NO SToPS: Assessment of a Supportive Care Program to Reduce Treatment Breaks in Patients With Head and Neck Cancer.

NO SToPS is an interprofessional supportive care program implemented in 2008 for patients with head and neck cancer undergoing chemoradiation. The goals of the program are to reduce radiation treatment breaks and hospitalizations related to toxicity from this difficult treatment. Breaks lead to lower locoregional control and survival rates in this population. This article describes the effect of the NO SToPS program.

Toxicity of topical lidocaine applied to the breasts to reduce discomfort during screening mammography.

BACKGROUND: We measured the effect of 30 milliliters (mL) of 4% lidocaine gel on the breasts and chest wall of healthy women covered for 1 h on plasma concentrations of lidocaine and its principal metabolite, monoethylglycinexylidide (MEGX), electrocardiogram (EKG) results, and adverse events. MATERIALS AND METHODS: This institutional review board-approved, prospective, open-label study complied with the Health Insurance Portability and Accountability Act (HIPAA). The study evaluated 10 healthy women aged 42-75 years with 30 mL of 4% lidocaine gel on the skin of the breasts and chest wall covered for 1 h. Cardiac and neurological assessments were performed and blood was drawn for lidocaine and MEGX levels at baseline and 1/2, 1, 2, 3, 4, 6, and 8 h after application. EKGs were performed before application and at 3 h. Subjects provided informed written consent. Primary and secondary outcomes were plasma concentrations of lidocaine and MEGX and frequency of adverse events, respectively. Statistical analysis included paired t-tests for EKGs and repeated measures regression for vital signs. RESULTS: No lidocaine was detected in the blood of 9 of 10 subjects. One subject had low plasma concentrations of lidocaine just above the level of detection the first 4 h after application only. No MEGX was detected. Mean decrease in heart rate was likely multifactorial. CONCLUSION: Thirty mL of 4% lidocaine gel on the breasts and chest wall covered for 1 h in healthy women resulted in plasma concentrations of lidocaine and MEGX well below therapeutic or toxic levels and no clinically significant adverse events.

NO SToPS: Reducing treatment breaks during chemoradiation for head and neck cancer.

The addition of chemotherapy to radiation aids in the survival of patients with head and neck cancer but also increases acute toxicity, primarily painful oral mucositis and dermatitis exacerbated by xerostomia. The consequences of these side effects often result in hospitalization and breaks in treatment, which lead to lower locoregional control and survival rates. No strategies reliably prevent radiation-induced mucositis; therefore, emphasis is placed on management to prevent treatment breaks. The NO SToPS approach describes specific multidisciplinary strategies for management of nutrition; oral care; skin care; therapy for swallowing, range of motion, and lymphedema; pain; and social support to assist patients through this difficult therapy.

Premedication to reduce discomfort during screening mammography.

PURPOSE: To test the hypothesis that premedication with acetaminophen, ibuprofen, and/or 4% lidocaine gel would decrease discomfort and improve satisfaction with screening mammography in women who expect a higher level of discomfort. MATERIALS AND METHODS: In this HIPAA-compliant, institutional review board-approved, prospective, double-blinded, placebo-controlled clinical trial, 418 women aged 32-89 years who expected substantial discomfort with screening mammography were randomly divided to receive premedication with acetaminophen, ibuprofen, and/or 4% lidocaine gel. Subjects provided informed written consent. The primary outcome was discomfort. Secondary outcomes were satisfaction and plans for future mammography on the basis of discomfort. Subjects completed structured questionnaires with visual analog scales to measure discomfort and satisfaction. A generalized linear mixed-models framework was used to assess the effect of medications on discomfort during mammography, and satisfaction with technologist and machine combinations was included as a random effect. The "plans for mammography next year" outcome was modeled by using a binary distribution and logit link function. RESULTS: Discomfort was significantly lower in the lidocaine gel group (P = .01). Satisfaction was significantly negatively correlated with discomfort (P < .001). Satisfaction and whether or not the subject had delayed her mammography because of fear of discomfort had significant effects on plans to undergo mammography next year (P < .001 for both). There were significant differences in discomfort between different combinations of technologists and machines. CONCLUSION: Premedication with 4% lidocaine gel significantly reduced discomfort during screening mammography, and reduced discomfort may improve the likelihood of future mammographic screening and early detection of breast cancer.