Aerobic exercise may reduce chemotherapy-induced peripheral neuropathy in ovarian cancer
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Key takeaways:
- Women assigned a 6-month intervention reported decreased chemotherapy-induced peripheral neuropathy symptoms.
- Women in the control group reported a slight increase in symptoms.
A 6-month aerobic exercise intervention significantly improved self-reported chemotherapy-induced peripheral neuropathy among women who underwent chemotherapy for ovarian cancer, according to study results published in JAMA Network Open.
Researchers suggested incorporating referrals to exercise programs into standard oncology care to reduce chemotherapy-induced peripheral neuropathy (CIPN) symptoms and improve patients’ quality of life.
Rationale and methodology
Ovarian cancer is the leading cause of gynecologic cancer mortality.
More than 90% of patients undergo extensive surgery and chemotherapy, according to Anlan Cao, MBBS, researcher in the department of chronic disease epidemiology at Yale School of Public Health.
“The quality of life of ovarian cancer survivors is generally low due to symptoms associated with cancer and its treatment, including CIPN,” Cao told Healio. “As many as 70% of patients with ovarian cancer may experience CIPN symptoms, such as numbness in feet, [or] pain and tingling sensations in extremities during or after chemotherapy treatment.
“Yet, there is limited research focusing on interventions to improve this very common side effect of chemotherapy treatment in this understudied patient population,” Cao added. “Exercise has shown promise in alleviating CIPN in observational studies, but evidence from randomized controlled trials was needed to assess this relationship more fully.”
Cao and colleagues performed a prespecified secondary analysis of data from the randomized phase 3 Women’s Activity and Lifestyle Study in Connecticut (WALC).
The analysis included 134 women (median age, 57.5 years; 94.8% white; mean time since diagnosis, 1.7 years) with ovarian cancer who underwent chemotherapy.
Sixty-nine women participated in a 6-month aerobic exercise intervention that included 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. The other 65 women received attention control, which consisted of weekly health education telephone calls from a WALC staff member.
Investigators used a mixed-effects model to assess the 6-month change in CIPN between the intervention and control groups. Change in CIPN served as the primary outcome.
Findings
At baseline, researchers observed mean CIPN scores of 8.1 in the exercise intervention group vs. 8.8 in the attention control group.
After completion of their assigned regimen, results showed a 1.3-point (95% CI, 2.3 to 0.2) reduction in self-reported score in the exercise group, and a 0.4% (95% CI, 0.8 to 1.5) increase in the control group. This equated to a between-group difference of 1.6 points (95% CI, 3.1 to 0.2).
The overall treatment effect appeared greater among the 127 study participants who reported CIPN symptoms at baseline (2; 95% CI, 3.6 to 0.5).
The CIPN components reported as most improved by participants in the intervention group included discomfort in feet, joint pain or muscle cramps, and overall weak feeling.
Study limitations included an inability to generalize findings to diverse populations. Researchers also noted the need for replication of the findings in other ovarian cancer trials with CIPN as the primary outcome.
Implications
“Ovarian cancer survivors themselves can help manage CIPN, which could in turn improve their quality of life,” Cao told Healio. “There is something they can do to improve their symptoms — exercise. We recommend incorporating referral to exercise programs as the standard of oncology care for patients with ovarian cancer to help manage [CIPN].”
The WALC research team has initiated another NCI-funded trial to assess the effect of a lifestyle intervention during chemotherapy treatment among patients with newly diagnosed ovarian cancer.
“In this new trial, we will be able to further assess the effect of exercise on not just treating but also preventing CIPN,” Cao said. “Implementation science research is also needed to understand how to better incorporate lifestyle interventions as a part of oncology care to benefit more cancer survivors.”
For more information:
Anlan Cao, MBBS, can be reached at anlan.cao@yale.edu.
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