Post on 20-Jan-2016
description
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!