Electric Stimulation on Nausea and Vomit Chemotherapy Induced

Not Applicable

• Conditions: Breast Cancer Female; Acupuncture
• Interventions: Device: Low Frequency Group; Device: Placebo Group; Device: High Frequency Group

• Registration Number: NCT03145727
• Lead Sponsor: Federal University of Health Science of Porto Alegre

Brief Summary

Chemotherapy induces nausea and vomit for some large patients. But, some chemotherapy protocol has a high indices of the incidence as observed in a combination of Anthracycline and Cyclophosphamide (AC). To prevent this symptoms, some medication can be used as Ondansetron. By other hands, the traditional acupuncture on Chinese Medicine have been used a PC6 point to avoid nausea and vomit. More recently, a transcutaneous electric nerve stimulation (TENS) also has been used for this application. Our study will test the TENS applied on PC6 point with two different frequencies (high and low) to evaluated the nausea and vomit inhibition effects.

Detailed Description

We will enroll 84 women that being starts a chemotherapy protocol with a Anthracycline and Cyclophosphamide (AC) as a part of breast cancer treatment. All volunteers will be submitted a 30 minutes TENS prior to chemotherapy administration. Three different TENS treatment will be test: 1) placebo; 2) high frequency and 3) low frequency. The self-adhesive electrodes will be positioned in the same position for all different TENS treatment (opposite arm to the chemotherapy infusion). The eletctrodes will be positioned as follows: the first electrode at the PC6 point which is located proximal to the flexion fold of the wrist in the middle of the anterior face of the forearm, between the tendons of the long palmar and radial flexor muscles of the carpus and the second electrode at any point in the hand. After that, all volunteers will receipt a formulary to self-complete a nausea and vomit symptoms record during the next 24 hours. Number of incidence and magnitude of the symptoms will express the accumulated indices the occurrence and severity of the symptoms, as further describe in this protocol.

Study Timeline

• Study First Submitted: 2017-05-05
• Study First Submitted QC: 2017-05-08
• Study First Posted: 2017-05-09
• Status Verified: 2017-08
• Study Start: 2017-08-01
• Last Update Submitted: 2017-08-21
• Last Update Posted: 2017-08-22
• Primary Completion: 2017-12-30
• Study Completion: 2018-10-30

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: Female
• Target Recruitment: 84

Inclusion Criteria

• Having breast cancer diagnosed through anatomopathological investigation;
• Indication of neoadjuvant or adjuvant chemotherapy treatment with the combination of anthracycline and cyclophosphamide associated with Ondasetron used as a routine of the Santa Rita Hospital chemotherapy service;
• Present Karnofsky score (KPS) higher than 70 points;
• Being female;
• Be between 18 and 65 years of age and be able to participate in outpatient chemotherapy.

Exclusion Criteria

• Patients with breast cancer treated with chemotherapeutic regimens other than anthracycline and cyclophosphamide;
• Inability to report nausea and vomiting due to neurological changes, difficulty understanding and / or lack of caregivers that may contribute to the completion of the report;
• Be submitted to radiation therapy concomitant with chemotherapy;
• Presence of gastrointestinal and cerebral metastases;
• Presence of cardiac pacemaker;
• Presence of active skin infection in PC6;
• Nausea and vomiting caused by electrolyte disturbances or intestinal;
• Presence of intra-cranial hypertension.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Low Frequency Group	Low Frequency Group	Low Frequency Group: In this group the TENS will be adjusted with frequency of 10Hz, pulse duration of 200 microseconds. The stimulation time will be 30 minutes and the intensity will be constantly adjusted in order to keep as high as possible within the tolerance threshold of the patient.
Placebo Group	Placebo Group	Placebo Group: In this group the participants received TENS with frequency of 75Hz, pulse duration of 200 microseconds. The stimulation time will be for only 10s.
High Frequency Group	High Frequency Group	High Frequency Group: In this group the TENS will be adjusted with frequency of 150Hz, pulse duration of 200 microseconds. The stimulation time will be 30 minutes and the intensity will be constantly adjusted in order to keep as high as possible within the tolerance threshold of the patient.

Primary Outcome Measures

Name	Time	Method
Cumulative index of nausea	Cumulative index of nausea in the first 24 hours after an infusion of chemotherapy.	The 24-hour follow-up record of symptoms of nausea and vomiting will be performed using a form developed from the MASEM anti-emetic instrument (MAT), especially for the present study. This form includes a diary to record emetic events within 24 hours after the administration of chemotherapy. Thus, we will evaluate: the cumulative index of nausea and vomiting over 24 hours after the infusion of the first cycle of high grade emetic chemotherapy.Participants will be instructed to fill out the instrument and take the questionnaire home, bringing it back to the investigators when they return to the outpatient clinic for another round of chemotherapy.

Secondary Outcome Measures

Name	Time	Method
Cumulative index of episodes of vomiting	Cumulative index of episodes of vomiting in the first 24 hours after an infusion of chemotherapy.	The 24-hour follow-up record of symptoms of nausea and vomiting will be performed using a form developed from the MASEM anti-emetic instrument (MAT), especially for the present study. This form includes a diary to record emetic events within 24 hours after the administration of chemotherapy. Thus, we will evaluate: the cumulative index of nausea and vomiting over 24 hours after the infusion of the first cycle of high grade emetic chemotherapy.Participants will be instructed to fill out the instrument and take the questionnaire home, bringing it back to the investigators when they return to the outpatient clinic for another round of chemotherapy.
Intensity of nausea symptoms	Intensity of the symptom of nausea within the first 24 hours after infusion of chemotherapy.	As for the intensity of nausea, a Visual Analog Scale will be used to help measure the intensity of each patient. The instrument will question the patient about the degree of nausea and it will provide an auto report with a note that can vary from 0 to 10, with note 0 representing absence of the symptom while note 10 represents the most intense sensation experienced by the patient . Participants will be instructed to fill out the instrument and take the questionnaire home, bringing it back to the investigators when they return to the outpatient clinic for another round of chemotherapy.
Severity of vomiting episodes	Severity of vomiting episodes within the first 24 hours after chemotherapy infusion.	The severity assessment of vomiting episodes includes a diary to record the number of episodes of vomiting, which may be small, medium or large. Thus, we will assess the severity of vomiting over 24 hours after the infusion of the first cycle of high grade emetic chemotherapy. Participants will be instructed to complete the instrument and take the questionnaire home, bringing it back to the investigators. When they return to the clinic for another round of chemotherapy.
Need for rescue antiemetic	Need for rescue antiemetic within the first 24 hours after chemotherapy infusion	The 24-hour follow-up record of symptoms of nausea and vomiting will be performed using a form developed from the MASEM anti-emetic instrument (MAT), especially for the present study. This form includes a diary to record emetic events within 24 hours after the administration of chemotherapy. Thus, we will evaluate: the cumulative index of nausea and vomiting over 24 hours after the infusion of the first cycle of emetic high-grade chemotherapy, the volume of vomiting in each episode and the need for rescue antiemetics will also be recorded. Will be instructed to fill out the instrument and take the questionnaire home, bringing it back to the researchers when they return to the clinic for their second course of chemotherapy.
Edmonton Symptom Assessment Scale	At the end of 24 hours, you will be asked to complete the Edmonton Symptom Assessment Scale	At home and at the end of 24 hours, will be asked to fill in the Edmonton Symptom Assessment Scale where symptoms of pain, tiredness, drowsiness, appetite, nausea, shortness of breath, depression, anxiety and well-being will be evaluated, Based on the Brazilian Consensus on Nausea and Vomiting. It is a scale where the patient provides an auto-report with a note that can vary from 0 to 10, with note 0 representing absence of the symptom while note 10 represents the most intense sensation experienced by the patient.

Trial Locations

Locations (2)

Comitê de Ética em Pesquisa - Santa Casa de Misericórdia de Porto Alegre; 🇧🇷 Porto Alegre, Rio Grande do Sul, Brazil

Fabrício Edler Macagnan; 🇧🇷 Porto Alegre, Rio Grande do Sul, Brazil