Download Targeting Taxane-Induced NeuropathyWith Exercise

Targeting Taxane-Induced
NeuropathyWith Exercise
Constance Visovsky PhD, RN, APRN-NP
Associate Dean of Student Affairs &
Director Community Engagement
Jim Bovaird, PhD
Statistician
University 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-week
home- based combination aerobic/resistance
exercise 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 Cancer
What 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 Study
Daily 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
Example:
Bicep Curls
Warm-up/
Cool Down
Monday
Tuesday
Y/G/R/B
Reps/ Sets
Reps / Sets
Y/G/R/B
Reps / Sets
5lb/12reps/2sets
Y/G/R/B
Triceps
Press
Straight Leg Raises
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps/ Sets
Reps / Sets
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps / Sets
Reps / Sets
Y/G/R/B
Reps / Sets
Reps / Sets
Y/G/R/B
Reps / Sets
Reps / Sets
Leg
Extension
Knee Extension
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps / Sets
Reps / Sets
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps / Sets
Reps / Sets
Y/G/R/B
Reps / Sets
Y/G/R/B
Reps / Sets
Reps / Sets
Y/G/R/B
Reps / Sets
Bicep Curls
Ankle Plantarflexion
Reps/ Sets
Reps / Sets
Exertion Level
(0-10)
0.25miles/ 1200steps/ 8 minutes
Example:
Walking
Mile/ Steps/ Time
Walking
Mile/ Steps/ Time
Exertion Level
(0-10)
Mile/ Steps/Time
Mile/Steps/ Time
Mile/Steps/ Time
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: (FACTTaxane) Likert scale: 0 (not at all) - 4 (very much)
• Gait & Balance (Timed Get Up and Go)
• Muscle strength (Dynamometry)
Data Analysis
A 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!