Targeting Taxane-Induced NeuropathyWith Exercise

Constance Visovsky PhD, RN, APRN-NP Associate Dean of Student Affairs &

Director Community EngagementJim Bovaird, PhD

StatisticianUniversity of Nebraska-Omaha

Background• The use of taxanes in breast cancer chemotherapy regimens is

considered standard first line therapy.

• 50%-60% of all patients who receive taxanes will develop chemotherapy-induced peripheral neuropathy (CIPN).

• Clinical manifestations include pain; numbness, tingling, diminished proprioception, and decreased vibration and touch sensation.

• CIPN remains a significant toxicity and no evidence-based preventative or treatment strategies are available

• The sensory and motor neuron dysfunction accompanying taxane chemotherapy interferes with physical functioning, impairs quality of life and can be disabling.

Purpose

To use a 2-group RCT to pilot test a 16-weekhome- based combination aerobic/resistanceexercise program for reducing symptoms of

chemotherapy-induced peripheral neuropathy in a convenience sample of 19 women receiving taxane-based chemotherapy for

breast cancer.

Physiological Framework

• Taxanes induce sensory and motor neuropathy by impairing axon structure and function.

• Loss of peripheral nerve vasculature and mitochondrial dysfunction follow.

• Results in neuropathic pain and functional impairment.

Study Design

• Two group, randomized clinical trial• 19 women with Stage I-IIIa breast cancer

receiving taxane-based chemotherapy were randomly assigned to either an aerobic and resistance training exercise program or an attention control group.

Attention Control Group Detailed Guide: Breast CancerWhat Happens After Treatment for Breast Cancer?

Completing Treatment can be both stressful and exciting. You will be relieved to finish treatment, yet it is hard not to worry about cancer coming back. (When cancer returns, it is called recurrence.) This is a very common concern among those who have had cancer. For ore information on this please refer to the separate American Cancer Society document, Living With Uncertainty: The Fear of Cancer Recurrence. It may take a while before your confidence in your own recovery begins to feel real and your fears are somewhat relieved. Even with no recurrences, people who have had cancer learn to live with uncertainty.  It is important to keep medical insurance. Even though no one wants to think of their cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment. Should your cancer come back the American Cancer Society document, When Your Cancer Comes Back: Cancer Recurrences gives you information on how to manage and cope with this phase of your treatment. You can get this document by calling 1-800-ACS-2345.

HOPE StudyDaily Planner

Features of the Intervention• Pedometer, exercise bands:

• Exercise Guide : DVD using peer models demonstrating the performance of the exercises

• Exercise Diary : record of the type of exercise band used, the number sets and repetitions done, steps/distance and the number of exercise sessions per week

Exercise Intervention Aerobic Exercise: Walking 30 min daily

Strength Training Exercises:–Arm Flexion–Arm Extension–Hip Flexion –Hip Extension–Leg Extension–Ankle Plantar and Dorsiflexion

Exercise Diary

Exercise Diary Date:

     

 Sunday

 Monday

 Tuesday

Example:Bicep Curls

 5lb/12reps/2sets

   

Warm-up/Cool Down

  

  

  

 Bicep Curls

Y / G / R / B Reps/ Sets Reps / Sets

Y / G / R / B Reps/ Sets Reps / Sets

Y / G / R / B Reps/ Sets Reps / Sets

TricepsPress

Y / G / R / B Reps / Sets

Y / G / R / B Reps / Sets

Y / G / R / B Reps / Sets

Straight Leg Raises Y / G / R / B Reps / Sets Reps / Sets

Y / G / R / B Reps / Sets Reps / Sets

Y / G / R / B Reps / Sets Reps / Sets

LegExtension

Y / G / R / B Reps / Sets

Y / G / R / B Reps / Sets

Y / G / R / B Reps / Sets

Knee Extension Y / G / R / B Reps / Sets Reps / Sets

Y / G / R / B Reps / Sets Reps / Sets

Y / G / R / B Reps / Sets Reps / Sets

Ankle Plantarflexion Y / G / R / B Reps / Sets

Y / G / R / B Reps / Sets

Y / G / R / B Reps / Sets

Exertion Level (0-10)

  

  

  

Example: Walking

 Mile/ Steps/ Time

0.25miles/ 1200steps/ 8 minutes  Mile/ Steps/Time

 Walking

 Mile/ Steps/ Time

 Mile/Steps/ Time

 Mile/Steps/ Time

Exertion Level (0-10)

     

Sample Characteristics (n =19)

Age 48.8 (range 24-65)

Race

Caucasian 16 (84.2%)

African American 2(11%)

Asian 1 (5.3%)

Employed 15 (78.9%)

Other Illnesses 8 (42.3%)

Married or Partnered 13 (68.4%)

Surgery Type

Neoadjuvant 5 (26.3%)

Lumpectomy 8 (42.1%)

Mastectomy 6 (31.6%)

Disease Stage

Stage I 9 (47.4%)

Stage II 7 (36.8%)

Stage III 2 (10.5%)

Data Collection

Data collection: baseline, 4, 8, 12, 16 and 24 weeks (2 months post-intervention)

Instruments• Neuropathy symptoms & QOL: (FACT-

Taxane) Likert scale: 0 (not at all) - 4 (very much)

• Gait & Balance (Timed Get Up and Go)

• Muscle strength (Dynamometry)

Data AnalysisA general linear mixed (GLM) modeling

was utilized to:• evaluate the effect of the

intervention (aerobic and resistance

exercises) on change in outcomes at post

intervention (16 weeks)

• at follow-up (24 weeks after the start of taxane chemotherapy).

Results: Neuropathy Symptoms

Results: Quality of Life

Results: Gait & Balance

Results: Muscle Strength

Conclusions

• CIPN remains a significant dose-limiting toxicity of many chemotherapy regimens.

• No gold-standard for the prevention or treatment of CIPN exists.

Conclusions

• Combination of aerobic and resistive exercise was feasible and effective in reducing neuropathic symptoms, improving gait & balance, specified areas of muscle strength, and QOL related to CIPN in women with breast cancer.

• Exercise is a promising intervention that can be easily applied to ambulatory cancer patients under treatment.

Thank You!