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Hammond E1, Shay B2, Pitz M3,4
1University of Manitoba, Human Anatomy and Cell Science, Winnipeg, Canada, 2University of Manitoba, Physical Therapy, Winnipeg, Canada, 3University of Manitoba, Internal Medicine, Winnipeg, Canada, 4Research Institute in Oncology and Hematology, Winnipeg, Canada
Background: Taxanes (Docetaxel or Paclitaxel) are widely used chemotherapeutic agents for the treatment of many solid tumors that prevent tumor growth through microtubule stabilizing mechanisms. A common side effect is chemotherapy induced peripheral neuropathy (CIPN). CIPN is a small fibre sensory neuropathy that develops in the hands/feet and worsens with increasing dose and duration of treatment. It impacts the Aβ, Aδ, and C-Fiber function involved in light touch and vibration sense, thermal detection and thermal pain. This results in a variety of positive and/or negative sensory symptoms including hypoesthesia, dysesthesias, hyperalgesia, allodynia and neuropathic pain. The majority of patients receiving chemotherapy experience CIPN, 60% continue to have symptoms months after chemotherapy is complete and 25% experience severe sensory disturbances for years post-treatment (Hershman et al., 2011; Park et al., 2011). CIPN symptom severity has been reported to cause dose reduction or treatment delay in 10% of individuals (Seretny et al., 2014). At present, there are few effective treatment options for CIPN.
Purpose: To evaluate a physical therapy nerve gliding home program during chemotherapy for the prevention and management of CIPN using quantitative sensory testing (QST).
Methods: Single blind (blinded assessor) randomized controlled pilot study compared standard care to a nerve specific physical therapy home program throughout chemotherapy. Patient questionnaires and QST were used to evaluate the treatment effect of these exercises for the hands on 4 reassessment visits: 1) midway through chemotherapy, 2) post chemotherapy, 3) 3 months post chemotherapy and 4) 6 months post chemotherapy). QST further identified whether sensory impairments were present between surgical and non-surgical side. Treatment consisted of three appointments with a physical therapist to develop an upper extremity nerve gliding home program. The control group received standard chemotherapy.
Results: Stage I-III patients with breast cancer (n=48) were included in analysis. The 11-point numeric pain rating scale (NPRS) was converted to a binomial value of no pain (0/10) or 1/10 and higher. 30% of participants in the treatment group had pain scores >1 compared to 49% in the control group. Using logistic mixed models for binary outcomes the treatment group had less pain (OR 0.41, 95% confidence 0.17-1.01; p=0.05) and pain decreased over time (OR 0.85, 95% CI 0.76-0.94; p=0.002). Using Linear mixed models predicted for continuous outcomes, pain pressure thresholds (p=0.03) and grip dynamometry (p>0.0001) were improved in the treatment group. Inconsistent results between left and right surgical side countered the hypothesis that sensory differences would be evident between the surgical and non-surgical side.
Conclusion(s): Physical therapy and nerve gliding home exercises during and after chemotherapy improves CIPN pain and maintains function in the upper extremity for patients with breast cancer. Surgical tumor excision prior to chemotherapy was not found to be a contributing risk factor for severity of CIPN symptoms on the surgical side.
Implications: This study helps support a role for physical therapy post-operatively and throughout chemotherapy in improving quality of life for patients with breast cancer. A neural gliding and range of motion home program assists in improving pain during chemotherapy.
Keywords: Chemotherapy Induced Peripheral Neuropathy (CIPN), Physical Therapy, Nerve Gliding
Funding acknowledgements: CancerCare Manitoba Foundation (CCMF)
Purpose: To evaluate a physical therapy nerve gliding home program during chemotherapy for the prevention and management of CIPN using quantitative sensory testing (QST).
Methods: Single blind (blinded assessor) randomized controlled pilot study compared standard care to a nerve specific physical therapy home program throughout chemotherapy. Patient questionnaires and QST were used to evaluate the treatment effect of these exercises for the hands on 4 reassessment visits: 1) midway through chemotherapy, 2) post chemotherapy, 3) 3 months post chemotherapy and 4) 6 months post chemotherapy). QST further identified whether sensory impairments were present between surgical and non-surgical side. Treatment consisted of three appointments with a physical therapist to develop an upper extremity nerve gliding home program. The control group received standard chemotherapy.
Results: Stage I-III patients with breast cancer (n=48) were included in analysis. The 11-point numeric pain rating scale (NPRS) was converted to a binomial value of no pain (0/10) or 1/10 and higher. 30% of participants in the treatment group had pain scores >1 compared to 49% in the control group. Using logistic mixed models for binary outcomes the treatment group had less pain (OR 0.41, 95% confidence 0.17-1.01; p=0.05) and pain decreased over time (OR 0.85, 95% CI 0.76-0.94; p=0.002). Using Linear mixed models predicted for continuous outcomes, pain pressure thresholds (p=0.03) and grip dynamometry (p>0.0001) were improved in the treatment group. Inconsistent results between left and right surgical side countered the hypothesis that sensory differences would be evident between the surgical and non-surgical side.
Conclusion(s): Physical therapy and nerve gliding home exercises during and after chemotherapy improves CIPN pain and maintains function in the upper extremity for patients with breast cancer. Surgical tumor excision prior to chemotherapy was not found to be a contributing risk factor for severity of CIPN symptoms on the surgical side.
Implications: This study helps support a role for physical therapy post-operatively and throughout chemotherapy in improving quality of life for patients with breast cancer. A neural gliding and range of motion home program assists in improving pain during chemotherapy.
Keywords: Chemotherapy Induced Peripheral Neuropathy (CIPN), Physical Therapy, Nerve Gliding
Funding acknowledgements: CancerCare Manitoba Foundation (CCMF)
Topic: Musculoskeletal: upper limb; Pain & pain management; Oncology, HIV & palliative care
Ethics approval required: Yes
Institution: University of Manitoba - Department of Physical Therapy
Ethics committee: Health Research Ethics Board (HREB)
Ethics number: H:2014:281
All authors, affiliations and abstracts have been published as submitted.
