Neuromuscular training reduces chemotherapy-induced neuropathy and improves patient outcomes

In a recent study published in JAMA Internal Medicine, researchers examine 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 Trial. Image Credit: nimito / Shutterstock.com

What is CIPN?

CIPN, a frequent side effect of chemotherapy treatment, causes loss of feeling, tingling, dysesthesia, pain, and balance, which subsequently leads to unsteady walking and falls. Dose reductions, treatment delays, or medication termination, all of which can be used to mitigate CIPN, can negatively impact the survival of cancer patients.

To date, there is no effective preventative against CIPN. Nevertheless, exercise and neuromuscular stimulation therapies, such as whole-body vibrations (WBV) and sensorimotor training (SMT), have successfully addressed the sensory and motor symptoms of CIPN and reduced the frequency of falls and injuries.

About the study

The current study included adults receiving chemotherapeutic agents like vinca alkaloids or oxaliplatin in Germany. Study participants were recruited between May 2014 and November 2020, and all data were analyzed through June 2021.

Any individuals with pre-existing neuropathy, previous therapies, contraindications for WBV, angina pectoris, myocardial infarction, or cardiovascular disease within six months before study initiation were excluded from the analysis.

Study participants were randomized to the SMT, WBV, or treatment as usual (TAU) groups, which comprised 55, 53, and 50 patients, respectively. In addition to standard care, the intervention group underwent supervised WBV or SMT twice weekly for 15-30 minutes.

The primary outcome was CIPN incidence. CIPN incidence and severity were determined using clinical nerve conduction tests, including vibration sensitivity, deep tendon reflexes, sensation of location, touch of legs and feet, calf muscle strength, motor and sensory nerves, and subjective symptom severity as determined by the Medical Research Council’s test battery. The study participants also completed the Functional Assessment of Cancer Therapy/Gynecology Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire.

Secondary outcomes included the duration of medicinal therapy, subjective neuropathy symptomatology, physical activity, balance control, clinical results, neuropathic pain, safety analysis, and life quality. The Freiburger Physical Activity Questionnaire was used to assess physical exercise levels, whereas the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30) and Pain-DETECT questionnaires were used to assess life quality and neuropathic pain, respectively.

Patients were evaluated before chemotherapy and 12 weeks and 10 days after their final treatment. Longer therapy durations resulted in an interim analysis at week 12 and a review within ten days.

Study findings

Among the 158 participants, the mean age was 49, 59% of whom were male. The incidence of CIPN was significantly lower among intervention recipients compared to controls, at 30%, 41%, and 71% for SMT, WBV, and TAU recipients, respectively.

Individuals who underwent SMT exhibited the greatest improvement in Achilles tendon reflex, vibration sensitivity, sensation of touch, and calf muscle strength as compared to the TAU and WBV groups. Patients using vinca alkaloids benefited the most from SMT and WBV treatments.

Reduced mortality in the SMT group was statistically significant as compared to the TAU group. SMT outperformed TAU in terms of monopedal and bipedal balance control with participant eyes open or closed, vibration sensitivity, calf muscle strength, touch sensing, burning sensation, pain reduction, chemotherapy dosage decrease, and mortality.

SMT recipients had fewer dosage reductions than the TAU and WBV groups. Patients in the SMT group also reported significantly lower pain and burning sensation (VAS) scores than those in the WBV or TAU groups.

There were seven adverse events recorded, one of which was significant; however, none of these events were associated with CIPN procedures.

Conclusions

SMT and WBV can reduce the onset of CIPN by 50-70%, with SMT recipients experiencing the greatest benefit. Patients who received vinca alkaloids were more amenable to these treatments, particularly when paired with SMT.

Thus, SMT may be the most appropriate therapeutic option for CIPN, as it appears to improve patient quality of life. Furthermore, SMT significantly affects oncological treatment, as these patients required fewer dosage reductions, experienced lower death rates, and engaged in more physical activity.

The study findings support the hypothesis that the human neuromuscular system may sustain relevant brain functions, even during chemotherapy, if used regularly and trained at maximal progression.