Neuromuscular training reduces chemotherapy-induced neuropathy and improves patient outcomes

In a recently published study, JAMA Internal MedicineResearchers are investigating the potential of neuromuscular training to prevent chemotherapy-induced peripheral neuropathy (CIPN).

study: Preventive effect of neuromuscular training on chemotherapy-induced neuropathy: a randomized clinical trialImage credit: nimito / Shutterstock.com

What is CIPN?

CIPN is a common side effect of chemotherapy that can cause loss of sensation, tingling, paresthesias, pain, and loss of balance, resulting in unsteady walking and falls. Attempts to reduce CIPN, such as reducing dosage, delaying treatment, or stopping medication, can negatively impact survival in cancer patients.

To date, there is no effective preventive method for CIPN. However, exercise and neuromuscular stimulation therapies, such as whole-body vibration (WBV) and sensorimotor training (SMT), have effectively addressed the sensory and motor symptoms of CIPN and reduced the frequency of falls and injuries.

About the Research

The study included adults in Germany who were receiving chemotherapy drugs such as vinca alkaloids and oxaliplatin. Participants were recruited between May 2014 and November 2020, and all data were analyzed through June 2021.

Individuals who had pre-existing neurological disorders, previous treatments, contraindications to WBV, angina pectoris, myocardial infarction, or cardiovascular disease within 6 months prior to study initiation were excluded from the analysis.

Study participants were randomized into SMT, WBV, or treatment as usual (TAU) groups, consisting of 55, 53, and 50 patients, respectively. In addition to standard care, the intervention group received WBV or SMT under supervision for 15–30 minutes twice a week.

The primary outcome was the incidence of CIPN. Incidence and severity of CIPN was determined using clinical nerve conduction tests including vibration sensitivity, deep tendon reflexes, position sense, leg and foot touch, calf strength, motor and sensory nerves, and subjective symptom severity determined by the Medical Research Council battery of tests. Study participants also completed the Functional Assessment of Cancer Treatment/Gynaecological Oncology Group Neurotoxicity (FACT/GOG-Ntx) questionnaire.

Secondary endpoints included duration of drug therapy, subjective neuropathic symptoms, physical activity, balance control, clinical outcomes, neuropathic pain, safety analysis, and quality of life. The Freiburger Physical Activity Questionnaire was used to assess physical exercise level, while the European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30) questionnaire and the Pain-DETECT questionnaire were used to assess quality of life and neuropathic pain, respectively.

Patients were assessed before chemotherapy and at 12 weeks and 10 days after their last treatment. Due to the long duration of treatment, an interim analysis was performed at week 12 with a review within 10 days.

research result

The mean age of the 158 participants was 49 years, of whom 59% were men. The incidence of CIPN in those who received the intervention was significantly lower than in the control group: 30%, 41%, and 71% for SMT, WBV, and TAU, respectively.

Patients who received SMT showed the greatest improvements in Achilles tendon reflex, vibration sensitivity, touch, and calf muscle strength compared to the TAU and WBV groups. Patients who received vinca alkaloids benefited the most from SMT and WBV treatment.

The reduction in mortality in the SMT group was statistically significant compared to the TAU group. SMT outperformed TAU in participants' balance control during unipedal and bipedal walking with their eyes open and closed, vibration sensitivity, calf strength, touch, burning sensation, pain reduction, reduction in chemotherapy dose, and mortality.

The SMT group experienced less dose reduction than the TAU and WBV groups, and patients in the SMT group also reported significantly lower pain and burning sensation (VAS) scores than patients in the WBV and TAU groups.

Seven adverse events were recorded, one of which was serious, but none of these events were related to the CIPN procedure.

Conclusion

SMT and WBV can reduce the incidence of CIPN by 50-70%, with patients receiving SMT experiencing the greatest benefit. Patients receiving vinca alkaloids were more compliant with these treatments, especially when combined with SMT.

Therefore, SMT may be the most suitable treatment option for CIPN, as it appears to improve the quality of life of patients. Moreover, SMT has a significant impact on oncological care, as these patients have fewer medication reductions, lower mortality rates, and more physical activity.

The findings support the hypothesis that the human neuromuscular system may be able to maintain relevant brain functions even during chemotherapy if it is regularly used and trained to maximize its progress.