Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Exercise Rehabilitation for Cancer Survivors with Chemotherapy Induced Peripheral Neuropathy: A Randomized Controlled Trial (#77)

Briana K Clifford 1 , David Goldstein 2 3 , Kimberley Au 1 , J. Matt McCrary 4 , Terry Trinh 2 5 , Tiffany Li 6 , Masarra Al Deleemy 6 , David Mizrahi 7 , Carole A Harris 2 8 , Benjamin C Forster 6 9 , William Huynh 5 6 , Frances Boyle 6 9 , Monica Tang 2 3 , Victoria Choi 10 , Peter Grimison 6 10 , Shelley Kay 10 , Brent Collier 11 , Alexandra M Smith 1 , Jasmine Menant 5 , Susanna B Park 6
  1. School of Health Sciences, University of New South Wales, Sydney, Australia
  2. University of New South Wales, Sydney, Australia
  3. Department of Medical Oncology, Prince of Wales Hospital, Randwick , NSW, Australia
  4. Institute of Human Genetics, Hannover Medical School, Hannover, Germany
  5. Neuroscience Research Australia, Sydney, Australia
  6. University of Sydney, Sydney, Australia
  7. The Daffodil Centre, University of Sydney, Sydney, Australia
  8. St George Hospital, Kogarah , Australia
  9. The Mater Hospital, North Sydney, Australia
  10. Chris O’Brien Lifehouse, Camperdown, Australia
  11. Peak Health, Gymea , Australia

Introduction: Chemotherapy induced peripheral neuropathy (CIPN) is a common and debilitating complication in cancer survivors, impacting 68% of patients treated with neurotoxic chemotherapy. Exercise may improve CIPN symptoms and function, however, the effect of structured exercise on objectively measured CIPN has not been comprehensively investigated in cancer survivors.  

Aim: To quantify the impact of exercise on objective neuropathy severity and patient function in cancer survivors.

Methods: A multi-site, open label, randomised controlled trial was undertaken.  Participants were randomised to an 8-week supervised exercise intervention or usual care. The primary outcome was the neurological grading scale Total Neuropathy Score clinical (TNSc). Secondary outcomes included patient-reported CIPN (EORTC CIPN20). The multimodal intervention incorporated aerobic and resistance exercise and balance training. Planned accrual target was 96 participants (48 per group), powered to demonstrate a 1.7-point difference in TNSc between treatment groups at 8-weeks (80% power, α=.05). A linear mixed model was used to assess differences between groups at 8-weeks using an intention to treat approach. Post hoc comparison of change scores within and between groups was also conducted.

Results: Between March 2019 and July 2023, participants were recruited from four oncology centres in Sydney, Australia. One-hundred-ninety-seven patients were assessed for eligibility, 90 were randomised and underwent baseline assessment (Intervention n=46, Control n=44). Seventy-six returned for follow up assessment after the 8-week intervention (Intervention n=37, Control n=39). Preliminary analysis demonstrated a post intervention, between group mean difference in TNSc of 1.41 points (95% CI: -0.009, 2.874; p=0.016). There was also a significant effect of exercise on the EORTC CIPN20 total score, with mean change score of -5.64 (95% CI: -7.91, -3.37; p<0.001) after exercise and mean change score of -1.83 (95% CI: -4.06, 0.40; p=0.11) after usual care.

Conclusions: 8-weeks of multimodal exercise may improve objectively assessed CIPN in cancer survivors.