Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial.
Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial.
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DOI：
10.1007/s00520-017-4013-0
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发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Mustian KM
中科院分区：
文献类型：
--
作者：
Kleckner IR;Kamen C;Gewandter JS;Mohile NA;Heckler CE;Culakova E;Fung C;Janelsins MC;Asare M;Lin PJ;Reddy PS;Giguere J;Berenberg J;Kesler SR;Mustian KM
超过一半的接受紫杉烷、铂类或长春花碱化疗的癌症患者会出现化疗诱导的周围神经病变（CIPN），包括麻木、刺痛、疼痛、冷敏感性和手足运动障碍。CIPN是一种剂量限制性毒性，可能增加死亡率。目前还没有FDA批准的药物来治疗CIPN，而行为干预，如运动，是有希望的，但研究不足。我们的全国性III期疲劳运动随机对照试验的二次分析检查（1）运动对CIPN症状的影响，（2）预测CIPN症状的因素，（3）运动对CIPN症状影响的因素。接受基于紫杉烷、铂类或长春新碱的化疗的癌症患者（N=355，56±11岁，93%女性，79%乳腺癌）被随机分配至化疗或化疗加癌症患者运动组（EXCAP ® ®）。EXCAP是一项标准化、个性化、中等强度、以家庭为基础的六周渐进式步行和阻力锻炼计划。患者在干预前和干预后报告了麻木和刺痛以及手/脚热/冷（0-10量表）的CIPN症状。我们探讨了基线神经病变、性别、年龄、体重指数、癌症分期和癌症类型作为与CIPN症状和运动有效性相关的可能因素。与对照组相比，运动减少了手/脚的热/冷（-0.46单位，p=0.045）和麻木和刺痛（-0.42单位，p=0.061）的CIPN症状。对于年龄较大（p=0.086）、男性（p=0.028）或患有乳腺癌（p=0.076）的患者，运动可以更多地减少CIPN症状。运动似乎可以减少接受紫杉烷、铂类或长春瑞滨化疗的患者的CIPN症状。临床医生应该考虑为这些患者开运动处方。
Over half of all cancer patients receiving taxane-, platinum-, or vinca alkaloid-based chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN), which includes numbness, tingling, pain, cold sensitivity, and motor impairment in the hands and feet. CIPN is a dose-limiting toxicity, potentially increasing mortality. There are no FDA-approved drugs to treat CIPN, and behavioral interventions such as exercise are promising yet understudied. This secondary analysis of our nationwide phase III randomized controlled trial of exercise for fatigue examines (1) effects of exercise on CIPN symptoms, (2) factors that predict CIPN symptoms, and (3) factors that moderate effects of exercise on CIPN symptoms. Cancer patients (N=355, 56±11 years, 93% female, 79% breast cancer) receiving taxane-, platinum-, or vinca alkaloid-based chemotherapy were randomized to chemotherapy or chemotherapy plus Exercise for Cancer Patients (EXCAP©®). EXCAP is a standardized, individualized, moderate-intensity, home-based, six-week progressive walking and resistance exercise program. Patients reported CIPN symptoms of numbness and tingling and hot/coldness in hands/feet (0–10 scales) pre- and post-intervention. We explored baseline neuropathy, sex, age, body mass index, cancer stage, and cancer type as possible factors associated with CIPN symptoms and exercise effectiveness. Exercise reduced CIPN symptoms of hot/coldness in hands/feet (−0.46 units, p=0.045) and numbness and tingling (−0.42 units, p=0.061) compared to the control. Exercise reduced CIPN symptoms more for patients who were older (p=0.086), male (p=0.028), or had breast cancer (p=0.076). Exercise appears to reduce CIPN symptoms in patients receiving taxane-, platinum-, or vinca alkaloid-based chemotherapy. Clinicians should consider prescribing exercise for these patients.
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