Abstract
Chemotherapy is recognized as a mainline treatment for all types of cancer, and its most debilitating and dose-limiting complication is Chemotherapy-induced peripheral neuropathy (CIPN), the mechanisms of nerve damage of which depends upon the specific chemotherapeutic agent used. Use of non-invasive treatment methods such as physical therapy may provide a valuable therapeutic adjunctive option in patients with CIPN. Physical therapy treatment methods had been shown to produce effective symptom control and enhance quality of life in palliative care. A detailed evidence-based update of literature is provided under evaluation and management of CIPN with a special perspective of physical therapy management using a proposed clinical reasoning-based treatment decision making algorithm so that an ‘out of the box’ self-reflective evidence-informed critical thinking process is applied along a collaborative multidisciplinary biopsychosocial approach. Keywords: Chemotherapy-induced neurotoxicity; Chemotherapy-induced neuropathy; Physical therapy; Palliative rehabilitation
Highlights
Chemotherapy is recognized as a mainline treatment for all types of cancer, and its most debilitating and dose-limiting complication is Chemotherapy-induced peripheral neuropathy (CIPN), the mechanisms of nerve damage of which depends upon the specific chemotherapeutic agent used [1,2]
Loss of balance and subsequent risk of falls increased with each cycle of chemotherapy and this risk was found to be drug-specific, with patients reporting muscle weakness and interference with walking or driving were at higher risk of falls [28]
This paper aimed at providing a focused update on assessment and treatment of CIPN from a physical therapy perspective, and the findings from existing evidence are insufficient, and they indicate the underreporting and underappreciation of CIPN [134] among other related professional disciplines such as physical therapy which is comprehensively associated with pain management teams in palliative care
Summary
Chemotherapy is recognized as a mainline treatment for all types of cancer, and its most debilitating and dose-limiting complication is Chemotherapy-induced peripheral neuropathy (CIPN), the mechanisms of nerve damage of which depends upon the specific chemotherapeutic agent used [1,2]. Depending on the substance used, a pure sensory and painful neuropathy (with cisplatin, oxaliplatin, carboplatin) or a mixed. CIPN occurs secondary to use of many chemotherapeutic agents like plant alkaloids, interferons, antimitotics [4] platinum compounds/analogues (cisplatin, oxaliplatin, carboplatin), taxanes (pacilitaxel, docetaxel), epothilones, vinca alkaloids (vincristine), thalidomide, lenolidamide and newer agents such as bortezomib [5], and it affects both adult and pediatric population [6]. The Chemotherapy-induced neurotoxicity (CIN) affects the peripheral nerves and can affect the nerve fibers and neuronal cell bodies especially the dorsal root ganglia [7], the axonal transport system, the myelin. The importance of understanding and recognition of CIPN by healthcare professionals was explored by Binner et al [12] in their survey of 39 oncology nurses who found that the participants had knowledge deficits pertaining to CIPN and lacked training, proficiency, and confidence in neurologic physical assessment; and by Kuroi et al [13] who found that physicians felt the need to assess peripheral neuropathy in patients undergoing chemotherapy
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