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Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial

Supportive Care in Cancer volume 26, pages 1019–1028 (2018)Cite this article

Abstract

Purpose

Over half of all cancer patients receiving taxane-, platinum-, or vinca alkaloid-based chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN), which includes numbness, tingling, pain, cold sensitivity, and motor impairment in the hands and feet. CIPN is a dose-limiting toxicity, potentially increasing mortality. There are no FDA-approved drugs to treat CIPN, and behavioral interventions such as exercise are promising yet understudied. This secondary analysis of our nationwide phase III randomized controlled trial of exercise for fatigue examines (1) effects of exercise on CIPN symptoms, (2) factors that predict CIPN symptoms, and (3) factors that moderate effects of exercise on CIPN symptoms.

Methods

Cancer patients (N = 355, 56 ± 11 years, 93% female, 79% breast cancer) receiving taxane-, platinum-, or vinca alkaloid-based chemotherapy were randomized to chemotherapy or chemotherapy plus Exercise for Cancer Patients (EXCAP©®). EXCAP is a standardized, individualized, moderate-intensity, home-based, six-week progressive walking and resistance exercise program. Patients reported CIPN symptoms of numbness and tingling and hot/coldness in hands/feet (0–10 scales) pre- and post-intervention. We explored baseline neuropathy, sex, age, body mass index, cancer stage, and cancer type as possible factors associated with CIPN symptoms and exercise effectiveness.

Results

Exercise reduced CIPN symptoms of hot/coldness in hands/feet (−0.46 units, p = 0.045) and numbness and tingling (− 0.42 units, p = 0.061) compared to the control. Exercise reduced CIPN symptoms more for patients who were older (p = 0.086), male (p = 0.028), or had breast cancer (p = 0.076).

Conclusions

Exercise appears to reduce CIPN symptoms in patients receiving taxane-, platinum-, or vinca alkaloid-based chemotherapy. Clinicians should consider prescribing exercise for these patients.

Trial registration

Clinical Trials.gov, # NCT00924651, http://www.clinicaltrials.gov.

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Acknowledgements

The authors would like to thank Drs. Susan Rosenthal and Amber Kleckner for their support on this project. We extend special thanks to the cancer patients, as well as the research staff in the University of Rochester Cancer Center NCORP Research Base at each of the NCI NCORP affiliates who recruited and followed participants in this study. We also thank the staff of the PEAK Human Performance Laboratory and the Cancer Control Psychoneuroimmunology Laboratory. We thank the National Cancer Institute and the Division of Cancer Prevention for their funding support of this project.

Funding

Funding was provided by the National Cancer Institute, including funds from NCORP (formerly CCOP) parent grant U10 CA037420, NCORP (formerly CCOP) supplement U10 CA037420, and R25 CA102618.

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Authors and Affiliations

  1. James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA

    Ian R. Kleckner, Charles Kamen, Jennifer S. Gewandter, Nimish A. Mohile, Charles E. Heckler, Eva Culakova, Chunkit Fung, Michelle C. Janelsins, Matthew Asare, Po-Ju Lin & Karen M. Mustian

  2. Cancer Control Center, Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., Box CU 420658, Rochester, NY, 14642, USA

    Ian R. Kleckner

  3. Wichita NCI Community Oncology Research Program (NCORP), Wichita, KS, USA

    Pavan S. Reddy

  4. Greenville NCORP, Greenville, SC, USA

    Jeffrey Giguere

  5. Hawaii NCORP, Honolulu, HI, USA

    Jeffrey Berenberg

  6. MD Anderson Cancer Center, Houston, TX, USA

    Shelli R. Kesler

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  1. Ian R. Kleckner
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  2. Charles Kamen
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Correspondence to Ian R. Kleckner.

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Kleckner, I.R., Kamen, C., Gewandter, J.S. et al. Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Support Care Cancer 26, 1019–1028 (2018). https://doi.org/10.1007/s00520-017-4013-0

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Keywords

  • CIPN
  • Exercise
  • Neuropathy