Argentine tango improves balance in cancer survivors with chemotherapy-induced peripheral neuropathy

The Argentine tango led to improvements in a biomechanical measure of fall risk in a small cohort of cancer survivors with chemotherapy-induced peripheral neuropathy, according to preliminary study results.

The analysis included 25 breast cancer survivors who reported chemotherapy-induced peripheral neuropathy symptoms at baseline and demonstrated postural sway outside the range of historical controls.

Lise Worthen-Chaudhari

Researchers assessed whether practicing the Argentine tango had an effect on biomechanical predictors of fall risk among these individuals. Participants were assigned to attend 1-hour Argentine tango sessions twice weekly for 10 weeks, and all participants attended at least 80% of intervention sessions.

The analysis included data from a historical control cohort of 29 breast cancer survivors tested before commencement of cancer treatment.

The amplitude of postural sway in frontal plane during quiet standing with eyes closed (RMSx) served as the primary outcome measure. Overall satisfaction with the intervention — measured by a 7-point Likert scale, in which a score of 1 equated to “very satisfied” — served as a secondary outcome.

Results showed RMSx changed from a mean 7.8 mm at baseline to a mean 4.7 mm at midpoint (P = .036) and 6.1 mm at study completion (P = .024). The mean overall satisfaction score was 1.6.

The data will be presented at The American College of Rehabilitation Medicine’s Annual Conference, which will be held Oct. 30-Nov. 4 in Chicago.

Lise Worthen-Chaudhari, MFA, MS, CCRC , associate director of the motion analysis and recovery laboratory and assistant professor of physical medicine and rehabilitation at The Ohio State University Comprehensive Cancer Center, spoke with HemOnc Today about the potential for Argentine tango to improve chemotherapy-induced peripheral neuropathy in cancer survivors.

Question: How did this study come about?

Answer: I was interested in trying the Argentine tango as a balance intervention for a while. A researcher from Emory University who studied the Argentine tango as an intervention for people with Parkinson’s disease found it improved their balance. If people with a severe disease like Parkinson’s could improve their balance with tango, I wondered if it would work for the balance issues patients with cancer experience during or after treatment.

Q: Were you surprised by the findings?

A: Yes, I did not expect it to work as well as it did. We tested balance using an existing outcome measure that is used clinically, and we used a biomechanical measure that has been shown to predict risk for falls. So, we had the standard clinical measure and we had a quantified biomechanical measure with which to assess balance. The clinical measure did not detect balance issues in any participant. However, of the 25 cancer survivors we tested, three survivors were identified as being at high risk for falls via the biomechanical measure, and this was corroborated by self-report. We asked participants if they were ever worried they would fall, and the survivors who were at high risk said they were worried. One survivor in the high-risk group reported “almost falling” every day.

Q: What are the potential benefits of Argentine tango for chemotherapy-induced peripheral neuropathy ?

A: Anyone who has or had peripheral neuropathy or who feels that they are having an issue with balance after chemotherapy treatment should have some form of rehabilitation or physical therapy. Once the patient has finished physical therapy, they should stay active. The Argentine tango is a wonderful way to stay active by attending a class twice per week with a partner or with friends, so they are partaking in something that is social, fun and active.

Mimi Lamantia, who designed a study that assessed whether the Argentine tango could help cancer survivors build strength and balance, dances with Tim Hickey, who suffered from peripheral neuropathy after cancer treatment.

Q: Can you describe how the Argentine tango helps patients improve their balance after treatment?

A: All of the literature on how to improve balance points to physical therapy as key. There is no pill or surgery that will fix balance. You have to move — in a way that might be hard — to see improvements. One type of functional movement that often is a focus of physical therapy is walking in different directions, including forward, backward and sidestepping. Argentine tango incorporates these walking directions in a gentle activity that does not cause exhaustion or extreme sweatiness. It is a great way to get a lot of repetition and a high dose of the types of movement that might complement physical therapy care while you get quality time with a loved one. The second way in which Argentine tango may improve balance is through the music. There is evidence that rhythmic auditory stimulation, or a beat, stimulates the auditory sensors of the brain and the motor units in the muscles to fire synchronously. When a song comes on and you cannot help but tap your foot, this seems to be a demonstration of the neural phenomenon linking what you hear to how you move. The auditory centers of the brain are stimulated in time with the music, and evidence shows our muscles are stimulated in synchrony with the brain, explaining that involuntary, rhythmic motion of your foot. Essentially, we believe the beat is potentiating muscle activity. The third way in which Argentine tango may help to improve balance is that social dancing lets us perform prescribed steps, but in our own way and time, so we have a chance to master movement intrinsically and more on our own terms.

Q: Is there a certain time during the course of treatment that is best for the patient to participate?

A: At this time, we do not know. A paper published in the journal Gait and Posture showed one chemotherapy session is enough to change a person’s central control of balance, seemingly even before they report symptoms of neuropathy. We need more study to find out if we can prevent the neuropathy or if our best chance is to focus on a quick recovery after chemotherapy is complete. We are hard at work on these questions. At this time, we do not have enough supporting evidence to say this should be standard of care. Satisfaction was very high among all involved in the class, so no harm will come from offering interventions like this.

Q: Do certain patients benefit more than others?

A: There are certain types of chemotherapy agents that are more likely to trigger peripheral neuropathy. However, all chemotherapy and radiation can cause fatigue and weakness, so efforts to keep the body strong or get the body strong again are needed for survivors of all ages and with all cancer types. – by Jennifer Southall

For more information:

Lise Worthen-Chaudhari, MFA, MS, CCRC , can be reached at The Ohio State University Comprehensive Cancer Center and The Ohio State University Neurological Institute, 460 W. 10th Ave., Columbus, OH 43210.

Reference:

Monfort SM, et al. Gait Posture. 2016;doi:10.1016/j.gaitpost.2016.06.011.

Disclosure: Worthen-Chaudhari reports no relevant financial disclosures.