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Kortikosteroide für erwachsene Patienten mit fortgeschrittenen Tumorerkrankungen mit Übelkeit und Erbrechen (nicht in Zusammenhang mit Chemotherapie, Strahlentherapie oder chirurgischem Eingriff)

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Referencias

References to studies included in this review

Bruera 2004 {published data only}

Bruera E, Moyano JR, Sala R, Rico MA, Bosnjak S, Bertolino M, et al. Dexamethasone in addition to metoclopramide for chronic nausea in patients with advanced cancer: a randomized controlled trial. Journal of Pain and Symptom Management 2004;28(4):381‐8. CENTRAL

Mystakidou 1998 {published data only}

Mystakidou K, Befon S, Liossi C, Vlachos L. Comparison of the efficacy and safety of tropisetron, metoclopramide, and chlorpromazine in the treatment of emesis associated with far advanced cancer. Cancer 1998;83(6):1214‐23. CENTRAL

Yennurajalingam 2013 {published data only}

Yennurajalingam S, Frisbee‐Hume S, Palmer JL, Delgado‐Guay MO, Bull J, Phan AT, et al. Reduction of cancer‐related fatigue with dexamethasone: a double‐blind, randomized, placebo‐controlled trial in patients with advanced cancer. Journal of Clinical Oncology 2013;31(25):3076‐82. CENTRAL

References to studies excluded from this review

Arvieux 2005 {published data only}

Arvieux C, Laval G, Mestrallet JP, Stefani L, Villard ML, Cardin N. Treatment of malignant intestinal obstruction. A prospective study over 80 cases. Annales De Chirurgie 2005;130(8):470‐6. CENTRAL

Bruera 1996 {published data only}

Bruera E, Seifert L, Watanabe S, Babul N, Darke A, Harsanyi Z, et al. Chronic nausea in advanced cancer patients: a retrospective assessment of a metoclopramide‐based antiemetic regimen. Journal of Pain and Symptom Management 1996;11(3):147‐53. CENTRAL

Currow 2012 {published data only}

Currow D, Clark K, Cartmill J, Craig AS, Pather S, Plummer J, et al. A randomised double blind placebo controlled trial of infusional subcutaneous octreotide in the management of malignant bowel obstruction in people with advanced cancer. Palliative Medicine 2012;26(4):403. CENTRAL

Currow 2015 {published data only}

Currow DC, Quinn S, Agar M, Fazekas B, Hardy J, McCaffrey N, et al. Double‐blind, placebo‐controlled, randomized trial of octreotide in malignant bowel obstruction. Journal of Pain and Symptom Management 2015;49(5):814‐21. CENTRAL

Feuer 2000 {published data only}

Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database of Systematic Reviews 2000, Issue 2. [DOI: 10.1002/14651858.CD001219]CENTRAL

Klein 2012 {published data only}

Klein C, Stiel S, Bukki J, Ostgathe C. Pharmacological treatment of malignant bowel obstruction in severely ill and dying patients. A systematic literature review. Schmerz 2012;26(5):587‐99. CENTRAL

Laval 2006 {published data only}

Laval G, Arvieux C, Stefani L, Villard ML, Mestrallet JP, Cardin N. Protocol for the treatment of malignant inoperable bowel obstruction: A prospective study of 80 cases at Grenoble University Hospital Center. Journal of Pain and Symptom Management 2006;31(6):502‐12. CENTRAL

Yennurajalingam 2012 {published data only}

Yennurajalingam S, Frisbee‐ Hume S, Palmer JL, Delgado‐Guay M, Bull J, Reddy AS, et al. Dexamethasone and symptom distress: Results of a placebo controlled, double‐blind randomized controlled trial in patients with advanced cancer. Supportive Care in Cancer 2012;20:S234. CENTRAL

Additional references

Ballatori 2007

Ballatori E, Roila F, Ruggeri B, Betti M, Sarti S, Soru G, et al. The impact of chemotherapy‐induced nausea and vomiting on health‐related quality of life. Supportive Care in Cancer 2007;15(2):179‐85.

Chu 2014

Chu CC, Hsing CH, Shieh JP, Chien CC, Ho CM, Wang JJ. The cellular mechanisms of the antiemetic action of dexamethasone and related glucocorticoids against vomiting. European Journal of Pharmacology 2014;5(722):48‐54.

Davis 2000

Davis MP, Walsh D. Treatment of nausea and vomiting in advanced cancer. Supportive Care in Cancer 2000;8(6):444‐52.

De Oliveira 2013

De Oliveira GS, Castro‐Alves LJS, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: An updated meta‐analysis of randomized controlled trials. Anesthesia and Analgesia 2013;116(1):58‐74.

Fainsinger 1991

Fainsinger R, Miller MJ, Bruera E, Hanson J, Maceachern T. Symptom control during the last week of life on a palliative care unit. Journal of Palliative Care 1991;7(1):5‐11.

Farr 1990

Farr WC. The use of corticosteroids for symptom management in terminally ill patients. American Journal of Hospice Care 1990;7(1):41‐6.

Feyer 1998

Feyer PC, Stewart Al, Titlbach OJ. Aetiology and prevention of emesis induced by radiotherapy. Supportive Care in Cancer 1998;6:253‐60.

Foubert 2005

Foubert J, Vaessen G. Nausea: the neglected symptom?. European Journal of Oncology Nursing 2005;9:21‐32.

Gan 2007

Gan TJ. Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist‐based pharmacotherapy. CNS Drugs 2001;21(10):813‐33.

Gannon 2002

Gannon C, McNamara P. A retrospective observation of corticosteroid use at the end of life in a hospice. Journal of Pain and Symptom Management 2002;24(3):328‐34.

Glare 2004

Glare P, Pereira G, Kristjanson LJ, Stockler M, Tattersall M. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far‐advanced cancer. Supportive Care in Cancer 2004;12:432‐40.

GRADEpro GDT 2014 [Computer program]

GRADE Working Group, McMaster University. GRADEpro Guideline Development Tool (GRADEpro GDT). Version accessed 21 October 2016. Hamilton (ON): GRADE Working Group, McMaster University, 2014.

Gralla 1999

Gralla RJ, Osoba D, Kris MG. Recommendations for the use of antiemetics: evidence‐based clinical practice guidelines. Journal of Clinical Oncology 1999;17:2971‐94.

Grunberg 2007

Grunberg SM. Antiemetic activity of corticosteroids in patients receiving cancer chemotherapy: Dosing,efficacy, and tolerability analysis. Annals of Oncology 2007;18(2):233‐40.

Hanks 2009

Hanks G, Cherny N, Christakis N, Fallon M, Kaasa S, Portenoy R (editors). Oxford Textbook of Palliative Care. 4th Edition. Oxford: Oxford Press, 2009.

Hardy 2001

Hardy J, Rees E, Ling J, Stone P, Burman R, Feuer D, et al. A prospective survey of the use of dexamethasone on a palliative care unit. Palliative Medicine 2001;15:3‐8.

Hardy 2015

Hardy JR, Glare P, Yates Patsy, Mannix KA. Palliation of nausea and vomiting, Section 10.2. In: Cherny N, Fallon M, Kaasa S, Portenoy RK, Currow DC editor(s). Oxford Textbook of Palliative Medicine. 5th Edition. Oxford: Oxford University Press, 2015.

Harris 2010

Harris DG. Nausea and vomiting in advanced cancer. British Medical Bulletin 2010;96:175‐85.

Haywood 2015

Haywood A, Good P, Khan S, Leupp A, Jenkins‐Marsh S, Rickett K, et al. Corticosteroids for the management of cancer‐related pain in adults. Cochrane Database of Systematic Reviews 2015, Issue 4. [DOI: 10.1002/14651858.CD010756.pub2]

Higgins 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.

Hursti 1993

Hursti TJ, Fredrikson M, Steineck G, Borjeson S, Furst CJ, Peterson C. Endogenous cortisol exerts antiemetic effect similar to that of exogenous corticosteroids. British Journal of Cancer 1993;68:112‐4.

Ioannidis 2000

Ioannidis JP, Hesketh PJ, Lau J. Contribution of dexamethasone to control chemotherapy‐induced nausea and vomiting: a meta‐analysis of randomized evidence. Journal of Clinical Oncology 2000;18(19):3409‐22.

Joss 1994

Joss RA, Bacchi M, Buser K, Kirchner V, Neuenschwander H, Orth B, et al. Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy‐ naive and previously treated patients. Annals of Oncology 1994;5:253‐8.

Latreille 1998

Latreille J, Pater J, Johnston D, Laberge F, Stewart D, Rusthoven J, et al. Use of dexamethasone and granisetron in the control of delayed emesis for patients who receive highly emetogenic chemotherapy. National Cancer Institute of Canada Clinical Trials Group. Journal of Clinical Oncology 1998;16:1174‐8.

Laval 2000

Laval G, Girardier J, Laussauumiere J, Leduc B, Haond C, Schaerer R. The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction?. Palliative Medicine 2000;14:3‐10.

Liberati 2009

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of Internal Medicine 2009;151(4):W65‐94.

Mantovani 1997

Mantovani G, Maccio A, Massa E, Lai P, Esu S. Cisplatin induces serotonin release from human peripheral blood mononuclear cells of cancer patients and methylprednisolone inhibits this effect. Oncology Reports 1997;4(5):1051‐3.

Mercadante 2004

Mercadante S, Ferrera P, Villari P, Marrazzo A. Aggressive pharmacological treatment for reversing malignant bowel obstruction. Journal of Pain & Symptom Management 2004;28(4):412‐6.

National Cancer Institute 2010

National Cancer Institute. National Institute of Health, Department of Health and Human Services. Common Terminology Citeria for Adverse Events (CTCAE) v.4.0. Available from evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010‐06‐14_QuickReference_5x7.pdf2010, issue accessed 6 June 2017.

Perugia Consensus Conference 1998

Perugia Consensus Conference. Prevention of chemotherapy‐ and radiotherapy‐induced emesis: results of Perugia Consensus Conference. Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC). Annals of Oncology 1998;9(8):811‐9.

Pirri 2013

Pirri C, Bayliss E, Trotter J, Olver IN, Katris P, Drummond P, et al. Nausea still the poor relation in antiemetictherapy? The impact on cancer patients' quality of life and psychological adjustment of nausea, vomiting and appetite loss, individually and concurrently as part of a symptom cluster. Supportive Care in Cancer 2013;21(3):735‐48.

Porternoy 1994

Porternoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander‐Klar H, Coyle N, et al. Symptom prevalence, characteristics and distress in a cancer population. Quality of Life Research 1994;3(3):183‐9.

Reuben 1986

Reuben D. Nausea and vomiting in terminal cancer patients. Archives of Internal Medicine 1986;146(10):2021‐3.

RevMan 2014 [Computer program]

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

Riechelmann 2007

Riechelmann RP, Krzyanowska MK, O'Carrol A, Zimmermann C. Symptom and medication profiles among cancer patients attending a palliative care clinic. Supportive Care in Cancer 2007;15(12):1407‐12.

Roila 2006

Roila F, Hesketh PJ, Herrstedt J. Prevention of chemotherapy‐ and radiotherapy‐induced emesis: results of the 2004 Perugia Internation Antiemetic Consensus Conference. Annals of Oncology 2006;17:20‐8.

Smith 2005

Smith HS. A receptor‐based paradigm of nausea and vomiting. Journal of Cancer Pain and Symptom Palliation 2005;1(1):11‐23.

Teunissen 2007

Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. Journal of Pain and Symptom Management 2007;34(1):94‐104.

Walsh 2000

Walsh D, Donnelly S, Rybicki L. The symptoms of advanced cancer: relationship to age, gender, and performance status in 1000 patients. Supportive Care in Cancer 2000;8(3):175‐9.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Bruera 2004

Methods

Randomised, double‐blind, parallel‐arm trial

Five international centres

Study duration: seven days

Participants

Fifty‐one participants (25 intervention, 26 control) with advanced cancer and chronic nausea (> two weeks) resulting from advanced cancer, despite treatment with metoclopramide at a minimal daily dose of 40 to 60 mg for two days.

Interventions

Participants randomised into two groups to receive dexamethasone (20 mg/day) + metoclopramide (60 mg/day), or placebo + metoclopramide (60 mg/day). All interventions administered per oral route.

Outcomes

Appetite, nausea, fatigue, and pain, measured on both a 0 to 10 numerical rating scale (NRS; 0 = symptom absent, 10 = worst possible symptom) and a categorical scale of four categories for appetite, nausea, and fatigue (1 = best appetite or no nausea or fatigue, 4 = worst). The number of vomiting episodes in the preceding 24 hours was recorded. Wellbeing was estimated on a 0 to 10 numerical scale (0 = best possible well‐being, 10 = worst possible well‐being). Quality of life (physical, social and family, emotional, and functional well‐being) measured by the Functional Assessment of Cancer Therapy (FACT) instrument.

Toxicity assessment: presence or absence of ankle oedema, insomnia, restlessness, or other symptoms (patient‐rated).

Notes

Dexamethasone was not significantly better than placebo in the management of chronic nausea, appetite, or fatigue. Dexamethasone did improve appetite sooner (day 3), however, no significant difference in improvement in appetite by day eight compared to placebo. No significant difference between the dexamethasone and placebo groups for well‐being, quality of life, medium number of daily vomiting episodes, or adverse effects. Study funded by The Brown Foundation, Houston, Texas. Author FS was supported by a grant from Swiss Cancer Research.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Low risk

Pharmacy‐controlled randomisation

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Double‐blind

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Double‐blind, capsules containing either drug or placebo were identical in appearance

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Three of 25 participants receiving dexamethasone dropped out, compared to five of 26 participants receiving placebo

Selective reporting (reporting bias)

Low risk

None detected

Other bias

High risk

Sample size: 51 participants; < 50 participants per treatment arm

Mystakidou 1998

Methods

Randomised, parallel‐arm trial

Single‐institution

Study duration: 14 days

Participants

Two hundred and eighty participants (40 metoclopramide + dexamethasone, 40 metoclopramide + tropisetron, 40 metoclopramide + tropisetron + dexamethasone) with advanced cancer who, though well controlled on antiemetic medication (metoclopramide 10 mg twice daily), suddenly presented with nausea and vomiting (≥ three vomiting or retching events/day).

Interventions

Participants randomised into seven groups to receive either: (i) metoclopramide (40 mg/day) + dexamethasone (2 mg/day), (ii) tropisetron (5 mg/day), (iii) tropisetron (5 mg/day) + metoclopramide (20 mg/day), (iv) tropisetron (5 mg/day) + metoclopramide (20 mg/day) + dexamethasone (2 mg/day), (v) chlorpromazine (50 mg/day) + dexamethasone (2 mg/day), (vi) tropisetron (5 mg/day) + chlorpromazine (25 mg/day), or (vii) tropisetron (5 mg/day) + chlorpromazine (25 mg/day) + dexamethasone (2 mg/ day) for 14 days. All interventions administered per oral route.

Outcomes

Nausea and vomiting measured on patient diary cards at 24 hours, days three, seven, and 15. Outcomes measured on a categorical scale of four categories. Nausea control was classified as total (no nausea), major (< 4 hrs), minor (> 4 hrs to < 8 hrs), or no control (> 8 hrs). Vomiting control was classified as total (no vomiting), major (one event), minor (two events), or no control (≥ three events).

Tolerability assessment: occurrence of adverse reactions (constipation, dizziness, weakness, extrapyramidal symptoms or other upsetting symptoms) (patient‐recorded).

Notes

Only duration of nausea evaluated, not intensity. All antiemetic drugs well tolerated with no significant difference between intervention groups. Study was supported by Santoz Pharma Ltd, Athens, Greece.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

Method of concealment not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Participants received different amounts of medication, therefore blinding not possible

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote: “…lack of blinded experimentation” and nausea was measured incompletely

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Participants withdrawing from the study due to minor emesis control was low, with similar numbers across the intervention groups

Selective reporting (reporting bias)

Low risk

None detected

Other bias

High risk

Sample size: 280 participants; < 50 participants per treatment arm

Yennurajalingam 2013

Methods

Randomised, double‐blind, placebo‐controlled

Three study centres

Study duration: 14 days

Participants

One hundred and twenty participants (62 intervention, 58 control) with advanced cancer who had ≥ three cancer‐related fatigue symptoms (fatigue, pain, nausea, loss of appetite, depression, anxiety, or sleep disturbance), ≥ 4 of 10 on the Edmonton Symptom Assessment Scale (ESAS).

Interventions

Participants randomised into two groups to receive dexamethasone 4 mg or placebo orally twice per day for 14 days.

Outcomes

The Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT‐F) subscale, ESAS, Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy–Anorexia‐Cachexia (FAACT) instruments were used. Participants were monitored for adverse events, and a research nurse supervised their completion of the rating scales.

Notes

Primary endpoint was fatigue (change in the FACIT‐F subscale from baseline to day 15). Secondary outcomes included anorexia, anxiety, depression, and symptom distress scores. Study supported by Mentored Research Scholar Grant from the American Cancer Society.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Randomisation method not specified

Allocation concealment (selection bias)

Unclear risk

Method of concealment not described

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

Double‐blind

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

All members of the research team except the investigational pharmacist and statistician were blinded to treatment assignment throughout the study

Incomplete outcome data (attrition bias)
All outcomes

High risk

Nineteen of 62 participants receiving dexamethasone were not evaluable
Seventeen of 58 participants receiving placebo were not evaluable

Selective reporting (reporting bias)

Low risk

None detected

Other bias

Unclear risk

Sample size: 120 participants; 50 to 199 participants per treatment arm

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Arvieux 2005

Wrong study design and symptoms measured did not include nausea

Bruera 1996

Wrong study design

Currow 2012

Wrong study design ‐ dexamethasone was used in both arms

Currow 2015

Wrong study design ‐ dexamethasone was used in both arms

Feuer 2000

Wrong outcomes ‐ did not measure nausea

Klein 2012

Wrong study design

Laval 2006

Wrong study design

Yennurajalingam 2012

Wrong outcomes ‐ nausea not reported as part of symptom distress

Data and analyses

Open in table viewer
Comparison 1. Nausea

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Nausea at 8 days Show forest plot

2

127

Mean Difference (IV, Random, 95% CI)

‐0.48 [‐1.53, 0.57]

Analysis 1.1

Comparison 1 Nausea, Outcome 1 Nausea at 8 days.

Comparison 1 Nausea, Outcome 1 Nausea at 8 days.

PRISMA Study flow diagram
Figuras y tablas -
Figure 1

PRISMA Study flow diagram

Risk of bias graph: review authors' judgements about each 'Risk of bias' domain, presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each 'Risk of bias' domain, presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each 'Risk of bias' domain for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each 'Risk of bias' domain for each included study.

Forest plot of comparison: 1 Nausea, outcome: 1.1 Nausea at 8 days.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Nausea, outcome: 1.1 Nausea at 8 days.

Comparison 1 Nausea, Outcome 1 Nausea at 8 days.
Figuras y tablas -
Analysis 1.1

Comparison 1 Nausea, Outcome 1 Nausea at 8 days.

Summary of findings for the main comparison. Dexamethasone compared to placebo for adult patients with advanced cancer who have nausea and vomiting (not related to chemo‐ or radiotherapy, or surgery)

Dexamethasone compared to placebo for adult patients with advanced cancer who have nausea and vomiting not related to chemotherapy, radiotherapy, or surgery

Patient or population: participants with advanced cancer who have nausea and vomiting not related to chemotherapy, radiotherapy, or surgery
Settings: inpatients and outpatients
Intervention: dexamethasone

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Dexamethasone

Nausea at 8 days
Scale from: 0 to 10; lower score = less nausea.

The mean difference in the intensity of nausea at day 8 in the control groups ranged from ‐0.45 to 5.7

The mean difference in the intensity of nausea at day 8 in the intervention groups was, on average, ‐0.48 (from ‐1.53 lower to 0.57 higher)

127
(2 studies)

⊕⊝⊝⊝
very low1

Number of vomiting episodes

No data

No data

Adverse events

No data

No data

Quality of life

No data

No data

Patient satisfaction

No data

No data

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are confident that the true effect lies close to that of the estimate of the effect.
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

1 We downgraded the quality of evidence by three levels due to imprecision, likely selection bias, attrition bias, and the small number of participants in the included studies.

Figuras y tablas -
Summary of findings for the main comparison. Dexamethasone compared to placebo for adult patients with advanced cancer who have nausea and vomiting (not related to chemo‐ or radiotherapy, or surgery)
Table 1. Primary sites of disease

Breast

Head, neck, and lung

Gastrointestinal

Gynaecological

Genitourinary

Sarcoma

Other

Bruera 2004

x

x

x

x

x

x

Mystakidou 1998

x

x

x

x

Yennurajalingam 2013

x

x

x

x

x

x

x

Figuras y tablas -
Table 1. Primary sites of disease
Comparison 1. Nausea

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Nausea at 8 days Show forest plot

2

127

Mean Difference (IV, Random, 95% CI)

‐0.48 [‐1.53, 0.57]

Figuras y tablas -
Comparison 1. Nausea