Rehabilitation, exercise, and related non-pharmacological interventions for chemotherapy-induced peripheral neurotoxicity: Systematic review and evidence-based recommendations

What do the data say about chemotherapy-induced peripheral neuropathy assessment and management?

“…Many non-pharmacological agents and interventions have been tested, and only physical exercise (particularly endurance training) has demonstrated modest benefit in preventing CIPN based on moderate evidence. 7 , 8 Sensorimotor (balance) training may be explored for the prevention and management of CIPN based on its safety and moderate-level evidence of its efficacy in improving CIPN symptoms and balance. 8 Regular screening for patient physical activity can be operationalized with tools such as the Physical Activity Vital Sign.…”

“… 7 , 8 Sensorimotor (balance) training may be explored for the prevention and management of CIPN based on its safety and moderate-level evidence of its efficacy in improving CIPN symptoms and balance. 8 Regular screening for patient physical activity can be operationalized with tools such as the Physical Activity Vital Sign. 9 Further, assessing for functional and balance disturbances can inform whether an individual requires referral to a physical therapist or clinical exercise physiologist.…”

“…Despite the lack of evidence, cryotherapy is increasingly observed in the infusion setting; thus, clinicians must be alert and ensure that cryotherapy is only used for patients receiving paclitaxel or docetaxel, as use of cryotherapy during platinum-based chemotherapy (eg., oxaliplatin) could cause further harm. 8 Several other non-pharmacological interventions not supported for the prevention or treatment of CIPN include neurofeedback, electrical stimulation, massage therapy. 8 Non-pharmacological interventions that are currently under study for the prevention or treatment of CIPN, but require further evidence to demonstrate efficacy, include yoga, acupuncture, and transcutaneous electrical nerve stimulation.…”

Wearables, sensors, and smart devices for the detection and monitoring of chemotherapy‐induced peripheral neurotoxicity: Systematic review and directions for future research

“…According to recently published guidelines, there is only a modest recommendation for the treatment of painful CIPN with duloxetine 12 . Rehabilitation, exercise, physical therapy, and other non‐pharmacological approaches have been tested for CIPN, but studies are generally of low quality and data should be cautiously considered 13‐15 . The only strategy to reduce CIPN symptoms is lowering the planned dose of chemotherapy or even discontinuation, which should consider cancer and patient factors and may have a negative effect on survival 7 …”

“…12 Rehabilitation, exercise, physical therapy, and other non-pharmacological approaches have been tested for CIPN, but studies are generally of low quality and data should be cautiously considered. [13][14][15] The only strategy to reduce CIPN symptoms is lowering the planned dose of chemotherapy or even discontinuation, which should consider cancer and patient factors and may have a negative effect on survival. 7 Delays in CIPN detection, leading to more severe neurotoxicity, increase the risk of irreversible effects that negatively influence long-term QoL and health outcomes.…”