Exercise May Benefit Chemotherapy-Induced Peripheral Neuropathy in Patients With Ovarian Cancer

Despite limited evidence, exercise intervention programs may offer potential benefits for chemotherapy-induced peripheral neuropathy (CIPN) in patients with ovarian cancer, especially when focused on daily physical activity, physical function, and skeletal muscle density.¹

The authors of the Gynecologic Oncology study said that the standard treatment for ovarian cancer is surgery followed by chemotherapy. Despite survival rate improvements, adverse treatment events remain a challenge. CIPN is a common adverse event for those with ovarian cancer undergoing chemotherapy and is a risk factor for decreased physical function, increased falls, and reduced quality of life (QOL).

Despite its impact on QOL, there is no consensus for evaluating, preventing, or treating CIPN among patients with ovarian cancer. However, past research reported the effectiveness of exercise in managing CIPN in those with breast and gastrointestinal cancers, suggesting a new strategy for improving or preventing CIPN.

Potential associations between physical fitness parameters and CIPN have also been suggested, including the possibility that physical activity may promote the recovery of neurological function and contribute to the prevention of CIPN through improved body composition.² Therefore, the researchers assessed the evidence on the effectiveness of exercise therapy in patients with ovarian cancer and explored potential associations between CIPN and physical fitness parameters.¹

Although evidence remains limited, exercise interventions may help manage chemotherapy-induced peripheral neuropathy (CIPN) in patients with ovarian cancer through improved physical activity and muscle function. | Image Credit: SkyLine - stock.adobe.com

On June 20, 2024, the researchers searched databases and registries, such as MEDLINE, Web of Science, and ClinicalTrials.gov, for eligible studies. They included articles published until June 2024, with no limitations on location, race, sex, or language. However, the studies needed to analyze patients older than 18 with ovarian cancer who were undergoing or completed chemotherapy and included those with CIPN. The studies also needed to be randomized or non-randomized controlled trials, single-arm intervention trials, prospective or retrospective cohort studies, or cross-sectional studies.

Two independent reviewers screened titles and abstracts based on their inclusion criteria. Potentially relevant studies were retrieved in full length, and the reviewers further assessed their eligibility based on the inclusion criteria. Disagreements at any stage were resolved through discussion or by another reviewer. From the studies reviewers agreed to analyze, they extracted various data, including its sample size, CIPN assessment methods, and key findings related to the scoping review question.

The researchers initially identified 1467 eligible studies, which they narrowed down to 10. Four papers were conducted in the US, 2 in Canada, and one each in Australia, Brazil, Japan, and Turkey. Regarding study design, there were 5 retrospective cohort studies, 2 cross-sectional studies, and one each of a randomized controlled trial, single-arm trial, and prospective cohort study. Additionally, 8 studies explored potential associations between CIPN and physical fitness parameters, while 2 examined the effectiveness of exercise therapy for CIPN.

The 10 studies included 3402 eligible participants. The mean age of patients was over 60 years in 3 studies, between 50 and 60 years in 6 studies, and not reported in 1 study. Also, the mean body mass index (BMI) exceeded 25.0 kg/m² in 6 studies, while the BMI data were not provided in the other 4 studies.

Among these patients, 6 studies specifically involved those diagnosed with epithelial ovarian cancer, while 4 studies included patients with ovarian cancer more generally. In 7 studies, over 50% of patients were diagnosed at clinical stages III or IV, compared with less than 50% in 2 studies; this data was unavailable in the remaining study. Lastly, patients received platinum and taxane-based chemotherapy in 6 studies.

Of the 10 studies, one randomized controlled trial evaluated the effectiveness of exercise therapy on CIPN. It found that a 6-month aerobic exercise therapy significantly improved self-reported CIPN symptoms. A subgroup analysis revealed an inverse correlation between CIPN and compliance with the American College of Sports Medicine (ACSM) guidelines, which recommend 150 minutes of moderate physical activity per week.

Similarly, 2 cross-sectional studies reported inverse associations between CIPN and daily physical inactivity. One determined that compliance with the ACSM physical activity guidelines among patients with ovarian cancer was extremely low at 28%. Therefore, CIPN was inversely correlated with compliance with this guideline, highlighting the link between low activity levels and higher CIPN prevalence.

Regarding other potential risk factors, one study identified pre-chemotherapy low skeletal muscle density as a CIPN risk factor, while 2 studies reported no such association. Similarly, only one study using a 6-minute walk test reported an association between physical function and CIPN. Lastly, conflicting findings were observed for BMI as one study found no association between pre-chemotherapy BMI and CPIN risk, whereas another linked overweight or obesity to increased CIPN risk.

The researchers acknowledged their limitations, one being that the review failed to explore key factors from a physical fitness perspective due to the lack of evidence and data in the identified studies. Similarly, no study objectively assessed CIPN or daily physical activity. They concluded by emphasizing the importance of exploring their limitations further through future research.

“These factors are critical in understanding the development and persistence of CIPN and may influence the effectiveness of exercise interventions,” the authors wrote. “Future research should address these gaps to provide a more comprehensive understanding of CIPN and refine exercise therapy strategies accordingly.”

References

1. Konuma M, Ikeda T, Mitoma T, et al. Effectiveness of exercise therapy on chemotherapy-induced peripheral neuropathy in patients with ovarian cancer: A scoping review. Gynecol Oncol. doi:10.1016/j.ygyno.2024.12.007
2. Yoshikawa T, Takano M, Miyamoto M, et al. Psoas muscle volume as a predictor of peripheral neurotoxicity induced by primary chemotherapy in ovarian cancers. Cancer Chemother Pharmacol. 2017;80(3):555-561. doi:10.1007/s00280-017-3395-5