Background
To explore the impact of acupuncture with other complementary and integrative medicine (CIM) modalities on chemotherapy‐induced peripheral neuropathy (CIPN) and quality of life (QoL) in ...oncology patients.
Methods
In this prospective, pragmatic, and patient‐preference study, patients with CIPN were treated with acupuncture and CIM therapies (intervention group) or standard care alone (controls) for 6 weeks. Patients in the intervention arm were randomized to twice‐weekly acupuncture‐only (group A) or acupuncture with additional manual‐movement or mind–body CIM therapies (group B). Severity of CIPN was assessed at baseline and at 6 weeks using the Functional Assessment of Cancer Therapy‐Taxane (FACT‐Tax) tool. Other QoL‐related outcomes were assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC); and the Measure Yourself Concerns and Well‐being questionnaire. Von Frey measurements examined perception thresholds.
Results
Of 168 participants, 136 underwent the study intervention (group A, 69; group B, 67), with 32 controls. Baseline‐to‐6‐week assessment scores improved significantly in the intervention arm (vs controls) on FACT‐Tax (p = .038) and emotional well‐being (p = .04) scores; FACT‐TAX scores for hand numbness/tingling (p = .007) and discomfort (p < .0001); and EORTC physical functioning (p = .045). Intervention groups A and B showed improved FACT‐Tax physical well‐being (p < .001), FACT‐TAX total score (p < .001), FACT‐TAX feet discomfort (p = .003), and EORTC pain (p = .017) scores.
Conclusions
Acupuncture, with or without CIM modalities, can relieve CIPN‐related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
Acupuncture, with or without additional complementary medicine modalities, can relieve chemotherapy‐induced peripheral neuropathy–related symptoms during oncology treatment. This is most pronounced for hand numbness, tingling, pain, discomfort, and for physical functioning.
Purpose
To assess the safety, dosing, and preventive effects of cannabidiol (CBD) on chemotherapy-induced peripheral neuropathy (CIPN) in patients receiving oxaliplatin- or paclitaxel-based ...chemotherapy.
Methods
Patients with cancer scheduled to undergo treatment with carboplatin and paclitaxel (Carbo-Tax) or capecitabine and oxaliplatin (CAPOX) received 150 mg CBD oil twice daily (300 mg/daily) for 8 days beginning 1 day before initiation of chemotherapy. Ten CIPN-specific patient-reported outcome (PRO) measures were captured at baseline and each day after the first cycle of chemotherapy for 8 days. Multi-frequency vibrometry (MF-V) was captured at baseline and day 4 ± 1 after initiation of chemotherapy. Controls were obtained from a similar patient cohort that did not receive CBD. Adverse events were captured using the CTCAE ver. 4.03.
Results
From March to December 2021, 54 patients were recruited. CBD-treated patients were significantly older (
p
= 0.013/0.037, CAPOX/Carbo-Tax) compared to controls. Patients receiving CBD and CAPOX or Carbo-Tax showed significantly lower (better) change in
Z
-scores in high-frequency MF-V (125 and 250 Hz) compared to controls. This difference was most pronounced for patients receiving Carbo-Tax (− 1.76, CI-95 = − 2.52; − 1.02 at 250 Hz). CAPOX patients treated with CBD had significantly lower peak baseline-adjusted difference in three PRO items on cold sensitivity to touch, discomfort swallowing cold liquids, and throat discomfort (− 2.08, − 2.06, and − 1.81, CI-95 = − 3.89; − 0.12, NRS 0–10). No significant differences in PRO items were found for patients receiving Carbo-Tax. Possible side effects included stomach pain (grades 1–2) for patients receiving CAPOX.
Conclusion
CBD attenuated early symptoms of CIPN with no major safety concerns. Long-term follow-up is ongoing. Results should be confirmed in a larger, randomized study.
Trial registration number
NCT 04,167,319 (U.S National Library of Medicine; ClinicalTrials.gov). Date of registration: November 18, 2019.
Objectives
The two aims of this systematic review and meta‐analysis were to (1) analyze the effect of exercise on chemotherapy‐induced peripheral neuropathy (CIPN) severity and (2) determine the best ...type of exercise for the management of CIPN.
Methods
We systematically searched the MEDLINE, WOS, Sportdiscus, Scopus, and Cochrane databases from inception to December 2020 for experimental studies addressing the effect of exercise on CIPN severity, as measured by symptom severity (SSS) and peripheral deep sensitivity (PDS). The DerSimonian and Laird method was used to compute pooled estimates of the standardized mean differences (SMDs) and its respective 95% confidence intervals (CIs). Subgroup analyses were performed based on the types of exercise and the frequency and length of the interventions.
Results
Thirteen studies were included in this meta‐analysis. In the analyses comparing exercise interventions versus controls, there was an improvement in the SSS (SMD = −0.21; 95% CI: −0.40 to −0.01; %change: −20.34%) and the PDS (SMD = 0.49; 95% CI: 0.06 to 0.91; %change: 31.64%) in favor of the intervention group. In the pre–post analyses, there was an improvement in the SSS (SMD = −0.72; 95% CI: −1.10 to −0.34; %change: −15.65%) and the PDS (SMD = 0.47; 95% CI: 0.15 to 0.79; %change:18.98%).
Conclusions
This meta‐analysis provides an overview of the evidence supporting exercise as a suitable intervention to reduce the severity of CIPN by reducing the severity of the symptoms and the peripheral deep sensitivity among patients with cancer or cancer survivors. Furthermore, sensoriomotor training and mind–body exercises appear to be more effective in reducing symptom severity, and active nerve‐specific exercises and mind–body exercises seem to be more effective in improving peripheral deep sensitivity.
Background
Chemotherapy‐induced peripheral neuropathy (CIPN) is one of the most debilitating long‐term side effects in breast cancer survivors. We conducted a randomized controlled pilot trial to ...assess the feasibility, safety, and effects of an acupuncture intervention on CIPN in this population.
Patients and Methods
Women with stage I–III breast cancer with grade 1 or higher CIPN after taxane‐containing adjuvant chemotherapy were randomized 1:1 to an immediate acupuncture (IA) arm or to a waitlist control group (CG). Participants in the IA arm received 18 sessions of acupuncture over 8 weeks, then received no additional acupuncture. Patients in the CG arm received usual care over 8 weeks, followed by nine sessions of acupuncture over 8 weeks. Measures including Patient Neurotoxicity Questionnaire (PNQ), Functional Assessment of Cancer Therapy—Neurotoxicity subscale (FACT‐NTX), and Brief Pain Inventory—short form (BPI‐SF) were collected at baseline and at 4, 8, and 16 weeks after enrollment.
Results
Forty women (median age, 54) were enrolled (20 to IA and 20 to CG), with median time between completion of chemotherapy and enrollment of 14 months (range 1–92). At 8 weeks, participants in the IA arm experienced significant improvements in PNQ sensory score (−1.0 ± 0.9 vs. −0.3 ± 0.6; p = .01), FACT‐NTX summary score (8.7 ± 8.9 vs. 1.2 ± 5.4; p = .002), and BPI‐SF pain severity score (−1.1 ± 1.7 vs. 0.3 ± 1.5; p = .03), compared with those in the CG arm. No serious side effects were observed.
Conclusion
Women with CIPN after adjuvant taxane therapy for breast cancer experienced significant improvements in neuropathic symptoms from an 8‐week acupuncture treatment regimen. Additional larger studies are needed to confirm these findings.
Implications for Practice
Chemotherapy‐induced peripheral neuropathy (CIPN) is a toxicity that often persists for months to years after the completion of adjuvant chemotherapy for early breast cancer. In a randomized pilot trial of 40 breast cancer survivors with CIPN, an 8‐week acupuncture intervention (vs. usual care) led to a statistically and clinically significant improvement in subjective sensory symptoms including neuropathic pain and paresthesia. Given the lack of effective therapies and established safety profile of acupuncture, clinicians may consider acupuncture as a treatment option for mild to moderate CIPN in practice.
Chemotherapy‐induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy. This article describes results of a study that evaluated the feasibility and benefits of acupuncture in breast cancer survivors with CIPN symptoms.
Featured Cover Willows, Jake W.; Robinson, Morganne; Alshahal, Zahra ...
Aging cell,
April 2023, Letnik:
22, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Cover legend: The cover image is based on the Research Article Age‐related changes to adipose tissue and peripheral neuropathy in genetically diverse HET3 mice differ by sex and are not mitigated by ...rapamycin longevity treatment by Jake W. Willows et al., https://doi.org/10.1111/acel.13784.
Objective
To evaluate the course of chemotherapy‐induced peripheral neuropathy (CIPN) among patients with ovarian cancer receiving taxanes.
Methods
In a retrospective case–control study conducted ...between January 1, 2016, and May 31, 2018, in Xiangya Hospital in Changsha, China, women with ovarian cancer received taxane and platinum‐complex combination therapy. The European Organization for Research and Treatment of Cancer Quality of Life, Ovarian cancer module questionnaire, was used to assess the severity of neuropathy by telephone.
Results
Out of the 88 women included in the study, 61 (69.3%) reported CIPN. Twelve months after chemotherapy, the percentage was 19.3%. The percentage of patients suffering from sensory peripheral neuropathy (SPN) was higher than motor peripheral neuropathy at any time during the study. Sensory peripheral neuropathy was associated with the use of docetaxel and paclitaxel (docetaxel vs liposomal paclitaxel: odds ratio OR 4.39, 95% confidence interval CI 1.69–11.42, P<0.01; paclitaxel vs liposomal paclitaxel: OR 5.91, 95% CI 1.09–31.97, P=0.04). The average weakness score in acute CIPN was lower than chronic CIPN (1.46 vs 2.00, P=0.019). Patients treated with vitamin B1 and amifostine experienced better relief from CIPN.
Conclusion
The present study showed a significant proportion of patients with ovarian cancer receiving taxanes suffered from long‐term residual neuropathy, and the use of docetaxel and paclitaxel was associated with SPN. Vitamin B1 or amifostine may improve the symptoms of CIPN.
A significant proportion of patients with ovarian cancer receiving taxanes suffered from long‐term residual neuropathy.
This review provides an update on the current clinical and preclinical understanding of chemotherapy induced peripheral neuropathy (CIPN). The overview of the clinical syndrome includes a review of ...its assessment, diagnosis and treatment. CIPN is caused by several widely-used chemotherapeutics including paclitaxel, oxaliplatin, bortezomib. Severe CIPN may require dose reduction, or cessation, of chemotherapy, impacting on patient survival. While CIPN often resolves after chemotherapy, around 30% of patients will have persistent problems, impacting on function and quality of life. Early assessment and diagnosis is important, and we discuss tools developed for this purpose. There are no effective strategies to prevent CIPN, with limited evidence of effective drugs for treating established CIPN. Duloxetine has moderate evidence, with extrapolation from other neuropathic pain states generally being used to direct treatment options for CIPN. The preclinical perspective includes a discussion on the development of clinically-relevant rodent models of CIPN and some of the potentially modifiable mechanisms that have been identified using these models. We focus on the role of mitochondrial dysfunction, oxidative stress, immune cells and changes in ion channels from summary of the latest literature in these areas. Many causal mechanisms of CIPN occur simultaneously and/or can reinforce each other. Thus, combination therapies may well be required for most effective management. More effective treatment of CIPN will require closer links between oncology and pain management clinical teams to ensure CIPN patients are effectively monitored. Furthermore, continued close collaboration between clinical and preclinical research will facilitate the development of novel treatments for CIPN.
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