Margaret Fischer

Transcutaneous electrical nerve stimulation as an adjunct for controlling chemotherapy-induced nausea and vomiting in gynecologic oncology patients.

BACKGROUND To evaluate the efficacy of a miniaturized portable transcutaneous electrical nerve stimulation (TENS) unit (ReliefBand) as an adjunct to standard antiemetic therapy for controlling nausea and vomiting induced by cisplatin-based chemotherapy in gynecologic oncology patients. METHODS Forty-two patients were enrolled in a randomized, double-blind, placebo-controlled parallel-subjects trial with a follow-up crossover trial. All patients received a standardized antiemetic protocol, then wore the ReliefBand continuously for 7 days. RESULTS Thirty-two patients were evaluable for the parallel-subjects component, 16 in each group. The percentage of patients with absent or minimal nausea was 59% overall, which was similar to that for both the active (56%) and placebo (62%) groups. The incidence and severity of nausea and vomiting was similar for each group. Eighteen patients completed two consecutive cycles and were evaluable for the crossover component. The average age of the crossover patients and their dose intensity were comparable with those of the overall study population (56.3 versus 58.6 years and 22.7 versus 22.7 mg/m2/week, respectively). The percentage of cycles with absent or minimal nausea was 47% overall, which was similar to that of the active (50%) and placebo (44%) cycles. However, the severity of nausea was significantly lower in the active cycles during days 2 to 4. Patients averaged less than one episode of vomiting daily in each cycle. CONCLUSIONS The ReliefBand is an effective adjunct to standard antiemetic agents for controlling nausea induced by cisplatin-based chemotherapy in gynecologic oncology patients.

A randomized controlled trial of postoperative nasogastric tube decompression in gynecologic oncology patients undergoing intra-abdominal surgery

Objective To evaluate the effect of nasogastric decompression after extensive intra-abdominal surgery in gynecologic oncology patients. Methods Over a 1-year period, 110 gynecologic oncology patients undergoing extensive intra-abdominal surgery were enrolled in a randomized controlled trial of postoperative nasogastric tube versus intra-operative orogastric tube decompression. Results The nasogastric and orogastric groups were similar in age, case distribution, surgery length, and blood loss. The nasogastric group had significantly longer times to first passage of flatus and tolerance of a clear liquid diet than did the orogastric group. However, both groups were similar in time to tolerance of a regular diet and hospital stay. On average, the nasogastric tube was maintained for 3.2 ± 2.1 days (range 1–8) after surgery. The average daily nasogastric output was 440 ± 283 mL (range 68–1565). No patient in the orogastric group required a nasogastric tube postoperatively, but one patient in the nasogastric group had a nasogastric tube reinserted for recurrent nausea and vomiting. Use of a nasogastric tube led to significantly more subjective complaints, eg, ear pain, painful swallowing, and nasal soreness, but did not significantly reduce the incidence of abdominal distention or nausea and vomiting. Major complications, eg, pneumonia, atelectasis, gastrointestinal bleeding, and wound breakdown or infection, occurred equally in both groups. However, the incidence of febrile morbidity was significantly greater in the nasogastric group. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematological indices and electrolytes were comparable in both groups. Conclusion Postoperative nasogastric tube decompression in gynecologic oncology patients undergoing extensive intra-abdominal surgery does not appear to provide any substantial benefit but significantly increases patient discomfort. As a result of this study, we have eliminated postoperative nasogastric decompression except in highly selected circumstances, such as extensive bowel surgery in patients with prior irradiation or substantial edema from bowel obstruction.

Primary care experience on a university-based gynecologic oncology service

Abstract We sought to document the incorporation of primary care education in the training of obstetrics and gynecology residents on the gynecologic oncology service at a university hospital in a tertiary care center. We conducted a prospective study of 177 consecutive admissions to the gynecologic oncology service at the University Hospital at Stony Brook during the 3 months from June to August 1996. Admissions were categorized into two groups: medical and surgical. Medical admissions were further categorized by diagnostic groups. For each admission, the medical history of each patient was recorded, as were any new diagnoses identified during that admission. Routine medications and newly initiated therapies were also recorded for each patient. All results were categorically summarized as frequencies and percentages. Of the 177 patients seen by the two residents staffing the gynecologic oncology service during the study period, 100 (56%) were admitted for medical conditions and 77 (44%) for surgical procedures. The patients’ ages ranged from 24 to 87 years, with the mean age being 59.1 years. One hundred thirty-two patients (74%) were admitted with comorbid medical conditions, and more than one quarter of them had a history of psychiatric illness. Moreover, 127 (72%) patients had a positive history of medications used for the chronic management of nongynecologic medical diseases. In addition, 150 (85%) patients were diagnosed with multiple new medical conditions, and the residents initiated new medical therapy for 128 (72%) patients. As flexibility training is introduced in obstetrics/gynecology, residents will gain a wealth of exposure to primary care on services with a high volume of patients who have medical comorbidities.

A Randomized Controlled Trial of Early Postoperative Feeding in Gynecologic Oncology Patients Undergoing Intra-abdominal Surgery

Objective To evaluate the safety and efficacy of early oral feeding after intra-abdominal surgery in gynecologic oncology patients. Methods During a 1-year period, 200 gynecologic oncology patients undergoing intra-abdominal surgery were enrolled in a randomized controlled trial of early compared with traditional oral postoperative feeding. Patients allocated to early postoperative oral feeding began a clear liquid diet on the first postoperative day and then advanced to a regular diet as tolerated. Patients allocated to traditional postoperative oral feeding received nothing by mouth until return of bowel function (defined as the passage of flatus in the absence of vomiting or abdominal distention), then began a clear liquid diet, and advanced to a regular diet as tolerated. Results Age, case distribution, surgery length, blood loss, and first passage of flatus were similar in the early and traditional feeding groups. Significantly more patients in the early group developed nausea. Despite this, the incidence of vomiting, abdominal distention, incidence and duration of nasogastric tube use, and percentage of patients who tolerated clear liquid and regular diets on the first attempt were comparable in both groups. Time to development of bowel sounds, time to initiation of clear liquid and regular diets, and hospital stay were significantly longer in the traditional group. Major complications (eg, pneumonia, atelectasis, and wound complications) and febrile morbidity occurred equally in both groups. There were no known anastamotic complications or aspirations in either group. Postoperative changes in hematologic indices and electrolytes were com-parable in both groups. Conclusion Early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery is safe and well tolerated.