Physical exercise prevents nerve damage caused by chemotherapy
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Certain physical exercises may prevent nerve damage caused by chemotherapy among individuals being treated for cancer, results of a randomized study published in JAMA Internal Medicine showed.
As cancer therapies have improved in recent decades and more emphasis has been placed on quality of life for patients after receiving treatment, the results provide oncologists with a potential solution for those who develop chemotherapy-induced peripheral neuropathy (CIPN), according to researchers.
“Cancer, and its therapy alone, is a challenge for every patient. Many patients additionally suffer from the severe side effects of neuropathy — nerve damage due to chemotherapy — such as pain, numbness, gait or balance instability,” Fiona Streckmann, PhD, research associate at University of Basel and the German Sport University Cologne, told Healio.
“But this side effect not only affects their quality of life, it also influences their medical therapy as it can cause therapy alterations, [including] dose reductions or even termination,” she added. “Furthermore, it can impact their ability to work, the necessity for assistance in their activities of daily living, impact sleep quality, as well as cause additional health costs and medication.”
Background, methodology
CIPN is a clinically relevant adverse effect for some patients after chemotherapy that can negatively impact a patient’s quality of life for weeks, months or even years.
A current lack of options to treat CIPN can cause patients to change cancer therapies, sometimes also reducing survival.
Researchers conducted a prospective clinical trial to determine whether sensorimotor training and whole-body vibration training could reduce symptoms and decrease the onset of CIPN of patients undergoing treatment with oxaliplatin or vinca alkaloids.
The study included 158 patients (mean age, 49.1 years; 58.9% men) randomly assigned to one of three treatment groups over a 5-year period at four centers in or near Cologne, Germany.
Of the 158 total patients, 55 (34.8%) received sensorimotor training and 53 (33.5%) received whole-body vibration training twice a week for 15 to 30 minutes per session, while another 50 (31.6%) received standard treatment.
Incidence of CIPN served as the study’s primary endpoint, with secondary endpoints of subjective neuropathy symptoms, balance control, physical activity levels, quality of life and clinical outcome.
Results
Study participants who received either sensorimotor training (12 out of 40, 30%; 95% CI, 17.9-42.1) or whole-body vibration training (14 of 34, 41.2%; 95% CI, 27.9-54.5) had a significantly lower incidence of CIPN compared with the control group (24 of 34, 70.6%; 95% CI, 58-83.2).
Patients who received vinca alkaloids and performed sensorimotor training benefited the most among those in the study.
In per-protocol analysis, researchers noted more pronounced results in patients who achieved greater than 75% participation in the intervention, which included eight of 28 patients (28.6%; 95% CI, 16.6-40.5) in the sensorimotor cohort, nine of 24 (37.5%; 95% CI, 24.4-50.5) in the whole-body vibration training cohort and 22 of 30 (73.3%; 95% CI, 61.6-85.6) in the standard treatment cohort.
Noted improvements in favor of sensorimotor training over standard treatment included balance control, vibration sensitivity, sense of touch, lower leg strength, pain reduction, burning sensation, chemotherapy dose reductions and mortality.
Limitations acknowledged by the researchers include the study taking place during the COVID-19 pandemic, causing a delay in training and testing with a high dropout rate, incomplete data from the final five patients and some incomplete pain assessment information received from patients.
In an accompanying editorial, Arjun Gupta, MD, assistant professor and researcher at University of Minnesota, and colleagues pointed out potential flaws regarding the trial’s population pool, but still concluded that the results contribute to the ever-growing pile of data highlighting benefits of exercise and physical intervention among patients at risk for neuropathy.
“The STOP trial supports the use of supervised exercise and physical medicine programs in reducing the risk [for] incident CIPN while receiving chemotherapy,” they wrote. “As the evidence supporting these interventions grows, we must ensure that we have the capacity and incentives in place so patients can harness these benefits and live their fullest lives.”
Next steps
“We had assumed from our previous findings, that the exercise could have the potential to target relevant side effects,” Streckmann told Healio.
“We had hoped that we could keep the symptoms of CIPN to a minimum — [by reducing] the grade of CIPN — or postpone the onset so that patients could receive the planned therapy as long as possible,” she added. “We were surprised, however, that we were able to prevent it altogether in so many cases even with a clinically relevant impact — meaning patients who trained also had less dose reductions than the treatment-as-usual group.”
Future research will look toward other areas where such treatment could benefit patients with other diseases, Steckmann said.
“Specific exercises have high potential and are frequently underestimated. Exercise therapy is currently the most promising treatment option available for CIPN, with no additional side effects; it should therefore be implemented into supportive therapy,” she said. “Furthermore, patients can be empowered to contribute to their own health.”
References:
- Gupta A, et al. JAMA Intern Med. 2024;doi:10.1001./jamainternmed/2024.2367.
- Streckmann F, et al. JAMA Intern Med. 2024;doi:10.1001/jamainternmed.2024.2354.
For more information:
Fiona Streckmann, PhD, can be reached at fiona.streckmann@unibas.ch.
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Streckmann F, et al. JAMA Intern Med. 2024;doi:10.1001/jamainternmed.2024.2354.
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