 8% reduction in arm volume. Thirty percent of the experimental group versus 18.8% of the control group responded to meet these criteria but was also statistically insignificant (p = 0.50). Lymphatic clearance rates were similar among groups and were not significant findings. Quality of life findings were similar among both groups and were not significant.
The study suggests that HBO therapy when added to best standard treatment of lymphedema in patients with breast cancer is not effective. The study does not confirm earlier reports of a therapeutic effect of HBO.
The study suggests that HBO therapy is an ineffective therapy for treating lymphedema in patients with breast cancer. The therapy should not be enacted into practice. Nursing researchers should analyze the randomized trial and non-randomized trials of this treatment program to identify confounding variables that may have made the non-randomized trial results significant and the randomized trial results not significant. If the study is repeated a larger sample size should be used.
Gothard, L., Stanton, A., MacLaren, J., Lawrence, D., Hall, E., Mortimer, P., . . . Yarnold, J. (2004). Non-randomized phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphedema and tissue fibrosis after radiotherapy for early breast cancer. Radiotherapy and Oncology, 70(3), 217–224.
To examine hyperbaric oxygen in the treatment of chronic arm lymphedema after radiotherapy
Patients received treatment with hyperbaric oxygen, compressed to 2.4 atmospheres absolute (ATA) in a multiplace category 1 hyperbaric chamber at Royal Hospital. Patients received 100% oxygen at pressure via a transparent hood. Total time at 2.4 ATA was 100 minutes, including two five-minute air breaks. Each participant received a total of 30 pressure exposures, treating five days per week for six weeks. The primary endpoint was an absolute change of greater than 20% in relative volume of the ipsilateral arm versus contralateral arm. The secondary endpoints were lymphoscintigraphy, patient self-assessments, and physician assessments. An unplanned endpoint was patient comments about arm softening and mobility as part of one relative change in arm volume.
The study took place at Royal Marsden Hospital based on observation from a previous study at the same institution evaluating hyperbaric oxygen in radiation-induced brachial plexopathy. In that study, two of the six patients with chronic lymphedema experienced major and persistent improvement in lymphedema.
Compliance with treatment was 100%. All questionnaires were returned, and only two patients missed follow-up assessments (one patient was hospitalized and the other moved); as a result, 94% of patients had Perometer measures. Only 71% participated in lymphoscintigraphy because of logistics, 7% missed follow-up scan at 12 months, and one scan was erased accidentally. Three patients responded according to defined 20% or greater reduction in arm volume, 16 were nonresponders. Mean percentage reduction in arm volume was 7.68. Quality-of-life measures were not clinically significant post-treatment. Comments by participants indicated they may not have been appropriate measures. Lymphoscinitgraphy improvement showed statistically significant changes.
Patients had good compliance with the treatment plan despite rigorous treatment. Median time since completion of the treatment is 14 years, which is encouraging given improvement in lymphoscintigraphy measures and limb tissue softening (a subjective measure).
The study has sufficient data to justify a randomized controlled trial. Careful screening of participants is needed.
Gotay, C.C., Moinpour, C.M., Unger, J.M., Jiang, C.S., Coleman, D., Martino, S. . . . Albain, K.S. (2007). Impact of a peer-delivered telephone intervention for women experiencing a breast cancer recurrence. Journal of Clinical Oncology, 25 (15), 2093–2098.
To evaluate the effects a brief telephone intervention on women experiencing a recurrence of breast cancer
Women were randomly assigned to either a telephone-intervention group (TG) or a control group (CG). TG received 4–8 counseling/information sessions by telephone at weekly intervals. Session content reflected primary patient concerns and common domains from a quality-of-life (QOL) model. After the first session, patients received an information packet. The packet consisted primarily of National Cancer Institute pamphlets. Counselors were breast cancer recurrence survivors at least one year postrecurrence. Assessments were completed at baseline, three months, and six months.
The study was conducted by SWOG (formerly the Southwest Oncology Group)—an organization, supported by the National Cancer Institute, that conducts clinical trials relating to cancer in adults.
Multisite
Secondary-outcome assessments:
Support services utilized and satisfaction with the telephone intervention were requested.
The telephone intervention was feasible and well accepted, but authors noted no benefits associated with the intervention, in regard to either emotional well-being or depressive symptoms. Patient distress started and remained very high in this sample. Statistically significant was the fact that more CG patients progressed during the six months of the study than did members of the TG group.
This is a well-designed RCT with adequate sample size; however, the study’s generalizability is unclear, given that the patients came from multiple institutions across the United States. The catchment cannot be precisely described, and characteristics of refusing patients were not reported. This sample included high levels of psychological and disease-related disability, and telephone calls from a nonprofessional may not have been an appropriate means of modifying patient distress. The study presents no significant findings.