Cancer-Related Peripheral
Neuropathy
Exercise can potentially improve symptoms of cancer-related peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a potential adverse treatment effect of many chemotherapeutic agents, most commonly taxanes, platinums and vinca alkaloids. Incidence rates are not clearly defined, but are reported to be approximately 40 percent across all cancer types when multiple agents are used and as high as 80 to 90 percent when undergoing treatment in some cancer subtypes.1-3

CIPN can increase costs and decrease compliance

CIPN has been associated with higher rates of falls, demonstrated recently in a 2016 report in JAMA Neurology,4 where individuals affected by cancer with symptomatic CIPN were found to have almost three times the fall rate of their asymptomatic counterparts.

This study found that not only did CIPN increase fall risk, but that CIPN-related falls were associated with increased utilization of health care resources.4 A 2017 study in the Journal of Clinical Oncology examined the prevalence of CIPN in 512 women with cancer. It found that almost 50 percent still experienced symptoms up to six years post-treatment with symptomatic survivors being almost twice as likely to fall when compared to asymptomatic counterparts.5

With a $30,000+ average cost per fall injury, these numbers can have a substantial impact on both patients’ quality of life and individual and societal cost burdens.6

CIPN may cause disruptions in the medical treatment schedule, including chemotherapy dose reductions and/or early discontinuation, thus potentially compromising patient outcomes and survival.7

Exercise shown to attenuate symptoms of CIPN

While the mechanism still isn’t fully understood, recent studies have provided evidence that exercise can help attenuate the symptoms of CIPN.

  1. A 2018 phase III randomized control trial found that engaging in exercise appears to reduce CIPN symptoms in adults who receive taxane-, platinum- or vinca alkaloid-based chemotherapy.

    For the 355 participants, exercise significantly reduced their symptoms of hot/coldness in hands/feet (-0.46 units, p = 0.045), and numbness and tingling (-0.42 units, p = 0.061) compared to the control group. The results were strongest among an older population.8 Another study of individuals with multiple cancer types with CIPN, tested multimodal exercise and found an improvement in balance, mobility and quality of life.9
  2. In another exercise-based study, 50 women with breast cancer who were experiencing CIPN were given a 10-week, home-based exercise program. Following 10 weeks of exercise, the women reported experiencing less unpleasant skin sensations, feeling less abnormally sensitive to touch and a reduction in pain coming on suddenly in bursts for no apparent reason (p =0.05).
  3. By engaging in the recommended 150 minutes of physical activity, a large registry study found that adults with cancer were more likely to have lessened CIPN symptoms and have a better quality of life than adults who were less active. 10
ReVital is a Leader in Cancer Rehabilitation

We have a common goal—to improve your patients’ quality of life. As oncologists, your focus is on life-saving medical interventions. As cancer rehabilitation therapists, our focus is to support you and your patients by helping to restore their function and quality of life.

With cancer’s complex nature, a deep understanding of it and its various treatment interventions, as well as the potential adverse effects on the body, is required to achieve optimal physical and functional outcomes with cancer survivors. ReVital therapists are licensed and specially-trained in oncology rehabilitation. They understand the unique challenges patients face in undergoing cancer treatment. Our therapists have extensive clinical training certifications, developed in conjunction with some of the top researchers in the field of cancer rehabilitation. Additionally, the ReVital training program includes competencies designed to ensure the highest quality care and requires ongoing education to continue building therapists’ base of knowledge and skills that align with the most current research. Together we can partner to help all cancer survivors live well beyond cancer.

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References
  1. Hershman DL, Lacchetti C, Loprinzi CL. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline Summary. J Oncol Pract. 2014;10(6):e421-e424.
  2. Hershman DL, Weimer LH, Wang A, et al. Association between patient reported outcomes and quantitative sensory tests for measuring long-term neurotoxicity in breast cancer survivors treated with adjuvant paclitaxel chemotherapy. Breast Cancer Res Treat. 2011;125(3):767-774.
  3. Beijers A, Mols F, Dercksen W, Driessen C, Vreugdenhil G. Chemotherapy-induced peripheral neuropathy and impact on quality of life 6 months after treatment with chemotherapy. J Community Support Oncol. 2014;12(11):401-406.
  4. Kolb NA, Smith AG, Singleton JR, et al. The association of chemotherapy-induced peripheral neuropathy symptoms and the risk of falling. JAMA neurology. 2016;73(7):860-866.
  5. Winters-Stone KM, Horak F, Jacobs PG, et al. Falls, functioning, and disability among women with persistent symptoms of chemotherapy-induced peripheral neuropathy. Journal of Clinical Oncology. 2017;35(23):2604.
  6. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults - United States. J Safety Res. 2016;58:99-103.
  7. Flatters SJL, Dougherty PM, Colvin LA. Clinical and preclinical perspectives on Chemotherapy-Induced Peripheral Neuropathy (CIPN): a narrative review. BJA: British Journal of Anaesthesia. 2017;119(4):737-749..
  8. Kleckner IR, Kamen C, Gewandter JS, et al. Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Supportive Care in Cancer. 2018;26(4):1019-1028.
  9. McCrary JM, Goldstein D, Sandler CX, et al. Exercise-based rehabilitation for cancer survivors with chemotherapy-induced peripheral neuropathy. Supportive Care in Cancer. 2019.
  10. Mols F, Beijers AJ, Vreugdenhil G, Verhulst A, Schep G, Husson O. Chemotherapy-induced peripheral neuropathy, physical activity and health-related quality of life among colorectal cancer survivors from the PROFILES registry. Journal of Cancer Survivorship. 2015;9(3):512-522.