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Revista Da Escola de Enfermagem Da U S P 2021To synthesize the best available evidence on the effectiveness of nursing interventions in radiotherapy patient care and to summarize the evidence on the experience and...
OBJECTIVE
To synthesize the best available evidence on the effectiveness of nursing interventions in radiotherapy patient care and to summarize the evidence on the experience and acceptability of interventions reported by health professionals involved in the prevention and treatment of side effects.
METHOD
A mixed-method systematic review. Quantitative and qualitative studies are presented.
RESULTS
Twelve studies published between 2013 and 2017 were included. Most interventions found focused on skin care, oral care, nausea and vomiting and nursing consultation. In accordance with high level of evidence and recommendation grade of the studies, the use of Calendula officinalis and thyme honey were considered effective for preventing and treating radiodermatitis and mucositis, respectively.
CONCLUSION
The quality of evidence of nursing interventions is weak. Although there are studies with a strong design and a high level of evidence, publication of nursing interventions is not enough and does not present a high quality to support practice to plan an effective patient-centered care.
Topics: Drug-Related Side Effects and Adverse Reactions; Health Personnel; Humans; Neoplasms; Qualitative Research; Stomatitis
PubMed: 33978137
DOI: 10.1590/S1980-220X2019026303697 -
Journal of the American Academy of... Mar 2021
Meta-Analysis
Incidence of dermatologic adverse events in patients with cancer treated with concurrent immune checkpoint inhibitors and radiation therapy: A systematic review and meta-analysis.
Topics: Chemoradiotherapy; Clinical Trials as Topic; Drug Eruptions; Humans; Immune Checkpoint Inhibitors; Incidence; Neoplasms; Radiodermatitis
PubMed: 33137440
DOI: 10.1016/j.jaad.2020.10.071 -
Breast (Edinburgh, Scotland) Apr 2020Radiation dermatitis is a common adverse effect of radiotherapy (RT) in breast cancer patients. Although radiation dermatitis is reported by either the clinician or the... (Meta-Analysis)
Meta-Analysis
Radiation dermatitis is a common adverse effect of radiotherapy (RT) in breast cancer patients. Although radiation dermatitis is reported by either the clinician or the patient, previous studies have shown disagreement between clinician-reported outcomes (CROs) and patient-reported outcomes (PROs). This review evaluated the extent of discordance between CROs and PROs for radiation dermatitis. Studies reporting both clinician and patient-reported outcomes for external beam RT were eligible. Nine studies met the inclusion criteria for the systematic review, while 8 of these studies were eligible for inclusion in a meta-analysis of acute and late skin toxicities. We found an overall agreement between CROs and PROs of acute skin colour change, fibrosis and/or retraction, and moist desquamation (p > 0.005). Reporting of late breast pain, breast edema, skin colour change, telangiectasia, fibrosis and/or retraction and induration/fibrosis alone (p > 0.005) were also in agreement between clinicians and patients. Our meta-analysis revealed a greater reporting of acute breast pain by patients (RR = 0.89, 95% CI 0.87-0.92, p < 0.001), greater reporting of acute breast edema by physicians (RR = 1.80, 95% CI 1.65-1.97, p < 0.001) and a greater reporting of late breast shrinkage by patients (RR = 0.61, 95% CI 0.44-0.86, p = 0.005). However, our review was limited by the discrepancies between PRO and CRO measurement tools as well as the absence of standard time points for evaluation of radiation dermatitis. Given potential discrepancies between CROs and PROs, both measures should be reported in future studies. Ultimately, we advocate for the development of a single tool to assess symptoms from both perspectives.
Topics: Breast; Breast Neoplasms; Edema; Fibrosis; Humans; Outcome Assessment, Health Care; Pain; Patient Reported Outcome Measures; Physicians; Radiodermatitis
PubMed: 31563429
DOI: 10.1016/j.breast.2019.09.009 -
Revista Latino-americana de Enfermagem 2018to evaluate the effects of trolamine in the prevention or treatment of radiation dermatitis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
to evaluate the effects of trolamine in the prevention or treatment of radiation dermatitis.
METHOD
systematic review and meta-analysis. Detailed individual search strategies for Cinahl, Cochrane Library Central, LILACS, PubMed, and Web of Science were developed in January 2016. A manual search was also performed to find additional references. A grey literature search was executed by using Google Scholar. Two researchers independently read the titles and abstracts from every cross-reference. The risk of bias of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool. The quality of evidence and grading of strength of recommendations was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE).
RESULTS
seven controlled clinical trials were identified. The controls used were calendula, placebo, institutional preference / usual care, Aquaphor®, RadiaCare™, and Lipiderm™. The studies were pooled using frequency of events and risk ratio with 95% confidence intervals, in subgroups according to radiation dermatitis graduation.
CONCLUSION
based on the studies included in this review, trolamine cannot be considered as a standardized product to prevent or treat radiation dermatitis in patients with breast and head and neck cancer.
Topics: Acute Disease; Ethanolamines; Humans; Radiodermatitis
PubMed: 29742271
DOI: 10.1590/1518-8345.2035.2929 -
Journal of B.U.ON. : Official Journal... 2017We conducted a network meta-analysis to evaluate the efficacy and toxicity of cetuximab and nimotuzumab in the treatment of advanced nasopharyngeal carcinoma (NPC).
PURPOSE
We conducted a network meta-analysis to evaluate the efficacy and toxicity of cetuximab and nimotuzumab in the treatment of advanced nasopharyngeal carcinoma (NPC).
METHODS
A systematic literature search was performed though Pubmed, Embase, Cochran Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical (CBM) and Wanfang databases. Totally, 19 randomized controlled trials (RCTs) (n=1201) met the study selection criteria and were incorporated in this network meta-analysis.
RESULTS
Compared with cetuximab, the results of network meta-analysis indicated that nimotuzumab may achieve higher complete remission rate (CRR) or overall remission rate (ORR) of the primary tumor, but no difference was noticed in 1- and 2-year overall survival (OS) rate and certain toxicities such as myelosuppression, radiodermatitis, mucositis and gastrointestinal reactions. Although nimotuzumab increased the 3-year OS rate, compared with cetuximab, this result needs to be interpreted cautiously because of the studies' heterogeneity.
CONCLUSION
Even though we didn't find significant difference between cetuximab and nimotuzumab in terms of survival outcomes, nimotuzumab is more advantageous in short-term efficacy.
Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Cetuximab; China; Humans; Nasopharyngeal Carcinoma; Network Meta-Analysis; Randomized Controlled Trials as Topic; Survival Rate
PubMed: 28952220
DOI: No ID Found -
European Journal of Dermatology : EJD Oct 2016Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small... (Review)
Review
Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small cell lung, prostate, gastric, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers. Although the true incidence of dermatological adverse events (AEs) in patients receiving taxanes is not known, and has never been prospectively analysed, they clearly represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous AEs during treatment with novel targeted and immunological therapies when used in combination with taxanes, a thorough understanding of reactions attributable to this class is imperative. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen. This analysis represents a systematic review of the dermatological conditions reported with the use of these drugs, complemented by experience at comprehensive cancer centres. The conditions reported herein include skin, hair, and nail toxicities. Lastly, we describe the dermatological data available for the new, recently FDA-and EMA- approved, solvent-free nab-paclitaxel.
Topics: Alopecia; Antineoplastic Agents; Docetaxel; Drug Eruptions; Edema; Humans; Lupus Erythematosus, Cutaneous; Nail Diseases; Paclitaxel; Pigmentation Disorders; Radiodermatitis; Taxoids
PubMed: 27550571
DOI: 10.1684/ejd.2016.2833 -
BMC Cancer Jan 2014Radiation-induced skin reaction (RISR) is a common side effect that affects the majority of cancer patients receiving radiation treatment. RISR is often characterised by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Radiation-induced skin reaction (RISR) is a common side effect that affects the majority of cancer patients receiving radiation treatment. RISR is often characterised by swelling, redness, pigmentation, fibrosis, and ulceration, pain, warmth, burning, and itching of the skin. The aim of this systematic review was to assess the effects of interventions which aim to prevent or manage RISR in people with cancer.
METHODS
We searched the following databases up to November 2012: Cochrane Skin Group Specialised Register, CENTRAL (2012, Issue 11), MEDLINE (from 1946), EMBASE (from 1974), PsycINFO (from 1806), CINAHL (from 1981) and LILACS (from 1982). Randomized controlled trials evaluating interventions for preventing or managing RISR in cancer patients were included. The primary outcomes were development of RISR, and levels of RISR and symptom severity. Secondary outcomes were time taken to develop erythema or dry desquamation; quality of life; time taken to heal, a number of skin reaction and symptom severity measures; cost, participant satisfaction; ease of use and adverse effects. Where appropriate, we pooled results of randomized controlled trials using mean differences (MD) or odd ratios (OR) with 95% confidence intervals (CI).
RESULTS
Forty-seven studies were included in this review. These evaluated six types of interventions (oral systemic medications; skin care practices; steroidal topical therapies; non-steroidal topical therapies; dressings and other). Findings from two meta-analyses demonstrated significant benefits of oral Wobe-Mugos E for preventing RISR (OR 0.13 (95% CI 0.05 to 0.38)) and limiting the maximal level of RISR (MD -0.92 (95% CI -1.36 to -0.48)). Another meta-analysis reported that wearing deodorant does not influence the development of RISR (OR 0.80 (95% CI 0.47 to 1.37)).
CONCLUSIONS
Despite the high number of trials in this area, there is limited good, comparative research that provides definitive results suggesting the effectiveness of any single intervention for reducing RISR. More research is required to demonstrate the usefulness of a wide range of products that are being used for reducing RISR. Future efforts for reducing RISR severity should focus on promising interventions, such as Wobe-Mugos E and oral zinc.
Topics: Humans; Neoplasms; Odds Ratio; Radiodermatitis; Radiotherapy; Risk Factors; Severity of Illness Index; Skin; Time Factors; Treatment Outcome; Wound Healing
PubMed: 24484999
DOI: 10.1186/1471-2407-14-53 -
BioMed Research International 2013A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates...
The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters.
A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.
Topics: Carcinoma; Disease-Free Survival; Head and Neck Neoplasms; Humans; Neoplasm Grading; Parotid Gland; Radiodermatitis; Radiotherapy, Intensity-Modulated; Treatment Outcome; Xerostomia
PubMed: 24228247
DOI: 10.1155/2013/401261 -
American Journal of Clinical Oncology Oct 2011During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were as follows: (1) systematically review the literature on... (Review)
Review
During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were as follows: (1) systematically review the literature on radiodermatitis and breast cancer; (2) summarize and describe patient-rated radiodermatitis measures; (3) determine whether consensus exists regarding subjective radiodermatitis measurement; and (4) provide recommendations for future research. PubMed and CINAHL were searched from their inception through August 2009. Study inclusion and exclusion criteria were: full abstract available, manuscript in English, focused on radiodermatitis resulting from breast cancer radiotherapy, and described a patient-rated empirical assessment of radiodermatitis. Three reviewers examined abstracts, and decisions about inclusion were reached by consensus. Twenty-two of 237 mutually identified studies met selection criteria. Using a standardized abstraction form, 3 authors independently extracted relevant information. Results indicated that (1) only 9% of the studies reviewed included a patient-rated measure; (2) generally, extant scales are very brief and focus almost exclusively on physical reactions, and (3) there is no "gold standard" measure of patient-rated radiodermatitis at this time. We conclude that significantly more research is needed to determine the best (most valid, reliable, sensitive, comprehensive) measure(s) to evaluate the experience of radiodermatitis from the patient's perspective, and that further scale development efforts are needed.
Topics: Brachytherapy; Breast Neoplasms; Female; Humans; Radiodermatitis
PubMed: 20838323
DOI: 10.1097/COC.0b013e3181e84b36 -
The Cochrane Database of Systematic... Apr 2009Homeopathic medicines are used by patients with cancer, often alongside conventional treatment. Cancer treatments can cause considerable morbidity and one of the reasons... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Homeopathic medicines are used by patients with cancer, often alongside conventional treatment. Cancer treatments can cause considerable morbidity and one of the reasons patients use homeopathic medicines is to help with adverse effects.
OBJECTIVES
Evaluate effectiveness and safety of homeopathic medicines used to prevent or treat adverse effects of cancer treatments.
SEARCH STRATEGY
The following were searched up to November 2008: Cochrane PaPaS Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; BNI; CancerLIT; AMED; CISCOM; Hom-Inform; SIGLE; National Research Register; Zetoc; www.controlled-trials.com; http://clinicaltrials.gov; Liga Medicorum Homeopathica Internationalis (LMHI, Liga) conference proceedings; reference lists of relevant studies were checked; and homeopathic manufacturers, leading researchers and practitioners were contacted.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of homeopathic medicines in participants with a clinical or histological diagnosis of cancer where the intervention was aimed at preventing or treating symptoms associated with cancer treatments. All age groups, and all stages of disease were included.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion and two review authors extracted data. Three review authors independently assessed trial quality using the Delphi List and the Cochrane Collaboration's tool for assessing risk of bias. Disagreements were resolved by consensus. Where available, data were extracted for analysis.
MAIN RESULTS
Eight controlled trials (seven placebo controlled and one trial against an active treatment) with a total of 664 participants met the inclusion criteria. Three studied adverse effects of radiotherapy, three studied adverse effects of chemotherapy and two studied menopausal symptoms associated with breast cancer treatment.Two studies with low risk of bias demonstrated benefit: one with 254 participants demonstrated superiority of topical calendula over trolamine (a topical agent not containing corticosteroids) for prevention of radiotherapy-induced dermatitis, and another with 32 participants demonstrated superiority of Traumeel S (a proprietary complex homeopathic medicine) over placebo as a mouthwash for chemotherapy-induced stomatitis. Two other studies reported positive results, although the risk of bias was unclear, and four further studies reported negative results.No serious adverse effects or interactions were reported attributable to the homeopathic medicines used.
AUTHORS' CONCLUSIONS
This review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute dermatitis during radiotherapy and Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis. These trials need replicating. There is no convincing evidence for the efficacy of homeopathic medicines for other adverse effects of cancer treatments. Further research is required.
Topics: Antineoplastic Agents; Breast Neoplasms; Calendula; Female; Homeopathy; Humans; Menopause; Minerals; Neoplasms; Phytotherapy; Plant Extracts; Radiation Injuries; Radiodermatitis; Randomized Controlled Trials as Topic; Stomatitis
PubMed: 19370613
DOI: 10.1002/14651858.CD004845.pub2