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Ninneman JV, Roberge GA, Stegner AJ, Cook DB. Exercise Training for Chronic Pain: Available Evidence, Current Recommendations, and Potential Mechanisms. Curr Top Behav Neurosci 2024. [PMID: 39120812 DOI: 10.1007/7854_2024_504] [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: 08/10/2024]
Abstract
Chronic pain conditions pose a significant global burden of disability, with epidemiological data indicating a rising incidence. Exercise training is commonly recommended as a standalone or complementary approach for managing various chronic pain conditions like low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, and neuropathic pain. Regardless of the specific condition or underlying cause (e.g., autoimmune disease, chronic inflammation), exercise training consistently leads to moderate to large reductions in pain. Moreover, exercise yields numerous benefits beyond pain alleviation, including small-to-moderate improvements in disability, quality of life, and physical function. Despite its efficacy, there is a lack of comprehensive research delineating the optimal intensity, duration, and type of exercise for maximal benefits; however, evidence suggests that sustained engagement in regular exercise or physical activity is necessary to achieve and maintain reductions in both clinical pain intensity ratings and the level that pain interferes with activities of daily living. Additionally, the precise mechanisms through which exercise mitigates pain remain poorly understood and likely vary based on the pathophysiological mechanisms underlying each condition.
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Affiliation(s)
- Jacob V Ninneman
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Gunnar A Roberge
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron J Stegner
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Dane B Cook
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA.
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Eroğlu İ, Kutlutürkan S. The effect of hand-foot exercises on chemotherapy-induced peripheral neuropathy-related pain, falls, and quality of life in colorectal cancer: A randomized controlled trial. Eur J Oncol Nurs 2024; 71:102641. [PMID: 38897103 DOI: 10.1016/j.ejon.2024.102641] [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: 11/26/2023] [Revised: 05/29/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The aim of this study is to determine the effect of hand-foot exercises on chemotherapy-induced peripheral neuropathy-related pain severity, falls, and quality of life in patients with colorectal cancer. METHODS The study was conducted in the outpatient chemotherapy unit of a public hospital between 25 April-31 December 2022. The enrolled 39 patients were randomly assigned to the intervention (n:19) and control (n:20) groups. The hand-foot exercises program was applied to the intervention group in three sessions a day and three days a week fashion for 8 weeks at home. No intervention was applied to the control group other than routine treatment and care. Data were collected through face-to-face interviews in the first interview and the 2nd, 4th, 6th, 8th weeks. The exercise program adherence of the intervention group was followed up through telephone/face-to-face interviews in weeks 1-8. Data were collected using the Numerical Pain Rating Scale, Fall Follow-Up Form, the CIPNAT scale, EORTC QLQ-C30 and EORTC QLQ-CR29 scales. Mann-Whitney U Test, Chi-square test, Wilcoxon signed test, and Friedman test were used to analyze the data. RESULTS The study found that as of week 4th, the intervention group experienced less pain severity than the control group (p < 0.001); at week 8th, the peripheral neuropathy symptoms of the intervention group decreased compared to the control group (p < 0.05); at weeks 2nd,4th,6th,8th, there was no statistically significant difference in falls (p > 0.05); at week 8th, while there was no significant difference between the groups regarding colorectal cancer quality of life (p > 0.05), the overall cancer quality of life improved in the intervention group (p < 0.05). CONCLUSIONS The hand-foot exercises program is effective in chemotherapy-induced peripheral neuropathy-related symptoms, pain severity, and overall cancer quality of life. TRIAL REGISTRATION www. CLINICALTRIALS gov, NCT05873829.
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Affiliation(s)
- İlayda Eroğlu
- Ankara University Nursing Faculty, Department of Internal Medicine Nursing, Ankara, Turkey.
| | - Sevinç Kutlutürkan
- Ankara University Nursing Faculty, Department of Internal Medicine Nursing, Ankara, Turkey.
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Zhang Q, Gao Y, Wang W, Zhao X, Yu J, Huang H. Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review. Front Oncol 2024; 14:1393902. [PMID: 39099690 PMCID: PMC11294253 DOI: 10.3389/fonc.2024.1393902] [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: 03/28/2024] [Accepted: 06/20/2024] [Indexed: 08/06/2024] Open
Abstract
Objective The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer. Methods We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises. Results In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer. Conclusions Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective. Systematic review registration www.inplasy.com, identifier INPLASY2023110034.
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Affiliation(s)
- Qiuhua Zhang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
| | - Yanan Gao
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
| | - Wenjun Wang
- Ningbo New Fitness Health Technology Co., Ltd, Ningbo, Zhejiang, China
| | - Xiaoguang Zhao
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
| | - Jiabin Yu
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
| | - Huiming Huang
- Faculty of Sports Science, Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China
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Lee KT, Bulls HW, Hoogland AI, James BW, Colon-Echevarria CB, Jim HSL. Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Narrative Review and Proposed Theoretical Model. Cancers (Basel) 2024; 16:2571. [PMID: 39061210 PMCID: PMC11274737 DOI: 10.3390/cancers16142571] [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: 06/25/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating symptom experienced by cancer survivors. Despite the burden of CIPN-related symptoms, interventions remain limited. OBJECTIVES This narrative review seeks to propose a framework for CIPN predisposing, precipitating, and perpetuating factors (3Ps), which will provide a foundation for future research and clinical interventions aimed at mitigating CIPN-related symptoms and morbidity. METHODS A comprehensive literature search was performed using PubMed, guided by keywords related to "chemotherapy-induced peripheral neuropathy." Studies were limited to those with full text available in English. RESULTS Predisposing factors outlined in this framework, such as older age and comorbid conditions, can be used to identify patients who have a higher risk of developing CIPN. The major precipitating factor of CIPN is the delivery of chemotherapy to peripheral nerves, which may be mitigated via cryotherapy or compression therapy during chemotherapy. Perpetuating factors can offer insight into psychological, cognitive, and behavioral modifications that could be treatment targets for CIPN management. CONCLUSION The proposed 3P model can guide the development of effective interventions for CIPN by suggesting modifiable psychological and behavioral treatment targets that may mitigate the impact of CIPN for cancer patients.
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Affiliation(s)
- Kimberley T. Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Hailey W. Bulls
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Aasha I. Hoogland
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Brian W. James
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | | | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
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Kaya A, Tuzcu A. A Bibliometric Analysis of the 36-Year History of Cancer Nursing (1987-2023). Cancer Nurs 2024; 47:252-260. [PMID: 38335453 DOI: 10.1097/ncc.0000000000001324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
BACKGROUND Bibliometric analysis is an effective method for evaluating the publication characteristics and development of a journal. To our knowledge, this study is the first such analysis of the publications in Cancer Nursing . OBJECTIVE This study aimed to analyze the publication characteristics and evolution of Cancer Nursing over a period of 36 years since its inception. METHODS Bibliometric analysis was carried out on 3095 publications. Data were collected from the Web of Science Core Collection database on September 15, 2023. Data analysis was conducted with Web of Science Core Collection, VOSviewer, and Bibliometrix package in R software. RESULTS The results showed a steady increase in the citation and publication structure of Cancer Nursing . "Quality of life" was at the center of the studies, and "quality of life," "women," and "breast cancer" were identified as trend topics. The United States was both at the center of the cooperation network and was the country that contributed the most publications to the journal. CONCLUSION Cancer Nursing has had an increasing contribution to and impact on cancer nursing in terms of the quality and citations of published articles. It was noted that the journal's network of collaboration has expanded globally and that its thematic diversity is high. Although quality of life, women, and breast cancer have been reported extensively, more studies addressing the concepts of "children," "support," and "needs" are needed in the journal. IMPLICATIONS FOR PRACTICE This study not only enriches global readers in the field of cancer nursing but may also be beneficial in providing input to guide future research.
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Affiliation(s)
- Ayla Kaya
- Author Affiliations: Department of Pediatric Nursing (Dr Kaya) and Department of Public Health Nursing (Dr Tuzcu), Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Romero-Elías M, González-Cutre D, Ruiz-Casado A, Tortosa-Martínez J, Beltrán-Carrillo VJ. Autonomy support in an exercise intervention with colorectal cancer patients during chemotherapy: a qualitative perspective. Psychol Health 2024:1-19. [PMID: 38907532 DOI: 10.1080/08870446.2024.2367984] [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: 11/20/2023] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE Physical activity (PA) has emerged as an important element of supportive care for cancer patients, but few patients engage with exercise. Considering that autonomy support is associated with healthy lifestyles, it would be useful to know the specific autonomy-supportive techniques that can help to encourage PA in colorectal cancer (CRC) patients. This study aims to qualitatively explore autonomy support perceptions through a self-determination-theory-based exercise program (FIT-CANCER) with CRC patients during chemotherapy treatment. METHODS AND MEASURES A total of 27 participants were included, 16 CRC patients, six relatives, and five healthcare professionals. Qualitative data from semi-structured interviews and observational field notes were analyzed with thematic analysis. RESULTS Three main themes were identified: Healthcare professionals encouraging enrollment in the exercise program, Relatives supporting attendance to the exercise sessions, Exercise instructor favoring adherence to the exercise program. The different subthemes showed autonomy-supportive techniques from these social agents to promote CRC patients' participation in the exercise program. CONCLUSION The present research showed the importance of autonomy support from healthcare professionals, relatives and the exercise instructor to promote the initiation and maintenance of CRC patients' PA behavior and improve their quality of life, health and well-being.
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Affiliation(s)
- María Romero-Elías
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David González-Cutre
- Department of Sport Sciences, Sports Research Centre, Miguel Hernandez University of Elche, Elche, Spain
| | - Ana Ruiz-Casado
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Juan Tortosa-Martínez
- Departament of General Didactics and Specifics Didactics, Area of Physical Education and Sport, Faculty of Education, University of Alicante, Alicante, Spain
| | - Vicente J Beltrán-Carrillo
- Department of Sport Sciences, Sports Research Centre, Miguel Hernandez University of Elche, Elche, Spain
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Ronconi G, Gatto DM, Codazza S, Ariani M, Martire E, Cerretti L, Carella V, Coraci D, Ferriero G, Ferrara PE. Conservative non-pharmacological treatments for chemotherapy-induced peripheral neuropathies in women treated for breast cancer: a systematic review. Eur J Phys Rehabil Med 2024; 60:505-513. [PMID: 38502556 PMCID: PMC11258912 DOI: 10.23736/s1973-9087.24.08197-8] [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: 08/23/2023] [Revised: 01/09/2024] [Accepted: 02/13/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Over the last few decades, the use of neo/adjuvant therapies has significantly increased the number of breast cancer survivors who experience chemotherapy-induced peripheral neuropathy (CIPN). To date, few, low-efficacy, pharmacological remedies exist to manage this side effect. For this reason, alternative treatments are increasingly being investigated as possible strategies to prevent or promote faster recovery from CIPN. In this review we aimed to provide an overview of the literature evidence regarding all the non-pharmacological and rehabilitative interventions for patients affected by CIPN secondary to breast cancer care. EVIDENCE ACQUISITION A comprehensive literature search was conducted on PubMed, Scopus and Web of Science and included a total of 1895 patients (1528 with breast cancer) with a wide range of CIPN (motor, sensory and autonomic neuropathies) and chemotherapy treatments (e.g., Taxanes, Platins, Vinca alkaloids or monoclonal antibody drugs). EVIDENCE SYNTHESIS Of the initial 1108 hits, only 25 studies - describing different treatment modalities for peripheral neuropathies - were finally included in the qualitative synthesis. Most studies focused on acupuncture, physiotherapy, cryotherapy, and yoga. CONCLUSIONS There is still controversial evidence on conservative non-pharmacological interventions for the management of CIPN symptoms. We believe however that moderate exercise, as well as all types of stress reducing activities like sport, yoga and mindfulness, should be encouraged in cancer patients for their positive effect on global physical and psychological health. Further studies of higher methodological quality are needed to determine the best conservative approach to CIPN.
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Affiliation(s)
| | - Dario M Gatto
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy -
| | - Sefora Codazza
- University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Mariantonietta Ariani
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy
| | - Eloisa Martire
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Cerretti
- Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Valentina Carella
- Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Padua, Italy
| | - Giorgio Ferriero
- Unit of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paola E Ferrara
- University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
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Arefian M, Asgari-Mobarakeh K. Psychoeducational Intervention for Pain, Psychological Distress, Hope, and Post-traumatic Growth Among Breast Cancer Patients During Chemotherapy: A Pilot Randomized Controlled Trial. Pain Manag Nurs 2024:S1524-9042(24)00153-X. [PMID: 38714424 DOI: 10.1016/j.pmn.2024.04.012] [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: 11/27/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND Chemotherapy is associated with many side effects, including pain and psychological distress, which affect patients' physical and psychological health. AIM The aim of this study was to elucidate the efficacy of a pain management intervention (POLA) to promote pain, psychological distress, hope and post-traumatic growth in breast cancer patients, also, to undertake a preliminary evaluation of the intervention. METHODS A pilot randomized controlled trial was conducted in an Iranian hospital involving 42 breast cancer (BC) patients during chemotherapy. The intervention group received a 6-week group therapy (90 minutes per session) administered by a psychologist. Meanwhile, the comparison group received standard care. patients' Pain, psychological distress, hope and post-traumatic growth were measured at 3 time points (baseline, week 6, and 12 weeks postintervention). RESULTS The study design was found to be feasible, with a recruitment rate of 61.64% and an attrition rate of 6.66%. Compared to the control group, the intervention group showed a significant reduction in pain, psychological distress, depression, anxiety, and stress, as well as a notable improvement in hope and post-traumatic growth (p < .01). These differences remained significant at follow-up (p < 0.05). The study population found the intervention acceptable, as evidenced by a high attendance rate of 90% and adherence rate of 90.47%. CONCLUSION Psychoeducational intervention positively affects the pain, psychological distress, hope and post-traumatic growth of BC patients during chemotherapy.
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Affiliation(s)
- Mohsen Arefian
- Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
| | - Karim Asgari-Mobarakeh
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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Pressler MP, Brenner B, Amgalan A, Mendelson AM. Approach to a patient with chemotherapy-induced peripheral neuropathy: problem-based learning discussion. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:303-305. [PMID: 38128041 DOI: 10.1093/pm/pnad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Mark P Pressler
- Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA 22903, United States
| | - Brian Brenner
- Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA 22903, United States
| | - Ariunzaya Amgalan
- Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA 22903, United States
| | - Andrew M Mendelson
- Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, VA 22903, United States
- Division of Pain Medicine, University of Virginia Medical Center, Charlottesville, VA 22903, United States
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Peters M, Butson G, Mizrahi D, Denehy L, Lynch BM, Swain CTV. Physical activity and pain in people with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:145. [PMID: 38321248 PMCID: PMC10847204 DOI: 10.1007/s00520-024-08343-3] [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: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Physical activity can provide analgesic benefit but its effect on cancer-related pain is unclear. This review synthesised and appraised the evidence for the effect of physical activity on pain in people living with or beyond cancer. METHODS A systematic search of Ovid Medline and Embase was performed to identify randomised controlled trials (RCTs), randomised cross-over studies (RXTs), and prospective observational studies that examined physical activity and pain outcomes in adults living with or beyond cancer. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to assess evidence quality. RESULTS One hundred twenty-one studies (n = 13,806), including 102 RCTs, 6 RXTs, and 13 observational studies, met the criteria for inclusion. Meta-analyses of RCTs identified a decrease in pain intensity (n = 3734; standardised mean difference (SMD) - 0.30; 95% confidence interval (CI) - 0.45, - 0.15) and bodily pain (n = 1170; SMD 0.28; 95% CI 0.01, 0.56) but not pain interference (n = 207; SMD - 0.13, 95% CI - 0.42, 0.15) following physical activity interventions. Individual studies also identified a reduction in pain sensitivity but not analgesic use, although meta-analysis was not possible for these outcomes. High heterogeneity between studies, low certainty in some effect estimates, and possible publication bias meant that evidence quality was graded as very low to low. CONCLUSION Physical activity may decrease pain in people living with and beyond cancer; however, high heterogeneity limits the ability to generalise this finding to all people with cancer or to specific types of cancer-related pain.
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Affiliation(s)
- Mitchell Peters
- Cancer Science Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Grace Butson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia.
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
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Nakagawa N, Yamamoto S, Hanai A, Oiwa A, Arao H. Exercise intervention for the management of chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis. Front Neurol 2024; 15:1346099. [PMID: 38352137 PMCID: PMC10861771 DOI: 10.3389/fneur.2024.1346099] [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: 11/28/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Purpose Although exercise is recommended for cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN), the effective types of exercise for preventing and treating CIPN remain unclear. This systematic review and network meta-analysis (NMA) aimed to evaluate the comparative effects of exercise on CIPN. Methods We included relevant randomized controlled trials (RCTs) identified in a 2019 systematic review that evaluated the effects of exercise on CIPN and conducted an additional search for RCTs published until 2023. We evaluated the risk of bias for each RCT; the comparative effectiveness of exercise on patient-reported quality of life (QOL) through an NMA; and the effectiveness of exercise on QOL scores, patient-reported CIPN symptoms, and pain through additional meta-analyses. Results Twelve studies (exercise, n = 540; control, n = 527) comparing 8 exercise interventions were included in the analysis. All studies were determined to have a high risk of bias. The meta-analyses showed significantly improved QOL [standard mean differences (SMD) 0.45; 95% confidence interval (CI) = 0.12 to 0.78] and CIPN symptoms (SMD 0.46; 95% CI = 0.11 to 0.82). No severe adverse events were reported. Pain tended to improve with exercise (SMD 0.84; 95% CI = -0.11 to 1.80). An NMA suggested that the interventions of a combination of balance and strength training showed a significant improvement in QOL scores compared to the control. Conclusion Exercise interventions may be beneficial for improving QOL and CIPN symptoms. High-quality large clinical trials and data are needed to conclude that exercise is beneficial and safe.
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Affiliation(s)
- Natsuki Nakagawa
- Department of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Sena Yamamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akiko Hanai
- Advanced Data Science Project, RIKEN, Yokohama, Japan
| | - Ayano Oiwa
- Division of Pain Clinic, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
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Hwang YJ, Kim IY, Hur HK, Lee JY, Park S. The Effects of an App-Based Physical Activity Program on Colorectal Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial. Cancer Nurs 2024:00002820-990000000-00211. [PMID: 38259073 DOI: 10.1097/ncc.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Colorectal cancer is one of the most common malignancies worldwide. Oxaliplatin, which is used as adjuvant chemotherapy, affects quality of life by causing oxaliplatin-induced peripheral neuropathy in colorectal cancer patients. OBJECTIVES This study examined the effects of an application (app)-based physical activity program for alleviating peripheral neuropathy symptoms in colorectal cancer patients undergoing chemotherapy. METHODS This was a randomized controlled study that included 34 patients undergoing chemotherapy after being diagnosed with colorectal cancer. Outcomes were compared between patients who participated in a 6-week app-based physical activity program (experimental group; n = 17) and who received standard booklet education (control group; n = 17). Data were collected using questionnaires, and exercise time was recorded to evaluate intervention adherence. RESULTS Significant differences were observed between the groups in peripheral neuropathy symptoms (F = 8.93, P = .002), interference with activities (Z = -2.55, P = .011), and quality of life (F = 7.65, P = .003). The experimental group showed significantly higher average exercise times at 1 to 4 weeks (Z = -2.10, P = .026), 5 to 6 weeks (Z = -4.02, P < .001), and 1 to 6 weeks (Z = -3.40, P = .001) than the control group. CONCLUSIONS The app-based physical activity program had a positive effect on participants' exercise adherence and reduced peripheral neuropathy symptoms. Thus, we propose the adoption of a mobile health app that can be used at any time or place as an intervention for preventing or alleviating adverse effects during the treatment of cancer patients. IMPLICATIONS FOR PRACTICE An app-based physical activity program using the mobile health app can be used as a nursing intervention to manage symptoms and increase the health behavior adherence in cancer patients.
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Affiliation(s)
- Yun Jeong Hwang
- Author Affiliations: Department of Nursing, Daewon University College (Dr Hwang); and Department of Surgery, Wonju College of Medicine (Dr Kim), Department of Nursing, Wonju College of Nursing (Drs Hur and Park), and Department of Neurology, Wonju College of Medicine (Dr Lee), Yonsei University, Republic of Korea
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Huang Y, Tan T, Liu L, Yan Z, Deng Y, Li G, Li M, Xiong J. Exercise for reducing chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 14:1252259. [PMID: 38283674 PMCID: PMC10813204 DOI: 10.3389/fneur.2023.1252259] [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: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024] Open
Abstract
Background More than half of cancer patients develop severe chemotherapy-induced peripheral neuropathy (CIPN), resulting in low quality of life, negative effects on function, and challenges in treatment compliance. Most recent studies have shown that exercise therapy has a positive impact on reducing CIPN symptoms and can also improve quality of life, balance, and activity levels. The aim of this meta-analysis was to evaluate the effect of exercise therapy on the efficacy of CIPN. Methods Computerized search of Embase, Web of Science, CNKI, Wan Fang Data, VIP, CBM for RCTs on exercise therapy for CIPN from database creation to November 2022, without language restriction. The Cochrane Handbook 5.3 risk of bias assessment tool was used to evaluate the quality of the included studies. Then Revman 5.3 software was used to evaluate the quality of the included studies. The heterogeneity of the research results is tested by I2, continuous variables were presented as weighted mean difference or standard mean difference, and confidence intervals were set at 95%. Stata15.0 was utilized to conduct a meta-analysis. Results A total of 15 RCTs with 1,124 patients were included. Meta-analysis showed that the test group was superior to the control group in terms of total symptom score (SMD: -0.62; 95% Cl: -0.99, -0.24), numbness, tingling, quality of life score (total score, physical, function), pain, balance, and neurotoxicity function assessment (FACT/GOG-NTX) questionnaire (p < 0.05). Limitations The duration and frequency of treatment are different every week, which may have some impact on the results. Conclusion Exercise therapy can be effective in treating CIPN by improving symptom score (total symptom score, numbness, tingling), quality of life score (total score, physical function), pain, balance, and FACT/GOG-NTX questionnaires. It still needs to be refined and validated by more high-quality, multicenter, large-sample RCTs in the future. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022373131, identifier: CRD42022373131.
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Affiliation(s)
- Yingjie Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian Tan
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lu Liu
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zijian Yan
- The First Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuexia Deng
- Southern Theater General Hospital, Guangzhou, China
| | - Guangyao Li
- Department of Traditional Chinese Medicine, Guangdong Provincial Key Laboratory ofMajor Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia Xiong
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi Province, China
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Sturgeon KM, Kok DE, Kleckner IR, Guertin KA, McNeil J, Parry TL, Ehlers DK, Hamilton A, Schmitz K, Campbell KL, Winters‐Stone K. Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors. Cancer Med 2023; 12:22278-22292. [PMID: 38018376 PMCID: PMC10757127 DOI: 10.1002/cam4.6753] [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: 05/08/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
INTRODUCTION The American College of Sports Medicine provided guidelines for exercise prescriptions in cancer survivors for specific cancer- and treatment-related health outcomes. However, there was insufficient evidence to generate exercise prescriptions for 10 health outcomes of cancer treatment. We sought to update the state of evidence. METHODS We conducted a systematic review of these 10 understudied health outcomes (bone health, sleep, cardiovascular function, chemotherapy-induced peripheral neuropathy (CIPN), cognitive function, falls and balance, nausea, pain, sexual function, and treatment tolerance) and provided an update of evidence. RESULTS While the evidence base for each outcome has increased, there remains insufficient evidence to generate exercise prescriptions. Common limitations observed across outcomes included: variability in type and quality of outcome measurement tools, variability in definitions of the health outcomes, a lack of phase III trials, and a majority of trials investigating breast or prostate cancer survivors only. CONCLUSION We identified progress in the field of exercise oncology for several understudied cancer- and treatment-related health outcomes. However, we were not able to generate exercise prescriptions due to continued insufficient evidence base. More work is needed to prescribe exercise as medicine for these understudied health outcomes, and our review highlights several strategies to aid in research acceleration within these areas of exercise oncology.
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Affiliation(s)
- Kathleen M. Sturgeon
- Department of Public Health SciencesCollege of Medicine, Penn State UniversityHersheyPennsylvaniaUSA
| | - Dieuwertje E. Kok
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Ian R. Kleckner
- Department of Pain & Translational Symptom Science, School of NursingUniversity of Maryland BaltimoreBaltimoreMarylandUSA
| | - Kristin A. Guertin
- Department of Public Health SciencesUniversity of Connecticut HealthStorrsConnecticutUSA
| | - Jessica McNeil
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Traci L. Parry
- Department of Kinesiology, School of Health and Human SciencesUniversity of North Carolina at GreensboroGreensboroNorth CarolinaUSA
| | - Diane K. Ehlers
- Division of Epidemiology, Department of Quantitative Health SciencesMayo Clinic ArizonaPhoenixArizonaUSA
| | - Andrew Hamilton
- Oregon Health & Science University, LibraryPortlandOregonUSA
| | - Kathryn Schmitz
- Division of Hematology/Oncology, University of Pittsburgh School of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Kristin L. Campbell
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kerri Winters‐Stone
- Division of Oncological Sciences, School of MedicineOregon Health & Science UniversityPortlandOregonUSA
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15
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Zhang HW, Tan HP, Feng QX. Low Back Pain in Resident Doctors with Standardized Training in China: A Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16:2459-2468. [PMID: 38024497 PMCID: PMC10660694 DOI: 10.2147/rmhp.s437810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Low back pain (LBP) is a prevalent occupational disease with high morbidity among healthcare workers. Since the implementation of standardized residency training in China in 2015, the training intensity has significantly increased, which may lead to a higher incidence of LBP. However, epidemiological studies on LBP among resident doctors with standardized training remain scarce. Objective To investigate the prevalence and associated factors of LBP among resident doctors with standardized training in a tertiary hospital in China. Methods A cross-sectional study was conducted using self-administered questionnaires to collect information on demographics, lifestyle factors, work-related factors, and LBP from 345 resident doctors. Descriptive statistics were used to analyze the prevalence of LBP. Logistic regression analysis was performed to identify factors associated with LBP. Results Among 345 participants, the 1-year prevalence of LBP was 75.9%. Multivariable analysis revealed that physical exercise, weekly working hours, and prolonged sitting were independent risk factors for LBP. Conclusion The prevalence of LBP among resident doctors was high. Promoting physical exercise, controlling working hours, and improving sitting posture may help prevent LBP. The study was limited by its cross-sectional design and self-reported data. Future studies should use longitudinal designs, objective measures, and larger and more representative samples to further explore the epidemiology and etiology of LBP among resident doctors with standardized training.
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Affiliation(s)
- Han-Wen Zhang
- Department of Pain Management, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People’s Republic of China
| | - Hong-Ping Tan
- Department of Pain Management, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People’s Republic of China
| | - Qiu-Xia Feng
- Outpatient Department, Nanchong Psychosomatic Hospital, Nanchong, Sichuan Province, People’s Republic of China
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16
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Ellikçi R, Arslan S. Peripheral neuropathy and lifestyle factors in women with breast cancer receiving taxane-based chemotherapy: Pathway analysis. Eur J Oncol Nurs 2023; 66:102415. [PMID: 37769541 DOI: 10.1016/j.ejon.2023.102415] [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: 05/03/2023] [Revised: 07/30/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE Peripheral neuropathy adversely affects the treatment process of cancer, and thus it is important to reveal the factors leading to peripheral neuropathy and to take the necessary precautions to avoid it. This study was conducted to investigate the relationship between chemotherapy-induced peripheral neuropathy (CIPN) and lifestyle factors (nutrition, physical activity and sleep quality). METHODS This descriptive and correlational study was conducted with 108 individuals who were treated in the chemotherapy unit of a hospital between April 2021 and April 2022 in Turkey. Data were collected using the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT), the International Physical Activity Questionnaire (IPAQ), the Mini Nutritional Assessment Test (MNA), and the sleep level Visual Analog Scale. Number, percentages, means, and standard deviations were calculated, and multiple linear regression analysis and path analysis were conducted to analyze the data. RESULTS The results indicate that the total MET score significantly and positively predicted the sleep scale score (β = 0.24, p < 0.01), while it negatively and significantly predicted the CIPNAT score (β = -0.30, p < 0.001). In addition, both the MNA screening score and the sleep scale score significantly and negatively predicted the CIPNAT score (β = -0.25, p < 0.01, β = -0.29, p < 0.001, respectively). CONCLUSIONS Lifestyle factors (exercise, nutrition, sleep) were found to have an effect on peripheral neuropathy. It is thought that increasing the level of exercise improves sleep quality, and regular nutrition, quality sleep and increased physical activity may be effective in reducing peripheral neuropathy.
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Affiliation(s)
- Rabia Ellikçi
- Konya City Hospital Intensive Care Unit, Konya, Turkey.
| | - Selda Arslan
- Department of Internal Medicine Nursing, Nursing Faculty, Necmettin Erbakan University, Konya, Turkey.
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17
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Plinsinga ML, Singh B, Rose GL, Clifford B, Bailey TG, Spence RR, Turner J, Coppieters MW, McCarthy AL, Hayes SC. The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis. Sports Med 2023; 53:1737-1752. [PMID: 37213049 PMCID: PMC10432370 DOI: 10.1007/s40279-023-01862-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. OBJECTIVES This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. METHODS Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. RESULTS In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. CONCLUSION The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. PROSPERO REGISTRATION NUMBER CRD42021266826.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.
| | - Ben Singh
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Grace Laura Rose
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Briana Clifford
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Rosalind Renee Spence
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Jemma Turner
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Michel Willem Coppieters
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Musculoskeletal Health Program, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
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18
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Cao A, Cartmel B, Li FY, Gottlieb LT, Harrigan M, Ligibel JA, Gogoi R, Schwartz PE, Esserman DA, Irwin ML, Ferrucci LM. Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2326463. [PMID: 37526937 PMCID: PMC10394582 DOI: 10.1001/jamanetworkopen.2023.26463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023] Open
Abstract
Importance Chemotherapy-induced peripheral neuropathy (CIPN), one of the most common and severe adverse effects of chemotherapy, is associated with worse quality of life among survivors of ovarian cancer. Currently, there is no effective treatment for CIPN. Objective To evaluate the effect of a 6-month aerobic exercise intervention vs attention-control on CIPN among women treated for ovarian cancer in the Women's Activity and Lifestyle Study in Connecticut (WALC) to provide evidence to inform the guidelines and recommendations for prevention or treatment of CIPN. Design, Setting, and Participants This prespecified secondary analysis evaluated the Women's Activity and Lifestyle Study in Connecticut (WALC), a multicentered, open-label, population-based, phase 3 randomized clinical trial of an aerobic exercise intervention vs attention control for CIPN in patients who were diagnosed with ovarian cancer. Only WALC participants who received chemotherapy were included in this analysis. Participants were randomized 1:1 to either a 6-month aerobic exercise intervention or to attention control. All analyses were conducted between September 2022 and January 2023. Interventions The exercise intervention consisted of home-based moderate-intensity aerobic exercise facilitated by weekly telephone counseling from an American College of Sports Medicine/American Cancer Society-certified cancer exercise trainer. Attention control involved weekly health education telephone calls from a WALC staff member. Main Outcomes and Measure Change in CIPN was the primary outcome in this secondary analysis. This outcome was represented by CIPN severity, which was self-measured by participants at baseline and 6 months using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale, with a score range of 0 to 44. A mixed-effects model was used to assess the 6-month change in CIPN between the exercise intervention and attention control arms. Results Of the 134 participants (all females; mean [SD] age, 57.5 [8.3] years) included in the analysis, 69 were in the exercise intervention arm and 65 were in the attention control arm. The mean (SD) time since diagnosis was 1.7 (1.0) years. The mean (SD) baseline CIPN scores were 8.1 (5.6) in the exercise intervention arm and 8.8 (7.9) in the attention control arm (P = .56). At 6 months, the self-reported CIPN score was reduced by 1.3 (95% CI, -2.3 to -0.2) points in the exercise intervention arm compared with an increase of 0.4 (95% CI, -0.8 to 1.5) points in the attention control arm. The between-group difference was -1.6 (95% CI, -3.1 to -0.2) points. The point estimate was larger among the 127 patients with CIPN symptoms at enrollment (-2.0; 95% CI, -3.6 to -0.5 points). Conclusions and Relevance Findings of this secondary analysis of the WALC trial indicate that a 6-month aerobic exercise intervention vs attention control significantly improved self-reported CIPN among patients who were treated for ovarian cancer. While replication of the findings in other studies is warranted, incorporating referrals to exercise programs into standard oncology care could reduce CIPN symptoms and increase quality of life in patients with ovarian cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02107066.
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Affiliation(s)
- Anlan Cao
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Brenda Cartmel
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Fang-Yong Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Linda T. Gottlieb
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Maura Harrigan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | | | | | | | - Denise A. Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Melinda L. Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Leah M. Ferrucci
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
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19
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Stoller S, Capozza S, Alberti P, Lustberg M, Kleckner IR. Framework to leverage physical therapists for the assessment and treatment of chemotherapy-induced peripheral neurotoxicity (CIPN). Support Care Cancer 2023; 31:293. [PMID: 37086308 DOI: 10.1007/s00520-023-07734-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neurotoxicity (CIPN) is a highly prevalent, dose-limiting, costly, and tough-to-treat adverse effect of several chemotherapy agents, presenting as sensory and motor dysfunction in the distal extremities. Due to limited effective treatments, CIPN can permanently reduce patient function, independence, and quality of life. One of the most promising interventions for CIPN is physical therapy which includes exercise, stretching, balance, and manual therapy interventions. Currently, there are no physical therapy guidelines for CIPN, thus limiting its uptake and potential effectiveness. METHODS Utilizing the authors' collective expertise spanning physical therapy, symptom management research, oncology, neurology, and treating patients with CIPN, we propose a comprehensive clinical workflow for physical therapists to assess and treat CIPN. This workflow is based on (1) physical therapy guidelines for treating neurologic symptoms like those of CIPN, (2) results of clinical research on physical therapy and exercise, and (3) physical therapy clinical judgement. RESULTS We present detailed tables of pertinent physical therapy assessment and treatment methods that can be used in clinical settings. CIPN assessment should include detailed sensory assessment, objective strength assessments of involved extremities, and validated physical performance measures incorporating static and dynamic balance, gait, and functional mobility components. CIPN treatment should involve sensorimotor, strength, balance, and endurance-focused interventions, alongside a home-based exercise prescription that includes aerobic training. We conclude with action items for oncology teams, physical therapists, patients, and researchers to best apply this framework to address CIPN. CONCLUSIONS Physical therapists are in a unique position to help assess, prevent, and treat CIPN given their training and prevalence, yet there are no physical therapy clinical practice guidelines for CIPN. Our preliminary suggestions for CIPN assessments and treatments can catalyze the development of guidelines to assess and treat CIPN. We urge oncology teams, physical therapists, patients, and researchers to develop, adapt, and disseminate this framework to help alleviate the burden of chemotherapy on patients with cancer.
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Affiliation(s)
- Stefanie Stoller
- Department of Physical and Occupational Therapy, Duke University Hospital, Durham, NC, USA
| | - Scott Capozza
- Rehabilitation Department, Yale New Haven Hospital, New Haven, CT, USA
| | - Paola Alberti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy and NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Maryam Lustberg
- Breast Medical Oncology, Yale Cancer Center, New Haven, CT, USA
| | - Ian R Kleckner
- Department of Pain & Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
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Couderc AL, Bouhnik AD, Rey D, Bendiane MK, Greillier L, Nouguerède É, Pille A, Montegut C, Rousseau F, Villani P, Mancini J. Quality of life in older French long-term lung cancer survivors: VICAN5 national survey. Lung Cancer 2023; 180:107197. [PMID: 37116376 DOI: 10.1016/j.lungcan.2023.107197] [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: 01/29/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES This study aimed to describe quality of life (QoL) five years after diagnosis, in a representative sample of lung cancer (LC) survivors, to compare the QoL of survivors aged 70 years or older with that of younger ones, and to identify factors associated with poorer long-term QoL in both age groups. MATERIALS AND METHODS Our study sample consists of all individuals with a LC diagnosed between January 2010 and December 2011, who participated in the French national survey VICAN 5. RESULTS A total of 371 participants had LC. At the time of the survey, 21.3% of the participants were 70 years or older. In this older age group, feeling self-conscious about appearance and suspected neuropathic pain were independently associated with physical QoL impairment and lower Post-Traumatic Growth Inventory score, and suspected neuropathic pain was associated with impaired mental QoL. In younger patients, impaired physical QoL was independently associated with male gender, metastatic cancer, suspected neuropathic pain, report of severe after-effects of LC and difficulty breathing at rest in the past 7 days, and impaired mental QoL was independently associated with male gender, impaired ECOG-PS, and anxiety. CONCLUSION Factors associated with an impaired QoL in LC survivors, varied according to patient age. In both populations, psychological support and adapted physical activity can be offered to improve mental QoL and physical symptomatology. For older survivors with neuropathic pain, analgesic therapies can be discussed to improve long-term QoL.
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Affiliation(s)
- Anne-Laure Couderc
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Dominique Rey
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Émilie Nouguerède
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Ariane Pille
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Coline Montegut
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Oncology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Patrick Villani
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France; Aix-Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Economics & Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; APHM, BIOSTIC, Hop Timone, Marseille, France
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D'Souza RS, Alvarez GAM, Dombovy-Johnson M, Eller J, Abd-Elsayed A. Evidence-Based Treatment of Pain in Chemotherapy-Induced Peripheral Neuropathy. Curr Pain Headache Rep 2023; 27:99-116. [PMID: 37058254 DOI: 10.1007/s11916-023-01107-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE OF REVIEW Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and often painful condition that occurs after administration of chemotherapeutic agents. The primary objective of this systematic review was to appraise the literature on conservative, pharmacological, and interventional treatment options for CIPN pain. RECENT FINDINGS There is level I evidence supporting modest to moderate improvement in CIPN pain from duloxetine treatment, as well as short-term modest improvement from physical therapy and acupuncture. Although opioid and cannabis administration may provide short-term modest improvement, administration is commonly limited by side effects. Generally, most studies reported no clinical benefit from yoga, topical neuropathic agents, gabapentinoids, and tricyclic antidepressants. Evidence is currently equivocal for scrambler therapy and transcutaneous electrical nerve stimulation. Finally, evidence on neuromodulation options is limited to mostly case reports/series and one observational study highlighting moderate improvement with auricular nerve stimulation. This systematic review provides an overview of conservative, pharmacologic, and interventional treatment modalities for CIPN pain. Furthermore, it provides a level of evidence and degree of recommendation based on the United States Preventive Services Task Force (USPSTF) criteria for each specific treatment modality.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | | | - Marissa Dombovy-Johnson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Hospital, Rochester, MN, USA
| | - Jennifer Eller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA.
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22
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Cuthbert C, Twomey R, Bansal M, Rana B, Dhruva T, Livingston V, Daun JT, Culos-Reed SN. The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:254. [PMID: 37039883 PMCID: PMC10088810 DOI: 10.1007/s00520-023-07716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Pain is a common side effect of cancer or cancer treatment that negatively impacts biopsychosocial wellbeing and quality of life. Exercise is a potential intervention to manage pain that is safe and has multiple benefits. The objective was to determine the role of exercise in cancer pain management. METHODS We completed a systematic review and meta-analysis of exercise interventions in adults with any type or stage of cancer by searching Ovid MEDLINE®, Embase, APA PsycInfo, the Cochrane Central Register of Controlled Trials, CINAHL, and SPORTDiscus. We included experimental and quasi-experimental designs where pain was measured as an outcome. Data synthesis included narrative and tabular summary. A meta-analysis was performed on studies powered to detect the effect of exercise on pain. Study quality was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the GRADE tool. RESULTS Seventy-six studies were included. Studies were predominantly conducted in breast cancer and exercise usually included a combination of aerobic and strength training. Ten studies were included in the meta-analysis demonstrating a significant effect for exercise in decreasing pain (estimated average standard mean difference (SMD) was g = - 0.73 (95% CI: - 1.16 to - 0.30)); however, the overall effect prediction interval was large. Overall risk of bias for most studies was rated as some concerns and the grading of evidence certainty was low. CONCLUSION There are limitations in the evidence for exercise to manage cancer-related pain. Further research is needed to understand the role of exercise in a multimodal pain management strategy.
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Affiliation(s)
- Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Mannat Bansal
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Benny Rana
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Tana Dhruva
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
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Guo S, Han W, Wang P, Wang X, Fang X. Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. J Cancer Surviv 2023; 17:318-331. [PMID: 35149899 DOI: 10.1007/s11764-022-01182-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Summarize and critically evaluate the existing studies to determine the effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients. METHODS We searched PubMed, Scopus, Web of Science, and Cochrane Library databases for randomized controlled trials reporting exercise intervention in cancer patients with chemotherapy-induced peripheral neuropathy. The outcomes of interest included chemotherapy-induced peripheral neuropathy symptoms, physical function (balance control, muscle strength, and functional status), and quality of life. The Cochrane Collaboration's tool was employed to assess the risk of bias. RESULTS The search identified 1309 studies, 16 of which eligible. Our meta-analysis revealed that exercise intervention significantly improved the quality of life (SMD = 0.83, 95% CI = 0.58 to 1.08, I2 = 0%, P < 0.00001) and relieved neuropathic pain (MD = - 4.93, 95% CI = - 5.60 to - 4.26, I2 = 0%, P < 0.00001). The muscular strength of the upper (SMD = 1.10, 95% CI = 0.68 to 1.51, I2 = 25%, P < 0.00001) and the lower limbs (SMD = 0.84, 95% CI = 0.42 to 1.26, I2 = 36%, P < 0.00001) increased and balance performance (SMD = 1.05, 95% CI = 0.62 to1.48, I2 = 0%, P < 0.00001) was better in the exercise group than in the group with usual care. However, no evidence was found that exercise intervention could improve CIPN symptoms. CONCLUSIONS The results of this study showed that combined exercise could be an effective option for improving quality of life, physical function (balance control and muscle strength), and neuropathic pain in cancer patients with chemotherapy-induced peripheral neuropathy. Further exploration of appropriate exercise prescriptions is needed to improve other outcomes. IMPLICATIONS FOR CANCER SURVIVORS Specific and appropriate exercise intervention for cancer patients with chemotherapy-induced peripheral neuropathy should be recommended because these interventions can improve their quality of life and physical function.
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Affiliation(s)
- Shaoning Guo
- School of Nursing, Jilin University, 965 Xinjiang Street, Changchun, 130021, Jilin, China
| | - Wenwen Han
- Department of Nursing, The First Bethune Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Pengju Wang
- Department of Nursing, The First Bethune Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Xue Wang
- School of Nursing, Changchun University of Chinese Medicine, Changchun, 130117, Jilin, China
| | - Xuedong Fang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, Jilin, China.
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Atkins SLP, Zimmer AS. Neurologic complications of breast cancer. Cancer 2023; 129:505-520. [PMID: 36537474 DOI: 10.1002/cncr.34518] [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: 06/01/2022] [Revised: 08/14/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022]
Abstract
Breast cancer is a heterogeneous disease with unique neurologic complications that can arise from central nervous system (CNS) involvement or secondary to treatments themselves. As progress is made, with more targeted therapies and combinations available, particularly in the realm of human epidermal growth factor receptor 2 (HER2)-positive disease, the role of these new agents in patients with CNS disease is gradually evolving, although intracranial efficacy itself is lagging. At the same time, both systemic and local standard therapies pose clinical challenges regarding neurologic complications, such as peripheral neuropathy and cognitive changes. The development of new agents, such as immunotherapy, and new strategies, such as incorporating systemic therapies into local therapy, unveil new presentations of neurological complications.
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Affiliation(s)
- Sarah L P Atkins
- Women's Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexandra S Zimmer
- Hematology and Medical Oncology Division, Oregon Health and Science University, Knight Cancer Institute, Portland, Oregon, USA
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Lee S, Ma C, Shi Q, Kumar P, Couture F, Kuebler P, Krishnamurthi S, Lewis D, Tan B, Goldberg RM, Venook A, Blanke C, O'Reilly EM, Shields AF, Meyerhardt JA. Potential Mediators of Oxaliplatin-Induced Peripheral Neuropathy From Adjuvant Therapy in Stage III Colon Cancer: Findings From CALGB (Alliance)/SWOG 80702. J Clin Oncol 2023; 41:1079-1091. [PMID: 36367997 PMCID: PMC9928634 DOI: 10.1200/jco.22.01637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We sought to evaluate the independent and interactive associations of planned treatment duration, celecoxib use, physical activity, body mass index (BMI), diabetes mellitus, and vitamin B6 with oxaliplatin-induced peripheral neuropathy (OIPN) among patients with stage III colon cancer enrolled in a clinical trial. METHODS We conducted a prospective, observational study of 2,450 patients with stage III colon cancer enrolled in the CALGB/SWOG 80702 trial, randomly assigned to 6 versus 12 cycles of adjuvant fluorouracil, leucovorin, and oxaliplatin chemotherapy with or without 3 years of celecoxib. OIPN was reported using the Common Terminology Criteria for Adverse Events (CTCAE) during and following completion of chemotherapy and the FACT/GOG-NTX-13 15-17 months after random assignment. Multivariate analyses were adjusted for baseline sociodemographic and clinical factors. RESULTS Patients assigned to 12 treatment cycles, relative to 6, were significantly more likely to experience higher-grade CTCAE- and FACT/GOG-NTX-13-reported neuropathy and longer times to resolution, while neither celecoxib nor vitamin B6 intake attenuated OIPN. Exercising ≥ 9 MET-hours per week after treatment relative to < 9 was associated with improvements in FACT/GOG-NTX-13-reported OIPN (adjusted difference in means, 1.47; 95% CI, 0.49 to 2.45; P = .003). Compared with patients with baseline BMIs < 25, those with BMIs ≥ 25 were at significantly greater risk of developing higher-grade CTCAE-reported OIPN during (adjusted odds ratio, 1.18; 95% CI, 1.00 to 1.40; P = .05) and following completion (adjusted odds ratio, 1.23; 95% CI, 1.01 to 1.50; P = .04) of oxaliplatin treatment. Patients with diabetes were significantly more likely to experience worse FACT/GOG-NTX-13-reported neuropathy relative to those without (adjusted difference in means, -2.0; 95% CI, -3.3 to -0.73; P = .002). There were no significant interactions between oxaliplatin treatment duration and any of these potentially modifiable exposures. CONCLUSION Lower physical activity, higher BMI, diabetes, and longer planned treatment duration, but not celecoxib use or vitamin B6 intake, may be associated with significantly increased OIPN severity.
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Affiliation(s)
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Pankaj Kumar
- Heartland Cancer Research NCORP, Illinois CancerCare PC, Peoria, IL
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH
| | | | - DeQuincy Lewis
- Southeast Clinical Oncology Research Consortium NCORP, Cone Health Medical Group, Asheboro, NC
| | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
| | | | - Alan Venook
- University of California San Francisco, San Francisco, CA
| | - Charles Blanke
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR
| | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY
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Tanay MAL, Armes J, Moss-Morris R, Rafferty AM, Robert G. A systematic review of behavioural and exercise interventions for the prevention and management of chemotherapy-induced peripheral neuropathy symptoms. J Cancer Surviv 2023; 17:254-277. [PMID: 33710510 PMCID: PMC9971149 DOI: 10.1007/s11764-021-00997-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) can result in functional difficulties. Pharmacological interventions used to prevent CIPN either show low efficacy or lack evidence to support their use and to date, duloxetine remains the only recommended treatment for painful CIPN. Non-pharmacological interventions such as exercise and behavioural interventions for CIPN exist. PURPOSE The aims were to (1) identify and appraise evidence on existing behavioural and exercise interventions focussed on preventing or managing CIPN symptoms, (2) describe psychological mechanisms of action by which interventions influenced CIPN symptoms, (3) determine the underpinning conceptual models that describe how an intervention may create behaviour change, (4) identify treatment components of each intervention and contextual factors, (5) determine the nature and extent of patient and clinician involvement in developing existing interventions and (6) summarise the relative efficacy or effectiveness of interventions to lessen CIPN symptoms and to improve quality of life, balance and muscle strength. METHODS A systematic search of Ovid Medline, Cochrane Library, EMBASE, PsycINFO, Health Management Information Consortium, Global Health and CINAHL was performed to identify articles published between January 2000 to May 2020, followed by OpenGrey search and hand-searching of relevant journals. Studies that explored behavioural and/or exercise interventions designed to prevent or improve symptoms of CIPN in adults who had received or were receiving neurotoxic chemotherapy for any type of cancer, irrespective of when delivered within the cancer pathway were included. RESULTS Nineteen randomised controlled trials and quasi-experimental studies which explored behavioural (n=6) and exercise (n=13) interventions were included. Four studies were rated as methodologically strong, ten were moderate and five were weak. Ten exercise and two behavioural interventions, including those that improved CIPN knowledge and self-management resources and facilitated symptom self-reporting, led to reduced CIPN symptoms during and/or after chemotherapy treatment. CONCLUSIONS The extent of potential benefits from the interventions was difficult to judge, due to study limitations. Future interventions should incorporate a clear theoretical framework and involve patients and clinicians in the development process. IMPLICATIONS FOR CANCER SURVIVORS Our findings show exercise interventions have beneficial effects on CIPN symptoms although higher quality research is warranted. Behavioural interventions that increase patient's CIPN knowledge, improve self-management capacity and enable timely access to symptom management led to reduced CIPN symptoms.
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Affiliation(s)
- Mary Anne Lagmay Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Jo Armes
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Rona Moss-Morris
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Dixit S, Tapia V, Sepúlveda C, Olate D, Berríos-Contreras L, Lorca LA, Alqahtani AS, Ribeiro IL. Effectiveness of a Therapeutic Exercise Program to Improve the Symptoms of Peripheral Neuropathy during Chemotherapy: Systematic Review of Randomized Clinical Trials. Life (Basel) 2023; 13:life13020262. [PMID: 36836620 PMCID: PMC9958632 DOI: 10.3390/life13020262] [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: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Therapeutic exercise has an important role to manage chemotherapy-induced peripheral neuropathy symptoms. However, there is little evidence of its effectiveness. OBJECTIVE To synthesize the evidence regarding therapeutic exercise during chemotherapy to improve peripheral neuropathy symptoms. DATABASES PubMed, CINAHL, Cochrane Library, PEDro, ScienceDirect, Scopus, Web of Science and BIREME. METHODOLOGY Randomized clinical trials were included. GRADE was used to synthesize evidence and an inverse variance model for meta-analysis. RESULTS Up to May 2022, 2172 references were analyzed and 14 studies that evaluated 1094 participants were included. The exercises were highly effective in improving pain threshold and moderately effective in improving peripheral neuropathy symptoms at the 8-week follow-up and the 4-24 weeks. Furthermore, the evidence was low in improving thermal threshold, tactile and vibratory sensitivity. CONCLUSION Therapeutic exercise generates a significant reduction in peripheral neuropathy symptoms in patients in short- and long-term follow-up with a moderate level of evidence quality.
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Affiliation(s)
- Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Valentina Tapia
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Carolina Sepúlveda
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Daniela Olate
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Lily Berríos-Contreras
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Luz Alejandra Lorca
- Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago de Chile 13123, Chile
| | - Abdulfattah S. Alqahtani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Ivana Leão Ribeiro
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
- Correspondence: ; Tel.: +56-712413622
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Bienfait F, Julienne A, Jubier-Hamon S, Seegers V, Delorme T, Jaoul V, Pluchon YM, Lebrec N, Dupoiron D. Evaluation of 8% Capsaicin Patches in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Study in a Comprehensive Cancer Center. Cancers (Basel) 2023; 15:349. [PMID: 36672298 PMCID: PMC9856924 DOI: 10.3390/cancers15020349] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is often painful and can arise during or after the end of oncological treatments. They are mostly induced by platinum salts, taxanes, and immunotherapies. Their incidence is estimated between 19 and 85%. They can require a chemotherapy dose reduction or early termination. The European Society for Medical Oncology (ESMO) recommends high-concentration capsaicin patch (HCCP) in second line for the treatment of painful CIPN. This treatment induces a significative pain relief but only shown by low-powered studies. The objective of this study was to evaluate efficacy and tolerability of HCCP applications in CIPN. Methods: This monocentric observational retrospective real-world-data study of the CERCAN cohort took place in the Western Cancer Institute's Anaesthesiology and Pain Department at Angers, France. Independent pain physicians completed the CGIC (Clinician Global Impression of Change) for each patient who benefited from HCCP applications for painful CIPN starting from 1 January 2014 to 22 December 2021, based on the collected data after every patch application. Results: A total of 57 patients (80.7% women) was treated with HCCP for painful CIPN, and 184 applications were realized, consisting of 296 sessions. CGIC found an important or complete pain relief for 61 applications (33.2%, corresponding to 43.9% patients). We found less efficacy for platinum-salts-induced CIPN compared to others (p = 0.0238). The efficacy was significatively higher for repeated applications when HCCP was used in second line compared to third line (p = 0.018). The efficacy of HCCP was significatively higher starting the third application (p = 0.0334). HCCPs were mainly responsible for local adverse events found in 66.6% patients (65.1% burning or painful sensation, 21.1% erythema). Conclusion: HCCP applications in painful CIPN induce an important pain relief with a global satisfying tolerability.
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Affiliation(s)
- Florent Bienfait
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Arthur Julienne
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Sabrina Jubier-Hamon
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Valerie Seegers
- Biometrics Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France;
| | - Thierry Delorme
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Virginie Jaoul
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Yves-Marie Pluchon
- Pain Management Consultation Center, Centre Hospitalier Départemental Vendée, 85925 La Roche-sur-Yon, France;
| | - Nathalie Lebrec
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
| | - Denis Dupoiron
- Anaesthesiology and Pain Department, Institut de Cancérologie de l’Ouest, 49100 Angers, France; (A.J.); (S.J.-H.); (T.D.); (V.J.); (N.L.); (D.D.)
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Natural Taxanes: From Plant Composition to Human Pharmacology and Toxicity. Int J Mol Sci 2022; 23:ijms232415619. [PMID: 36555256 PMCID: PMC9779243 DOI: 10.3390/ijms232415619] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Biologically active taxanes, present in small- to medium-sized evergreen conifers of various Taxus species, are widely used for their antioxidant, antimicrobial and anti-inflammatory effects, but mostly for their antitumour effects used in the treatment of solid tumours of the breast, ovary, lung, bladder, prostate, oesophagus and melanoma. More of the substances found in Taxus plant extracts have medical potential. Therefore, at the beginning of this review, we describe the methods of isolation, identification and determination of taxanes in different plant parts. One of the most important taxanes is paclitaxel, for which we summarize the pharmacokinetic parameters of its different formulations. We also describe toxicological risks during clinical therapy such as hypersensitivity, neurotoxicity, gastrointestinal, cardiovascular, haematological, skin and renal toxicity and toxicity to the respiratory system. Since the effect of the drug-form PTX is enhanced by various Taxus spp. extracts, we summarize published clinical intoxications and all fatal poisonings for the Taxus baccata plant. This showed that, despite their significant use in anticancer treatment, attention should also be focused on the risk of fatal intoxication due to ingestion of extracts from these plants, which are commonly found in our surroundings.
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Molecular mechanisms of exercise contributing to tissue regeneration. Signal Transduct Target Ther 2022; 7:383. [PMID: 36446784 PMCID: PMC9709153 DOI: 10.1038/s41392-022-01233-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022] Open
Abstract
Physical activity has been known as an essential element to promote human health for centuries. Thus, exercise intervention is encouraged to battle against sedentary lifestyle. Recent rapid advances in molecular biotechnology have demonstrated that both endurance and resistance exercise training, two traditional types of exercise, trigger a series of physiological responses, unraveling the mechanisms of exercise regulating on the human body. Therefore, exercise has been expected as a candidate approach of alleviating a wide range of diseases, such as metabolic diseases, neurodegenerative disorders, tumors, and cardiovascular diseases. In particular, the capacity of exercise to promote tissue regeneration has attracted the attention of many researchers in recent decades. Since most adult human organs have a weak regenerative capacity, it is currently a key challenge in regenerative medicine to improve the efficiency of tissue regeneration. As research progresses, exercise-induced tissue regeneration seems to provide a novel approach for fighting against injury or senescence, establishing strong theoretical basis for more and more "exercise mimetics." These drugs are acting as the pharmaceutical alternatives of those individuals who cannot experience the benefits of exercise. Here, we comprehensively provide a description of the benefits of exercise on tissue regeneration in diverse organs, mainly focusing on musculoskeletal system, cardiovascular system, and nervous system. We also discuss the underlying molecular mechanisms associated with the regenerative effects of exercise and emerging therapeutic exercise mimetics for regeneration, as well as the associated opportunities and challenges. We aim to describe an integrated perspective on the current advances of distinct physiological mechanisms associated with exercise-induced tissue regeneration on various organs and facilitate the development of drugs that mimics the benefits of exercise.
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Tay N, Laakso EL, Schweitzer D, Endersby R, Vetter I, Starobova H. Chemotherapy-induced peripheral neuropathy in children and adolescent cancer patients. Front Mol Biosci 2022; 9:1015746. [PMID: 36310587 PMCID: PMC9614173 DOI: 10.3389/fmolb.2022.1015746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
Brain cancer and leukemia are the most common cancers diagnosed in the pediatric population and are often treated with lifesaving chemotherapy. However, chemotherapy causes severe adverse effects and chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting and debilitating side effect. CIPN can greatly impair quality of life and increases morbidity of pediatric patients with cancer, with the accompanying symptoms frequently remaining underdiagnosed. Little is known about the incidence of CIPN, its impact on the pediatric population, and the underlying pathophysiological mechanisms, as most existing information stems from studies in animal models or adult cancer patients. Herein, we aim to provide an understanding of CIPN in the pediatric population and focus on the 6 main substance groups that frequently cause CIPN, namely the vinca alkaloids (vincristine), platinum-based antineoplastics (cisplatin, carboplatin and oxaliplatin), taxanes (paclitaxel and docetaxel), epothilones (ixabepilone), proteasome inhibitors (bortezomib) and immunomodulatory drugs (thalidomide). We discuss the clinical manifestations, assessments and diagnostic tools, as well as risk factors, pathophysiological processes and current pharmacological and non-pharmacological approaches for the prevention and treatment of CIPN.
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Affiliation(s)
- Nicolette Tay
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
| | - E-Liisa Laakso
- Mater Research Institute-The University of Queensland, South Brisbane, QLD, Australia
| | - Daniel Schweitzer
- Mater Research Institute-The University of Queensland, South Brisbane, QLD, Australia
| | - Raelene Endersby
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Irina Vetter
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
- The School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Hana Starobova
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, QLD, Australia
- *Correspondence: Hana Starobova,
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Jung MS, Kim M, Cha K, Cui X, Lee JW. Psychometric Properties of the Korean Version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool. Res Theory Nurs Pract 2022; 36:RTNP-2022-0037.R1. [PMID: 36096521 DOI: 10.1891/rtnp-2022-0037] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a multidimensional symptom cluster induced by neurotoxic chemotherapy agents among patients with cancer. A well-developed tool for assessing CIPN can help with the early detection and timely management of patients. This study assessed the reliability and validity of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) in Korean women with breast cancer who were treated with chemotherapy. METHODS A psychometric analysis of the Korean version of CIPNAT was conducted with 207 patients with breast cancer who were treated with chemotherapy. Patients were assessed using the CIPNAT and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy-20 (CIPN-20). Analyses of internal consistency reliability, concurrent validity, and construct validity (based on structural and discriminant validity testing) were performed to evaluate the psychometric properties. RESULTS The Korean version of the CIPNAT had good internal consistency (Cronbach's alpha = 0.95; the item-total correlation coefficients ranged 0.34-0.76). The CIPNAT and CIPN-20 were moderately correlated (r = .67). Confirmatory factor analyses showed a four-factor structural model with acceptable model fit indices. Discriminant validity was supported by differences between individuals treated with and without taxane-based chemotherapy (p < .001). IMPLICATIONS FOR PRACTICE The Korean version of the CIPNAT was a valid and reliable screening tool for identification of CIPN symptoms and functional interference in Korean women who received chemotherapy for breast cancer. The instrument can be useful for the timely and routine assessment of CIPN symptoms and functional limitations of patients with cancer by oncology nurses.
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Affiliation(s)
- Mi Sook Jung
- Department of Nursing, Chungnam National University, Moonhwaro 266, Daejeon, 35015 South Korea
| | - Mijung Kim
- Department of Nursing, Catholic Kkottongnae University, 133 Sangsam-gil, Hyundo-myeon, Seowon-gu, Cheonju-si, Chungbuk, 28211 South Korea
| | - Kyeongin Cha
- Department of Nursing, Chungnam National University, Moonhwaro 266, Daejeon, 35015 South Korea
| | - Xirong Cui
- Department of Nursing, Chungnam National University, Moonhwaro 266, Daejeon, 35015 South Korea
| | - Ji Wan Lee
- Department of Nursing, Chungnam National University, Moonhwaro 266, Daejeon, 35015 South Korea
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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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Clavo B, Rodríguez-Abreu D, Galván S, Federico M, Martínez-Sánchez G, Ramallo-Fariña Y, Antonelli C, Benítez G, Rey-Baltar D, Jorge IJ, Rodríguez-Esparragón F, Serrano-Aguilar P. Long-term improvement by ozone treatment in chronic pain secondary to chemotherapy-induced peripheral neuropathy: A preliminary report. Front Physiol 2022; 13:935269. [PMID: 36111149 PMCID: PMC9468657 DOI: 10.3389/fphys.2022.935269] [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: 05/03/2022] [Accepted: 08/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Pain secondary to chemotherapy-induced peripheral neuropathy (CIPN) can limit the administration of chemotherapy, cancer-treatment outcomes, and the quality of life of patients. Oxidative stress and inflammation are some of the key mechanisms involved in CIPN. Successful treatments for CIPN are limited. This report shows our preliminary experience using ozone treatment as a modulator of oxidative stress in chronic pain secondary to CIPN. Methods: Ozone treatment, by rectal insufflation, was administered in seven patients suffering from pain secondary to grade II or III CIPN. Pain was assessed by the visual analog scale (VAS). Results: All patients, except one, showed clinically relevant pain improvement. Median pain score according to the VAS was 7 (range: 5–8) before ozone treatment, 4 (range: 2–6) at the end of ozone treatment (p = 0.004), 5.5 (range: 1.8–6.3) 3 months after the end of ozone treatment (p = 0.008), and 6 (range: 2.6–6.6) 6 months after the end of ozone treatment (p = 0.008). The toxicity grade, according to the Common Terminology Criteria for Adverse Events (CTCAE v.5.0), improved in half of the patients. Conclusion: This report shows that most patients obtained clinically relevant and long-lasting improvement in chronic pain secondary to CIPN after treatment with ozone. These observed effects merit further research and support our ongoing randomized clinical trial (NCT04299893).
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Affiliation(s)
- Bernardino Clavo
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Chronic Pain Unit, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
- Molecular and Translational Pharmacology Group, Universitary Institute for Research in Biomedicine and Health (iUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias de la Universidad de La Laguna, Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Spanish Group of Clinical Research in Radiation Oncology (GICOR), Madrid, Spain
- *Correspondence: Bernardino Clavo, ; Francisco Rodríguez-Esparragón,
| | - Delvys Rodríguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Saray Galván
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Carla Antonelli
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Gretel Benítez
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Dolores Rey-Baltar
- Radiation Oncology Department, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Ignacio J Jorge
- Chronic Pain Unit, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Francisco Rodríguez-Esparragón
- Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias de la Universidad de La Laguna, Tenerife, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Bernardino Clavo, ; Francisco Rodríguez-Esparragón,
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Instituto de Salud Carlos III, Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Servicio de Evaluación y Planificación del Servicio Canario de Salud (SESCS), Santa Cruz de Tenerife, Spain
- Red de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, Spain
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Supportive care interventions for cancer patients in low- and middle-income countries (LMICs): a scoping review. Support Care Cancer 2022; 30:9483-9496. [PMID: 35962827 DOI: 10.1007/s00520-022-07319-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/04/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE In high-income countries (HICs), supportive care is often used to assist cancer patients as they seek treatment and beyond. However, in low-and middle-income countries (LMICs), where more than 70% of all cancer-related deaths occur [1], the provision of supportive care has not been assessed. The purpose of this scoping review is to assess the type of supportive care interventions for cancer patients across the cancer care continuum in LMICs. METHODS We examined published articles reporting on supportive care interventions in LMICs. Following PRISMA guidelines, we performed a systematic search of PubMed, ERIC, CINAHL, and PsycINFO. We limited the scope to original research studies focused on LMICs, studies concerning any type of supportive care intervention for adult cancer patients, from diagnosis, treatment, and post-treatment. RESULTS Thirty-five studies met the criteria for inclusion in the scoping review. The majority were randomized clinical trials (RCT) or used a quasi-experimental design. The highest number of studies (n = 23) was implemented in the WHO Eastern-Mediterranean region, followed by South-East Asia (n = 6), Africa (n = 4), and Western-Pacific Regions (n = 2). Most studies focused on women's cancers and included interventions for psychosocial support, symptom management, health literacy/education, and patient navigation. CONCLUSIONS Although we found only a small number of interventions being conducted in these settings, our results suggest that providing different types of supportive services in less-resourced settings, even when health systems are fragmented and fragile, can improve mental health, physical health, and the quality of life (QoL) of cancer patients.
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36
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Hiensch AE, Monninkhof EM, Schmidt ME, Zopf EM, Bolam KA, Aaronson NK, Belloso J, Bloch W, Clauss D, Depenbusch J, Lachowicz M, Pelaez M, Rundqvist H, Senkus E, Stuiver MM, Trevaskis M, Urruticoechea A, Rosenberger F, van der Wall E, de Wit GA, Zimmer P, Wengström Y, Steindorf K, May AM. Design of a multinational randomized controlled trial to assess the effects of structured and individualized exercise in patients with metastatic breast cancer on fatigue and quality of life: the EFFECT study. Trials 2022; 23:610. [PMID: 35906659 PMCID: PMC9335464 DOI: 10.1186/s13063-022-06556-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/16/2022] [Indexed: 11/12/2022] Open
Abstract
Background Many patients with metastatic breast cancer experience cancer- and treatment-related side effects that impair activities of daily living and negatively affect the quality of life. There is a need for interventions that improve quality of life by alleviating fatigue and other side effects during palliative cancer treatment. Beneficial effects of exercise have been observed in the curative setting, but, to date, comparable evidence in patients with metastatic breast cancer is lacking. The aim of this study is to assess the effects of a structured and individualized 9-month exercise intervention in patients with metastatic breast cancer on quality of life, fatigue, and other cancer- and treatment-related side effects. Methods The EFFECT study is a multinational, randomized controlled trial including 350 patients with metastatic breast cancer. Participants are randomly allocated (1:1) to an exercise or control group. The exercise group participates in a 9-month multimodal exercise program, starting with a 6-month period where participants exercise twice a week under the supervision of an exercise professional. After completing this 6-month period, one supervised session is replaced by one unsupervised session for 3 months. In addition, participants are instructed to be physically active for ≥30 min/day on all remaining days of the week, while being supported by an activity tracker and exercise app. Participants allocated to the control group receive standard medical care, general written physical activity advice, and an activity tracker, but no structured exercise program. The primary outcomes are quality of life (EORTC QLQ-C30, summary score) and fatigue (EORTC QLQ-FA12), assessed at baseline, 3, 6 (primary endpoint), and 9 months post-baseline. Secondary outcomes include physical fitness, physical performance, physical activity, anxiety, depression, pain, sleep problems, anthropometric data, body composition, and blood markers. Exploratory outcomes include quality of working life, muscle thickness, urinary incontinence, disease progression, and survival. Additionally, the cost-effectiveness of the exercise program is assessed. Adherence and safety are monitored throughout the intervention period. Discussion This large randomized controlled trial will provide evidence regarding the (cost-) effectiveness of exercise during treatment of metastatic breast cancer. If proven (cost-)effective, exercise should be offered to patients with metastatic breast cancer as part of standard care. Trial registration ClinicalTrials.govNCT04120298. Registered on October 9, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06556-7.
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Affiliation(s)
- Anouk E Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Cabrini Cancer Institute, The Szalmuk Family Department of Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia
| | - Kate A Bolam
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jon Belloso
- R&D department, Fundación Onkologikoa, Donostia-San Sebastian, Spain
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Dorothea Clauss
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Johanna Depenbusch
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Milena Lachowicz
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Mireia Pelaez
- R&D department, Fundación Onkologikoa, Donostia-San Sebastian, Spain
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elzbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Martijn M Stuiver
- Center for Quality of Life and Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Mark Trevaskis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | | | - Friederike Rosenberger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Philipp Zimmer
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany.,Division of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Yvonne Wengström
- Cabrini Cancer Institute, The Szalmuk Family Department of Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia.,Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
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Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients. Pain Res Manag 2022; 2022:8943292. [PMID: 35463627 PMCID: PMC9023204 DOI: 10.1155/2022/8943292] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/08/2022] [Accepted: 03/29/2022] [Indexed: 12/25/2022]
Abstract
Objective This study aimed to conduct a retrospective observational study to understand the status of characteristics of pain and identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP) in advanced cancer patients. Methods Advanced cancer patients over 18 years of age; diagnosed with cancer of any type and stage III or IV in the palliative care ward with available data were enrolled between 2018 and 2020. Demographic data and pain-related information were collected by using structured electronic extraction form from Hospital Information System (HIS). Patients who had well-controlled background pain with an intensity ≤4 on a 0–10 numerical scale for >12 hours/day, the presence of transient exacerbations of pain with moderate-severe intensity (≧5), and clearly distinguish from background pain were regarded to have suffered BTP. Spearman correlation was conducted to explore the relationship between pain score and demographics characteristics. Factors significant in univariate analysis were included in the multiple regression model to explore independent predictive factors associated with the BTP. Results Of 798 advanced cancer patients, the mean age was 56.7 (SD = 11.84) years. Lung cancer (29.95%) was the most common cancer, and pain (93%) was the most common symptom. More than half (n = 428, 53.6%) of the patients experienced BTP. The median number of BTP episodes was 4 (IQR = 2, 7, range: 1–42). The median intensity of BTP was 6 (IQR = 6, 7, range 5–10). Patients with severe background pain or BTP had longer hospital stay and more symptoms. Besides, more severe background pain was related to higher activity of daily living. Intramuscular injection of hydromorphone hydrochloride was the main medication for BTP onset. Younger age, background pain, anorexia, and constipation were independently associated with the presentation of BTP. BTP pain intensity was independently associated with bloating. Symptom numbers were an independent factor and positively associated with BTP episodes. Conclusions BTP resulted in poor prognosis, which has a variable presentation depending on interdependent relationships among different characteristics. Good controlling of background pain and assessment of pain-related symptoms are essential for BTP management. BTP should be managed individually, especially the invisible pain among aged patients. Furthermore, BTP-related education and training were still needed.
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Srivastava SP, Sinha AP, Sharma KK, Malik PS. Severity, Risk Factors and Quality of Life of Patients associated with Chemotherapy-Induced Peripheral Neuropathy. Clin Nurs Res 2022; 31:1080-1090. [PMID: 35362333 DOI: 10.1177/10547738221085613] [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: 11/15/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) refers to numbness, tingling, and burning sensation caused by chemotherapy that can cause impairment in Quality of Life (QoL) of the patients. Study assesses severity, risk factors, and quality of life of patients associated with CIPN. A cross sectional descriptive study was conducted at day care ward, tertiary care hospital India. Total of 98 patients receiving paclitaxel for ≥4 months were enrolled by convenient sampling. Data regarding demographics and clinical characteristics, CIPN severity, risk factors, and QoL were collected by structured questionnaires. Study revealed that median score of autonomic symptoms was higher than sensory and motor symptoms. Mean score of FACT/GOG-Ntx sub-domain was 99.05 ± 20.87on a scale of 0 to 152. ECOG Performance status, current exercise behavior, and fruit and vegetable intake was found to be significantly (at p < .05) associated with sensory, motor, and autonomic symptom score. Therefore, CIPN was found to have debilitating effect on QoL.
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39
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Tamburin S, Park SB, Schenone A, Mantovani E, Hamedani M, Alberti P, Yildiz-Kabak V, Kleckner IR, Kolb N, Mazzucchelli M, McNeish BL, Argyriou AA, Cavaletti G, Hoke A. Rehabilitation, exercise, and related non-pharmacological interventions for chemotherapy-induced peripheral neurotoxicity: Systematic review and evidence-based recommendations. Crit Rev Oncol Hematol 2022; 171:103575. [PMID: 34968623 PMCID: PMC10658987 DOI: 10.1016/j.critrevonc.2021.103575] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/22/2022] Open
Abstract
Pharmacological strategies for chemotherapy-induced peripheral neurotoxicity (CIPN) are very limited. We systematically reviewed data on rehabilitation, exercise, physical therapy, and other physical non-pharmacological interventions and offered evidence-based recommendations for the prevention and treatment of CIPN. A literature search using PubMed, Web of Science and CINAHL was conducted from database inception until May 31st, 2021. 2791 records were title-abstract screened, 71 papers were full-text screened, 41 studies were included, 21 on prevention and 20 on treatment of CIPN. Treatment type, cancer type, chemotherapy compounds were heterogeneous, sample size was small (median: N = 34) and intention-to-treat analysis was lacking in 26/41 reports. Because of the methodological issues of included studies, the reviewed evidence should be considered as preliminary. Exercise, endurance, strength, balance, and sensorimotor training have been studied in low-to-moderate quality studies, while the evidence for other treatments is preliminary/inconclusive. We offer recommendation for the design of future trials on CIPN.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Italy; IRCCS San Martino Hospital, Genoa, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mehrnaz Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Vesile Yildiz-Kabak
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Noah Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | | | - Brendan L McNeish
- Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ahmet Hoke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Recent advances in managing chemotherapy-induced peripheral neuropathy: A systematic review. Eur J Oncol Nurs 2022; 58:102134. [DOI: 10.1016/j.ejon.2022.102134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022]
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Park SB, Tamburin S, Schenone A, Kleckner IR, Velasco R, Alberti P, Kanzawa-Lee G, Lustberg M, Dorsey SG, Mantovani E, Hamedani M, Argyriou AA, Cavaletti G, Hoke A. Optimal outcome measures for assessing exercise and rehabilitation approaches in chemotherapy-induced peripheral-neurotoxicity: Systematic review and consensus expert opinion. Expert Rev Neurother 2022; 22:65-76. [PMID: 34894974 PMCID: PMC8963967 DOI: 10.1080/14737175.2022.2018300] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Chemotherapy-induced peripheral neurotoxicity (CIPN) remains a significant toxicity in cancer survivors without preventative strategies or rehabilitation. Exercise and physical activity-based interventions have demonstrated promise in reducing existing CIPN symptoms and potentially preventing toxicity, however there is a significant gap in evidence due to the lack of quality clinical trials and appropriate outcome measures. AREAS COVERED We systematically reviewed outcome measures in CIPN exercise and physical rehabilitation studies with expert panel consensus via the Peripheral Nerve Society Toxic Neuropathy Consortium to provide recommendations for future trials. Across 26 studies, 75 outcome measures were identified and grouped into 16 domains within three core areas - measures of manifestations of CIPN (e.g. symptoms/signs), measures of the impact of CIPN and other outcome measures. EXPERT OPINION This article provides a conceptual framework for CIPN outcome measures and highlights the need for definition of a core outcome measures set. The authors provide recommendations for CIPN exercise and physical rehabilitation trial design and outcome measure selection. The development of a core outcome measure set will be critical in the search for neuroprotective and treatment approaches to support cancer survivors and to address the gap in the identification of effective rehabilitation and treatment options for CIPN.
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Affiliation(s)
- Susanna B. Park
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Sydney, Australia,Corresponding author: Susanna Park, Address: Brain and Mind Centre, The University of Sydney, Camperdown NSW 2050, Australia, Telephone: +61 2 9351 0932,
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa Italy,IRCCS San Martino, Genoa, Italy
| | - Ian R. Kleckner
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Roser Velasco
- Neurology Department, Neuro-Oncology Unit-IDIBELL, Hospital Universitari de Bellvitge-Institut Català d’Oncologia L’Hospitalet, 08907 Barcelona, Spain,Department of Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 08193 Bellaterra, Spain
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Grace Kanzawa-Lee
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Maryam Lustberg
- Yale Breast Center and Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Susan G. Dorsey
- Department of Pain & Translational Symptom Science, University of Maryland, Baltimore, Baltimore Maryland USA
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mehrnaz Hamedani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa Italy
| | - Andreas A. Argyriou
- Department of Neurology, “Saint Andrew’s” State General Hospital of Patras, Patras, Greece
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Ahmet Hoke
- Johns Hopkins School of Medicine, Department of Neurology, Baltimore, Maryland, USA
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Mezzanotte JN, Grimm M, Shinde NV, Nolan T, Worthen-Chaudhari L, Williams NO, Lustberg MB. Updates in the Treatment of Chemotherapy-Induced Peripheral Neuropathy. Curr Treat Options Oncol 2022; 23:29-42. [PMID: 35167004 PMCID: PMC9642075 DOI: 10.1007/s11864-021-00926-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with treatment with platinum-based agents, taxanes, vinca alkaloids, and other specific agents. The long-term consequences of this condition can result in decreased patient quality of life and can lead to reduced dose intensity, which can negatively impact disease outcomes. There are currently no evidence-based preventative strategies for CIPN and only limited options for treatment. However, there are several strategies that can be utilized to improve patient experience and outcomes as more data are gathered in the prevention and treatment setting. Before treatment, patient education on the potential side effects of chemotherapy is key, and although trials have been limited, recommending exercise and a healthy lifestyle before and while undergoing chemotherapy may provide some overall benefit. In patients who develop painful CIPN, our approach is to offer duloxetine and titrate up to 60 mg daily. Chemotherapy doses may also need to be reduced if intolerable symptoms develop during treatment. Some patients may also try acupuncture and physical therapy to help address their symptoms, although this can be limited by cost, time commitment, and patient motivation. Additionally, data on these modalities are currently limited, as studies are ongoing. Overall, approaching each patient on an individual level and tailoring treatment options for them based on overall physical condition, their disease burden, goals of care and co-morbid health conditions, and willingness to trial different approaches is necessary when addressing CIPN.
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Affiliation(s)
- Jessica N. Mezzanotte
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Room 334B, Columbus, OH 43210
| | - Michael Grimm
- The Ohio State University Comprehensive Cancer Center, 460 W. 10th Avenue, Columbus, OH 43210
| | - Namrata V. Shinde
- Department of Radiology, The Ohio State University Wexner Medical Center, 395 W 12th Avenue, Columbus, OH 43210
| | - Timiya Nolan
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210
| | - Lise Worthen-Chaudhari
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, 480 Medical Center Drive, Dodd Hall, Suite 1060, Columbus, OH 43210
| | - Nicole O. Williams
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, 1800 Cannon Drive, 1310K Lincoln Tower, Columbus, OH 43210
| | - Maryam B. Lustberg
- Smilow Cancer Hospital/Yale Cancer Center, 35 Park Street, New Haven, CT 06519
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Streckmann F, Balke M, Cavaletti G, Toscanelli A, Bloch W, Décard BF, Lehmann HC, Faude O. Exercise and Neuropathy: Systematic Review with Meta-Analysis. Sports Med 2021; 52:1043-1065. [PMID: 34964950 DOI: 10.1007/s40279-021-01596-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Peripheral neuropathies are a prevalent, heterogeneous group of diseases of the peripheral nervous system. Symptoms are often debilitating, difficult to treat, and usually become chronic. Not only do they diminish patients' quality of life, but they can also affect medical therapy and lead to complications. To date, for most conditions there are no evidence-based causal treatment options available. Research has increased considerably since the last review in 2014 regarding the therapeutic potential of exercise interventions for patients with polyneuropathy. OBJECTIVE Our objective in this systematic review with meta-analysis was to analyze exercise interventions for neuropathic patients in order to update a systematic review from 2014 and to evaluate the potential benefits of exercise on neuropathies of different origin that can then be translated into practice. METHODS Two independent reviewers performed a systematic review with meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Inclusion criteria according to the PICOS approach were: neuropathic patients, exercise interventions only, an inactive or non-exercising control group, and solely randomized controlled trials with the following outcome parameters: neuropathic symptoms, balance parameters, functional mobility, gait, health-related quality of life, and HbA1c (glycated hemoglobin). RESULTS A total of 41 randomized, controlled trials met all inclusion criteria, 20 of which could be included in the quantitative analysis. Study quality varied from moderate to high. Current data further support the hypothesis that exercise is beneficial for neuropathic patients. This is best documented for patients with diabetic peripheral neuropathy (DPN) (27 studies) as well as for chemotherapy-induced peripheral neuropathy (CIPN) (nine studies), while there are only few studies (five) on all other causes of neuropathy. We found standardized mean differences in favor of the exercise group of 0.27-2.00 for static balance, Berg Balance Scale, Timed-up-and-go-test, nerve conduction velocity of peroneal and sural nerve as well as for HbA1c in patients with DPN, and standardized mean differences of 0.43-0.75 for static balance, quality of life, and neuropathy-induced symptoms in patients with CIPN. CONCLUSION For DPN, evidence-based recommendations can now be made, suggesting a combination of endurance and sensorimotor training to be most beneficial. For patients with CIPN, sensorimotor training remains the most crucial component. For all other neuropathies, more high-quality research is needed to derive evidence-based recommendations. Overall, it seems that sensorimotor training has great potential to target most neuropathies and combined with endurance training is therefore currently the best treatment option for neuropathies. REGISTRATION NUMBER: (PROSPERO 2019 CRD42019124583)/16.04.2019.
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Affiliation(s)
- Fiona Streckmann
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland. .,Department of Oncology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - Maryam Balke
- Department of Early Neurological and Interdisciplinary Rehabilitation, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany.,Department of Rehabilitation Sciences, University of Witten/Herdecke, Holthauser Talstraße 2, 58256, Ennepetal, Germany
| | - Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900, Monza, Italy
| | - Alexandra Toscanelli
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
| | - Wilhelm Bloch
- Institute for Cardiovascular Research and Sports Medicine, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Bernhard F Décard
- Department of Medicine, Neurologic Clinic and Policlinic, University Hospital Basel and University of Basel, 4031, Basel, Switzerland.,Department of Biomedicine, Neurologic Clinic and Policlinic, University Hospital Basel and University of Basel, 4031, Basel, Switzerland.,Department of Clinical Research, Neurologic Clinic and Policlinic, University Hospital Basel and University of Basel, 4031, Basel, Switzerland
| | - Helmar C Lehmann
- Department of Neurology, University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Grosse Allee 6, 4052, Basel, Switzerland
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Sealy MJ, Stuiver MM, Midtgaard J, van der Schans CP, Roodenburg JLN, Jager-Wittenaar H. Perception and Performance of Physical Activity Behavior after Head and Neck Cancer Treatment: Exploration and Integration of Qualitative and Quantitative Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:287. [PMID: 35010547 PMCID: PMC8751059 DOI: 10.3390/ijerph19010287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
Maintaining or increasing physical activity (PA) may prevent loss of muscle mass and strength after completion of head and neck cancer (HNC) treatment. However, the exercise level of HNC patients may not meet PA guidelines. We aimed to explore HNC survivors' views on PA, their report of PA, and to compare these with objectively measured PA. Combined qualitative and quantitative data of HNC survivors were explored post-treatment. Data from semi-structured interviews, questionnaires, and objective measurements of PA were collected, analyzed, and integrated. This resulted in the identification of five themes related to prioritizing, day-to-day life, intention, positive feelings, and social support, respectively, in nine HNC survivors (male: n = 5; age: 52-67 years). Objectively measured PA levels were sedentary to low. The lack of intention to increase PA may be related to HNC survivors' perception that their current activity level is sufficient, despite low levels of measured PA. While some participants feel they need no help with PA, others are insecure about possible harms. Healthcare professionals may be able to help improve PA in HNC survivors with a tailored approach that reduces fear of harm and helps to incorporate higher intensity PA in daily activities.
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Affiliation(s)
- Martine J. Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; (C.P.v.d.S.); (H.J.-W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands;
| | - Martijn M. Stuiver
- Center for Quality of Life, Department of Head and Neck Surgery and Oncology, Division of Psychosocial Oncology and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 AZ Amsterdam, The Netherlands
| | - Julie Midtgaard
- Mental Health Services in the Capital Region of Denmark, Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, DK-2600 Glostrup, Denmark;
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Cees P. van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; (C.P.v.d.S.); (H.J.-W.)
- Department of Rehabilitation Medicine and Department of Health Psychology Research, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Jan L. N. Roodenburg
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands;
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; (C.P.v.d.S.); (H.J.-W.)
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands;
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Zhang YH, Hu HY, Xiong YC, Peng C, Hu L, Kong YZ, Wang YL, Guo JB, Bi S, Li TS, Ao LJ, Wang CH, Bai YL, Fang L, Ma C, Liao LR, Liu H, Zhu Y, Zhang ZJ, Liu CL, Fang GE, Wang XQ. Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus. Front Med (Lausanne) 2021; 8:756940. [PMID: 34901069 PMCID: PMC8654102 DOI: 10.3389/fmed.2021.756940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/25/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. Design: A systematic review and expert consensus. Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five–ten years.
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Affiliation(s)
- Yong-Hui Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hao-Yu Hu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China
| | - Yuan-Chang Xiong
- Department of Pain Therapy, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Changgeng Peng
- The First Rehabilitation Hospital of Shanghai, Brain and Spinal Cord Innovation Research Center, School of Medicine, Advanced Institute of Translational Medicine, Tongji University, Shanghai, China
| | - Li Hu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Ya-Zhuo Kong
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yu-Ling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Bao Guo
- The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
| | - Sheng Bi
- Rehabilitation Medicine Centre, Chinese PLA General Hospital, Beijing, China
| | - Tie-Shan Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Juan Ao
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Chu-Huai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Fang
- School of Rehabilitation Science, Shanghai University of T.C.M., Shanghai, China
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin-Rong Liao
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Hao Liu
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Yi Zhu
- Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Chun-Long Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-En Fang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China
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Liampas A, Hadjigeorgiou L, Nteveros A, Ioannou C, Varrassi G, Zis P. Adjuvant physical exercise for the management of painful polyneuropathy. Postgrad Med 2021; 134:458-462. [PMID: 34779342 DOI: 10.1080/00325481.2021.2004733] [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: 10/19/2022]
Abstract
INTRODUCTION Physical exercise appeared to be effective, when implemented as an adjuvant to the pharmacotherapy option, in a variety of painful conditions. Peripheral neuropathic pain (PNP) is very prevalent and affects up to two-thirds of individuals with polyneuropathy (PN), regardless of etiology. The aim of this systematic review was to evaluate the currently available studies that assess adjuvant physical exercise for the management of PNP. METHODS A systematic literature search was conducted in the PubMed international database. For the systematic search, three medical subject headings (MeSH) were used. Term A was 'physical exercise' OR 'exercise' OR 'activity' OR 'workout' OR 'training'; term B was 'pain' OR 'painful'; term C was 'neuropathy' OR 'polyneuropathy.' Additionally, three filters were used: human subjects, English language, and full text. The reference lists of eligible papers and relevant reviews were also meticulously searched in order to include further relevant studies. Six papers eligible to be included were identified. RESULTS Physical exercise in various forms can be of benefit in the management of PNP when used as an adjuvant to the standard care. Overall, using the American Society of Interventional Pain Physicians (ASIPP) criteria, the current best available evidence exists for both aerobic and muscle strengthening exercise programs (level II evidence). The intensity of the exercise seems to play a significant role, with higher intensity interval training programs being more promising, though this remains to be confirmed in future studies. CONCLUSIONS Physical exercise is a promising non-pharmacological intervention for the management of PNP. Future RCTs should be conducted to make a face-to-face comparison of the available exercise treatments with the aim to design specific exercise programs for patients with PNP.
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Affiliation(s)
- Andreas Liampas
- Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | - Loizos Hadjigeorgiou
- Department of Surgery, General Hospital of Agios Nikolaos, Agios Nikolaos, Greece
| | | | | | | | - Panagiotis Zis
- Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus.,Medical School, University of Cyprus, Nicosia, Cyprus
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Maugeri G, D'Agata V, Trovato B, Roggio F, Castorina A, Vecchio M, Di Rosa M, Musumeci G. The role of exercise on peripheral nerve regeneration: from animal model to clinical application. Heliyon 2021; 7:e08281. [PMID: 34765794 PMCID: PMC8571504 DOI: 10.1016/j.heliyon.2021.e08281] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/26/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Peripheral nerve injury is a complex condition with a variety of signs and symptoms depending on the severity and nerves involved. Peripheral nerve damage may lead to sensory and motor functions deficits and even lifelong disability, causing important socioeconomic costs worldwide. Despite the increase in knowledge of the mechanisms of injury and regeneration, a full functional recovery is still unsatisfying in the majority of patients. It is well known that exercise promotes physical and psychological well-being, by ameliorating general health. In the last years, there has been a growing interest in evaluating the effects of exercise on the peripheral nervous system. Experimental works with rodent models showed the potential utility of exercise following peripheral nerve injuries, as evinced by increasing axon regeneration, muscle reinnervation, better recovery of strength, muscle mass and higher expression of neurotrophic factors. Moreover, clinical evidence showed positive trends in favour of physical therapy following peripheral nerve damage based on the improvement of range of motion (ROM), muscle power grade and pain. After a brief overview of peripheral nerve anatomy and the different types of nerve injury, the present review aims to summarize the impact of exercise on peripheral nerve regeneration. Some clinical evidence regarding the effect of exercise after peripheral nerve injury will also be discussed.
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Affiliation(s)
- Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy
| | - Velia D'Agata
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy
| | - Bruno Trovato
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Federico Roggio
- Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy
| | - Alessandro Castorina
- Laboratory of Cellular and Molecular Neuroscience (LCMN), School of Life Sciences, Faculty of Science, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.,Laboratory of Neural Structure and Function (LNSF), School of Medical Sciences, (Anatomy & Histology), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Michele Vecchio
- Unit of Rehabilitation, Vittorio Emanuele University Hospital, Catania, Italy
| | - Michelino Di Rosa
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human, Histology and Movement Science Section, University of Catania, Via S. Sofia n°87, 95123, Catania, Italy.,Research Center on Motor Activities (CRAM), University of Catania, Via S. Sofia n°97, 95123, Catania, Italy.,Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, 19122, USA
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48
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Grusdat NP, Stäuber A, Tolkmitt M, Schnabel J, Schubotz B, Schulz H. Routine Cancer Treatment Regimens and Its Impact on Fine Motor Dexterity in Breast Cancer. Oncol Res Treat 2021; 45:37-44. [PMID: 34644712 DOI: 10.1159/000519829] [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: 06/22/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breast cancer can be a major challenge for those affected. Knowledge of changes in fine motor dexterity in affected women due to routine cancer therapies can help guide effective support. METHODS For this prospective observational study, we collected data of 79 women with a mean age 54.6 ± 9.5 years prior to, after breast cancer therapy (T1), and at 3-month follow-up. The fine motor dexterity was assessed for 4 treatment subgroups: SC = Surgery + Chemotherapy, SCR = Surgery + Chemotherapy + Radiotherapy Therapy, SR = Surgery + Radiotherapy, and S = Surgery. RESULTS Over time, women with breast cancer showed significant decreases in fine motor dexterity across all treatment groups (p < 0.001). The strongest negative effect was seen in the treatment groups receiving additional chemotherapy. SCR group showed pronounced limitations for dominant hand (DH) -12%; non-dominant hand (NDH) -15%; both hands (BH) -17%; assembly (ASSY) -11% at T1. Significant interaction was noticeable in DH (F = 5.59, p < 0.001), NDH (F = 6.61, p < 0.001), BH (F = 13.11 p < 0.001), and ASSY (F = 5.84 p < 0.001). DISCUSSION/CONCLUSION Our study showed that the extent of change in fine motor dexterity depends on the treatment regimen. The detection of unmet care needs could help to personalize and optimize clinical and survivorship care. Based on our findings, multidisciplinary support initiated early in breast cancer therapy is required.
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Affiliation(s)
- Niklas Paul Grusdat
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Alexander Stäuber
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
| | - Marion Tolkmitt
- Deutsches Rotes Kreuz Krankenhaus Chemnitz-Rabenstein, German Red Cross Hospital, Chemnitz, Germany
| | - Jens Schnabel
- Deutsches Rotes Kreuz Krankenhaus Chemnitz-Rabenstein, German Red Cross Hospital, Chemnitz, Germany
| | - Birgit Schubotz
- Tumorzentrum Chemnitz e.V., Clinical Cancer Registry Chemnitz, Chemnitz, Germany
| | - Henry Schulz
- Professorship of Sports Medicine/Sports Biology, Chemnitz University of Technology, Chemnitz, Germany
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Zhang S. Chemotherapy-induced peripheral neuropathy and rehabilitation: A review. Semin Oncol 2021; 48:193-207. [PMID: 34607709 DOI: 10.1053/j.seminoncol.2021.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication after chemotherapy that can damage the sensory, motor, autonomic, or cranial nerves in approximately 30%-60% of patients with cancer. CIPN can lead to detrimental dose modifications and/or premature chemotherapy discontinuation due to patient intolerance. The long-term impact of CIPN is particularly challenging and can have a profound impact on the quality of life (QoL) and survivorship. However, this condition is often underdiagnosed. No agents have been established to prevent CIPN. Pre-chemotherapy testing is recommended for high-risk patients. Duloxetine is considered a first-line treatment, whereas gabapentin, pregabalin, tricyclic antidepressants, and topical compounding creams may be used for neuropathic pain control. Home-based, low-to-moderate walking, and resistance exercise during chemotherapy can reduce the severity and prevalence of CIPN symptoms, especially in older patients. Pre-habilitation and rehabilitation should be recommended for all patients receiving cytotoxic chemotherapies. The purpose of this article is to review common chemotherapeutic drugs causing CIPN, risk factors, diagnosis and treatment of CIPN, and evidence of the benefits of rehabilitation.
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Affiliation(s)
- Shangming Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey medical Center, Hershey, PA.
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50
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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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