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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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Dan X, He YL, Tian YL, Huang Y, Ren JH. Summary of evidence on comprehensive healthcare for chemotherapy-induced peripheral neuropathy in cancer patients. Support Care Cancer 2024; 32:264. [PMID: 38564034 DOI: 10.1007/s00520-024-08466-7] [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: 11/01/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE This paper aims to provide an evidence-based summary of the most effective strategies for comprehensive healthcare of chemotherapy-induced peripheral neuropathy (CIPN) in cancer patients. METHOD Following the "6S" model, relevant evidence on CIPN management was collected from reputable evidence-based resource websites and databases nationally and internationally. The included articles were evaluated for methodological quality, and evidence was extracted using the Australian JBI Evidence-based Health Care Center's literature evaluation standard (2016 edition). RESULTS A total of 60 articles were included in this study, comprising 2 guidelines, 5 expert consensus statements, and 53 systematic reviews. The findings of these articles were summarized across 7 dimensions, including risk factor screening, assessment, diagnosis, prevention, treatment, management, and health education, resulting in the identification of 42 relevant pieces of evidence. CONCLUSIONS This study provides a comprehensive synthesis of evidence-based recommendations for managing CIPN in cancer patients, offering guidance for healthcare professionals engaged in clinical practice. However, when implementing these recommendations, it is crucial to consider the individual patient's clinical circumstances, preferences, and expert judgment, ensuring feasibility and applicability in real-world clinical settings.
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Affiliation(s)
- Xin Dan
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Ya-Lin He
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Ya-Lin Tian
- Department of Radiation Therapy and Chemotherapy for Cancer Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jian-Hua Ren
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan, China.
- Department of Obstetrics and Gynecology Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
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Mizrahi D, Goldstein D, Trinh T, Li T, Timmins HC, Harrison M, Marx GM, Hovey EJ, Lewis CR, Friedlander M, Park SB. Physical activity behaviors in cancer survivors treated with neurotoxic chemotherapy. Asia Pac J Clin Oncol 2023; 19:243-249. [PMID: 35879821 PMCID: PMC10947250 DOI: 10.1111/ajco.13834] [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: 03/30/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 01/20/2023]
Abstract
AIM There are many barriers to physical activity among cancer survivors. Survivors treated with neurotoxic chemotherapy may develop chemotherapy-induced peripheral neuropathy (CIPN) and experience additional barriers related to sensorimotor and mobility deficits. This study examined physical activity behaviors, including physical activity predictors, among cancer survivors treated with neurotoxic chemotherapies. METHODS A cross-sectional study of 252 participants, 3-24 months after neurotoxic chemotherapy, was undertaken. Physical activity was self-reported (IPAQ). CIPN was self-reported (FACT/GOG-Ntx-13), clinically graded (NCI-CTCAE), and objectively measured using neurological grading scales and neurophysiological techniques (tibial and sural nerve conduction studies). Balance (Swaymeter) and fine motor skills (grooved pegboard) were assessed. Regression models were used to identify clinical, demographic and CIPN predictors of walking and moderate-vigorous physical activity. RESULTS Forty-four percent of participants did not meet recommended physical activity guidelines (≥150 min/week). Sixty-six percent presented with CIPN. Nineteen percent of participants with CIPN reported that symptoms interfered with their ability to be physically active. A lower proportion of survivors aged ≥60, with grade ≥1 CIPN or BMI ≥30, reported meeting physical activity guidelines (all p < .05). Regression models identified older age, higher BMI, and patient-reported CIPN associated with lower walking, while higher BMI and females were associated with lower moderate-vigorous physical activity. Neurologically assessed CIPN did not associate with walking or moderate-vigorous physical activity. CONCLUSION Cancer survivors exposed to neurotoxic chemotherapy have low physical activity levels. Further work should examine the factors causing physical activity limitations in this cohort and designing interventions to improve physical function and quality of life in survivors.
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Affiliation(s)
- David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Gavin M Marx
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Elizabeth J Hovey
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Jeong JG, Ahn CH, Min YS, Kim SE, Kim JY, Jung TD. Electrophysiologic Patterns of Symptomatic Vincristine-Induced Peripheral Neuropathy in Children with Acute Lymphocytic Leukemia. J Clin Med 2023; 12:jcm12020686. [PMID: 36675615 PMCID: PMC9864890 DOI: 10.3390/jcm12020686] [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: 11/18/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Acute lymphocytic leukemia is one of the most common cancers in children. Multi-drug chemotherapy is used for treatment, and the representative drug is vincristine. Although various side effects may occur due to vincristine, the association with peripheral neuropathy is high compared to that of other drugs. This study focused on children under the age of 18 years of age with ALL who received chemotherapy containing vincristine. We retrospectively analyzed the results of a nerve conduction study and a cumulative dose of vincristine in 30 children diagnosed with peripheral neuropathy. The average cumulative dose until diagnosis of vincristine-induced peripheral neuropathy was 14.99 ± 1.21 mg/m2, and motor nerves were predominantly involved. Additionally, a marked decrease in average amplitude was also observed in motor nerves. In addition, when the relationship between the incidence of peripheral neuropathy and the cumulative dose was analyzed through the survival curve, about 50% of children developed peripheral neuropathy at a dose of 15.5 ± 1.77 mg/m2. Based on the electrophysiological characteristics of pediatric vincristine-induced peripheral neuropathy, as well as the relationship between the incidence rate and the cumulative dose, it is possible to observe more closely the vincristine-induced peripheral neuropathy occurrence in children with ALL at an appropriate time.
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Affiliation(s)
- Jae-Gyeong Jeong
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Chang-Hwan Ahn
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Yu-Sun Min
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Sung Eun Kim
- Department of Pediatrics, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (J.Y.K.); (T.-D.J.)
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (J.Y.K.); (T.-D.J.)
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Lopez-Garzon M, Cantarero-Villanueva I, Postigo-Martin P, González-Santos Á, Lozano-Lozano M, Galiano-Castillo N. Can physical exercise prevent chemotherapy-induced peripheral neuropathy in patients with cancer? A systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2197-2208. [PMID: 35271844 DOI: 10.1016/j.apmr.2022.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/04/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This systematic review analyzed the effects of physical exercise programs in patients with cancer undergoing chemotherapy on Chemotherapy-induced Peripheral Neuropathy (CIPN) prevention. DATA SOURCES PubMed, Web of Science, Scopus, and Cochrane Library were searched for relevant studies published before December 2020. Additional references were identified by manual screening of the reference lists. STUDY SELECTION Based on the PICOS strategy, randomized controlled trials in which physical exercise was applied before or during chemotherapy to prevent or ameliorate CIPN were included. DATA EXTRACTION Two reviewers blinded and independent screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Sensitivity and precision analysis databases was included. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. DATA SYNTHESIS Of 229 potentially relevant studies, eight randomized controlled trials were included and scored. They comprise a total of 618 patients with cancer. Medline and Scopus databases recorded the highest sensitivity. None of the studies achieved a "low" overall risk of bias. Four studies were included in meta-analysis for quality of life, and a significance standardized mean difference was found between groups from baseline of 14.62, 95% CI 6.03, 23.20, with a large effect size g= .83, 95% CI .48, 1.18) in favor to physical exercise program compared with usual care. CONCLUSIONS Physical exercise at the onset of chemotherapy has shown promising effects on the prevention of CIPN, specially improving quality of life.
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Affiliation(s)
- Maria Lopez-Garzon
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Irene Cantarero-Villanueva
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Paula Postigo-Martin
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain
| | - Ángela González-Santos
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain.
| | - Mario Lozano-Lozano
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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Desforges AD, Hebert CM, Spence AL, Reid B, Dhaibar HA, Cruz-Topete D, Cornett EM, Kaye AD, Urits I, Viswanath O. Treatment and diagnosis of chemotherapy-induced peripheral neuropathy: An update. Biomed Pharmacother 2022; 147:112671. [PMID: 35104697 PMCID: PMC11118018 DOI: 10.1016/j.biopha.2022.112671] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/01/2023] Open
Abstract
When peripheral neuropathy occurs due to chemotherapy treatment, it is referred to as chemotherapy-induced peripheral neuropathy (CIPN). Typically, symptoms are sensory rather than motor and include reduced feeling and heightened sensitivity to pressure, pain, temperature, and touch. The pathophysiology of CIPN is very complex, and it involves multiple mechanisms leading to its development which will be described specifically for each chemotherapeutic class. There are currently no approved or effective agents for CIPN prevention, and Duloxetine is the only medication that is an effective treatment against CIPN. There is an unavoidable necessity to develop preventative and treatment approaches for CIPN due to its detrimental impact on patients' lives. The purpose of this review is to examine CIPN, innovative pharmacological and nonpharmacological therapy and preventive strategies for this illness, and future perspectives for this condition and its therapies.
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Affiliation(s)
| | | | - Allyson L Spence
- Department of Pharmaceutical Sciences, Regis University School of Pharmacy, Denver, CO 80221, USA.
| | - Bailey Reid
- Regis University School of Pharmacy, Denver, CO 80221, USA.
| | - Hemangini A Dhaibar
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Diana Cruz-Topete
- Department of Molecular and Cellular Physiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Alan David Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, 330 Brookline Ave, Boston, MA 02215, USA.
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, University of Arizona College of Medicine - Phoenix, Department of Anesthesiology, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA.
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Rattanakrong N, Promma N, Saraboon C, Waongenngarm P. Physical impairments, sensory disturbance, and functional ability in a cancer patient with and without chemotherapy-induced peripheral neuropathy symptoms. Support Care Cancer 2022; 30:5055-5062. [PMID: 35217909 DOI: 10.1007/s00520-022-06927-5] [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: 10/02/2021] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The present study examined the objective and patient-reported measures of physical impairments, sensory disturbance, and functional ability between cancer patients with and without chemotherapy-induced peripheral neuropathy (CIPN) symptoms. METHODS Forty-one cancer survivors exposed to neurotoxic chemotherapies were conveniently recruited and completed a single cross-sectional assessment of patient-reported outcomes (VAS for pain intensity and ABC scale) and objective assessments (SWM test, TUG test, 5xSTS test, Romberg test with eyes open and eyes closed, 6MWT, and FAB scale). RESULTS Cancer patients who had undergone chemotherapy with CIPN symptoms did significantly worse in the SWM test, TUG test, 5xSTS test, Romberg test with eyes closed, 6MWT, FAB scale, and ABC scale (p < 0.05) when compared with cancer survivors without CIPN symptoms. CONCLUSION Cancer survivors with CIPN symptoms have lower physical performance, sensory perception, and functional ability, which may increase the risk of falling and disability. These findings further emphasize the need for effective rehabilitation and interventions to treat CIPN symptoms and related physical impairment and functional deficits.
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Affiliation(s)
- Nida Rattanakrong
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Noppawan Promma
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Chanatsupang Saraboon
- Department of Rehabilitation Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Pooriput Waongenngarm
- Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand.
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The effects of exercise on chemotherapy-induced peripheral neuropathy symptoms in cancer patients: a systematic review and meta-analysis. Support Care Cancer 2021; 29:5303-5311. [PMID: 33660078 DOI: 10.1007/s00520-021-06082-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of current studies to determine whether exercise affects chemotherapy-induced peripheral neuropathy (CIPN) symptoms in cancer patients. DESIGN The Medline, Embase, Cochrane Library, CINAHL, PubMed, and National Central Library databases, and the reference lists of the included studies were surveyed. The Consolidated Standards of Reporting Trials (CONSORT) extension checklist for non-pharmacologic treatment was used to evaluate the literature. SETTING AND PARTICIPANTS Exercise interventions offered in hospitals or at home. A total of 178 participants from 5 studies were assessed in the meta-analysis, with their mean age ranging from 48.56 to 71.82 years. METHODS The randomized control trials were summarized in a systematic review. The effects of the exercise interventions were compiled for meta-analysis. A forest plot was constructed using a fixed effect model to obtain a pooled mean difference. RESULTS The pooled results indicated that exercise interventions significantly improved the CIPN symptoms of the participants (mean difference: 0.5319; 95% confidence interval: 0.2295 to 0.8344; Z = 3.45; P = 0.0006). A combination of exercise protocols including a nerve gliding exercise intervention was found to have improved CIPN symptoms. In addition, a sensorimotor-based exercise intervention was found to have reduced CIPN-induced loss of postural stability. CONCLUSIONS AND IMPLICATIONS The findings indicated that the effects of exercise could improve CIPN symptoms in cancer patients. Nevertheless, further investigations of different exercise protocols and intensity of intervention utilizing larger sample sizes and more specific outcome measures will further inform the best practices for cancer patients.
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Niemand EA, Cochrane ME, Eksteen CA. Physiotherapy management of chemotherapy-induced peripheral neuropathy in Pretoria, South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1482. [PMID: 33102888 PMCID: PMC7565663 DOI: 10.4102/sajp.v76i1.1482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/14/2020] [Indexed: 11/01/2022] Open
Abstract
Background The increase in newly diagnosed patients with cancer in South Africa and globally, may contribute to the increase in patients living with chemotherapy-induced peripheral neuropathy (CIPN). Chemotherapy-induced peripheral neuropathy negatively impacts on quality of life (QoL) during and post chemotherapy treatment. Physiotherapy management of CIPN helps patients to manage symptoms and improves function in activity- and participation-levels to ultimately improve QoL. However, little evidence exists regarding the type or combination of physiotherapy management strategies in South Africa. Objectives The purpose of our study was to determine how the symptoms of CIPN were managed by physiotherapists in Pretoria, South Africa. Method A quantitative, descriptive study design was used. Electronic questionnaires were distributed to physiotherapists who worked with cancer patients and who treated patients with CIPN. Results Physiotherapists used massage, proprioceptive neuromuscular facilitation, sensory integration, activities of daily living training, postural drainage, lifestyle modifications; Bobath-, breathing-, stability-, stretching-, strengthening- and endurance-exercises; electrical stimulation, thermal modalities, transcutaneous electrical nerve stimulation, soft tissue mobilisation; muscle energy-, positional- and Mulligan-techniques in the management of CIPN. Conclusion Cardiopulmonary therapy, therapeutic exercises, manual therapy and neuro-developmental techniques were used by physiotherapists in the management of CIPN. Almost half of the participants did not use electrotherapy techniques. Physiotherapy management strategies that are used in Pretoria are similar to published research. Clinical implications Physiotherapists in Pretoria are managing CIPN according to international practices. However, studies to determine the effectiveness of the management strategies in a South African context should be conducted. Alternative management strategies, based on the pathophysiology of CIPN, should be explored. Keywords physiotherapy; chemotherapy-induced peripheral neuropathy; intervention; management; cancer.
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Affiliation(s)
- Esther A Niemand
- Department of Physiotherapy, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Maria E Cochrane
- Department of Physiotherapy, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Carina A Eksteen
- Department of Physiotherapy, Faculty of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Bao T, Zhi I, Baser R, Hooper M, Chen C, Piulson L, Li QS, Galantino ML, Blinder V, Robson M, Seidman A, Panageas KS, Mao JJ. Yoga for Chemotherapy-Induced Peripheral Neuropathy and Fall Risk: A Randomized Controlled Trial. JNCI Cancer Spectr 2020; 4:pkaa048. [PMID: 33225208 PMCID: PMC7666827 DOI: 10.1093/jncics/pkaa048] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating side effect that worsens quality of life and increases the risk of falls in cancer survivors. Evidence of yoga’s safety and efficacy in treating CIPN is lacking. Methods In a randomized controlled study, we assigned breast and gynecological cancer survivors with persistent moderate-to-severe CIPN pain, numbness, or tingling with a score of 4 or greater (0-10 numeric rating scale [NRS]) for at least 3 months after chemotherapy to 8 weeks of usual care or yoga focused on breathwork and musculoskeletal conditioning. Primary endpoint was treatment arm differences for NRS, and secondary endpoints were Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale (FACT/GOG-Ntx), and Functional Reach Test after week 8. We tested treatment arm differences for each outcome measure using linear mixed models with treatment-by-time interactions. All statistical tests were two-sided. Results We randomly assigned 41 participants into yoga (n = 21) or usual care (n = 20). At week 8, mean NRS pain decreased by 1.95 points (95% confidence interval [CI] = -3.20 to -0.70) in yoga vs 0.65 (95% CI = -1.81 to 0.51) in usual care (P = .14). FACT/GOG-Ntx improved by 4.25 (95% CI = 2.29 to 6.20) in yoga vs 1.36 (95% CI = -0.47 to 3.19) in usual care (P = .035). Functional reach, an objective functional measure predicting the risk of falls, improved by 7.14 cm (95% CI = 3.68 to 10.59) in yoga and decreased by 1.65 cm (95% CI = -5.00 to 1.72) in usual care (P = .001). Four grade 1 adverse events were observed in the yoga arm. Conclusion Among breast and gynecological cancer survivors with moderate-to-severe CIPN, yoga was safe and showed promising efficacy in improving CIPN symptoms.
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Affiliation(s)
- Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris Zhi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raymond Baser
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Connie Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren Piulson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qing S Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Seidman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Harrington SE, Stout NL, Hile E, Fisher MI, Eden M, Marchese V, Pfalzer LA. Cancer Rehabilitation Publications (2008-2018) With a Focus on Physical Function: A Scoping Review. Phys Ther 2020; 100:363-415. [PMID: 32043151 PMCID: PMC8204886 DOI: 10.1093/ptj/pzz184] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. PURPOSE This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. DATA SOURCES PubMed and CINAHL were searched up to September 2018. STUDY SELECTION Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. DATA EXTRACTION Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. DATA SYNTHESIS Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). LIMITATIONS Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. CONCLUSIONS This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function.
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Affiliation(s)
- Shana E Harrington
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Blatt PE Center, 101G, Columbia, SC 29208 (USA)
| | - Nicole L Stout
- Office of Strategic Research, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland; Cancer Prevention and Control, Department of Hematology/Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Elizabeth Hile
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Mary Insana Fisher
- Department of Physical Therapy, School of Education and Health Sciences, University of Dayton, Dayton, Ohio
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona
| | - Victoria Marchese
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Lucinda A Pfalzer
- Physical Therapy Department, University of Michigan–Flint, Flint, Michigan
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Ogle T, Alexander K, Miaskowski C, Yates P. Systematic review of the effectiveness of self-initiated interventions to decrease pain and sensory disturbances associated with peripheral neuropathy. J Cancer Surviv 2020; 14:444-463. [PMID: 32080785 PMCID: PMC7360651 DOI: 10.1007/s11764-020-00861-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE A small number of studies report that patients with peripheral neuropathy (PN) who engage in activities that promote a sense of personal well-being and provide physical, emotional, or spiritual comfort have a better quality of life and higher levels of adjustment to the changes generated by their illness and accompanying symptoms. This systematic review sought to evaluate the effectiveness of self-management activities that patients with PN initiate themselves to relieve PN symptoms and improve quality of life. METHODS Search terms were limited to include self-management activities initiated by patients (i.e., activities with no or minimal involvement from clinicians) that aim to provide relief of PN symptoms. Outcomes included in searches were pain, numbness, and tingling, associated with PN and quality of life. RESULTS The database searches identified 2979 records, of which 1620 were duplicates. A total of 1322 papers were excluded on the basis of screening the abstract. An additional 21 full text articles were excluded because they did not meet the eligibility criteria. A total of 16 papers were included in the review. CONCLUSION This review identified that a number of self-management strategies that were initiated by patients, including heat, exercise, meditation, and transcutaneous electrical nerve stimulation (TENS) therapy, may reduce self-reported PN symptoms. As the available studies were of low quality, these strategies warrant further investigation with more homogeneous samples, using more rigorously designed trials and larger samples. IMPLICATIONS FOR CANCER SURVIVORS Patients experiencing PN may find a range of self-initiated strategies beneficial in reducing PN symptoms and improving quality of life. However, because of the low quality of the available studies, clinicians need to monitor patients' responses to determine the effectiveness of these interventions as adjuncts to clinician-initiated interventions.
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Affiliation(s)
- Theodora Ogle
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia.
| | - Kimberly Alexander
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
| | - Christine Miaskowski
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
- School of Nursing, University of California, San Francisco, CA, USA
| | - Patsy Yates
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
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Hao J, Zhu X, Bensoussan A. Effects of Nonpharmacological Interventions in Chemotherapy-Induced Peripheral Neuropathy: An Overview of Systematic Reviews and Meta-Analyses. Integr Cancer Ther 2020; 19:1534735420945027. [PMID: 32875921 PMCID: PMC7476348 DOI: 10.1177/1534735420945027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Chemotherapy-induced peripheral neuropathy (CIPN) is one of the prevalent and disabling side effects of cancer treatment. However, management strategies for CIPN currently remain elusive, with treatment restricted to neuropathic pain medications, supportive care, and chemotherapy dosing adjustments. This overview explores evidence on the potential benefits and safety of nonpharmacological interventions in preventing and treating CIPN in cancer patients. METHODS Seven databases were searched for systematic reviews of randomized controlled trials (RCTs). The methodological quality of the selected reviews was assessed by AMSTAR 2, and the quality of evidence was judged by GRADE. Twenty-eight systematic reviews were considered eligible for this review. RESULTS It was found that nonpharmacological interventions (acupuncture, exercise, herbal medicine, nutritional supplements) provided potential benefits for patients with CIPN. Furthermore, Chinese herbal medicine, administered orally or externally, significantly prevented and/or relieved the incidence and severity of CIPN in comparison to control groups (no additional treatment, placebo, and conventional western medicine). However, the quality of evidence and strength of recommendations were compromised by the inconsistencies and imprecision of included studies. The main concerns regarding the quality of systematic reviews included the lack of sufficiently rigorous a priori protocols, and the lack of protocol registration adopted in the included studies. CONCLUSIONS Though looking across reviews, Chinese herbal medicine appear generally effective in CIPN, uncertainty remains about the effects of many other nonpharmacological interventions. The evidence on what works was particularly compromised by reporting and methodological limitations, which requires further investigation to be more certain of their effects.
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Affiliation(s)
- Jie Hao
- Western Sydney University, Sydney, New South Wales, Australia
| | - Xiaoshu Zhu
- Western Sydney University, Sydney, New South Wales, Australia
| | - Alan Bensoussan
- Western Sydney University, Sydney, New South Wales, Australia
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Galantino ML, Tiger R, Brooks J, Jang S, Wilson K. Impact of Somatic Yoga and Meditation on Fall Risk, Function, and Quality of Life for Chemotherapy-Induced Peripheral Neuropathy Syndrome in Cancer Survivors. Integr Cancer Ther 2019; 18:1534735419850627. [PMID: 31131640 PMCID: PMC6537287 DOI: 10.1177/1534735419850627] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective. Chemotherapy-induced peripheral neuropathy (CIPN)
syndrome causes significant pain as an adverse effect of treatment, with few
nonpharmacological interventions tested. A somatic yoga and meditation (SYM)
intervention on functional outcomes and quality of life (QOL) was investigated.
Design and methods. Individuals diagnosed with CIPN were
enrolled in an open-label, single-arm, mixed-methods feasibility trial.
Participants and Setting. In an outpatient rehabilitation
center, ten participants with median age 64.4 years (47-81) attended 61% of the
sessions with no adverse events. Intervention. SYM twice a week
for 8 weeks for 1.5 hours, with home program and journaling. Main
outcome measures. Primary functional outcomes included Sit and
Reach (SR), Functional Reach (FR), and Timed Up and Go (TUG). Self-reported
Patient Neurotoxicity Questionnaire (PNQ) and Functional Assessment of Cancer
Therapy—Neurotoxicity (FACT-GOG-NTX) were secondary CIPN outcomes. Biomarkers
included salivary cortisol (stress) and bioesthesiometer (vibration).
Results: Quantitative findings. Significant improvements
were found in flexibility (SR; P = .006); balance (FR;
P = .001) and fall risk (TUG; P = .004).
PNQ improved significantly (P = .003) with other measures
improving non-significantly. Qualitative findings. Five themes
emerged: (1) vacillation of CIPN pain perception over time; (2) transferability
of skills to daily activities; (3) improvement in physical function; (4)
perceived relaxation as an effect of SYM; and (5) group engagement provided a
social context for not feeling isolated with CIPN. Conclusion.
Preliminary data suggest SYM may improve QOL, flexibility, and balance in cancer
survivors with CIPN, with a fully powered randomized controlled trial
indicated. Trial registration: NCT03786055
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Affiliation(s)
- Mary Lou Galantino
- 1 School of Health Sciences, Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA.,2 University of Pennsylvania, Philadelphia, PA, USA.,3 University of Witwatersrand, Johannesburg, South Africa
| | | | | | - Shera Jang
- 1 School of Health Sciences, Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA
| | - Kim Wilson
- 1 School of Health Sciences, Doctor of Physical Therapy Program, Stockton University, Galloway, NJ, USA
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