Efficacy and Safety of Ginger on Chemotherapy-Induced Nausea and Vomiting: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) is a prevalent and distressing side effect. Historically, ginger has been explored as a potential remedy for various ailments, including its potential efficacy against CINV. OBJECTIVE: The aim of this study was to determine whether taking ginger supplements can relieve CINV. METHOD: A comprehensive search was conducted across PubMed, EMBASE, Cochrane Library, and the Wanfang database. Randomized controlled trials meeting our inclusion criteria were analyzed. The primary outcomes were the incidence and severity of CINV. The protocol was registered on PROSPERO, and the number is CRD4202232104. RESULT: Of the 35 randomized controlled trials analyzed, 22 trials employed ginger capsules as the primary intervention, whereas 13 studies evaluated the prophylactic effects of ginger-partitioned moxibustion. The outcomes indicated that combining ginger capsules with standard antiemetic agents can significantly reduce the incidence of grade 3 acute nausea (Risk Ratio [RR], 0.19; P < .001) and the incidence of high-grade overall vomiting (RR, 0.47; P = .01). Moreover, ginger-partitioned moxibustion can significantly alleviate the incidence of both mild (RR, 0.56; P = .001) and severe (RR, 0.39; P < .00001) vomiting. Only 2.8% of patients experienced dizziness after ginger-partitioned moxibustion. CONCLUSIONS: Our findings indicate that ginger capsules, when used alongside antiemetic drugs, enhance the management of severe CINV, particularly in highly emetogenic chemotherapy regimens. IMPLICATIONS FOR PRACTICE: Based on our findings, we recommend initiating ginger supplements before chemotherapy, in conjunction with standard antiemetics, to reduce the severity of CINV. The promising results warrant more rigorous clinical trials to firmly establish the role of ginger in CINV management.

Effectiveness of glutamine for the treatment of radiodermatitis in cancer patients: a meta-analysis of randomized controlled trials.

BACKGROUND: After receiving radiation therapy, 60%-95% of patients with cancer develop radiodermatitis, which causes pain, wound infection, and poor quality of life. Glutamine is a popular nutritional supplement for patients with cancer. Several studies examined the usefulness of glutamine for reducing radiodermatitis. However, there is still no consolidated evidence for clinical use. METHODS: We searched PubMed, Embase, Cochrane Library, CINAHL PLUS, and the China Knowledge Resource Integrated Database for the relevant literature published up to March 2023, without language restrictions. Two reviewers screened, filtered, and appraised these articles independently, and their data were pooled using a random-effects model. RESULTS: Five randomized controlled trials (RCTs) with 218 participants were analyzed. The incidence of radiodermatitis in the glutamine group (89/110) was significantly lower than in the placebo group (99/108; risk ratio [RR], 0.90; 95% CI, 0.81-1.00; p = 0.05; I2 = 7%). The incidence of moderate to severe radiodermatitis was significantly lower in the glutamine group than in the placebo group (RR, 0.49; 95% CI, 0.32-0.76; p = 0.001; I2 = 52%). Moreover, subgroup analysis demonstrated heterogeneity (I2 = 52%) for moderate to severe radiodermatitis, the risk of which might be significantly reduced by a glutamine dose of 20-30 g/day (RR, 0.60; 95% CI, 0.41-0.87; I2 = 0%). CONCLUSION: The meta-analysis indicate that glutamine might lead to a lower incidence of radiodermatitis, and that a glutamine dose of 20-30 g/day might decrease the incidence of moderate to severe dermatitis. Thus, the serious impact of radiodermatitis on treatment follow-up makes the clinical use of glutamine even more important. PROSPERO number: CRD42021254394.

Effect of bright light therapy on cancer-related fatigue and related symptoms: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Cancer-related fatigue (CRF) is a common side effect in cancer patients, possibly due to disrupted circadian rhythms. While bright light therapy (BLT) is known to modulate circadian rhythms, its role in mitigating CRF remains unclear. This study examined the impact of BLT on CRF and other related symptoms. METHODS: PubMed, Embase, Cochrane Library, and SCOPUS databases were searched. The trials were selected according to the PRISMA guidelines. The severity and quality of CRF and related symptoms were investigated in post-BLT intervention. RESULTS: Twelve trials involving 691 were included. BLT significantly reduced CRF (SMD = -0.92, 95% CI: -1.45 to -0.40, p < 0.00001, I2 = 90%) and insomnia (SMD = -2.80, 95% CI: -4.61 to -0.98, I2 = 0%). Subgroup analyzes were performed based on various factors including light illuminance and intervention duration. BLT was found to be effective in both preventing and treating CRF, though it did not significantly enhance sleep quality, depression, and quality of life (QoL). CONCLUSION: BLT is a promising intervention for managing CRF in cancer patients. Its efficacy in improving sleep quality, and insomnia, reducing depression, and enhancing QoL requires further exploration. A 4-week BLT intervention with ≥10,000 lx is recommended for preventing and treating CRF, with longer or less intense interventions also showing effectiveness. Otherwise, BLT exhibited minimal adverse effects.

Effects of Music Therapy on Spiritual Well-Being among Patients with Advanced Cancer in Palliative Care: A Meta-Analysis of Randomized Controlled Trials.

PURPOSE: Patients with advanced cancer in palliative care often experience physical and psychological symptoms that negatively impact their quality of life (QoL) and spiritual well-being. Music therapy can be used for symptom management in these patients. However, the effectiveness is uncertain. To determine the effectiveness of music therapy on spiritual well-being, QoL, pain, and psychological distress using randomized controlled trials (RCTs). DATA SOURCE: A systematic search was conducted in EMBASE, PubMed, Cochrane Library, CINAHL, Web of Science, and the ClinicalTrial.gov registry up to September 2022. CONCLUSION: The meta-analysis included seven RCTs with a total of 747 advanced cancer patients. Music therapy was found to significantly improve spiritual well-being with a mean difference of 0.43 (95% CI: 0.25 to 0.61, P < .001) in the intervention group compared to the control group. However, no significant group differences were found between the intervention and control groups for QoL (SMD: 0.53, 95% CI: -0.12 to 1.13, P = .11), pain (MD: -0.81, 95% CI: -2.06 to 0.44, P = .20), and psychological distress (SMD: -0.05, 95% CI: -0.41 to 0.32, P = .81). Music therapy can effectively improve the spiritual well-being of palliative care patients. However, its beneficial effects on QoL, pain, and psychological distress were minimal. IMPLICATIONS FOR NURSING PRACTICE: Music therapy interventions can be introduced to help patients deal with spiritual/existential needs. Future studies should identify optimal characteristics of music therapy interventions to aid in enhancing the quality of palliative care for patients with advanced cancer.

Efficacy of smartphone-based virtual reality relaxation in providing comfort to patients with cancer undergoing chemotherapy in oncology outpatient setting in Indonesia: protocol for a randomised controlled trial.

INTRODUCTION: Patients with cancer undergoing chemotherapy experience various physical and psychological problems and discomfort. Virtual reality (VR) can be used in technology-based non-pharmacological therapy that can serve as a potential distractor in the symptom management of patients with cancer undergoing chemotherapy. We propose a smartphone-based virtual reality relaxation (S-VR) technique as a complementary modality to provide comfort to patients with cancer, and we will evaluate its effect on patients with cancer undergoing chemotherapy. METHODS AND ANALYSIS: We will recruit 80 patients from the One Day Chemotherapy 'Tulip' Center of Dr. Sardjito General Hospital, Yogyakarta, Indonesia. This will be a two-arm parallel randomised controlled trial, with a 1:1 allocation and the primary outcome assessor blinded. This study will be divided into two groups: (1) an intervention group, with participants receiving 360° panoramic video content and music relaxation intervention through a VR device (head-mounted display) placed on their head during chemotherapy for ±10 min plus standard care and (2) a control group, with participants receiving guided imagery relaxation therapy in the form of a leaflet plus standard care. We will measure the outcomes after one chemotherapy cycle for each participant. The primary outcome is the effectiveness of the S-VR in improving the comfort of patients. The secondary outcome is the effect of the S-VR on the patients' symptom management self-efficacy, pain, anxiety, blood pressure (systolic blood pressure and diastolic blood pressure) and pulse rate. ETHICS AND DISSEMINATION: This study was approved by the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health and Nursing of Universitas Gadjah Mada-Dr. Sardjito General Hospital, Yogyakarta, Institutional Review Board (approval number: KE/FK/0301/EC/2023). Written informed consent will be obtained from all participants who enrol in the study. Dissemination will be conducted through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT05756465.

Effects of Ginseng on Cancer-Related Fatigue: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Cancer-related fatigue (CRF) is a common yet troublesome adverse effect that compromises patient quality of life (QoL). Ginseng is often used to boost energy. OBJECTIVES: The aim of this study was to systematically appraise evidence whether ginseng could alleviate CRF and improve QoL. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials on the effectiveness of ginseng for relieving CRF. The primary outcome was fatigue. The secondary outcomes included QoL, anxiety, adverse events, depression, and laboratory markers. RESULTS: The final sample comprised seven trials. The pooled results showed that ginseng consumption led to significant reductions in CRF levels (standard mean difference [SMD], -0.21; 95% confidence interval [CI], -0.42 to 0.00). Furthermore, improvements in physical well-being (SMD, 0.25; 95% CI, 0.09-0.41) and emotional well-being (SMD, 0.20; 95% CI, 0.01-0.40) were observed, as were nonsignificant trends toward improvement in vigor (SMD, 0.18; 95% CI, -0.02 to 0.38), mitigated nausea (SMD, 0.38; 95% CI, -0.09 to 0.85), dyspnea (SMD, 0.27; 95% CI, -0.04 to 0.59), and anxiety (mean difference, -0.97; 95% CI, -2.12 to 0.18). CONCLUSIONS: Ginseng consumption alleviates CRF and may have certain benefits in improving QoL especially physical well-being. IMPLICATIONS FOR PRACTICE: Ginseng may be used as an energy or nutrient supplement to alleviate CRF. However, the concentration of ginseng's functional components is affected by the production methods and thus probably its effects. Oncology nurses are encouraged to have a better understanding of the benefits and functional limitations of ginseng as an energy or nutrient supplement for CRF.

Comparison of the effects of acupotomy and acupuncture on knee osteoarthritis: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Acupotomy and acupuncture are both treatments for knee osteoarthritis symptoms. However, acupotomy also has the additional anatomical effect of dissecting inflamed tissue. The problem this study aims to address is whether acupotomy is a better treatment than acupuncture in treating knee osteoarthritis. METHODS: We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Airiti Library, and Wanfang Data databases from inception to March 2022 for randomized controlled clinical trials (RCTs) comparing the effects of acupotomy and acupuncture in patients with knee osteoarthritis. RESULTS: In total, we identified 43 RCTs in this meta-analysis. Compared to the acupuncture group, acupotomy had a higher cure rate (odds ratio (OR) 2.94, 95% confidence interval (CI) 2.36 to 3.65), indicating a better improvement in daily activity function. Acupotomy was also more effective in pain relief and knee score improvement. However, some RCTs indicated that adverse events in the acupotomy group were greater than in the acupuncture group (OR 1.23, 95% CI 0.42 to 3.60). CONCLUSION: Our findings indicated that acupotomy was a more effective treatment for knee osteoarthritis than acupuncture. However, most of the included RCTs had moderate risk of bias, meaning that more high-quality RCTs were needed.

Effects of Low-Level Laser Therapy on Muscular Performance and Soreness Recovery in Athletes: A Meta-analysis of Randomized Controlled Trials.

CONTEXT: Athletes must maintain their peak state of strength. Previous studies have investigated the effect of low-level laser therapy (LLLT) on muscular performance. A previous systematic review and meta-analysis has investigated this issue in healthy participants but not in physically active athletes. OBJECTIVE: To investigate whether LLLT can improve muscular performance and soreness recovery in athletes. DATA SOURCES: PubMed, EMBASE, and Cochrane Library. STUDY SELECTION: Published randomized controlled trials and crossover studies till December 2020. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Assessment of study quality was rated using the risk of bias assessment method for randomized trials (Cochrane Handbook for Systematic Reviews of Interventions). RESULTS: A total of 24 studies were included. LLLT application before exercise significantly improved lower-limb muscle strength in 24-hour, 48-hour, 96-hour, and 8-week follow-up groups. Furthermore, decreased soreness index, serum creatine kinase concentrations, interleukin-6, and thiobarbituric acid reactive substance concentrations and a trend toward the improvement of contract repetition number and VO2 kinetic outcomes were observed. CONCLUSION: Although a definite therapeutic effect of LLLT is yet to be established, the current evidence supports that LLLT use improves muscular performance in physically active athletes. Additional trials with large sample sizes and robust design should be conducted before strong recommendations are made.

Effect of progressive muscle relaxation on postoperative pain, fatigue, and vital signs in patients with head and neck cancers: A randomized controlled trial.

OBJECTIVE: Surgery for head and neck cancers are associated with significant preoperative stress. We investigated the effects of progressive muscle relaxation (PMR) on postoperative pain, fatigue, and vital signs in patients with head and neck cancers. METHODS: All patients were hospitalized and randomly assigned to intervention or usual care groups. A generalized estimating equation was used to evaluate the PMR effects on pain and symptoms across the preoperative day to postoperative day 10. RESULTS: The PMR group displayed significantly lower overall pain and muscle tightness than control group along with the timeline of multiple measurements (p < 0.01). PMR significantly reduces sleep disturbances and levels of fatigue, anxiety, and depression compared with the control group with time trend (p < 0.01). PMR also lowered the respiratory rates and diastolic blood pressure (p < 0.01). CONCLUSIONS: PMR can reduce sleep disturbances and levels of pain, fatigue, muscle tightness, anxiety, and depression in patients with head and neck cancer undergoing major surgeries. Future study should focus on improving the effectiveness of the exercise and standardization of the application. PRACTICAL IMPLICATIONS: progressive muscle relaxation help relieve discomforts in patients with head and neck cancers with minimal costs and efforts.

Bright Light Therapy for Parkinson Disease: A Literature Review and Meta-Analysis of Randomized Controlled Trials.

Sleep disorders and depression are significant nonmotor symptoms (NMSs) of Parkinson disease (PD). However, few effective, evidence-proven medical treatments are available for alleviating these symptoms. Bright light therapy (BLT) is a well-established treatment for circadian rhythm sleep disorders and seasonal affective disorder. The present study conducted a literature review for the effect of BLT on PD, especially a meta-analysis of randomized controlled trials (RCTs). We searched for studies using the PubMed and Cochrane Library databases. The major outcomes were the effects on sleep and depression. The effect on motor symptoms was also analyzed as a secondary outcome. This study was registered with PROSPERO (CRD42020204454). Six studies were included in the literature review only, and the other five RCTs were included in the meta-analysis. Despite the positive effects of BLT on PD patients, which were demonstrated in noncontrolled studies, in the meta-analysis of the RCTs, BLT did not significantly improve the depressive symptoms (standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.48 to 0.17, p = 0.36) and excessive daytime sleepiness (EDS) (SMD: -0.12, 95% CI: -0.49 to 0.25, p = 0.53) in PD patients. Regarding motor symptoms, no significant beneficial effects were conferred (SMD: -0.11, 95% CI: -0.44 to 0.21, p = 0.49). In conclusion, BLT did not significantly alleviate depression and sleepiness. The inconsistency between BLT protocols, such as the varied timing, dosages, and treatment durations, may render BLT's efficacy difficult to demonstrate. The small effect size obtained from the present meta-analysis indicates that future RCTs are necessary, for which BLT protocols are standardized and more patients are enrolled to determine whether a significant therapeutic benefit was conferred.

Effects of photobiomodualtion therapy on breast cancer-related lymphoedema: A systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: Lymphoedema characterised by the persistent accumulation of the interstitial fluid in peripheral tissues post breast cancer treatments. Photobiomodualtion therapy (PBMT) is widely used as supportive care in patients with breast cancer or breast cancer-related lymphoedema (BCRL). This systematic review and meta-analysis analysed the effectiveness and safety of PBMT for the treatment of BCRL. METHOD: PubMed, EMBASE, PEDro, SCOPUS, CINAHL, and Cochrane Central Register of Controlled Trials were searched for RCTs on PBMT published before July 2019. Randomised controlled trials (RCTs) that evaluated the efficacy of PBMT on BCRL were included. The primary outcome was the arm circumference or volume, and secondary outcomes were grip strength and pain scores. This study is registered with PROSPERO (number CRD 42018102107). RESULTS: We reviewed nine RCTs that included 316 patients and six studies for mata-analysis. We found no significant difference in the reduction of the arm circumference or arm volume after treatment, one month, and three month follow-up between the PBMT and control groups. Studies revealed no significant differences in the reduction in grip strength and pain scores at 0, 1, 2, and 3 month between the PBMT and control groups. CONCLUSIONS: Although PBMT demonstrated a slight improvement in reducing arm circumference and arm volume, the results of our meta-analysis did not show significant benefits in relieving of lymphoedema. Further trials are needed to recruit more participants, and to evaluate the long-term efficacy and safety of PBMT in management of breast cancer-related lymphoedema.

Prophylactic management for taxane-induced nail toxicity: A systematic review and meta-analysis.

OBJECTIVE: This meta-analysis was performed to assess the efficacy of cryotherapy and nail solution (NS) use in preventing nail toxicity (NT) induced by taxane-based chemotherapy. METHODS: PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov registry databases were searched for relevant studies published up to December 2018. The primary outcome was taxane-induced NT. Secondary outcomes were skin toxicity (ST), time to toxicity and patient comfort. RESULTS: We reviewed three randomised control trials and six prospective studies with 708 patients. For meta-analysis, taxane-induced NT grading was compared. NT and ST were significantly lower in the cryotherapy patients than in the controls (grade 1 NT: risk ratio [RR] = 0.51, 95% confidence interval [CI] = 0.30-0.89; grade 2-3 NT: RR = 0.36, 95% CI = 0.11-1.12; total NT: RR = 0.49; 95% CI = 0.30-0.79; ST: RR = 0.46, 95% CI = 0.33-0.64). The NS-treated patients exhibited significantly lower NT than the controls. CONCLUSIONS: Nail solution-treated or cryotherapy patients exhibited lower NT incidence and severity associated with taxane-based chemotherapy than the controls. For patients who can afford and comply with NS use or cryotherapy, these measures represent effective prophylactic management for taxane-induced NT and improve their quality of life and functional statuses. Further studies are needed to establish the routine usage protocols, long-term efficacy and safety for these interventions.

Prophylactic and therapeutic effects of honey on radiochemotherapy-induced mucositis: a meta-analysis of randomized controlled trials.

PURPOSE: Oral mucositis is a common side effect of radiochemotherapy and may adversely affect the patients' quality of life (QoL). Honey application may reduce the mucositis grade in patients. Here, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the prophylactic and therapeutic effects of honey on radiochemotherapy-induced oral mucositis. METHODS: Publications on RCTs were extracted from the PubMed, Embase, CINAHL, and Cochrane Library databases. The primary outcomes were mucositis grades and pain scores. Secondary outcomes were the recovery time and QoL. The study was registered with PROSPERO (number CRD42018108486). RESULTS: Nineteen RCTs, involving 1276 patients, were reviewed. Honey considerably mitigated oral mucositis in both prophylactic and therapeutic phases. In the prophylactic phase, intolerable mucositis development was significantly prevented in the honey-treated group (RR = 0.18, 95% confidence interval [CI] = 0.09 to 0.41). Patients treated with honey showed significant decrease in pain scores in the first month of treatment (weighted mean difference [WMD] = - 3.25, 95% CI = - 4.41 to - 2.09) and at the end of the treatment (WMD = - 2.32, 95% CI = - 4.47 to - 0.18). CONCLUSION: Honey, which is relatively cheap and easily available, prevented mucositis and effectively mitigate mucositis in patients after radiochemotherapy. Moreover, it significantly reduced the mucositis grade and engendered a fast and painless healing process. Therefore, honey use during and after radiochemotherapy is recommended for mucositis prevention and treatment.

Effect of acupuncture on aromatase inhibitor-induced arthralgia in patients with breast cancer: A meta-analysis of randomized controlled trials.

PURPOSE: Aromatase inhibitor (AI)-induced arthralgia (AIA) is a common side effect that may lead to premature discontinuation of effective hormonal therapy in patients with breast cancer. Acupuncture may relieve joint pain in patients with AIA. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of acupuncture in pain relief in AIA. METHODS: The PubMed, Embase, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were searched for studies published before February 2017. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using a random effect model. Pain was assessed using the Brief Pain Inventory (BPI) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3-4, 6-8, and 12 weeks. Secondary outcomes included disability level, upper extremity function, physical performance, and quality of life. RESULTS: Five trials involving 181 patients were reviewed. Significant pain reduction was observed after 6-8 weeks of acupuncture treatment. Patients receiving acupuncture showed a significant decrease in the BPI worst pain score (weighted mean difference [WMD]: -3.81, 95% confidence interval [CI]: -5.15 to -2.47) and the WOMAC pain score (WMD: -130.77, 95% CI: -230.31 to -31.22) after 6-8 weeks of treatment. One of the 4 trials reported 18 minor adverse events in 8 patients during 398 intervention episodes. CONCLUSION: Acupuncture is a safe and viable nonpharmacologic treatment that may relieve joint pain in patients with AIA. Additional studies involving a higher number of RCTs are warranted.

Effects of manual lymphatic drainage on breast cancer-related lymphedema: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Lymphedema is a common complication of axillary dissection for breast cancer. We investigated whether manual lymphatic drainage (MLD) could prevent or manage limb edema in women after breast-cancer surgery. METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the effectiveness of MLD in the prevention and treatment of breast-cancer-related lymphedema. The PubMed, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro), SCOPUS, and Cochrane Central Register of Controlled Trials electronic databases were searched for articles on MLD published before December 2012, with no language restrictions. The primary outcome for prevention was the incidence of postoperative lymphedema. The outcome for management of lymphedema was a reduction in edema volume. RESULTS: In total, 10 RCTs with 566 patients were identified. Two studies evaluating the preventive outcome of MLD found no significant difference in the incidence of lymphedema between the MLD and standard treatment groups, with a risk ratio of 0.63 and a 95% confidence interval (CI) of 0.14 to 2.82. Seven studies assessed the reduction in arm volume, and found no significant difference between the MLD and standard treatment groups, with a weighted mean difference of 75.12 (95% CI, -9.34 to 159.58). CONCLUSIONS: The current evidence from RCTs does not support the use of MLD in preventing or treating lymphedema. However, clinical and statistical inconsistencies between the various studies confounded our evaluation of the effect of MLD on breast-cancer-related lymphedema.