Optimal outcome measures for assessing exercise and rehabilitation approaches in chemotherapy-induced peripheral-neurotoxicity: Systematic review and consensus expert opinion

ABSTRACT

Introduction

Chemotherapy-induced peripheral neurotoxicity (CIPN) remains a significant toxicity in cancer survivors without preventative strategies or rehabilitation. Exercise and physical activity-based interventions have demonstrated promise in reducing existing CIPN symptoms and potentially preventing toxicity, however there is a significant gap in evidence due to the lack of quality clinical trials and appropriate outcome measures.

Areas Covered

We systematically reviewed outcome measures in CIPN exercise and physical rehabilitation studies with expert panel consensus via the Peripheral Nerve Society Toxic Neuropathy Consortium to provide recommendations for future trials. Across 26 studies, 75 outcome measures were identified and grouped into 16 domains within three core areas – measures of manifestations of CIPN (e.g. symptoms/signs), measures of the impact of CIPN and other outcome measures.

Expert Opinion

This article provides a conceptual framework for CIPN outcome measures and highlights the need for definition of a core outcome measures set. The authors provide recommendations for CIPN exercise and physical rehabilitation trial design and outcome measure selection. The development of a core outcome measure set will be critical in the search for neuroprotective and treatment approaches to support cancer survivors and to address the gap in the identification of effective rehabilitation and treatment options for CIPN.

KEYWORDS:

• Chemotherapy induced peripheral neurotoxicity
• exercise
• rehabilitation
• outcome measures
• peripheral neuropathy
• neurotoxicity
• cancer survivorship
• treatment

Article highlights

• Chemotherapy-induced peripheral neurotoxicity (CIPN) is a significant toxicity in cancer survivors.

• Exercise and physical activity-based interventions have demonstrated promise in reducing the burden of symptoms and potentially preventing toxicity.

• There is a lack of definitive studies and outcome measure consistency.

• We undertook a systematic review and consensus expert opinion approach to provide a conceptual framework for CIPN outcome measures.

• A total of 75 outcome measures were identified from 26 studies, grouped into measures of manifestations of CIPN (e.g. symptoms/signs), measures of the impact of CIPN and other outcome measures.

• This article highlights the need for definition of a core outcome measures set, providing recommendations for CIPN exercise and physical rehabilitation trial design, and outcome measure selection.

• The development of a core outcome measure set will be critical in the search for neuroprotective and treatment approaches to support cancer survivors and to address the significant gap in the identification of effective rehabilitation and treatment options for CIPN.

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the National Health and Medical Research Council of Australia under Grants (#1148595, #1080521 to SBP), Cancer Institute NSW under Grant (#14/TPG/1-05 to SB Park), National Cancer Institute under Grant (K07CA221931 to IR Kleckner), Instituto de Salud Carlos III under Grant (project PI20/00283 co‐funded by European Regional Development Fund. ERDF, a way to build Europe, to R Velasco), CERCA Programme /Generalitat de Catalunya for institutional support to R Velasco and University of Milano-Bicocca Under Grant (‘Bicocca Starting Grant’ to P Alberti). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.