TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.

PURPOSE: Arthralgias occur in up to 50% of women with breast cancer treated with adjuvant aromatase inhibitors (AIs), and are one of the most common reasons for poor adherence to therapy. We examined whether a year-long exercise program improves arthralgias in breast cancer survivors taking AIs. METHODS: Postmenopausal women diagnosed with hormone receptor-positive breast cancer were identified via the Connecticut Tumor Registry. Women who were taking an AI for at least 6-months and reported ≥ 3 out of 10 on the worst joint pain item of the Brief Pain Inventory-Short Form (BPI) were eligible and randomized to either exercise (150 min/wk of moderate-intensity aerobic exercise and twice-weekly supervised resistance exercise sessions) or usual care. The BPI questionnaire was completed at baseline, 6- and 12-months. VO2 max testing and Dual Energy X-ray Absorptiometry (DEXA) scans were also collected at baseline, 6- and 12-months. The primary outcome was change in BPI worst joint pain score between 0 and 12 months. We performed intent-to-treat statistical analyses including analysis of covariance, where each participant's change in outcome was modeled as a function of randomization group RESULTS: Out of 728 women screened that were taking an AI, we randomized 121 women, with 61 women randomized to exercise and 60 women randomized to usual care. Baseline characteristics were comparable between the two groups. Over 12 months, women randomized to exercise attended, on average, 80% ± 14% of the twice-weekly supervised resistance training exercise sessions and participated in an average 146 ± 75 min/wk of at least moderate-intensity aerobic exercise. Worst joint pain scores decreased by 20% at 12 months among women randomized to exercise vs. a 3% decrease among women randomized to usual care (p = .017). Joint pain severity also decreased significantly in exercise vs. usual care groups (p = 0.025), as well as joint pain-related interference (p = 0.005). The exercise intervention also favorably impacted body weight (p = 0.0057) and cardiorespiratory fitness (p = 0.024). Baseline to 12 month changes in BPI joint pain scores (mean (SD)) Baseline Values  Change from baseline to 12 months  BPI ItemExercisersUsual Carep-valueExercisersUsual Carep-valueWorst Pain5.5 (1.9)5.9 (1.9)0.29-1.1 (2.5)-0.2 (1.6)0.017Pain Severity3.9 (1.6)4.3 (1.8)0.27-0.8 (2.1)0.0 (1.5)0.025Pain Interference2.8 (2.1)2.9 (2.3)0.81-0.8 (2.0)0.2 (1.9)0.005Body weight (kg)80.9 (16.8)74.6 (14.5)0.11-3.5 (6.0)0.1 (3.7)0.0057VO2max (ml/kg/min)23.5 (4.8)23.1 (4.3)0.751.9 (1.9)0.4 (2.7)0.024 CONCLUSION: We found that participating in an exercise intervention led to clinically meaningful improvements in AI-induced arthralgias in breast cancer survivors experiencing moderate joint pain. The intervention also induced favorable changes in body weight and cardiorespiratory fitness, factors that may be linked to incidence and severity of AI-induced arthralgias. Further work is needed to determine whether exercise leads to increased AI adherence and possibly better outcomes in women with breast cancer. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-03.

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BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is one of the major dose-limiting side effects in breast cancer patients, with up to 97% of patients receiving an adjuvant taxane experiencing this symptom in the months and years after breast cancer treatment. CIPN often leads to loss of physical function; difficulties in activities of daily living and decreased of quality of life (QOL). Few effective interventions have been developed to alleviate CIPN in this patient population. We conducted a pilot randomized controlled trial to assess the feasibility, safety and preliminary effect of an acupuncture intervention on CIPN in breast cancer survivors. METHODS: Patients with stage I-III breast cancer who were experiencing CIPN after the completion of a taxane-containing adjuvant chemotherapy regimen were enrolled and randomized 1:1 to immediate participation in an acupuncture intervention or to a delayed intervention control group. Participants randomized to the acupuncture arm received 18 sessions of a standardized acupuncture protocol over 8 weeks while the control group received a lower-dose acupuncture protocol consisting of 9 acupuncture sessions over 8 weeks, after the initial 8-week control period. Measures including the Patient Neurotoxicity Questionnaire (PNQ), Functional Assessment of Cancer Therapy Neurotoxicity subscale (FACT-NTX), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-induced Peripheral Neuropathy 20 (EORTC QLQ-CIPN20) were collected at baseline and at 8 weeks after enrollment. RESULTS: A total of 40 patients were enrolled; 20 were randomized to the immediate acupuncture group and 20 to control. All enrolled patients were female, median age was 54, median time between enrollment and completion of chemotherapy was 14.3 months, and 72.5% of participants were White. Thirty-two patients (84%) completed at least 80% of the required sessions. No serious acupuncture-related side effects were observed. Participants randomized to the acupuncture arm experienced improvements in the PNQ sensory score (p=0.02), FACT-NTX summary score (p=0.002) and EORTC QLQ-CIPN20 score (p=0.006), respectively equivalent to 40%, 36% and 53% improvement in CIPN symptoms, as compared to controls. MeasurementsTime pointsAcupunctureUsual CareP-valueNMeanSDMeanSDPNQ summary sensory score (0-4)Baseline202.50.82.50.90.97Changes at 8 week15-1.00.9-0.30.60.02FACT-NTX summary score (0-44)Baseline2025.08.422.19.40.40Changes at 8 week159.09.21.25.40.002EORTC QLQ-CIPN20 sensory score (0-100)Baseline2044.919.945.022.30.93Changes at 8 week15-23.818.1-5.16.40.006 CONCLUSIONS: Women with CIPN after adjuvant taxane therapy for early breast cancer experienced a significant and clinically meaningful improvement in neuropathy symptoms as a result of an 8-week acupuncture protocol. Given the prevalence of taxane-induced neuropathy in women treated for early breast cancer, acupuncture could significantly improve QOL and functional status of thousands of women treated for breast cancer every year. Larger studies are needed to confirm these findings and evaluate the impact of acupuncture on functional measures in women with CIPN. Citation Format: Lu W, Giobbie-Hurder A, Freedman R, Yung R, Lin N, Partridge A, Shockro L, Stecker K, O'Connor KA, Rosenthal DS, Ligibel JA. Acupuncture for chemotherapy-induced peripheral neuropathy in breast cancer, preliminary results of a pilot randomized controlled trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD4-01.