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Ford K, Duddle M, Turner M, Paterson C. Distal-Extremity Cryotherapy in Preventing Chemotherapy-Induced Peripheral Neuropathy from Paclitaxel Administration in People Affected by Breast Cancer: A Systematic Review. Semin Oncol Nurs 2024; 40:151673. [PMID: 38918150 DOI: 10.1016/j.soncn.2024.151673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To explore the experiences of utilising distal-extremity cryotherapy in reducing chemotherapy-induced peripheral neuropathy during Paclitaxel treatment on physical functioning, clinical and patient-reported outcomes, compared to standard care in people affected by breast cancer. METHODS Four databases and one register were searched on 11 April 2023 to identify all relevant studies meeting the inclusion and exclusion criteria. These were CINAHL (via EBSCOhost), Cochrane Central Register of Controlled Trials, Medline (via EBSCOhost), Scopus, and Web of Science Core Collection, with no limiters placed on any of the searches. Additionally, relevant systematic reviews were scrutinised for potentially relevant studies for screening. RESULTS Distal-extremity cryotherapy is a safe intervention with minimal risk for serious adverse events. However, insufficient data supports the mainstay clinical use of cryotherapy in reducing chemotherapy-induced peripheral neuropathy from Paclitaxel use within the breast cancer population. Heterogeneity in study design, cryotherapy mode, and measurement tools underscore the need for additional research. CONCLUSION Despite limited data on the impact of distal-extremity cryotherapy in preventing chemotherapy-induced peripheral neuropathy, there are valuable implications for nursing practice arising from this review. IMPLICATIONS FOR NURSING PRACTICE Nurses play a vital role in the clinical and experiential journey of people with breast cancer, it is important that they understand the available evidence and act as patient advocates. Assisting patients in understanding current research and encouraging participation in future studies, thereby enhancing our knowledge, and strengthening the available evidence base.
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Affiliation(s)
- Kelly Ford
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Maree Duddle
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Catherine Paterson
- Caring Futures Institute, Flinders University, Kelly Ford, Adelaide; Central Adelaide Local Health Network, Adelaide, Australia; Robert Gordon University, Aberdeen, Scotland, UK; Faculty of Health, University of Canberra, Bruce, ACT, Australia.
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Khemthong U, Hawsawi S, Schneider JK. Effects of Exercise on Balance in Cancer Survivors With Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00267. [PMID: 38941127 DOI: 10.1097/ncc.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Balance impairment in cancer survivors can be a consequence of chemotherapy-induced peripheral neuropathy (CIPN). Previous meta-analyses suggested that exercise significantly improved balance, but the results were only based on 3 and 4 primary studies. OBJECTIVES This meta-analysis examined the effects of exercise on balance in cancer survivors with CIPN and investigated the moderating effects of source, methods, interventions, and participant characteristics. METHODS We searched 12 electronic databases and 5 websites without date restriction through December 18, 2023, for primary studies examining the effect of exercise to improve balance in cancer survivors with CIPN reported in English. We retrieved 12 studies that provided 14 comparisons (N = 576), coded them, assessed quality indicators, and evaluated effect sizes across studies. RESULTS Using the random-effects model, the estimated summary effect (Hedges' g) of exercise on balance was 0.68 (Knapp-Hartung adjusted 95% confidence interval, 0.41-0.94; P = .0001) compared with comparison groups. Subgroup analysis revealed that blinded data collectors, intervention fidelity examination, and difference in exercise protocol significantly influenced effect size. Meta-regression analysis showed that session minutes was associated with higher effect sizes. CONCLUSION Exercise with balance training significantly improved balance in cancer survivors. Balance training should be integrated into the current exercise guidelines for cancer survivors with CIPN. IMPLICATIONS FOR PRACTICE Nurses should encourage cancer survivors to engage in exercise with balance training when undergoing chemotherapy. Physical function and barriers to exercise should be assessed before delivering exercise interventions. Exercises should be tailored according to individual performance.
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Affiliation(s)
- Usa Khemthong
- Authors' Affiliation: Trudy Busch Valentine School of Nursing, Saint Louis University, Missouri
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Rattanakrong N, Siriphorn A, Boonyong S. The alteration of static and dynamic postural stability among women with breast cancer during taxane-based chemotherapy: a descriptive study. Physiother Theory Pract 2024; 40:1172-1180. [PMID: 36305704 DOI: 10.1080/09593985.2022.2139654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Women with breast cancer who underwent taxane-based chemotherapy demonstrate diminished postural stability. However, the data concerning dynamic postural stability among women with breast cancer during taxane-based chemotherapy remains insufficient. PURPOSE To investigate postural stability among women with breast cancer during taxane-based chemotherapy. METHODS Fifteen women with breast cancer participated in this study. Postural stabilities were assessed at five intervals during the course of chemotherapy treatment. Static postural stability was measured during single leg with eyes open (SEO) and eyes closed (SEC) conditions, while dynamic postural stability was measured during performance of the limit of stability test (LOS). Postural stability was described using 95% confidence ellipse area (EA), center of pressure (COP) path length (PL), and COP average velocity (AV). RESULTS For static postural stability assessment, SEO condition was found to have significant increases in EA, PL, and AV (p = .001, p < .001, and p = .02, respectively). For dynamic postural stability assessment, a significant difference in EA was observed in the forward, backward, right, and left directions (p = .02, p = .02, p < .001, and p = .01, respectively). In addition, a significant difference in PL was found while performing in a backward direction (p = .02). CONCLUSIONS The findings showed that women with breast cancer may have experienced decreased static and dynamic postural stability.
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Affiliation(s)
- Nida Rattanakrong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
- Department of Rehabilitation Medicine, Physical Therapy Unit, Bangkok, Thailand
| | - Akkradate Siriphorn
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Sujitra Boonyong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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Lin KY, Chen PS, Lin CF. Physical function as a predictor of chemotherapy-induced peripheral neuropathy in patients with pancreatic cancer. BMC Gastroenterol 2024; 24:154. [PMID: 38711006 DOI: 10.1186/s12876-024-03227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND A growing body of research indicates that poor functional status before chemotherapy may be correlated with the severity of chemotherapy-induced peripheral neuropathy (CIPN) after the neurotoxic treatment. However, little is known about the associations between pre-chemotherapy physical function and CIPN in patients with pancreatic cancer. PURPOSE To identify the predictors of CIPN in relation to pre-chemotherapy physical function in patients with pancreatic cancer. METHODS This secondary analysis included data from patients with pancreatic cancer who participated in a longitudinal research study at National Cheng Kung University Hospital, Tainan, Taiwan. Four physical function tests (i.e., grip strength, Timed Up and Go (TUG), 2-minute step test (2MST), and Romberg test) and two questionnaires (The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] and Chemotherapy-Induced Peripheral Neuropathy Module [CIPN20]) were assessed at baseline (i.e., before first chemotherapy session) and 2-, 3-, 4-, and 6-month follow-up. Multiple linear regression with adjustment for confounding factors was used to assess the associations between the four functional tests at baseline and the CIPN20 total score and individual subscale scores (sensory, motor, and autonomic) at 6-month follow-up. RESULTS Data from a total of 209 pancreatic cancer patients (mean age: 64.4 years, 54.5% male) were analyzed. The findings showed that the severity of CIPN at 6-month follow-up was significantly associated with the baseline TUG completion time (β = 0.684, p = 0.003). The TUG completion time was also positively correlated with the 6-month CIPN sensory and autonomic subscales. In addition, a baseline positive Romberg test (β = 0.525, p = 0.009) was a significant predictor of the severity of motor neuropathy at 6-month follow-up. CONCLUSION The TUG completion time and positive Romberg test before chemotherapy may be predictive factors of the CIPN severity 6 months after the commencement of chemotherapy. Accordingly, the incorporation of TUG and Romberg tests into the clinical assessment protocol emerges as imperative for individuals diagnosed with pancreatic carcinoma undergoing chemotherapy regimens.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - Po See Chen
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan.
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan.
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Gewandter JS, Culakova E, Davis JN, Gada U, Guido JJ, Bearden JD, Burnette B, Shah D, Morrow G, Mustian K, Sluka K, Mohile N. Wireless Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Proof-of-Concept Randomized Clinical Trial. THE JOURNAL OF PAIN 2024; 25:104431. [PMID: 37993030 PMCID: PMC11058028 DOI: 10.1016/j.jpain.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) affects approximately 30 to 60% of people who receive neurotoxic chemotherapy. CIPN is associated with impaired quality of life and function and has few effective treatments. This 6-site, subject and assessor-blinded randomized clinical trial (RCT) was designed to assess 1) preliminary efficacy (ie, alpha pre-specified at .2) of a wearable, app-controlled, transcutaneous electrical nerve stimulation (TENS) device for chronic CIPN and 2) feasibility of conducting a confirmatory trial within the National Cancer Institute Community Oncology Research Program (NCORP) (NCT04367480). The primary outcome was the EORTC-CIPN20. The main secondary outcomes were individual symptoms assessed daily (via 0-10 numeric rating scales). The primary analysis was an analysis of covariance (outcome: EORTC-CIPN20, fixed effect: arm, covariates: baseline EORTC-CIPN20 and site). Secondary analyses used a similar analysis of covariance models (excluding site) for each symptom on subgroups of subjects with ≥4 out of 10 for that symptom at baseline. 142 eligible subjects were randomized and received a device; 130 (91%) completed the study. The difference between groups in the EORCT-CIPN20 at the endpoint (placebo-active) was 1.05 (95% Confidence Interval: -.56, 2.67; P = .199). The difference between groups for the individual symptoms was as follows: hot/burning pain: 1.37 (-.33, 3.08; P = .112), sharp/shooting pain: 1.21 (-.37, 2.79; P = .128), cramping: 1.35 (-.32, 3.02; P = .110), tingling: .23 (-.61, 1.08; P = .587), numbness: .27 (-.51, 1.05; P = .492). An RCT of an app-controlled TENS device for chronic CIPN with excellent retention is feasible in the NCORP. Preliminary efficacy evidence suggests that TENS is promising for pain and cramping from CIPN. A confirmatory RCT of TENS for painful CIPN is highly warranted. PERSPECTIVE: Daily, home-based TENS therapy demonstrates promising efficacy for painful CIPN symptoms in this proof-of-concept randomized clinical trial. Future confirmatory trial is warranted.
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Affiliation(s)
- Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester NY
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Jenae N. Davis
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester NY
| | - Umang Gada
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Joseph J. Guido
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - James D. Bearden
- Upstate Carolina Consortium Community Oncology Research Program (UPSTATE), Gibbs Cancer Center and Research Institute, Spartanburg SC
| | - Brain Burnette
- Cancer Research of Wisconsin and Northern Michigan NCORP, Green Bay, Wisconsin
| | - Dhaval Shah
- Helen F. Graham Cancer Center and Research Institute, Christiana Care, Newark, DE
| | - Gary Morrow
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Karen Mustian
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Kathleen Sluka
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Nimish Mohile
- Department of Neurology, University of Rochester Medical Center, Rochester NY
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Ahmad I, Ahmad S, Ahmad A, Zughaibi TA, Alhosin M, Tabrez S. Curcumin, its derivatives, and their nanoformulations: Revolutionizing cancer treatment. Cell Biochem Funct 2024; 42:e3911. [PMID: 38269517 DOI: 10.1002/cbf.3911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 01/26/2024]
Abstract
Curcumin is a natural compound derived from turmeric and can target malignant tumor molecules involved in cancer propagation. It has potent antioxidant activity, but its effectiveness is limited due to poor absorption and rapid elimination from the body. Various curcumin derivatives have also shown anticancer potential in in-vitro and in-vivo models. Curcumin can target multiple signaling pathways involved in cancer development/progression or induce cancer cell death through apoptosis. In addition, curcumin and its derivatives could also enhance the effectiveness of conventional chemotherapy, radiation therapy and reduce their associated side effects. Lately, nanoparticle-based delivery systems are being developed/explored to overcome the challenges associated with curcumin's delivery, increasing its overall efficacy. The use of an imaging system to track these formulations could also give beneficial information about the bioavailability and distribution of the nano-curcumin complex. In conclusion, curcumin holds significant promise in the fight against cancer, especially in its nanoform, and could provide precise delivery to cancer cells without affecting normal healthy cells.
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Affiliation(s)
- Iftikhar Ahmad
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sameer Ahmad
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Biotechnology & Genetics, Faculty of Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ausaf Ahmad
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Lucknow, India
| | - Torki A Zughaibi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud Alhosin
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Marker RJ, Wechsler S, Leach HJ. Cancer-related fatigue is associated with objective measures of physical function before and after a clinical exercise program: A retrospective analysis. REHABILITATION ONCOLOGY 2024; 42:31-38. [PMID: 38774708 PMCID: PMC11104554 DOI: 10.1097/01.reo.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Background:
Cancer-related fatigue (CRF) is a common symptom reported by survivors of cancer. CRF is associated with reduced self-reported physical function, but associations with objective measures of physical function are less robust. Exercise programs have been shown to improve both CRF and objective physical function, but the interaction of exercise, CRF, and function has not been explored.
Methods:
Retrospective data were collected from baseline (n = 420) and final assessments (n = 234) of survivors who participated in a 3-month clinical exercise program. Assessments included measures of CRF (Functional Assessment of Chronic Illness Therapy–Fatigue) and physical function (6-minute walk test, usual and fast gait speed, 30-second sit-to-stand test, and the Timed Up and Go test). Multiple regression analyses investigated associations between CRF and physical function before and after the program. CRF and functional changes following the program were calculated and associations investigated with multiple regressions.
Results:
All measures of CRF and physical function significantly improved following the program (P < .01). CRF was associated with all functional measures at baseline (standardized β = −0.18 to 0.29, P < .01) and final assessments (r = −0.27 to 0.26, P < .01). Changes in CRF were associated with changes in function (standardized β = −0.12 to 0.23, P < .05), except usual gait speed (P = .17).
Conclusion:
This investigation demonstrated associations between CRF and objective physical function before and after participation in an exercise program. The 3-way interaction between CRF, physical function, and exercise can be used clinically to personalize rehabilitation strategies. Future studies should investigate changes in CRF and function during an exercise program.
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Affiliation(s)
- Ryan J Marker
- Assistant Professor, Department of Physical Medicine and
Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Stephen Wechsler
- Post-Doctoral Research Fellow, Department of Occupational
Therapy, MGH Institute of Health Professions
| | - Heather J Leach
- Associate Professor, Department of Health and Exercise
Science, Colorado State University
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Winters-Stone KM, Krasnow SM, Horak FB, Mancini M, Cameron MH, Dieckmann NF, Stoyles SA, Roeland EJ. Identifying trajectories and predictors of chemotherapy-induced peripheral neuropathy symptoms, physical functioning, and falls across treatment and recovery in adults treated with neurotoxic chemotherapy: the PATTERN observational study protocol (NCT05790538). BMC Cancer 2023; 23:1087. [PMID: 37946117 PMCID: PMC10636878 DOI: 10.1186/s12885-023-11546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and dose-limiting side effect of systemic cancer therapy. In many cancer survivors, CIPN persists after treatment ends and is associated with functional impairments, abnormal gait patterns, falls, and diminished quality of life. However, little is known regarding which patients are most likely to develop CIPN symptoms that impair mobility and increase fall risk, when this risk develops, or the optimal timing of early intervention efforts to mitigate the impact of CIPN on functioning and fall risk. This study will address these knowledge gaps by (1) characterizing trajectories of symptoms, functioning, and falls before, during, and after treatment in adults prescribed neurotoxic chemotherapy for cancer; and (2) determining the simplest set of predictors for identifying individuals at risk for CIPN-related functional decline and falls. METHODS We will enroll 200 participants into a prospective, observational study before initiating chemotherapy and up to 1 year after completing chemotherapy. Eligible participants are aged 40-85 years, diagnosed with stage I-III cancer, and scheduled to receive neurotoxic chemotherapy. We perform objective assessments of vibratory and touch sensation (biothesiometry, tuning fork, monofilament tests), standing and dynamic balance (quiet stance, Timed-Up-and-Go tests), and upper and lower extremity strength (handgrip dynamometry, 5-time repeated chair stand test) in the clinic at baseline, every 4-6 weeks during chemotherapy, and quarterly for 1 year post-chemotherapy. Participants wear devices that passively and continuously measure daily gait quality and physical activity for 1 week after each objective assessment and self-report symptoms (CIPN, insomnia, fatigue, dizziness, pain, cognition, anxiety, and depressive symptoms) and falls via weekly electronic surveys. We will use structural equation modeling, including growth mixture modeling, to examine patterns in trajectories of changes in symptoms, functioning, and falls associated with neurotoxic chemotherapy and then search for distinct risk profiles for CIPN. DISCUSSION Identifying simple, early predictors of functional decline and fall risk in adults with cancer receiving neurotoxic chemotherapy will help identify individuals who would benefit from early and targeted interventions to prevent CIPN-related falls and disability. TRIAL REGISTRATION This study was retrospectively registered with ClinicalTrials.gov (NCT05790538) on 3/30/2023.
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Affiliation(s)
- Kerri M Winters-Stone
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Stephanie M Krasnow
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Martina Mancini
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michelle H Cameron
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA
- VA Portland Health Care System, Portland, OR, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
- Division of Psychology, Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Sydnee A Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Eric J Roeland
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Reinmann A, Koessler T, Bodmer A, Baud-Grasset A, Mentha G, Gligorov J, Bruyneel AV. Feasibility, criterion and construct convergent validity of the 2-minute walk test and the 10-meter walk test in an oncological context. Heliyon 2023; 9:e22180. [PMID: 38045222 PMCID: PMC10692807 DOI: 10.1016/j.heliyon.2023.e22180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To examine the feasibility, the criterion, and the construct convergent validity of the 2-Minute Walk Test (2MWT) and the 10-Meter Walk Test (10MeWT) against the 6-Minute Walk Test (6MWT) to assess walking capacity in people with cancer. The criterion concurrent validity of a self-test version of the 10MeWT (10MeWTself-test) was also evaluated against the 10MeWT. Methods Fifty-six people with cancer performed the 2MWT, the 10MeWT at comfortable and fast speeds, the 6MWT, and the 10MeWTself-test. The feasibility of the tests was assessed using safety, adverse events, space requirements, time taken to administer and interpret the tool, equipment or training required, cost, and portability as criteria. Validity was assessed using Pearson correlation coefficients and Bland Altman plots. Results The 2MWT, 6MWT, 10MeWT, and 10MeWTself-test were feasible for people with cancer. The 2MWT and the 10MeWT results were moderately to strongly correlated with the 6MWT results (0.61 < r < 0.84, p < 0.001). The 10MeWTself-test results were strongly correlated with the 10MeWT results at comfortable and fast speeds (r = 0.99, p < 0.001). Conclusions The 2MWT, 10MeWT, and 10MeWTself-test are simple, rapid, and feasible tests for use in people with cancer. The strong correlation between the 2MWT and 6MWT results indicates that the 2MWT can be used as an alternative walking capacity assessment tool. The 10MeWT results moderately correlated with those of the other two tests, suggesting that it partially measures the same construct of walking capacity in walking-independent outpatients with cancer. The 10MeWTself-test showed promising results but needs further investigations in ecological settings.
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Affiliation(s)
- Aline Reinmann
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
- Sorbonne University, INSERM U938, Centre de Recherche Saint Antoine, CRSA, Paris, France
| | - Thibaud Koessler
- Service of Oncology, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Alexandre Bodmer
- Service of Oncology, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Axelle Baud-Grasset
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Géraldine Mentha
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Joseph Gligorov
- Sorbonne University, INSERM U938, Centre de Recherche Saint Antoine, CRSA, Paris, France
- University Institute of Cancerology AP-HP Sorbonne University, Medical Oncology site Tenon, Paris, France
| | - Anne-Violette Bruyneel
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
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Li R, Liu Y, Xue R, Wang Y, Zhao F, Chen L, Liu JE. Effectiveness of Nonpharmacologic Interventions for Chemotherapy-Induced Peripheral Neuropathy in Patients With Breast Cancer: A Systematic Review and Network Meta-analysis. Cancer Nurs 2023:00002820-990000000-00177. [PMID: 37851424 DOI: 10.1097/ncc.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect in patients with breast cancer (BC) during treatment. Patients experiencing CIPN develop neuropathic symptoms, which could lead to the modification or discontinuation of chemotherapy. Nonpharmacological interventions can be simple and safe, but evidence of their effectiveness in patients with BC experiencing CIPN is currently insufficient. OBJECTIVE To compare and rank the effectiveness of nonpharmacologic interventions for CIPN in patients with BC. METHODS We conducted a systematic search of randomized controlled trials registered from database inception until October 2022 in 7 databases. We assessed studies that met the inclusion and exclusion criteria and evaluated the risk of bias. Network meta-analysis was conducted using Stata SE 17.0 (StataCorp, College Station, Texas). RESULTS A total of 13 studies involving 9 nonpharmacologic interventions and comprising 571 participants were included. The results of the network meta-analysis showed that cryotherapy (standard mean difference, -1.22; 95% confidence interval, -2.26 to -0.17) exerted significant effects versus usual care. Cryotherapy (surface under the cumulative ranking area [SUCRA]: 0.74) was associated with the highest likelihood of effectively alleviating CIPN in patients with BC, followed by exercise (SUCRA: 0.62) and self-acupressure (SUCRA: 0.59). CONCLUSIONS Cryotherapy was the most effective nonpharmacologic intervention for alleviating CIPN in patients with BC. Large-scale studies are required to verify the present findings. IMPLICATIONS FOR PRACTICE This study provides evidence regarding the effectiveness of nonpharmacologic interventions for CIPN. Physicians and nurses could incorporate cryotherapy into clinical practice to alleviate CIPN in patients with BC.
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Affiliation(s)
- Ruolin Li
- Authors' Affiliation: School of Nursing, Capital Medical University, Beijing, People's Republic of China
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11
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Wang AB, Housley SN, Ludvig D, Franz CK, Flores AM, Cope TC, Perreault EJ. Cancer survivors post-chemotherapy exhibit unimpaired short-latency stretch reflexes in the proximal upper extremity. J Neurophysiol 2023; 130:895-909. [PMID: 37671425 PMCID: PMC10649846 DOI: 10.1152/jn.00299.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
Oxaliplatin (OX) chemotherapy can lead to long-term sensorimotor impairments in cancer survivors. The impairments are often thought to be caused by OX-induced progressive degeneration of sensory afferents known as length-dependent dying-back sensory neuropathy. However, recent preclinical work has identified functional defects in the encoding of muscle proprioceptors and in motoneuron firing. These functional defects in the proprioceptive sensorimotor circuitry could readily impair muscle stretch reflexes, a fundamental building block of motor coordination. Given that muscle proprioceptors are distributed throughout skeletal muscle, defects in stretch reflexes could be widespread, including in the proximal region where dying-back sensory neuropathy is less prominent. All previous investigations on chemotherapy-related reflex changes focused on distal joints, leading to results that could be influenced by dying-back sensory neuropathy rather than more specific changes to sensorimotor circuitry. Our study extends this earlier work by quantifying stretch reflexes in the shoulder muscles in 16 cancer survivors and 16 healthy controls. Conduction studies of the sensory nerves in hand were completed to detect distal sensory neuropathy. We found no significant differences in the short-latency stretch reflexes (amplitude and latency) of the shoulder muscles between cancer survivors and healthy controls, contrasting with the expected differences based on the preclinical work. Our results may be linked to differences between the human and preclinical testing paradigms including, among many possibilities, differences in the tested limb or species. Determining the source of these differences will be important for developing a complete picture of how OX chemotherapy contributes to long-term sensorimotor impairments.NEW & NOTEWORTHY Our results showed that cancer survivors after oxaliplatin (OX) treatment exhibited stretch reflexes that were comparable with age-matched healthy individuals in the proximal upper limb. The lack of OX effect might be linked to differences between the clinical and preclinical testing paradigms. These findings refine our expectations derived from the preclinical study and guide future assessments of OX effects that may have been insensitive to our measurement techniques.
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Affiliation(s)
- Allison B Wang
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Stephen N Housley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Daniel Ludvig
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
| | - Colin K Franz
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- The Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, United States
| | - Timothy C Cope
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, United States
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Georgia Institute of Technology, Atlanta, Georgia, United States
- Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Eric J Perreault
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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12
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Lantis K, Schnell P, Bland CR, Wilder J, Hock K, Vargo C, Glover NA, Hackney ME, Lustberg MB, Worthen-Chaudhari L. Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trial and preliminary baseline data. Trials 2023; 24:564. [PMID: 37658464 PMCID: PMC10472642 DOI: 10.1186/s13063-023-07554-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/28/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through neurologic dance training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX. METHODS In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1-month follow-up, and 6-month follow-up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups. DISCUSSION The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. TRIAL REGISTRATION This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.
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Affiliation(s)
- Kristen Lantis
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA.
| | - Patrick Schnell
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Courtney R Bland
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Jacqueline Wilder
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
| | - Karen Hock
- Comprehensive Cancer Center, The Ohio State University, 281 W Lane Ave, Columbus, OH, 43210, USA
| | - Craig Vargo
- Comprehensive Cancer Center, The Ohio State University, 281 W Lane Ave, Columbus, OH, 43210, USA
| | - Nelson A Glover
- George Mason University, 4400 University Dr, Fairfax, VA, 22030, USA
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, 2015 Uppergate Dr, Atlanta, GA, 30307, USA
| | | | - Lise Worthen-Chaudhari
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, USA
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Veiga-Seijo R, Pertega-Diaz S, Perez-Lopez ME, Martinez LC, Novoa SA, Gonzalez-Martin C. Foot health and quality of life in women with breast cancer undergoing chemotherapy: a cross-sectional study. J Foot Ankle Res 2023; 16:52. [PMID: 37599367 PMCID: PMC10440865 DOI: 10.1186/s13047-023-00650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Chemotherapy is one of the most widely used therapies for breast cancer, triggering important repercussions on people's quality of life. However, little research has been undertaken about podiatric adverse effects. This study aimed was to determine the prevalence of podiatric pathology developed in people with breast cancer who receive chemotherapy. METHODS Observational, descriptive, and cross-sectional study was conducted in the Oncology service of the A Coruña University Hospital (northwest Spain). People with breast cancer and undergoing chemotherapy treatment of legal age (≥ 18), who signed the informed consent (n = 117) were included. Sociodemographic, comorbidity, disease and foot health variables, as well as two self-administered questionnaires (Foot Health Status Questionnaire and Foot Function Index) were studied. The current ethical-legal aspects were followed. RESULTS Foot health problems were highly prevalent, highlighting nail color changes (59.8%), onychocryptosis (39.7%), xerosis (62.4%), plantar fasciitis (12.8%), and neuropathic symptoms (75.2%). Some foot pain was presented in 77.8% of the sample, predominantly at nail level (15.4%) or sole of the foot and nail (14.5%). Most participants described their foot health as fair or poor (56.4%) and felt limited in walking (65.8%). The lowest score for the Foot Health Status Questionnaire was footwear (30.6(33.5)). CONCLUSIONS Foot health adverse effects represent worrisome problems in women with breast cancer undergoing chemotherapy, due to their high prevalence and negative implications on quality of life. These problems are critical as they may have implications for stopping or reducing chemotherapy. All these results call for the development of more research to contribute to the care and wellbeing of people with cancer who receive treatments such as chemotherapy. Thus, this line of research is a new path to be developed by the podiatry community.
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Affiliation(s)
- Raquel Veiga-Seijo
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Esteiro, Ferrol, 15471, Spain.
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Sergas, Universidade da Coruña (UDC), A Coruña, 15006, Spain.
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Universidade da Coruña (UDC), Campus Oza, A Coruña, 15008, Spain.
| | - Sonia Pertega-Diaz
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Esteiro, Ferrol, 15471, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Sergas, Universidade da Coruña (UDC), A Coruña, 15006, Spain
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Universidade da Coruña (UDC), Campus Oza, A Coruña, 15008, Spain
| | - Maria Eva Perez-Lopez
- Breast Unit, Medical Oncology Department, Hospital Universitario de A Coruña (HUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, A Coruña, 15006, Spain
| | - Lourdes Calvo Martinez
- Breast Unit, Medical Oncology Department, Hospital Universitario de A Coruña (HUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, A Coruña, 15006, Spain
| | - Silvia Antolin Novoa
- Breast Unit, Medical Oncology Department, Hospital Universitario de A Coruña (HUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Sergas, A Coruña, 15006, Spain
| | - Cristina Gonzalez-Martin
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Campus Esteiro, Ferrol, 15471, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Sergas, Universidade da Coruña (UDC), A Coruña, 15006, Spain
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Universidade da Coruña (UDC), Campus Oza, A Coruña, 15008, Spain
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14
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Teng C, Chiarovano E, Tighe D, Bui KT, Venkatesha, Blinman PL, MacDougall HG, Vardy JL. Exploring assessment of balance using virtual reality in patients at risk of chemotherapy-induced peripheral neuropathy. Intern Med J 2023; 53:1356-1365. [PMID: 35762188 PMCID: PMC10946840 DOI: 10.1111/imj.15861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity for people treated for cancer. Impaired balance and falls are functional consequences of CIPN. Virtual reality (VR) technology may be able to assess balance and identify patients at risk of falls. AIMS To assess the impact of potentially neurotoxic chemotherapy on balance using VR, and explore associations between VR balance assessment, falls and CIPN. METHODS This prospective, repeated measures longitudinal study was conducted at two Australian cancer centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colorectal cancer (CRC), per institutional guidelines. Balance assessments using VR were conducted at baseline, end of chemotherapy and 3 and 6 months after completion of chemotherapy. Participants also completed a comprehensive CIPN assessment comprising clinical and patient-reported outcomes, and recorded falls or near falls. RESULTS Out of 34 participants consented, 24 (71%) had breast cancer and 10 (29%) had CRC. Compared to baseline, balance threshold was reduced in 10/28 (36%) evaluable participants assessed at the end of chemotherapy, and persistent in 7/22 (32%) at 6 months. CIPN was identified in 86% at end of chemotherapy and persisted to 6 months after chemotherapy completion in 73%. Falls or near falls were reported by 12/34 (35%) participants, and were associated with impaired VR balance threshold (P = 0.002). CONCLUSIONS While VR balance assessment was no better at identifying CIPN than existing measures, it is a potential surrogate method to assess patients at risk of falls from CIPN.
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Affiliation(s)
- Christina Teng
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
- Department of Medical OncologyCentral Coast Cancer CentreSydneyNew South WalesAustralia
| | - Elodie Chiarovano
- School of PsychologyUniversity of SydneySydneyNew South WalesAustralia
| | - David Tighe
- Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Kim Tam Bui
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Venkatesha
- Clinical Research CentreSydney Local Health DistrictSydneyNew South WalesAustralia
| | - Prunella L. Blinman
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | | | - Janette L. Vardy
- Concord Cancer CentreConcord Repatriation General HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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15
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Wegge-Larsen C, Mehlsen M, Jensen AB. The motivation of breast cancer patients to participate in a national randomized control trial. Support Care Cancer 2023; 31:468. [PMID: 37452876 PMCID: PMC10349774 DOI: 10.1007/s00520-023-07930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Clinical trials are essential for development of better cancer care. Therefore, patient willingness to participate in these trials is important. The aim of this study was to assess motivation and thoughts of breast cancer patients concerning participation in a clinical trial. METHODS Twenty-one patients participated in two semi-structed interviews about participating in a clinical trial testing the efficacy of cryotherapy for the prevention of chemotherapy-induced peripheral neuropathy in breast cancer patients treated with paclitaxel. The interviews took place before and after the intervention and were coded and categorized following the steps in Braun & Clarke's thematic analysis to identify motivational factors and experiential themes. RESULTS Four overarching themes were identified: (1) reasons to participate in the trial, (2) personal resources, (3) safety, and (4) experience of the randomization. The most frequent reason for participating in the trial was to support research and help others, but many also participated hoping to receive the intervention treatment. The study showed that a surplus of personal resources played an important role when the patients decided to participate in the trial. Differences were found between patients belonging to the intervention and the control group in relation to these themes. Finally, both groups experienced the extra examinations received during the trial as an additional source of safety. CONCLUSION This qualitative study found different factors influencing the experience of participating in a clinical trial, e.g., intervention-status, personal resources, and safety. This knowledge can be valuable when planning future clinical trials involving breast cancer patients.
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Affiliation(s)
- C Wegge-Larsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - M Mehlsen
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - A B Jensen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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16
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Lantis KD, Schne P, Bland CR, Wilder J, Hock K, Glover NA, Hackney ME, Lustberg MB, Worthen-Chaudhari L. Biomechanical effect of neurologic dance training (NDT) for breast cancer survivors with chemotherapy-induced neuropathy: study protocol for a randomized controlled trail and preliminary baseline data. RESEARCH SQUARE 2023:rs.3.rs-2988661. [PMID: 37461666 PMCID: PMC10350217 DOI: 10.21203/rs.3.rs-2988661/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background Breast cancer (BC) is among the most common forms of cancer experienced by women. Up to 80% of BC survivors treated with chemotherapy experience chemotherapy-induced neuropathy (CIN), which degrades motor control, sensory function, and quality of life. CIN symptoms include numbness, tingling, and/or burning sensations in the extremities; deficits in neuromotor control; and increased fall risk. Physical activity (PA) and music-based medicine (MBM) are promising avenues to address sensorimotor symptoms. Therefore, we propose that we can combine the effects of music- and PA-based medicine through Neurologic Dance Training (NDT) through partnered Adapted Tango (NDT-Tango). We will assess the intervention effect of NDT-Tango v. home exercise (HEX) intervention on biomechanically-measured variables. We hypothesize that 8 weeks of NDT-Tango practice will improve the dynamics of posture and gait more than 8 weeks of HEX. Methods In a single-center, prospective, two-arm randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the NDT-Tango experimental or the HEX active control intervention group. Primary endpoints are change from baseline to after intervention in posture and gait. Outcomes are collected at baseline, midpoint, post, 1mo follow up, and 6mo follow up. Secondary and tertiary outcomes include clinical and biomechanical tests of function and questionnaires used to compliment primary outcome measures. Linear mixed models will be used to model changes in postural, biomechanical, and PROs. The primary estimand will be the contrast representing the difference in mean change in outcome measure from baseline to week 8 between treatment groups. Discussion The scientific premise of this study is that NDT-Tango stands to achieve more gains than PA practice alone through combining PA with MBM and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. Trial Registration This trial was first posted on 11/09/21 at ClinicalTrials.gov under the identifier NCT05114005.
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Affiliation(s)
- Kristen D Lantis
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Patrick Schne
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, Ohio
| | - Courtney R Bland
- College of Public Health, Division of Biostatistics, The Ohio State University, Columbus, Ohio
| | - Jacqueline Wilder
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
| | - Karen Hock
- Comprehensive Cancer Center, The Ohio State University, Columbus OH
| | | | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA
| | | | - Lise Worthen-Chaudhari
- College of Medicine, Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio
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17
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Nikolaeva A, Pospelova M, Krasnikova V, Makhanova A, Tonyan S, Krasnopeev Y, Kayumova E, Vasilieva E, Efimtsev A, Levchuk A, Trufanov G, Voynov M, Shevtsov M. Elevated Levels of Serum Biomarkers Associated with Damage to the CNS Neurons and Endothelial Cells Are Linked with Changes in Brain Connectivity in Breast Cancer Patients with Vestibulo-Atactic Syndrome. PATHOPHYSIOLOGY 2023; 30:260-274. [PMID: 37368372 DOI: 10.3390/pathophysiology30020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Vestibulo-atactic syndrome (VAS), which represents a combination of motor and vestibular disorders, can be manifested as a clinical complication of breast cancer treatment and has a significant impact on patients' quality of life. The identification of novel potential biomarkers that might help to predict the onset of VAS and its progression could improve the management of this group of patients. In the current study, the levels of intercellular cell adhesion molecule 1 (ICAM-1), platelet/endothelial cell adhesion molecule 1 (PECAM-1), NSE (neuron-specific enolase), and the antibodies recognizing NR-2 subunit of NMDA receptor (NR-2-ab) were measured in the blood serum of BC survivor patients with vestibulo-atactic syndrome (VAS) and associated with the brain connectome data obtained via functional magnetic resonance imaging (fMRI) studies. A total of 21 patients were registered in this open, single-center trial and compared to age-matched healthy female volunteers (control group) (n = 17). BC patients with VAS demonstrated higher serum levels of ICAM-1, PECAM-1, and NSE and a lower value of NR-2-ab, with values of 654.7 ± 184.8, 115.3 ± 37.03, 49.9 ± 103.9, and 0.5 ± 0.3 pg/mL, respectively, as compared to the healthy volunteers, with 230.2 ± 44.8, 62.8 ± 15.6, 15.5 ± 6.4, and 1.4 ± 0.7 pg/mL. According to the fMRI data (employing seed-to-voxel and ROI-to-ROI methods), in BC patients with VAS, significant changes were detected in the functional connectivity in the areas involved in the regulation of postural-tonic reflexes, the coordination of movements, and the regulation of balance. In conclusion, the detected elevated levels of serum biomarkers may reveal damage to the CNS neurons and endothelial cells that is, in turn, associated with the change in the brain connectivity in this group of patients.
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Affiliation(s)
- Alexandra Nikolaeva
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Maria Pospelova
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Varvara Krasnikova
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Albina Makhanova
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Samvel Tonyan
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Yurii Krasnopeev
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Evgeniya Kayumova
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Elena Vasilieva
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Aleksandr Efimtsev
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Anatoliy Levchuk
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Gennadiy Trufanov
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Mark Voynov
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
| | - Maxim Shevtsov
- Personalized Medicine Centre, Almazov National Medical Research Centre, Akkuratova Str. 2, 197341 Saint Petersburg, Russia
- Department of Radiation Oncology, Technishe Universität München (TUM), Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
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18
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Veiga-Seijo R, Gonzalez-Martin C. Foot Health in People with Cancer Undergoing Chemotherapy: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11111588. [PMID: 37297728 DOI: 10.3390/healthcare11111588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Chemotherapy has relevant implications for cancer patients' physical, social, and psychological health. Foot health has gained relevance in recent years due to its importance to independence and wellbeing, especially in chronic conditions. This study aims to explore the scope of the literature regarding foot health problems in people with cancer undergoing chemotherapy. METHODS scoping review following the PRISMA-ScR, Arksey and O'Malley, and the Joanna Briggs Institute guidelines. Different databases were used (Cochrane Plus, Scopus, Web of Science, and Pubmed). A total of 4911 articles were identified. Finally, 11 papers were included. RESULTS Foot problems are relevant and deteriorate wellbeing. The prevalence of some podiatric pathologies is controversial. The main literature deals with hand-foot syndrome and peripheral neuropathy. Focused instruments on foot health were not thoroughly used. CONCLUSION There is insufficient evidence on foot health problems and their influence on the quality of life of people with cancer undergoing chemotherapy. Even though a significant percentage of this population has a foot problem, its care and importance are neglected. More studies are needed to contribute to the care of people with cancer through foot health.
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Affiliation(s)
- Raquel Veiga-Seijo
- Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Esteiro, Campus Industrial de Ferrol, Universidade da Coruña, 15471 Ferrol, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Universidade da Coruña, Sergas, 15006 A Coruña, Spain
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Campus Oza, Universidade da Coruña, 15008 A Coruña, Spain
| | - Cristina Gonzalez-Martin
- Department of Health Sciences, Faculty of Nursing and Podiatry, Campus Esteiro, Campus Industrial de Ferrol, Universidade da Coruña, 15471 Ferrol, Spain
- Research Group in Nursing and Health Care, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario de A Coruña (HUAC), Universidade da Coruña, Sergas, 15006 A Coruña, Spain
- Research Group in Rheumatology and Health (GIR-S), Faculty of Physiotherapy, Campus Oza, Universidade da Coruña, 15008 A Coruña, Spain
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Morishita S, Suzuki K, Okayama T, Inoue J, Tanaka T, Nakano J, Fukushima T. Recent Findings in Physical Exercise for Cancer Survivors. Phys Ther Res 2023; 26:10-16. [PMID: 37181484 PMCID: PMC10169310 DOI: 10.1298/ptr.r0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/10/2023] [Indexed: 05/16/2023]
Abstract
In recent years, the number of cancer survivors has been increasing each year due to advances in the early diagnosis and treatment of cancer. Cancer survivors present a variety of physical and psychological complications due to cancer and its treatment. Physical exercise is an effective nonpharmacological treatment for complications in cancer survivors. Furthermore, recent evidence has shown that physical exercise improves the prognosis of cancer survivors. The benefits of physical exercise have been widely reported, and guidelines for physical exercise for cancer survivors have been published. These guidelines recommend that cancer survivors engage in moderate- or vigorous-intensity aerobic exercises and/or resistance training. However, many cancer survivors have a poor commitment to physical exercise. In the future, it is necessary to promote physical exercise among cancer survivors through outpatient rehabilitation and community support.
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Affiliation(s)
- Shinichiro Morishita
- Department of Physical Therapy, School of Health Sciences, Fukushima Medical University, Japan
| | | | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Japan
| | - Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, Japan
| | - Takashi Tanaka
- Department of Rehabilitation, Hyogo Medical University Hospital, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Japan
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Suzuki K, Morishita S, Nakano J, Okayama T, Inoue J, Tanaka T, Fukushima T. Neurological Outcomes of Chemotherapy-Induced Peripheral Neuropathy in Patients With Cancer: A Systematic Review and Meta-Analysis. Integr Cancer Ther 2023; 22:15347354231185110. [PMID: 37822238 PMCID: PMC10571681 DOI: 10.1177/15347354231185110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to determine whether chemotherapy-induced peripheral neuropathy (CIPN) affects the risk of falls and physical function in patients with cancer. METHODS A literature search was conducted in the CINAHL, Scopus, and PubMed databases for articles published from January 1950 to April 2022. Seven review authors retrieved studies using predetermined eligibility criteria, extracted the data, and evaluated the quality. RESULTS Nine studies were included in the analysis. Patients with CIPN had a significantly higher risk of falls than those without CIPN (risk ratio = 1.38, 95% confidence interval [CI] =1.18-1.62). Patients with CIPN had lower grip strength (standardized mean difference [SMD] =-0.42, 95% CIs = -0.70 to -0.14, P = .003), longer chair stand time (SMD = 0.56, 95% CIs = -0.01 to 1.17, P = .05), worse timed up and go test time (SMD = 0.79, 95% CIs = 0.41 to 1.17, P < .0001), and lower mean Fullerton Advanced Balance scale score (SMD = -0.81, 95% CIs = -1.27 to -0.36, P = .005) than patients without CIPN. There were no significant differences in gait speed (P = .38) or Activities-specific Balance Confidence Scale score (P = .09) between patients with and without CIPN. CONCLUSIONS This systematic review and meta-analysis demonstrated that patients with CIPN are prone to falls and impaired balance function and muscle strength.
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Affiliation(s)
| | | | | | | | - Junichiro Inoue
- Kobe University Hospital International Clinical Cancer Research Center, Kobe, Japan
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21
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Skiba MB, Harker G, Guidarelli C, El-Gohary M, Horak F, Roeland EJ, Silbermann R, Hayes-Lattin B, Winters-Stone K. Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study. JMIR Cancer 2022; 8:e39271. [PMID: 36480243 PMCID: PMC9782382 DOI: 10.2196/39271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. OBJECTIVE We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. METHODS Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. RESULTS Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. CONCLUSIONS Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.
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Affiliation(s)
- Meghan B Skiba
- Biobehavioral Health Science Division, College of Nursing, University of Arizona, Tucson, AZ, United States
- The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Graham Harker
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Carolyn Guidarelli
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Fay Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
- APDM, Inc, a division of Clario International, Portland, OR, United States
| | - Eric J Roeland
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca Silbermann
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Brandon Hayes-Lattin
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Kerri Winters-Stone
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, United States
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Reinmann A, Bruyneel AV, Gligorov J, Mesure S, Combescure C, Koessler T, Bodmer A. Influence of chemotherapy on postural control and quality of life in women with gynaecological cancer: a protocol of a prospective observational study. BMJ Open 2022; 12:e061664. [PMID: 36691184 PMCID: PMC9454005 DOI: 10.1136/bmjopen-2022-061664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/31/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Chemotherapy-induced peripheral neuropathy is a frequent side effect of some chemotherapies that can cause postural control disorders and has a serious impact on quality of life (QoL). An enhanced understanding of postural control dysfunction could help build a systematic and accurate assessment as well as specific exercises to limit the impact on QoL. This study aims to assess the influence of chemotherapy on postural control and the QoL for women with gynaecological cancer. METHODS AND ANALYSIS This prospective observational study will include 37 participants with cancer treated using neurotoxic chemotherapy. Their postural control in various conditions (rigid and foam surfaces, eyes open and closed, with and without tendon vibration, and dual tasks), limits of stability, QoL and modified Total Neuropathy Score will be assessed. A linear mixed model will compare postural control pre-chemotherapy and post-chemotherapy. ETHICS AND DISSEMINATION This study was approved by an ethical review board in Geneva (CCER-2020-01639). The study findings will be disseminated through conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04692168.
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Affiliation(s)
- Aline Reinmann
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Anne-Violette Bruyneel
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Joseph Gligorov
- Department of Oncology, AP-HP. Sorbonne University, Paris, France
| | - Serge Mesure
- Institute of Movement Sciences, National Centre of Scientific Research, Aix-Marseille-University, Marseille, France
| | - Christophe Combescure
- CRC & Division of clinical epidemiology, Department of health and community medicine, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland
| | - Thibaud Koessler
- Service of Oncology, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | - Alexandre Bodmer
- Service of Oncology, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
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Rattanakrong N, Siriphorn A, Boonyong S. Incidence and risk factors associated with falls among women with breast cancer during taxane-based chemotherapy. Support Care Cancer 2022; 30:7499-7508. [PMID: 35665857 DOI: 10.1007/s00520-022-07181-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aims to evaluate the falling incidence density and examine the potential risk factors associated with falling among women with breast cancer during taxane-based chemotherapy. METHODS One hundred and twenty-three women with breast cancer participated in this study. The fall incidence density, taxane-induced peripheral neuropathy (TIPN) symptoms, and physical performance tests were evaluated at five time points throughout chemotherapy treatment. A fall diary was used to record fall incidence during treatment. The fall incidence density was calculated by dividing the number of first fall occurrences by person-time at risk. The risk factors associated with time to first fall were analyzed using the Cox proportional hazards model. The Kaplan-Meier curve illustrated the probability of survival from a fall during chemotherapy treatment. RESULTS Over the course of treatment, 29 (23.58%) participants reported falls. The fall incidence density was 3 per 1000 person-day. This study discovered a significant link between age (adjusted HR (HRadj) = 1.07; 95% CI: 1.02-1.13) and BMI (HRadj = 1.11; 95% CI: 1.02-1.21) and falling. CONCLUSIONS Women with breast cancer could fall for the first time at any time after starting chemotherapy until the end of the follow-up period. Furthermore, time to first fall was associated with age and BMI. Early detection of falling in women with breast cancer, particularly among older persons and those with a high BMI, may be essential to preventing falls.
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Affiliation(s)
- Nida Rattanakrong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, 154 Rama I Road, Wangmai, Pathumwan, Bangkok, Thailand.,Department of Rehabilitation Medicine, Physical Therapy Unit, Chulabhorn Hospital, Bangkok, Thailand
| | - Akkradate Siriphorn
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, 154 Rama I Road, Wangmai, Pathumwan, Bangkok, Thailand
| | - Sujitra Boonyong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, 154 Rama I Road, Wangmai, Pathumwan, Bangkok, Thailand.
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Responsiveness and Interrater Reliability of the Short Form of Fullerton Advance Balance Scale in Women With Breast Cancer Following Chemotherapy. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wu CJ, Chan YN, Yen LY, Chen YH, Lo C, Tseng LM, Wang YJ. Extremity Exercise Program in Breast Cancer Survivors Suffering from Chemotherapy-Induced Peripheral Neuropathy: A Feasibility Pilot Study. Healthcare (Basel) 2022; 10:healthcare10040688. [PMID: 35455864 PMCID: PMC9024995 DOI: 10.3390/healthcare10040688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 02/04/2023] Open
Abstract
Objectives: To evaluate the feasibility of implementation of an extremity exercise program and to examine its preliminary effects in breast cancer survivors suffering from chemotherapy-induced peripheral neuropathy (CIPN). Sample & Setting: Thirteen breast cancer survivors from one hospital in northern Taiwan. Methods and Variables: A single group with repeated measures, and a quasi-experimental design. The intervention program was a four week, home-based extremity exercise program that was comprised of 10 skilled hand exercises and Buerger-Allen exercises. The Total Neuropathy Scale (clinical version), Functional Assessment of Cancer Therapy/Gynecologic Oncology Group, Neurotoxicity (13-Item Version), Identification Pain Questionnaire, and pain Visual Analogue Scale were used to measure CIPN before exercise (T1), during (T2~T4), and after exercise (T5). Qualitative data were also collected at each time point. Data were analyzed by using descriptive statistics, generalized estimating equations, and directed content analysis. Results: None of the participants reported adverse events during the study period. The extremity exercise program significantly improved patient-reported CIPN after intervention at T4 or T5 but was insignificant on clinician-assessed CIPN. The qualitative data of participant experience indicated that this program is feasible and easy to follow. Conclusion: The extremity exercise program is feasible but needs to increase the sample size and prolong the intervention period for confirmation.
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Affiliation(s)
- Chih-Jung Wu
- Department of Hematology and Oncology, China Medical University Hospital, No. 2, Yude Rd., Taichung 404332, Taiwan;
| | - Ya-Ning Chan
- School of Nursing, University of North Carolina at Chapel Hill, 120 N. Medical Dr. Carrington Hall #CB 7460, Chapel Hill, NC 27599-7460, USA;
| | - Li-Yu Yen
- Research Nurse, Department of Internal Medicine, National Taiwan University Hospital, Rm. 607, 6F., Laboratory Building, No. 1, Changde St., Taipei 10048, Taiwan;
| | - Yun-Hen Chen
- Department of Nursing, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih, Pai Rd., Taipei 11217, Taiwan;
| | - Chyi Lo
- School of Nursing, China Medical University, No. 100, Sec. 1, Jingmao Rd., Taichung 406040, Taiwan;
| | - Ling-Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih, Pai Rd., Taipei 11217, Taiwan;
| | - Ya-Jung Wang
- Department of Nursing, DaYeh University, No. 168, University Rd., Dacun, Changhua 51591, Taiwan
- Correspondence:
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Beatty JD, Sun Q, Markowitz D, Chubak J, Huang B, Etzioni R. Identifying breast cancer recurrence histories via patient-reported outcomes. J Cancer Surviv 2022; 16:388-396. [PMID: 33852139 PMCID: PMC8525779 DOI: 10.1007/s11764-021-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To test accuracy of patient self-report of breast cancer recurrence for enhancing standard population-based cancer registries that do not routinely collect cancer recurrence data despite the importance of this outcome. METHODS Potential research subjects were identified in the Breast Cancer Research Database (BCRD) of the Swedish Cancer Institute (SCI). The BCRD has collected data within 45 days of each medical encounter on new primary breast cancer patients receiving all or part of their initial care at SCI. Females diagnosed with a new primary breast cancer 2004-2016, Stages I-III, and alive at the time of study initiation (2018) were identified. Recurrent breast cancer patients were matched 1:1 to surviving non-recurrent patients by patient age, date of diagnosis, and single or multiple primary tumors. Consented research subjects were surveyed about their initial and subsequent diagnostic, therapeutic, and recurrent events. PRO survey responses were compared with BCRD information for each individual participant. Discrepancies were reviewed in medical records. RESULTS A matched sample of 88 recurrent and 88 non-recurrent patients were used in analyses. Respondents correctly identified the date of diagnosis of first primary breast cancer within 1 year 94% (165/176). Recurrence was reported by 97% (85/88) of recurrent patients. No recurrence was reported by 100% (88/88) of non-recurrent patients. Recurrence date within 1 year was correctly identified in 79% (67/85). Recurrence site was correctly identified in 82% (70/85). Medical record review of survey-registry discrepancies led to BCRD corrections in 4.5% (8/176) of cases. IMPLICATIONS FOR CANCER SURVIVORS Breast cancer patients can accurately report their disease characteristics, treatments, and recurrence history. Patient-reported information would enhance cancer registry data.
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Affiliation(s)
- J David Beatty
- Swedish Cancer Institute, Clinical Informatics, Seattle, USA
| | - Qin Sun
- Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research, Seattle, USA
| | | | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Bin Huang
- College of Medicine, Division of Cancer Biostatistics, University of Kentucky, Lexington, USA
| | - Ruth Etzioni
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Biostatistics Program, 1100 Fairview Avenue North, M2-B500, Seattle, WA, 98109, USA.
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Wang AB, Housley SN, Flores AM, Cope TC, Perreault EJ. Cancer survivors post-chemotherapy exhibit unique proprioceptive deficits in proximal limbs. J Neuroeng Rehabil 2022; 19:32. [PMID: 35321749 PMCID: PMC8944065 DOI: 10.1186/s12984-022-01010-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oxaliplatin (OX) chemotherapy for colorectal cancer is associated with adverse neurotoxic effects that can contribute to long-term sensorimotor impairments in cancer survivors. It is often thought that the sensorimotor impairments are dominated by OX-induced dying-back sensory neuropathy that primarily affects the distal regions of the limb. Recent preclinical studies have identified encoding dysfunction of muscle proprioceptors as an alternative mechanism. Unlike the dying-back sensory neuropathy affecting distal limbs, dysfunction of muscle proprioceptors could have more widespread effects. Most investigations of chemotherapy-induced sensorimotor impairments have considered only the effects of distal changes in sensory processing; none have evaluated proximal changes or their influence on function. Our study fills this gap by evaluating the functional use of proprioception in the shoulder and elbow joints of cancer survivors post OX chemotherapy. We implemented three multidirectional sensorimotor tasks: force matching, target reaching, and postural stability tasks to evaluate various aspects of proprioception and their use. Force and kinematic data of the sensorimotor tasks were collected in 13 cancer survivors treated with OX and 13 age-matched healthy controls. RESULTS Cancer survivors exhibited less accuracy and precision than an age-matched control group when they had to rely only on proprioceptive information to match force, even for forces that required only torques about the shoulder. There were also small differences in the ability to maintain arm posture but no significant differences in reaching. The force deficits in cancer survivors were significantly correlated with self-reported motor dysfunction. CONCLUSIONS These results suggest that cancer survivors post OX chemotherapy exhibit proximal proprioceptive deficits, and that the deficits in producing accurate and precise forces are larger than those for producing unloaded movements. Current clinical assessments of chemotherapy-related sensorimotor dysfunction are largely limited to distal symptoms. Our study suggests that we also need to consider changes in proximal function. Force matching tasks similar to those used here could provide a clinically meaningful approach to quantifying OX-related movement dysfunction during and after chemotherapy.
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Affiliation(s)
- Allison B Wang
- Department of Biomedical Engineering, Northwestern University, 355 E Erie St 21st Floor, Evanston, IL, 60611, USA.
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
- Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Stephen N Housley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Timothy C Cope
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
- W.H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Georgia Institute of Technology, Atlanta, GA, USA
- Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Eric J Perreault
- Department of Biomedical Engineering, Northwestern University, 355 E Erie St 21st Floor, Evanston, IL, 60611, USA
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern, Chicago, IL, USA
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Mechanisms, Mediators, and Moderators of the Effects of Exercise on Chemotherapy-Induced Peripheral Neuropathy. Cancers (Basel) 2022; 14:cancers14051224. [PMID: 35267533 PMCID: PMC8909585 DOI: 10.3390/cancers14051224] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/18/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect of neurotoxic antineoplastic agents commonly used to treat cancer. Patients with CIPN experience debilitating signs and symptoms, such as combinations of tingling, numbness, pain, and cramping in the hands and feet that inhibit their daily function. Among the limited prevention and treatment options for CIPN, exercise has emerged as a promising new intervention that has been investigated in approximately two dozen clinical trials to date. As additional studies test and suggest the efficacy of exercise in treating CIPN, it is becoming more critical to develop mechanistic understanding of the effects of exercise in order to tailor it to best treat CIPN symptoms and identify who will benefit most. To address the current lack of clarity around the effect of exercise on CIPN, we reviewed the key potential mechanisms (e.g., neurophysiological and psychosocial factors), mediators (e.g., anti-inflammatory cytokines, self-efficacy, and social support), and moderators (e.g., age, sex, body mass index, physical fitness, exercise dose, exercise adherence, and timing of exercise) that may illuminate the relationship between exercise and CIPN improvement. Our review is based on the studies that tested the use of exercise for patients with CIPN, patients with other types of neuropathies, and healthy adults. The discussion presented herein may be used to (1) guide oncologists in predicting which symptoms are best targeted by specific exercise programs, (2) enable clinicians to tailor exercise prescriptions to patients based on specific characteristics, and (3) inform future research and biomarkers on the relationship between exercise and CIPN.
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Curcumin as an Enhancer of Therapeutic Efficiency of Chemotherapy Drugs in Breast Cancer. Int J Mol Sci 2022; 23:ijms23042144. [PMID: 35216255 PMCID: PMC8878285 DOI: 10.3390/ijms23042144] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/21/2022] Open
Abstract
Female breast cancer is the world’s most prevalent cancer in 2020. Chemotherapy still remains a backbone in breast cancer therapy and is crucial in advanced and metastatic breast cancer treatment. The clinical efficiency of chemotherapy regimens is limited due to tumor heterogeneity, chemoresistance, and side effects. Chemotherapeutic drug combinations with natural products hold great promise for enhancing their anticancer efficacy. Curcumin is an ideal chemopreventive and chemotherapy agent owning to its multitargeting function on various regulatory molecules, key signaling pathways, and pharmacological safety. This review aimed to elucidate the potential role of curcumin in enhancing the efficacy of doxorubicin, paclitaxel, 5-fluorouracil, and cisplatin via combinational therapy. Additionally, the molecular mechanisms underlying the chemosensitizing activity of these combinations have been addressed. Overall, based on the promising therapeutic potential of curcumin in combination with conventional chemotherapy drugs, curcumin is of considerable value to develop as an adjunct for combination chemotherapy with current drugs to treat breast cancer. Furthermore, this topic may provide the frameworks for the future research direction of curcumin–chemotherapy combination studies and may benefit in the development of a novel therapeutic strategy to maximize the clinical efficacy of anticancer drugs while minimizing their side effects in the future breast cancer treatment.
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Jones KF, Wechsler S, Zulewski D, Wood L. Pharmacological and Nonpharmacological Management of Chemotherapy-Induced Peripheral Neuropathy: A Scoping Review of Randomized Controlled Trials. J Palliat Med 2022; 25:964-995. [PMID: 35128938 DOI: 10.1089/jpm.2021.0512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment with no effective preventative strategy or definitive treatment. Purpose: To synthesize empiric literature from randomized controlled trials (RCTs) of pharmacological and nonpharmacological management of CIPN. Data Sources: Articles published between January 1, 2010, and February 28, 2021, were identified using keywords searching Medline, PubMed, CINAHL, Web of Science, Cochrane Library, and Embase. Study Selection: RCTs that recruited individuals who were post-chemotherapy and experienced persistent CIPN symptoms. Data Extraction and Synthesis: Three independent reviewers screened a total of 2023 abstracts. After screening, full-text review, and quality appraisal, 22 articles were included in this review. Data related to study design, participant characteristics, interventions, controls, outcome measures, and relevant findings were extracted from full texts. Descriptive quantitative summaries were calculated and narrative analysis was performed. Results: Of the 22 studies, 4 investigated pharmacologic treatments, 2 compared acupuncture to pharmacologic treatments, and 16 studies examined nonpharmacologic treatments. Pharmacologic studies reported mixed results with evidence of participant response varying by history of chemotherapeutic agent. Acupuncture, exercise/physical therapy, and neurofeedback appear to be effective treatments for CIPN. Evidence regarding biophysical agents and cognitive-behavioral therapy is equivocal. Scrambler therapy is not supported. Limitations: Studies included in this review share several limitations, including widely variable outcome measures, small and demographically homogenous samples, and nonstandardized treatment protocols. Conclusion: This scoping review summarized the current body of high-quality RCTs investigating treatment for CIPN. The majority of studies in this review reports benefits of pharmacologic and nonpharmacologic interventions, although management may require a multipronged approach and should be tailored to the individual. Clinical implications are proposed and suggestions made for future research include implementation of standardized intervention protocols, use of outcome measures representative of the spectrum of CIPN symptoms, and stratification by the chemotherapeutic agent.
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Affiliation(s)
| | - Stephen Wechsler
- Massachusetts General Hospital Institute for Health Professionals, School of Rehabilitation Science, Boston, Massachusetts, USA
| | - David Zulewski
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Lisa Wood
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
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Goel Y, Fouda R, Gupta K. Endoplasmic Reticulum Stress in Chemotherapy-Induced Peripheral Neuropathy: Emerging Role of Phytochemicals. Antioxidants (Basel) 2022; 11:antiox11020265. [PMID: 35204148 PMCID: PMC8868275 DOI: 10.3390/antiox11020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a significant dose-limiting long-term sequela in cancer patients undergoing treatment, often leading to discontinuation of treatment. No established therapy exists to prevent and/or ameliorate CIPN. Reactive oxygen species (ROS) and mitochondrial dysregulation have been proposed to underlie the pathobiology of CIPN. However, interventions to prevent and treat CIPN are largely ineffective. Additional factors and mechanism-based targets need to be identified to develop novel strategies to target CIPN. The role of oxidative stress appears to be central, but the contribution of endoplasmic reticulum (ER) stress remains under-examined in the pathobiology of CIPN. This review describes the significance of ER stress and its contribution to CIPN, the protective role of herbal agents in countering ER stress in nervous system-associated disorders, and their possible repurposing for preventing CIPN.
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Affiliation(s)
- Yugal Goel
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92697, USA; (Y.G.); (R.F.)
| | - Raghda Fouda
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92697, USA; (Y.G.); (R.F.)
| | - Kalpna Gupta
- Hematology/Oncology, Department of Medicine, University of California, Irvine, CA 92697, USA; (Y.G.); (R.F.)
- VA Medical Center, Southern California Institute for Research and Education, Long Beach, CA 90822, USA
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence:
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Saraboon C, Siriphorn A. Effects of foam pad balance exercises on cancer patients undergoing chemotherapy: A randomized control trial. J Bodyw Mov Ther 2021; 28:164-171. [PMID: 34776136 DOI: 10.1016/j.jbmt.2021.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND This study sought to investigate the effects of foam pad balance exercises on balance, physical performance, peripheral neuropathy symptoms, and quality of life in cancer patients undergoing taxane-based chemotherapy. METHODS Thirty cancer patients receiving chemotherapy were randomly divided into 2 groups (n = 15/group): control group (CG) and balance exercise group (BG). The BG were asked to perform foam pad balance exercises 60 min/day, twice/week for 6 weeks, along with conventional therapy. The CG only received conventional therapy. The Fullerton Advanced Balance (FAB) Score, Short Physical Performance Battery (SPPB), Michigan Diabetic Neuropathy Score (MDNS), and Functional Assessment of Cancer Therapy-Taxane (FACT-Taxane) were used to assess balance, physical performance, peripheral neuropathy symptoms, and quality of life, respectively, at baseline and after 4 and 6 weeks of treatment. RESULTS At 4 and/or 6 weeks, the CG showed a decline in FAB and SPPB Scores, while the BG maintained their baseline levels. There were significant differences in the FAB Scores between the groups at the 4th and 6th week (p = 0.04 and p < 0.01, respectively) and significant differences in SPPB Scores at only the 6th week (p = 0.03). MDNS showed no significant changes between or within groups. For FACT-Taxane between groups, the CG and BG showed significant decreases (p < 0.01) and increases (p < 0.01), respectively, at 6th week. CONCLUSIONS Foam pad balance exercises during chemotherapy can be used to alleviate declining balance and enhance physical performance and quality of life of cancer patients.
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Affiliation(s)
- Chanatsupang Saraboon
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Akkradate Siriphorn
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand.
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Overcash J, Riffle H, Sinnott L, Williams N. Self-Reported and Performance-Based Evaluations of Functional Status in Older Women With Breast Cancer. Oncol Nurs Forum 2021; 48:657-668. [PMID: 34673762 DOI: 10.1188/21.onf.657-668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate self-reported and performance-based functional status (FS) in older women with breast cancer according to stage and time of visit during treatment. SAMPLE & SETTING 72 women with breast cancer aged 78 years or older and receiving any type of treatment at a midwestern outpatient clinic. METHODS & VARIABLES FS was evaluated using grip strength, the Index of Activities of Daily Living (ADLs), the instrumental ADLs (IADLs) scale, and the Timed Up and Go Test (TUGT). Mixed models were fit for grip strength and the TUGT, and generalized estimating equations were used to fit binary logistic regressions for the Index of ADLs and the IADLs scale. Continuous FS outcomes were evaluated using means and standard deviations. RESULTS Cancer stage and time of visit did not affect self-reported or performance-based FS scores. Most participants were considered independent on the Index of ADLs, the IADLs scale, and the TUGT, which did not change significantly between visits. Self-reported measures revealed less impairment. IMPLICATIONS FOR NURSING Monitoring FS using self-reported and performance-based measures can ensure that older patients receive timely support.
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Dasdemir Ilkhan G, Celikhisar H. Evaluation of chemotherapy-related peripheral neuropathy in lung cancer treatment. TUMORI JOURNAL 2021; 107:392-399. [PMID: 34669524 DOI: 10.1177/0300891620975868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Chemotherapy-related peripheral neuropathies are observed frequently in lung cancer treatment in clinical practice. The present study aimed to evaluate the electrophysiologic findings and clinical symptoms in patients treated for lung cancer with different chemotherapy regimens who had the findings of peripheral neuropathy. METHODS Patients who had electromyography (EMG) examinations with the prediagnosis of peripheral neuropathy at two different centers between January 2011 and December 2019 were included. The demographic data, neurologic examination findings, symptoms, EMG findings, and chemotherapeutic agents used in the treatment were evaluated retrospectively. RESULTS A total of 742 patients were included in the study, with 630 (84.90%) male and 112 (15.10%) female patients. Of the patients included in the study, 406 (54.71%) had positive sensorial symptoms, 494 (66.57%) had negative sensorial symptoms, 162 (21.83%) had motor symptoms, and 254 (34.23%) had pain symptoms. The patients were classified into two groups on the basis of the presence of polyneuropathy detected via EMG as group I (n = 500, 67.38%) including the patients with polyneuropathy and group II (n = 242, 32.61%) including the patients without polyneuropathy. Negative sensorial symptoms and motor symptoms in group I along with dysesthesia and paresthesia symptoms in group II were observed at ratios that were higher at a statistically significant level (p = 0.001, p = 0.001, p = 0.001, p = 0.001). CONCLUSION Sensorial symptoms are observed most frequently in chemotherapy-related peripheral neuropathies in lung cancer treatment and motor symptoms may also increase according to the chemotherapy regimen.
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Affiliation(s)
| | - Hakan Celikhisar
- Chest Diseases Clinic, Izmir Metropolitan Municipality Hospital, Izmir, Turkey
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Müller J, Weiler M, Schneeweiss A, Haag GM, Steindorf K, Wick W, Wiskemann J. Preventive effect of sensorimotor exercise and resistance training on chemotherapy-induced peripheral neuropathy: a randomised-controlled trial. Br J Cancer 2021; 125:955-965. [PMID: 34226683 PMCID: PMC8476560 DOI: 10.1038/s41416-021-01471-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common, unpleasant and usually long-lasting side effect of neurotoxic chemotherapeutic agents. This study aimed to investigate the preventive potential of sensorimotor- (SMT) and resistance training (RT) on CIPN. METHODS Patients (N = 170) were randomised to SMT, RT or usual care (UC). Both exercise groups trained 3×/week for a total of 105 min/week during neurotoxic chemotherapy (mean length: 20 weeks). Before and 3 weeks after neurotoxic chemotherapy, CIPN signs/symptoms were assessed via Total Neuropathy Score (TNSr; primary endpoint) and EORTC QLQ-CIPN15 questionnaire. In addition, balance (centre of pressure), muscle strength (isokinetic), quality of life (QoL, EORTC QLQ-C30) and relative chemotherapy dose intensity (RDI) were investigated. The follow-up period covered 6 months after the end of chemotherapy. RESULTS Intention-to-treat analyses (N = 159) revealed no differences regarding CIPN signs/symptoms. Exploratory per-protocol analyses (minimum training attendance rate 67%; N = 89) indicated that subjectively perceived sensory symptoms in the feet increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) than in the UC group (-8.3 points (-16.1 to -0.4); P = 0.039, ES = 1.27). Furthermore, adherent exercisers received a higher RDI (96.6 ± 4.8 vs. 92.2 ± 9.4; P = 0.045), showed a better course of muscular strength (+20.8 Nm (11.2-30.4); P < 0.001, ES = 0.57) and QoL (+12.9 points (3.9-21.8); P = 0.005, ES = 0.64). During follow-up, CIPN signs/symptoms persisted in all groups. CONCLUSIONS This study demonstrates that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet and other clinically relevant cancer therapy-related outcomes, if an appropriate training stimulus is achieved. CLINICAL TRIAL REGISTRATION NCT02871284.
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Affiliation(s)
- Jana Müller
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Markus Weiler
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Division of Gynecological Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- grid.5253.10000 0001 0328 4908Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Karen Steindorf
- grid.7497.d0000 0004 0492 0584Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Wolfgang Wick
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Wiskemann
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
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Drat-Gzubicka J, Pyszora A, Budzyński J, Currow D, Krajnik M. Is Neuropathic Pain a Good Marker of Peripheral Neuropathy in Hospice Patients with Advanced Cancer? The Single Center Pilot Study. Diagnostics (Basel) 2021; 11:diagnostics11081377. [PMID: 34441311 PMCID: PMC8391735 DOI: 10.3390/diagnostics11081377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/17/2021] [Accepted: 07/28/2021] [Indexed: 12/03/2022] Open
Abstract
Neuropathic pain (NP) affects approximately 30% of patients with advanced cancer. The prevalence of neuropathic pain related to peripheral neuropathy (NP-RPN) in these patients is not known. The aim of the study was to evaluate NP-RPN prevalence in hospice patients and to find out whether the absence of this pain is sufficient to rule out peripheral neuropathy. The study included a total of 76 patients with advanced cancer who were cared for at inpatient hospices. All patients were asked about shooting or burning pain (of the feet and hands), were examined systematically for sensory deficits and had a nerve conduction study performed. NP-RPN was found in 29% of the patients. Electrophysiologically-diagnosed peripheral neuropathy was found in 79% of patients, and the diagnostic electrophysiological criteria for neuropathy were met by one half of the patients without NP-RPN. The severity of NP-RPN was correlated with the clinically assessed severity of sensory neuropathy and the Karnofsky score, but was not correlated with the intensity of the clinical signs of motor neuropathy. The presence of NP-RPN did not reflect greater prevalence of motor and sensory abnormalities in neurological and electrophysiological examinations. The absence of NP-RPN did not rule out polyneuropathy in hospice patients.
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Affiliation(s)
- Joanna Drat-Gzubicka
- Neurology Department, Specialist Hospital, ul. Leśna 10, 89-606 Chojnice, Poland
- Correspondence:
| | - Anna Pyszora
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (A.P.); (M.K.)
| | - Jacek Budzyński
- Department of Vascular and Internal Diseases, Collegium Medicum in Bydgoszcz, Jan Biziel University Hospital No 2, Nicolaus Copernicus University in Toruń, ul. Ujejskiego 75, 85-168 Bydgoszcz, Poland;
| | - David Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, 2007 Ultimo, Australia;
| | - Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (A.P.); (M.K.)
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Waibel S, Wehrle A, Müller J, Bertz H, Maurer C. Type of exercise may influence postural adaptations in chemotherapy-induced peripheral neuropathy. Ann Clin Transl Neurol 2021; 8:1680-1694. [PMID: 34278743 PMCID: PMC8351395 DOI: 10.1002/acn3.51426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Traditional posturography measurements characterize postural instability in patients with chemotherapy-induced peripheral neuropathy (CIPN), while underlying postural control mechanisms remain unclear. Taking a model-based approach can yield insights into these mechanisms. This study's aim was to characterize the modifications in postural control of CIPN patients associated with exercise in relation to the postural behavior of healthy control participants (hCON) via an exploratory approach. METHODS Thirty-one CIPN patients were randomly assigned to two interventions (balance plus moderate endurance training vs. moderate endurance training only) and exercised twice per week over 12 weeks. Baseline data were compared to 36 matched hCONs. We recorded spontaneous sway and postural reactions to platform tilts using Optotrak and a Kistler force platform pre- and post-intervention. Data interpretation relied on a model-based parameter identification procedure. RESULTS Spontaneous sway amplitudes were larger and postural reactions smaller, with a relative phase advance, in our pre-intervention patients than the hCONs. Post-intervention, spontaneous sway, and postural reactions were reduced and the sensory-motor ratio larger in both groups, while the postural reaction timing differed between groups. INTERPRETATION The abnormally small postural reactions in CIPN patients before the intervention can be interpreted as the consequence of abnormally strong velocity control-a strategy modification that may serve as a prediction mechanism to compensate for the lack of timely and accurate proprioceptive signals. While both groups reduced postural sway and showed an adapted sensory-motor ratio post-intervention, the interventions seemed to trigger different velocity control strategies. This study emphasizes the need for taking a more differentiated perspective on intervention effects. TRIAL REGISTRATION German Clinical Trials Register (DRKS) number: DRKS00005419, prospectively registered on November 19, 2013.
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Affiliation(s)
- Sarah Waibel
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anja Wehrle
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany.,Institute for Exercise and Occupational Medicine, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jana Müller
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Working Group Exercise Oncology, Department of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Hartmut Bertz
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Medina HN, Liu Q, Cao C, Yang L. Balance and vestibular function and survival in US cancer survivors. Cancer 2021; 127:4022-4029. [PMID: 34265083 DOI: 10.1002/cncr.33787] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cancer and its treatment damage the musculoskeletal system and induce neurotoxicity, affecting the key sensory inputs for maintaining balance. The present study describes the pattern of balance impairment and evaluated its association with mortality among US cancer survivors. METHODS Data on a nationally representative sample of cancer survivors from the US National Health and Nutrition Examination Survey from 1999 to 2015 was analyzed. Sensory-specific balance impairment was measured at baseline by the modified Romberg test of standing balance on firm and compliant support surfaces. The linked mortality data were updated through December 31, 2015. RESULTS Among 511 cancer survivors, 282 (48.3%) had a balance impairment, predominantly attributing to vestibular dysfunction (251; 89.0% of 282 and 44.5% of 511). A higher prevalence of balance impairment was observed among cancer survivors with advanced age, lower socioeconomic status or educational attainment, body mass index <25 kg/m2 , and an inactive lifestyle. During up to 16.4 years of follow-up (median, 11.3 years; 5088 person-years), 253 cancer survivors had died. Cancer survivors with a balance impairment had a 63% higher risk of death from all causes (hazard ratio, 1.63; 95% confidence interval [CI], 1.12-2.38) after adjusting for sociodemographic factors, comorbidities, and cancer type. Specifically, those with vestibular dysfunctions had approximately 1.54 (95% CI, 1.05-2.27) times the risk of death compared to those without any balance impairment. These associations were stronger in males than in females. CONCLUSIONS In a US nationally representative sample of cancer survivors, balance impairment and vestibular dysfunctions were prevalent and associated with heightened all-cause mortality.
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Affiliation(s)
- Heidy N Medina
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Qinran Liu
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | - Chao Cao
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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McNeish BL, Richardson JK, Bell SG, Whitney DG. Chemotherapy-induced peripheral neuropathy increases nontraumatic fracture risk in breast cancer survivors. JBMR Plus 2021; 5:e10519. [PMID: 34368609 PMCID: PMC8328798 DOI: 10.1002/jbm4.10519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022] Open
Abstract
Chemotherapy is a common treatment for breast cancer (BrCa) and can cause chemotherapy‐induced peripheral neuropathy (CIPN). CIPN contributes to falls, and is thus a potential risk factor for nontraumatic fractures (NTFx); yet, the effect of CIPN on NTFx risk has not been examined for BrCa survivors. We therefore investigated the association between CIPN and NTFx in BrCa survivors. Data were extracted from Optum's Deidentified Clinformatics® Data Mart Database years 2010–2015 in this retrospective cohort study. Among women, three groups were derived based on BrCa and CIPN status: BrCa+/CIPN+ (primary group of interest), BrCa+/CIPN− (first comparison group), and BrCa−/CIPN− (second comparison group). After propensity score matching the comparison groups to BrCa+/CIPN+ at a ratio of 1:11 (BrCa:control) for demographics, osteoporosis, glucocorticoid medication, comorbidities, and cancer‐related variables for BrCa+/CIPN−, 1‐year incidence rate (IR) of NTFx was determined for each group. The incident rate ratio (IRR) determined if the IR for NTFx was different for BrCa+/CIPN+ compared to BrCa+/CIPN− and BrCa−/CIPN−. Cox proportional hazards regression models estimated the hazard ratios (HRs) after adjusting for covariates that were unable to be matched for. The crude IR (95% confidence interval [CI]) of NTFx was 4.54 (2.32–6.77) for BrCa+/CIPN+ (n = 359), 2.53 (2.03–3.04) for BrCa+/CIPN− (n = 3949), and 1.76 (1.35–2.18) for BrCa−/CIPN− (n = 3949). The crude IRR of NTFx was significantly elevated for BrCa+/CIPN+ as compared to BrCa+/CIPN− (IRR = 1.80; 95% CI, 1.06–3.05) and BrCa−/CIPN− (IRR = 2.58; 95% CI, 1.50–4.44). The elevated rate of NTFx for BrCa+/CIPN+ remained unchanged after adjusting for aromatase inhibitors compared to BrCa+/CIPN− (HR = 1.79; 95% CI, 1.06–3.04). Female BrCa survivors have an increased 1‐year IR of NTFx after the onset of CIPN, suggesting that CIPN is an additive burden on NTFx risk among BrCa survivors. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Brendan L McNeish
- Department of Physical Medicine and Rehabilitation Michigan Medicine Ann Arbor Michigan USA
| | - James K Richardson
- Department of Physical Medicine and Rehabilitation Michigan Medicine Ann Arbor Michigan USA
| | - Sarah G Bell
- Department of Obstetrics and Gynecology University of Michigan Ann Arbor Michigan USA
| | - Daniel G Whitney
- Department of Physical Medicine and Rehabilitation Michigan Medicine Ann Arbor Michigan USA.,Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA
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Murphy SP, Hayward R, Smith JD. Exercise training improves postural steadiness in cancer survivors undergoing chemotherapy. Gait Posture 2021; 87:136-142. [PMID: 33915436 DOI: 10.1016/j.gaitpost.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cancer and cancer treatments negatively affect somatosensory, vestibular, and visual inputs that regulate postural stability and balance, increasing the risk of falling. Exercise training has been shown to mitigate other negative side effects of cancer treatments, such as reducing peripheral neuropathy. RESEARCH QUESTION How does 12 weeks of supervised exercise training influence postural stability in cancer survivors who receive chemotherapy? METHODS Postural stability of cancer survivors (n = 25; mass = 79.0 ± 22.6 kg; height = 1.66 ± 0.08 m; age = 61 ± 10 years) receiving chemotherapy was assessed prior to and following a 12-week individualized exercise training program by quantifying changes in center of pressure data. A series of 2-factor (pre/post x condition) analysis of variance with repeated measures were used to identify differences between conditions and pre- and post- training program on time and frequency domain measures. RESULTS Mediolateral root mean square excursion (p = 0.040; es = 0.20) and resultant mean frequency (p = 0.044; es = 0.29) of the center of pressure trajectory were found to be significantly different between pre- and post-training program. Further, participants dealt better with perturbations after completing the training program by reducing mediolateral root mean square excursion and 95 % confidence ellipse when visual stimulus was removed. SIGNIFICANCE Supervised exercise training in cancer patients undergoing chemotherapy improves postural stability in the mediolateral direction. Given that mediolateral movement of the center of pressure has previously been associated with fallers in other populations, exercise training during cancer treatments may be beneficial.
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Affiliation(s)
- Shane P Murphy
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA; School of Integrative Physiology & Athletic Training, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Reid Hayward
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA; University of Northern Colorado Cancer Rehabilitation Institute, Campus Box 6, Greeley, CO, 80639, USA.
| | - Jeremy D Smith
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA.
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Sohn EH, Lee JS, Jung MS, Kim JR. A Prospective Study of Taxane-Induced Neuropathy with Breast Cancer: Proper Assessment Tool for Taxane-Induced Neuropathy. South Asian J Cancer 2021; 10:58-63. [PMID: 34568215 PMCID: PMC8460343 DOI: 10.1055/s-0041-1731100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Many chemotherapeutic agents, especially taxanes, can induce peripheral neuropathy. Aim To evaluate the clinical characteristics of taxane-induced neuropathy (TIN) and determine the proper assessment tool for TIN in patients with breast cancer. Setting and Design Single-center, observational, prospective study. Methods and Material Forty-three patients with breast cancer treated with taxanes were prospectively enrolled. The reduced version of the Total Neuropathy Score (TNSr) was performed at baseline and 3 months after enrollment. TIN was diagnosed if the difference between the baseline and 3-month TNSr was greater than 1. In patients with TIN, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Chemotherapy-Induced Peripheral Neuropathy (20-item scale (EORTC-CIPN20) was also assessed 3 months after enrollment. Results Thirty-seven out of 43 (86.0%) patients were diagnosed with TIN. Sensory symptoms (64.9%) were the most frequent abnormality, followed by autonomic symptoms (54.1%). No patients reported motor symptoms or motor weakness. The TNSr sensory symptom score positively correlated with that of the EORTC-CIPN20. Nerve conduction studies showed reduced nerve conduction velocities and amplitudes after taxane treatment compared to those before chemotherapy in all tested nerves; however, only three (8.1%) patients had sural sensory nerve action potential amplitude outside normal limits. Conclusions TIN was predominantly sensory with normal nerve conduction studies which is the main feature of small fiber neuropathy. A combination scale comprising of a clinician-based scale and a patient-reported questionnaire and specialized tests for small nerve fibers should be considered as proper assessment tools to evaluate TIN.
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Affiliation(s)
- Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, Korea
| | - Jin Sun Lee
- Department of Surgery and Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Korea
| | - Mi Sook Jung
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Je Ryong Kim
- Department of Surgery and Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Korea
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Blackwood J, Rybicki K. Assessment of Gait Speed and Timed Up and Go Measures as Predictors of Falls in Older Breast Cancer Survivors. Integr Cancer Ther 2021; 20:15347354211006462. [PMID: 33784836 PMCID: PMC8020039 DOI: 10.1177/15347354211006462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Older breast cancer survivors are at an increased risk of loss of postural balance and accidental falls, however, the ability of clinical mobility measures to predict falls has not been determined. The purpose of this study was to examine the prognostic ability, sensitivity, and specificity to predict accidental falls in measures of gait speed and functional mobility in older breast cancer survivors. METHODS Thirty-four breast cancer survivors 65 years and older performed 3 measures of gait speed (GS) (usual, fast, dual-task) and Timed Up and Go (TUG) (TUG, TUG-Cognitive, TUG-Manual). Follow-up calls were made 3 months after testing to track falls. RESULTS The area under the curve (AUC) was below 0.5 for all GS measures, indicating poor predictive ability and all GS measures had low sensitivity and specificity to predict falls. All TUG measures had AUC values above 0.5. The cutoff score with the best sensitivity/specificity to predict falls was: TUG-Cognitive = 11.32 seconds, Sens = 0.64, Spec = 0.80; TUG-Manual = 9.84 seconds, Sens = 0.71, Spec = 0.65. CONCLUSION When assessing fall risk in older breast cancer survivors, performance on the TUG and TUG-Cognitive are able to predict falls.
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Müller J, Kreutz C, Ringhof S, Koeppel M, Kleindienst N, Sam G, Schneeweiss A, Wiskemann J, Weiler M. Chemotherapy-induced peripheral neuropathy: longitudinal analysis of predictors for postural control. Sci Rep 2021; 11:2398. [PMID: 33504885 PMCID: PMC7840973 DOI: 10.1038/s41598-021-81902-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/12/2021] [Indexed: 11/09/2022] Open
Abstract
Impaired postural control is often observed in response to neurotoxic chemotherapy. However, potential explanatory factors other than chemotherapy-induced peripheral neuropathy (CIPN) have not been adequately considered to date due to primarily cross-sectional study designs. Our objective was to comprehensively analyze postural control during and after neurotoxic chemotherapy, and to identify potential CIPN-independent predictors for its impairment. Postural control and CIPN symptoms (EORTC QLQ-CIPN20) were longitudinally assessed before, during and three weeks after neurotoxic chemotherapy, and in three and six months follow-up examinations (N = 54). The influence of peripheral nerve function as determined by nerve conduction studies (NCS: compound motor action potentials (CMAP) and sensory action potentials (SNAP)), physical activity, and muscle strength on the change in postural control during and after chemotherapy was analyzed by multiple linear regression adjusted for age and body mass index. Postural control, CIPN signs/symptoms, and CMAP/SNAP amplitudes significantly deteriorated during chemotherapy (p < .01). During follow-up, patients recovered from postural instabilities (p < .01), whereas CIPN signs/symptoms and pathologic NCS findings persisted compared to baseline (p < .001). The regression model showed that low CMAP and high SNAP amplitudes at baseline predicted impairment of postural control during but not after chemotherapy. Hence, pre-therapeutically disturbed somatosensory inputs may induce adaptive processes that have compensatory effects and allow recovery of postural control while CIPN signs/symptoms and pathologic peripheral nerve function persist. Baseline NCS findings in cancer patients who receive neurotoxic chemotherapy thus might assist in delineating individual CIPN risk profiles more precisely to which specific exercise intervention programs could be tailor-made.
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Affiliation(s)
- Jana Müller
- Institute of Sports and Sport Science, Heidelberg University, Im Neuenheimer Feld 700, 69120, Heidelberg, Germany.,German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Charlotte Kreutz
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.,Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Steffen Ringhof
- Department of Sport and Sport Science, University of Freiburg, Schwarzwaldstr. 175, 79117, Freiburg, Germany
| | - Maximilian Koeppel
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health; Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Georges Sam
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Wang AB, Housley SN, Flores AM, Kircher SM, Perreault EJ, Cope TC. A review of movement disorders in chemotherapy-induced neurotoxicity. J Neuroeng Rehabil 2021; 18:16. [PMID: 33494755 PMCID: PMC7836454 DOI: 10.1186/s12984-021-00818-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy agents used in the standard treatments for many types of cancer are neurotoxic and can lead to lasting sensory and motor symptoms that compromise day-to-day movement functions in cancer survivors. To date, the details of movement disorders associated with chemotherapy are known largely through self-reported symptoms and functional limitations. There are few quantitative studies of specific movement deficits, limiting our understanding of dysfunction, as well as effective assessments and interventions. The aim of this narrative review is to consolidate the current understanding of sensorimotor disabilities based on quantitative measures in cancer survivors who received chemotherapy. We performed literature searches on PubMed and found 32 relevant movement studies. We categorized these studies into three themes based on the movement deficits investigated: (1) balance and postural control; (2) gait function; (3) upper limb function. This literature suggests that cancer survivors have increased postural sway, more conservative gait patterns, and suboptimal hand function compared to healthy individuals. More studies are needed that use objective measures of sensorimotor function to better characterize movement disabilities and investigate the underlying causes, as required for developing targeted assessments and interventions. By updating our understanding of movement impairments in this population, we identify significant gaps in knowledge that will help guide the direction of future research.
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Affiliation(s)
- Allison B Wang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA. .,Shirley Ryan AbilityLab, 355 E Erie St 21st Floor, Chicago, IL, 60611, USA.
| | - Stephen N Housley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Sheetal M Kircher
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Department of Hematology and Oncology, Northwestern University, Chicago, IL, USA
| | - Eric J Perreault
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Shirley Ryan AbilityLab, 355 E Erie St 21st Floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Timothy C Cope
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA.,W.H. Coulter, Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Georgia Institute of Technology, Atlanta, GA, USA.,Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
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45
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Magnuson A, Sedrak MS, Gross CP, Tew WP, Klepin HD, Wildes TM, Muss HB, Dotan E, Freedman RA, O'Connor T, Dale W, Cohen HJ, Katheria V, Arsenyan A, Levi A, Kim H, Mohile S, Hurria A, Sun CL. Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer. J Clin Oncol 2021; 39:608-618. [PMID: 33444080 DOI: 10.1200/jco.20.02063] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer. METHODS Patients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated. RESULTS In 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively (P < .01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity (P < .01). CONCLUSION The Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer.
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Affiliation(s)
| | | | | | - William P Tew
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Hyman B Muss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Croarkin E, Zampieri C. On the EDGE of Task Force Recommendations: Computerized Balance Assessment. REHABILITATION ONCOLOGY 2021; 39:64-67. [PMID: 38404645 PMCID: PMC10888498 DOI: 10.1097/01.reo.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Earllaine Croarkin
- Board Certified Neurological Clinical Specialist, Physical Therapist, Clinical Research Center, National Institutes of Health, Bethesda, MD
| | - Cris Zampieri
- Research Physical Therapist, Functional and Applied Biomechanics Laboratory, Clinical Research Center, National Institutes of Health, Bethesda, MD
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Single-Leg Stance Times in a Diverse Group of Survivors of Cancer and the Relationship to History of Recent Falls. REHABILITATION ONCOLOGY 2021. [DOI: 10.1097/01.reo.0000000000000243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ng DQ, Tan CJ, Soh BC, Tan MML, Loh SY, Tan YE, Ong HH, Teng PPC, Chan JJ, Chay WY, Lee J, Lai G, Beh SY, Tan TJY, Yap YS, Lee GE, Wong M, Dent R, Lo YL, Chan A, Loh KWJ. Impact of Cryotherapy on Sensory, Motor, and Autonomic Neuropathy in Breast Cancer Patients Receiving Paclitaxel: A Randomized, Controlled Trial. Front Neurol 2020; 11:604688. [PMID: 33424755 PMCID: PMC7793726 DOI: 10.3389/fneur.2020.604688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: We conducted a randomized controlled trial evaluating the efficacy and tolerability of cryotherapy in preventing chemotherapy-induced peripheral neuropathy (CIPN) in patients with early breast cancer receiving neo/adjuvant weekly paclitaxel. Methods: Patients were recruited from the National Cancer Centre Singapore and randomized (1:1) to receive either cryotherapy or usual care. Cryotherapy was applied as frozen gloves and socks on all extremities from 15 min before paclitaxel until 15 min post-infusion every cycle. Efficacy was measured by patient-reported outcomes (Patient Neurotoxicity Questionnaire [PNQ] and EORTC QLQ-CIPN20) and electrophysiological assessments. The primary endpoint was PNQ severity at 2 weeks after 12 cycles of weekly paclitaxel. Results: A total of 46 patients were recruited, of which 8 dropped out before paclitaxel treatment, leaving 38 evaluable. There was no significant difference in PNQ severity between cryotherapy and usual care at 2 weeks after paclitaxel treatment (sensory: p = 0.721; motor: p = 1.000). A benefit was observed at 3 months post-paclitaxel based on PNQ (sensory: 14.3 vs. 41.2%, p = 0.078; motor: 0 vs. 29.4%, p = 0.012) and CIPN20 (sensory: β = −3.6, 95%CI = −10.5–3.4, p = 0.308; motor: β = −7.3, 95%CI = −14.6–0, p = 0.051). Additionally, cryotherapy subjects have lower CIPN20 autonomic score (β = −5.84, 95%CI = −11.15 to −0.524, p = 0.031) and higher sympathetic skin response hand amplitudes (β = 0.544, 95%CI = 0.108–0.98, p = 0.014), suggesting possible autonomic benefits from cryotherapy. Temporary interruption with cryotherapy occurred in 80.9% of the subjects due to cold intolerance. Conclusions: There is insufficient evidence that cryotherapy prevents sensory neuropathy which may be due to the high rates of cryotherapy interruption in this study. The autonomic benefits of cryotherapy should be further investigated with appropriate outcome measures. Clinical Trial Registration:ClinicalTrials.gov: NCT03429972.
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Affiliation(s)
- Ding Quan Ng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore.,Department of Clinical Pharmacy Practice, University of California, Irvine, Irvine, CA, United States
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Boon Chua Soh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mabel May Leng Tan
- Division of Nursing, National Cancer Centre Singapore, Singapore, Singapore
| | - Soon Yue Loh
- Division of Nursing, National Cancer Centre Singapore, Singapore, Singapore
| | - Yam Eng Tan
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - Hui Hui Ong
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | | | - Jack Junjie Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joycelyn Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Gillianne Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yew Long Lo
- Department of Neurology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National Neuroscience Institute, Singapore, Singapore
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California, Irvine, Irvine, CA, United States.,Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Kiley Wei-Jen Loh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson's Disease: A Systematic Review. SENSORS 2020; 20:s20226627. [PMID: 33228056 PMCID: PMC7699399 DOI: 10.3390/s20226627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
The occurrence of peripheral neuropathy (PNP) is often observed in Parkinson’s disease (PD) patients with a prevalence up to 55%, leading to more prominent functional deficits. Motor assessment with mobile health technologies allows high sensitivity and accuracy and is widely adopted in PD, but scarcely used for PNP assessments. This review provides a comprehensive overview of the methodologies and the most relevant features to investigate PNP and PD motor deficits with wearables. Because of the lack of studies investigating motor impairments in this specific subset of PNP-PD patients, Pubmed, Scopus, and Web of Science electronic databases were used to summarize the state of the art on PNP motor assessment with wearable technology and compare it with the existing evidence on PD. A total of 24 papers on PNP and 13 on PD were selected for data extraction: The main characteristics were described, highlighting major findings, clinical applications, and the most relevant features. The information from both groups (PNP and PD) was merged for defining future directions for the assessment of PNP-PD patients with wearable technology. We established suggestions on the assessment protocol aiming at accurate patient monitoring, targeting personalized treatments and strategies to prevent falls and to investigate PD and PNP motor characteristics.
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50
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Chemotherapy-induced peripheral neuropathy in newly diagnosed breast cancer survivors treated with taxane: a prospective longitudinal study. Support Care Cancer 2020; 29:2959-2971. [DOI: 10.1007/s00520-020-05796-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
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