Orange Interventions for Symptoms Associated With Dimethyl Sulfoxide During Stem Cell Reinfusions: A Feasibility Study

Effects of aromatherapy on nausea and vomiting in patients with cancer: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

and purpose: Aromatherapy offers a low-risk solution for effectively managing common nausea and vomiting in cancer patients. This systematic review and meta-analysis aimed to assess its impact on these symptoms to facilitate practical guidelines establishment.

METHODS

PubMed, Web of Science, Cochrane Library, MEDLINE, CINAHL, and Embase were searched for articles published until April 30, 2023. Inclusion criteria were randomized controlled trials (RCTs) on the effect of aromatherapy on nausea and vomiting in patients with cancer (age ≥18 years). The effect size was calculated using standardized mean differences (SMDs) with a random effects model. Subgroup analyses, meta-analysis of variance, and meta-regression were performed using the "meta" package in R version 4.0.2. Heterogeneity was assessed using I2 statistics. Sensitivity and publication bias analyses were performed; two reviewers independently assessed risk of bias using Cochrane's risk-of-bias tool 2.0.

RESULTS

Twenty-five RCTs across 10 articles revealed that aromatherapy reduced overall nausea and vomiting in patients with cancer with significant efficacy (SMD = -0.81, 95 % confidence interval [CI]: -1.11 to -0.52). Furthermore, aromatherapy reduced nausea (SMD = -0.85, 95 % CI: -1.23 to -0.46) and combined nausea and vomiting (SMD = -1.08, 95 % CI: -1.68 to -0.47), but not vomiting alone (SMD = -0.24, 95 % CI: -1.03 to 0.55). Inhalation and massage yielded positive results, especially in chemotherapy-induced cases; peppermint oil was particularly successful.

CONCLUSION

Our findings underscore aromatherapy's value in managing cancer treatment-associated nausea and vomiting. Conclusive evidence on aromatherapy-led nausea reduction is lacking due to limited RCTs; research is warranted for robust conclusions.

Effectiveness of Inhaled Aromatherapy on Chemotherapy-Induced Nausea and Vomiting: A Systematic Review

Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and feared side effects of cancer treatments. Their presence has a negative impact on the quality of life and morbidity associated with the disease. Despite increasingly effective antiemetic treatments, 40% of cancer patients experience CINV during the acute or delayed phase of their treatment. This distressing experience lived through by a large number of people makes it a priority in the improvement of cancer patients and a daily concern for nurses in cancer care units. In an attempt to alleviate this problem, the idea of using aromatherapy as supportive care has led the authors to research the knowledge available on this subject. Objective: The purpose of this systematic review was to examine the existing scientific evidence regarding the effectiveness of respiratory aromatherapy on CINV in addition to standard treatment compared with their recommended management in people with cancer. Design: Systematic review. Methods: This review was conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines and queried six databases (PubMed, Scopus, Cochrane Database, Embase, CINAHL, and Google Scholar). An analysis of the risk of bias using the Cochrane "Risks of Bias" tools and a qualitative synthesis of the results of the studies were carried out. Results: Eleven studies were included, nine in adults and two in children. Seven out of nine studies showed statistically significant results in adults with either direct or dry inhalation. Four out of seven alleviated both nausea and vomiting thanks to peppermint, ginger essential oil; three decreased nausea only with chamomilla, ginger or cardamom essential oil. Atmospheric diffusion and the use of inhaled aromatherapy in children did not show any benefit. Conclusions: Results appear promising for the use of direct inhaled aromatherapy in the management of CINV. However, most of the studies found the women concerned suffered from gynecologic cancers and had certain methodological limitations. Indeed, small samples and a wide variety of interventions were studied (different essential oils, number of drops of essential oils used, method of administration, etc.), making it impossible so far to generalize these results. Studies with a more robust methodology and larger samples will make it possible to confirm the potential usefulness of this complementary treatment.

PROTOCOL OF NURSING CARE ON ZERO DAY OF THE TRANSPLANTATION OF HEMATOPOETIC STEM CELLS: COLLECTIVE CONSTRUCTION

ABSTRACT Objective: to construct a protocol of nursing care to the patient on day zero of hematopoietic stem cell transplantation. Method: a convergent care research was developed from August to December 2016 in a Bone Marrow Transplant Service. The participants were twenty-two nurses from this service. The technique of data collection used was discussion groups. For the analysis the following steps were taken: transcription of the data, highlighting the suggestions of the participants; distribution of contributions by theme, for synthesis of the elements in a coherent whole, scientific evidence and contributions of the participants; and construction of the protocol, with refinement and approval of the final version by nurses. Results: the protocol, guides nursing care to be provided by the nurse on day zero of hematopoietic stem cell transplantation, according to the infusion mode: fresh and cryopreserved-thawed. These precautions aim to prevent, identify and intervene early in complications related to cell infusion. Conclusion: the protocol, product of the research, was elaborated in the union of scientific evidences, with the reality of the service and the experience of the participating nurses. The utilization of the methodological steps of convergent care research was a facilitator, because, as it presupposes, it provided the union of care practice with scientific research. The participation of nurses in the construction and approval of the protocol enabled the subsequent implementation and use of this tool in nursing service.

Adverse reactions on day zero of hematopoietic stem cell transplantation: integrative review

OBJECTIVE

To identify the adverse reactions associated with the infusion of hematopoietic stem cells on day zero of hematopoietic stem cell transplantation.

METHODOLOGY

Integrative literature review, without temporal cut, with search in the following databases: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science and CAPES; the final sample consisted of 18 scientific articles, published between 1998 and 2017, based on the inclusion and exclusion criteria.

RESULTS

Mild and moderate adverse reactions were the most frequent in studies that used the classification by severity, and nausea and emesis had the highest incidence; the most affected organ systems were the cardiovascular, respiratory and gastrointestinal.

CONCLUSION

The main adverse reactions identified in the studies were nausea and emesis. Those classified as mild and moderate were the most frequent in the studies that used the severity classification; and the cardiovascular, respiratory and gastrointestinal systems were the most affected in those that used the classification by organic systems.

Integrative Therapeutic Approaches for the Management and Control of Nausea in Children Undergoing Cancer Treatment: A Systematic Review of Literature

Chemotherapy-induced nausea and vomiting (CINV) continues to be a common symptom experienced by children undergoing cancer treatment despite the use of contemporary antiemetics. Integrative therapeutic approaches in addition to standard pharmacologic antiemetic regimes offer potential to control CINV. The purpose of this review was to identify current evidence on integrative therapeutic approaches for the control of CINV in children with cancer. Online search engines (PubMed, CINAHL, PsychINFO) were queried using MESH terms. Titles, abstracts, and then full-text articles were reviewed for relevance to the review. The search resulted in 53 studies. Twenty-one studies met our review criteria. Integrative therapies identified included acupuncture/acupressure, aromatherapy, herbal supplements, hypnosis, and other cognitive behavioral interventions. Our review identified little information on the effectiveness and safety of most integrative therapeutic approaches for the control and management of CINV in children with cancer. However, evidence from adult cancer studies and some pediatric studies identify promising interventions for further testing.

Potential effects of pleasant and cold stimuli on nausea and vomiting induced by disgusting tastes

Several pharmacological agents have disgusting tastes that are perceived strongly in the back of the mouth and may trigger nausea and vomiting (NV), resulting in poor adherence to medication schedules and negative impacts on clinical outcomes. Pleasant stimuli and cold temperature lessen the disgusting stimuli, lowering NV through different mechanisms. A pleasant stimulus can mask an unpleasant one, presumably through lateral inhibitory connections in the local neuronal circuit. Similarly, temperature deeply influences taste perception because the response to bitter as well as to salty and sour has been found to assume a reversed U-shaped form, being reduced by cooling to 18°C and enhanced by warming to 30-37°C. This Review describes the mechanisms by which pleasant and cold stimuli may mask emetogenic disgusting stimuli and identifies the potential clinical applications of cooling for inhibiting objectionable drug-related gustatory reactions. © 2015 Wiley Periodicals, Inc.

Delayed chemotherapy-induced nausea and vomiting in autologous hematopoietic cell transplant patients: an exploratory analysis

PURPOSE

Delayed chemotherapy-induced nausea and vomiting (CINV) continues to be a problem in patients undergoing a hematopoietic cell transplant (HCT) despite progress in antiemetic prophylaxis. This study investigated the clinical course of nausea and vomiting (NV) and retching over the 5 days following an autologous HCT in a transplant setting.

METHODS

This longitudinal observational study was an exploratory analysis of data from a trial that assessed the efficacy of aroma in preventing NV related to dimethyl sulfoxide in 69 autologous HCT patients undergoing highly emetogenic chemotherapy (HEC; n = 56) or moderately emetogenic chemotherapy (MEC; n = 13).

RESULTS

Nausea started to increase on the second day after reinfusion, with a peak between 72 and 96 hours, and decreased on the fifth day. The pattern for vomiting was similar, while retching episodes remained unchanged after the third day following transplant. Nausea and emesis were observed in 73% (n = 41) and 64% (n = 36) of HEC patients, respectively, and in 85% (n = 11) and 62% (n = 8) of MEC patients, respectively.

CONCLUSIONS

Uncontrolled delayed CINV is still a challenge for autologous HCT patients. Nausea, vomiting and retching are 3 different symptoms that should be assessed and managed separately in routine clinical practice.

Controlled breathing with or without peppermint aromatherapy for postoperative nausea and/or vomiting symptom relief: a randomized controlled trial

PURPOSE

With little scientific evidence to support use of aromatherapy for postoperative nausea and/or vomiting (PONV) symptoms, this study evaluated controlled breathing with peppermint aromatherapy (AR) and controlled breathing alone (CB) for PONV relief.

DESIGN

A single blind randomized control trial design was used.

METHODS

On initial PONV complaint, symptomatic subjects received either CB (n = 16) or AR (n = 26) intervention based on randomization at enrollment. A second treatment was repeated at 5 minutes if indicated. Final assessment occurred 10 minutes post initial treatment. Rescue medication was offered for persistent symptoms.

FINDINGS

Among eligible subjects, PONV incidence was 21.4% (42/196). Gender was the only risk factor contributing to PONV symptoms (P = .0024). Though not statistically significant, CB was more efficacious than AR, 62.5% versus 57.7%, respectively.

CONCLUSIONS

CB can be initiated without delay as an alternative to prescribed antiemetics. Data also support use of peppermint AR in conjunction with CB for PONV relief.

Are orange lollies effective in preventing nausea and vomiting related to dimethyl sulfoxide? A multicenter randomized trial

PURPOSE

Nausea and vomiting (NV) related to DMSO affect patients undergoing auto-SCT despite antiemetic measures. Orange flavoring may reduce gastrointestinal symptoms.

METHODS

A multicenter, randomized, three-arm, open-label trial in four Italian large bone marrow transplant centers was conducted to assess the effectiveness of orange aroma in preventing NV related to DMSO. Patients were randomized to orange ice lollies, non-citrus ice lollies, and routine treatment (deep breaths) during reinfusion. Data on NV were collected up to 5 days after infusion; 69/98 patients were randomized: 23 to orange, 21 to non-citrus ice lollies, and 25 to routine treatment.

RESULTS

Although 48 h after transplantation no differences were observed in controlled nausea (Numerical Rating Scale (NRS) 0-100, ≤25) or vomiting, significantly fewer patients had no episodes of vomiting, no antiemetic rescue therapy, and no nausea (NRS <5) in the deep breath vs lollies groups (P = 0.017). The intensity of nausea over time differed significantly between ice lollies vs routine care (P = 0.001) groups, but not between the orange and non-citrus groups (P = 0.428).

CONCLUSION

The vasoconstrictive action of ice may prevent NV related to DMSO in the acute phase and reduce the need for rescue antiemetic therapy. Ice lollies offer a simple, noninvasive, and economic means for relieving nausea and vomiting related to this preservative.