Novel interventions for chemotherapy-induced neuropathy

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Project Abstract: Cancer treatment causes dose-limiting sensory symptoms and postural control dysfunction (neuropathy) in up to 80% of breast cancer (BC) survivors, yet non-invasive treatments to restore motor control remain underdeveloped. To restore mobility, interventions that address motor control, patient-reported symptoms, and motivation to participate - in combination - are most likely to succeed. Thus, we propose to test effect of partnered Adapted Argentine Tango (Tango) as an ideal intervention to simultaneously target restoration of mobility and alleviation of symptoms through socially-motivated participation. Tango is moderate intensity social dance, adapted for individuals with mobility deficits, that delivers sensorimotor and cardiovascular training to rhythmic music. Tango promotes survivor participation through creative engagement and caregiver inclusion. Previous research by the investigators established Tango as feasible for aging survivors (up to 82 years) to engage in with high satisfaction and effects to neuropathy-related motor control deficits. Therefore, we propose to conduct a Phase II, randomized clinical trial investigating Tango in 52 BC survivors with neuropathy. Our overarching hypothesis is that Tango is associated with improved postural control (primary) as well as improved balance, locomotor control and patient-reported outcomes (PROs) (secondary) relative to an evidence- based home exercise program (HEX). Our rationale: Tango combines the effects of rhythmic auditory stimulation on postural control regulation; physical activity practice on neuromotor control and cardiovascular fitness; with social motivation to participate in treatment. Our long-term goal is to optimize prevention and treatment of neuropathy utilizing non-invasive, patient-centered treatment to improve motor control more definitively and more quickly for more people. Toward this goal, BC survivors with balance deficits associated with neuropathy will be randomly assigned to Tango or HEX training, twice per week, for an 8 week period. Using an intent-to-treat approach, this innovative pilot study will determine impact of Tango on (AIM1) 1) postural control; 2) balance; 3) PROs including sensory symptoms, pain, fatigue, mood, quality of life, and intrinsic motivation; as well as explore (AIM2) 4) locomotor control. These data will enable us to establish effect sizes and estimate sample size for a future trial that will investigate relationship of neuromotor control and PROs to structural changes in regions of the brain involved in motor control and planning, central dopamine regulation, and systemic inflammation among individuals with neurotrauma.