Reflexology in the management of chemotherapy induced peripheral neuropathy: A pilot randomized controlled trial

Reflexology in oncological treatment - a systematic review

BACKGROUND

As cancer and its therapy comes with a wide range of negative effects, people look for options to mitigate these effects. Reflexology is among the options of complementary medicine.

METHOD

In March 2022 a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning the use, effectiveness and potential harm of reflexology on cancer patients.

RESULTS

From all 821 search results, 29 publications concerning 26 studies with 2465 patients were included in this systematic review. The patients treated with reflexology were mainly diagnosed with breast, lung, gastrointestinal and hematological cancer. Outcomes were mainly pain, quality of life, anxiety, depression, fatigue. The studies had moderate to low quality and reported heterogeneous results: Some studies reported significant improvements in above mentioned outcomes while other studies did not find any changes concerning these endpoints.

CONCLUSION

Due to the very heterogeneous results and methodical limitations of the included studies, a clear statement regarding the effectiveness of reflexology on cancer patients is not possible. The current evidence indicates that reflexology is superior to passive control groups for pain, quality of life and fatigue, however, more studies with comparable active control groups are needed.

Non-pharmacological therapy for chemotherapy-induced peripheral neurotoxicity: a network meta-analysis of randomized controlled trials

BACKGROUND

Chemotherapy-induced peripheral neurotoxicity (CIPN) is the most common adverse effect in patients undergoing chemotherapy, and no effective interventions are currently available for its prevention and treatment. Non-pharmacological therapies appear to be beneficial for the prevention and treatment of CIPN, but it remains unclear which therapy is most effective. The aim of this study was to identify the most effective non-pharmacological therapy for CIPN patients.

METHODS

PubMed, Web of Science, Embase, and Cochrane Library were searched for randomized controlled trials on non-pharmacological therapies for CIPN. The primary outcomes included pain and peripheral neuropathological symptoms, and the secondary outcomes included quality of life, sensory and motor symptoms. The pairwise analysis and a network meta-analysis were performed using a random effects model.

RESULTS

A total of 46 articles were included in this study, involving 2,878 participants. Our study showed that massage was more effective in pain-alleviating compared with acupuncture [SMD = 0.81, 95%CI (0.04, 1.57)], vitamin and gabapentin [SMD = 2.56, 95%CI (1.39, 3.74)], and usual care and placebo [SMD = 0.9, 95%CI (0.31, 1.49)]. As for attenuating peripheral neuropathological symptoms, massage was more effective than usual care and placebo [SMD = 0.75, 95%CI (0.33, 1.17)], sensorimotor training [SMD = 1.17, 95%CI (0.24, 2.10)], electrostimulation [SMD=-1.18, 95%CI (-2.14, -0.21)], multimodal exercise [SMD=-0.82, 95%CI (-1.57, -0.08)], and resistance training [SMD = 1.03, 95%CI (0.11, 1.95)]. Massage was also more effective than other non-pharmacological therapies in improving quality of life, sensory and motor symptoms.

CONCLUSIONS

According to our study, massage has advantages in alleviating pain, improving quality of life, and improving peripheral neuropathological symptoms and has better effect than other non-pharmacological interventions, representing certain clinical significance. However, the results of this study should be interpreted with caution due to the limitations of the included studies. In the future, more high-quality multi arm randomized controlled trials can be attempted to provide direct comparisons of the relative effects of non-pharmacological interventions.

Living with chemotherapy-induced peripheral neuropathy: a nested qualitative study

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side-effect for patients undergoing a variety of chemotherapy regimens. These effects can have a detrimental impact on patients' quality of life and ability to perform everyday tasks.

OBJECTIVE

This study aimed to explore the experience of living with CIPN prior to and while participating in a randomised study of acupuncture versus a control wait group.

DESIGN

The study was nested within a randomised trial (n=120) with participants randomised to acupuncture or to control (wait list for acupuncture).

METHOD

Participants (n=23) volunteered to be interviewed either by telephone (n=20) or face to face (n=3). The audiotapes produced were transcribed verbatim and analysed using a thematic approach.

RESULTS

Four themes developed; these included daily life with CIPN, signs and symptoms, interacting with others and management of CIPN. Patients reported compromised dexterity and ability to safely carry out activities. They were often reliant on help and sought out information from others living with the condition. There were also concerns about the lack of effectiveness and the side-effects of medication prescribed.

CONCLUSION

Participants were self-selecting volunteers across different cancer groups, but the information gathered could influence future study designs and increase understanding of the impact of CIPN on patients' lives.

The effect of Benson relaxation technique on cancer patients: a systematic review

PURPOSE

Although many studies have investigated the effect of this method on cancer patients, no review of the available literature has been done. So, a literature review is conducted to evaluate all published literature on the Benson relaxation technique in cancer patients.

METHODS

A systematic literature search was conducted. A systematic search of online electronic databases including PubMed/MEDLINE, Scopus Web of Science, PsycINFO, and EMBASE was performed using keywords extracted from Medical Subject Headings such as "Benson Relaxation Technique," "Cancer Patients," "Malignancy," and "Neoplasia" from the beginning to April 27, 2023. A total of 810 publications were assessed for relevance by title and abstract. The remaining 31 articles were examined using inclusion criteria for all Persian and English-language publications that evaluate the effectiveness of the Benson relaxation technique on cancer patients. We did not have gray literature in our review. The methodological quality of the included studies was appraised using specific checklists.

RESULTS

Finally, nine studies were included in this systematic review. Studies on breast cancer patients showed improvement in fatigue, nausea, vomiting, pain, shortness of breath, insomnia, anorexia, constipation, diarrhea, treatment side effects, breast symptoms, arm symptoms, worry about hair loss, and scores of hope. Two studies were conducted among cervical cancer patients that showed a decrease in anxiety scores and an improvement in the quality of sleep. Another study on gastric cancer patients showed decreased Chemotherapy-Induced Nausea, Vomiting, and Retching scores.

CONCLUSION

Overall, this systematic review showed that the Benson relaxation method could improve sleep quality, appetite, anxiety, and quality of life. Therefore, using the Benson relaxation technique is suggested to improve health-related outcomes in cancer patients.

Chemotherapy-Induced Peripheral Neuropathy: Diagnosis, Agents, General Clinical Presentation, and Treatments

PURPOSE OF REVIEW

This review aims to discuss pathophysiology, diagnosis, clinical presentation, and treatment of chemotherapy-induced peripheral neuropathy. Agent-specific presentation and pathophysiology is also being discussed.

RECENT FINDINGS

As new systemic oncological treatments continue to be developed, the number of cancer survivors continues to grow. Survivors are living longer with the long-term side effects of oncological treatments. We reviewed the pathophysiology of agent-specific chemotherapy-induced peripheral neuropathy and the updates in its treatment and preventative tools. Chemotherapy-induced peripheral neuropathy is a debilitating long-term side effect that often impairs cancer survivors' function and quality of life. The increasing life expectancy of cancer survivors has resulted in increased prevalence of this condition. Understanding its intricacies can provide physicians with better treatment tools and research opportunities to develop or identify new therapeutic agents.

The Benefits of Integrative Medicine for Pain Management in Oncology: A Narrative Review of the Current Evidence

The aim of this evidence-based study is to narrate and evaluate the current evidence on recommendations for practicing physicians and other healthcare providers regarding integrative approaches to managing pain in patients with cancer. This review will assess the guideline recommendations and analyze the role of integrative medicine in addressing cancer pain in patients. The literature search highlights relevant studies that will inform evidence-based recommendations for practicing physicians, highlighting their relevance and weaknesses. Acupuncture, massage, and hypnosis have intermediate-strength evidence quality and are moderately recommended for various types of cancer pain. Most of the evidence points to acupuncture being recommended for aromatase inhibitor-related joint pain, hypnosis for procedural pain, and massage for palliative care pain. Other practices with lower-quality evidence include yoga and guided imagery with progressive muscle relaxation, mostly recommended for general cancer pain or musculoskeletal pain. Additionally, music therapy is recommended for procedural or surgical pain. Low-quality or inconclusive evidence was found for other mind-body interventions or natural products. Similarly, there is insufficient evidence to provide recommendations for pediatric patients. Further research is required to enhance our understanding of the role of integrative medicine interventions in caring for cancer patients.

The effectiveness of reflexology on mental health in cancer patients: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND AND PURPOSE

The current body of research examining the effectiveness of reflexology in patients with cancer have predominantly focused on managing physical symptoms and treatment side effects. This review aimed to synthesise evidence from randomised controlled trials (RCTs) examining the effectiveness of reflexology on mental health outcomes in people with cancer.

METHODS

RCTs published in English and measuring stress, anxiety, depression or quality of life (QoL) were included. Eligible RCTs were identified through search of MEDLINE, Embase, Emcare, PsycINFO, Scopus, the Cochrane Library, OTseeker, PEDro (18 June 2021) and Google and Google Scholar (21 June 2021). The Critical Appraisal Skills Programme Randomised Controlled Trials Checklist was used to assess risk of bias. Meta-analysis and narrative synthesis were undertaken. The certainty of evidence was assessed by using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.

RESULTS

Fifteen RCTs (1356 adult participants) were included. Evidence for stress and anxiety (primary outcomes), as well as depression and QoL (secondary outcomes), were mixed and conflicting. The certainty of the evidence was low to very low.

CONCLUSION

An unequivocal recommendation supporting reflexology cannot be made. Greater utilisation of well-established reporting guidelines, together with increased investment in well-designed, high-quality clinical research are required.

Acupuncture and integrative oncology for taxane-induced peripheral neuropathy: a randomized multicentered study

OBJECTIVE

To compare the effectiveness of acupuncture alone or with additional integrative oncology modalities for taxane-induced peripheral neuropathy-related symptoms in patients with gynecological and breast cancer.

METHODS

The study was a prospective evaluation of patients undergoing twice-weekly treatments with either acupuncture alone (single-modality, group A) or with additional manual-movement and mind-body therapies (multimodality, group B), for 6 weeks. Symptom severity was assessed at baseline, 6 weeks, and 9 weeks using the Functional Assessment of Cancer Therapy-Taxane (FACT-Tax) tool; and von Frey perception thresholds. Additional symptoms were also assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Measure Yourself Concerns and Wellbeing (MYCaW) study tool.

RESULTS

For the 120 participants (60 in each study arm), baseline to 6-week scores were similar in both groups for improved FACT-Tax physical wellbeing and scores for hand numbness/tingling; EORTC physical functioning and global health status; and MYCaW scores. FACT-Tax taxane subscales and scores for foot numbness/tingling improved only in group A (p=0.038), while emotional wellbeing FACT-Tax (p=0.02) and EORTC pain (p=0.005) improved only in group B. Group B showed greater improvement for FACT-Tax neuropathy-related concerns than group A at 24 hours (p=0.043) and 7 days (p=0.009) after the first treatment.

CONCLUSION

Acupuncture alone or with additional integrative oncology modalities may help reduce neuropathy-related symptoms. The single-modality group demonstrated greater improvement for foot numbness/tingling, and the multimodality group demonstrated improvement for pain and improved emotional wellbeing and neuropathy-related concerns in the first week of treatment.

TRIAL REGISTRATION NUMBER

NCT03290976.

Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline

PURPOSE

The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer.

METHODS

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 227 relevant studies to inform the evidence base for this guideline.

RECOMMENDATIONS

Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.

Chemotherapy-induced peripheral neuropathy in children and adolescent cancer patients

Brain cancer and leukemia are the most common cancers diagnosed in the pediatric population and are often treated with lifesaving chemotherapy. However, chemotherapy causes severe adverse effects and chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting and debilitating side effect. CIPN can greatly impair quality of life and increases morbidity of pediatric patients with cancer, with the accompanying symptoms frequently remaining underdiagnosed. Little is known about the incidence of CIPN, its impact on the pediatric population, and the underlying pathophysiological mechanisms, as most existing information stems from studies in animal models or adult cancer patients. Herein, we aim to provide an understanding of CIPN in the pediatric population and focus on the 6 main substance groups that frequently cause CIPN, namely the vinca alkaloids (vincristine), platinum-based antineoplastics (cisplatin, carboplatin and oxaliplatin), taxanes (paclitaxel and docetaxel), epothilones (ixabepilone), proteasome inhibitors (bortezomib) and immunomodulatory drugs (thalidomide). We discuss the clinical manifestations, assessments and diagnostic tools, as well as risk factors, pathophysiological processes and current pharmacological and non-pharmacological approaches for the prevention and treatment of CIPN.

Rehabilitation, exercise, and related non-pharmacological interventions for chemotherapy-induced peripheral neurotoxicity: Systematic review and evidence-based recommendations

Pharmacological strategies for chemotherapy-induced peripheral neurotoxicity (CIPN) are very limited. We systematically reviewed data on rehabilitation, exercise, physical therapy, and other physical non-pharmacological interventions and offered evidence-based recommendations for the prevention and treatment of CIPN. A literature search using PubMed, Web of Science and CINAHL was conducted from database inception until May 31st, 2021. 2791 records were title-abstract screened, 71 papers were full-text screened, 41 studies were included, 21 on prevention and 20 on treatment of CIPN. Treatment type, cancer type, chemotherapy compounds were heterogeneous, sample size was small (median: N = 34) and intention-to-treat analysis was lacking in 26/41 reports. Because of the methodological issues of included studies, the reviewed evidence should be considered as preliminary. Exercise, endurance, strength, balance, and sensorimotor training have been studied in low-to-moderate quality studies, while the evidence for other treatments is preliminary/inconclusive. We offer recommendation for the design of future trials on CIPN.

Influence of intermittent pneumatic compression on foot sensation and balance control in chemotherapy-induced peripheral neuropathy patients

BACKGROUND

Chemotherapy-induced peripheral neuropathy, a side effect of cancer treatment, presents several issues to patients, including reduced sensation and increased fall risk. Previously, massage therapy has been shown to improve chemotherapy-induced peripheral neuropathy symptoms, possibly through increased blood flow. A custom built intermittent pneumatic compression device, previously shown to increase lower leg blood flow, was tested as a plausible treatment modality.

METHODS

Seven cancer survivors suffering from chemotherapy-induced peripheral neuropathy were recruited. Foot sensation (Semmes-Weinstein test) as well as static (dual and tandem stance) and dynamic (timed-up-and-go) balance control tests were performed both pre and post a 5-min intermittent pneumatic compression intervention. Self-reported feedback was provided by participants following testing and 24-h later.

FINDINGS

Five participants reported positive changes in their feet immediately following intermittent pneumatic compression treatment while four of those participants reported positive changes up to 24 h after intervention. Foot sensation was unchanged regardless of location tested (P ≥ 0.23). Postural sway path length and sway area were unchanged following intervention during dual stance (P ≥ 0.14), but path length was significantly reduced (~19.9%) following intervention during tandem stance (P = 0.033). Timed-up-and-go duration was also significantly reduced (~7.0%, P = 0.012).

INTERPRETATION

Overall, these findings demonstrate that intermittent pneumatic compression may be a plausible treatment modality for improving self-reported foot sensation as well as static and dynamic balance control. As a pilot study, this study provides sufficient context for further research exploring the efficacy of intermittent pneumatic compression as a treatment using a randomized control trial design.

Experiences and coping strategies of women receiving treatment for breast and gynecological cancers during the COVID-19 pandemic: A qualitative study

Purpose

The aim of this study was to examine experiences and coping strategies of women receiving treatment for breast and gynecological cancers during the COVID-19 pandemic.

Methods

A descriptive, phenomenological approach was adopted. The study included 15 women receiving treatment for breast and gynecological cancers in the chemotherapy center of a university hospital. Data was collected with a descriptive characteristic form and semi-structured in-depth interviews.

Results

Data analysis revealed three main themes: Problems, protection and coping. The main theme of 'problems' was grouped into four categories: living with anxiety and fear, social isolation, physical difficulties, and financial difficulties. 'Protection' was grouped into four categories: decreased stigmatization, increased preventive measures, increased communication between family members, and keeping distance. Coping was grouped into four categories: religious practices, social support, positive thinking, and hobbies.

Conclusions

The participants were found to experience psychosocial, financial and physical difficulties. However, they also mentioned positive aspects of the pandemic: elimination of stigmatization due to the obligation for everyone to wear a mask, lack of visits due to the lockdown and enhanced communication with family members due to increased time spent at home. Religious practices, social support, positive thinking and spending time on hobbies were helpful to cope with the problems experienced during the pandemic. The results of this study can guide nurses in offering high-quality nursing care and counseling to women treated for breast and gynecological cancers during the pandemic.

The effects of reflexology on anxiety, depression and quality of life in patients with gynecological cancers with reference to Watson's theory of human caring

OBJECTIVES

This study aimed to examine the effects of reflexology based on Watson's theory of human caring on anxiety, depression, and quality of life in gynecological cancer patients.

MATERIAL AND METHODS

The study was a prospective, single-blind, randomized controlled trial with a pretest-posttest and a control group. The clinical trial was conducted at a university hospital in the Aegean region between October 2016 and June 2018. It was completed with 62 women, of whom 31 were in the intervention group and 31 were in the control group. Data were collected by using a personal information form, the Beck Anxiety Inventory, the Beck Depression Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-version 3.0.

RESULTS

Anxiety and depression levels were lower in the intervention group than in the control group. Besides, the quality of life was higher in the intervention group than in the control group. Reflexology significantly reduced symptoms due to chemotherapy, such as fatigue, pain, insomnia, and loss of appetite. Although there was a decrease in symptoms, such as nausea, vomiting, diarrhea and constipation immediately after reflexology, an increase in symptoms was observed in the intervention group two weeks later.

CONCLUSION

These results showed that reflexology based on Watson's theory of human caring is effective in reduction of anxiety and depression and improves the quality of life in gynecological cancer patients during chemotherapy. It can be suggested that offering reflexology at certain intervals during chemotherapy will increase the duration of its effect.

Chemotherapy-Induced Peripheral Neuropathy: Nursing Implications

Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It manifests with numbness, tingling, and possibly neuropathic pain and motor and autonomic symptoms. This review aims to provide an evidence synthesis that prepares nurses to comprehensively assess, provide supportive care for, and critically evaluate the literature on CIPN. The prevalence, significance, characteristics, mechanisms, and risk factors of CIPN will be discussed, as well as nursing-relevant evidence on the assessment, prevention, and management of CIPN. The importance of critical literature evaluation before clinical implementation to reduce physical and financial harms to patients will also be highlighted.

Vesicular trafficking-related proteins as the potential therapeutic target for breast cancer

Vesicular trafficking between endoplasmic reticulum and Golgi plays a major role in the growth and proliferation of breast cancer cells. Various proteins regulate this ER-Golgi kinetics; however, their potential as therapeutic targets in breast cancer has not been much evaluated. In the present review, we try to shed light on the implication of vesicular trafficking-related proteins like Rab family of proteins, in the pathogenesis of breast cancer via promoting cancer cell proliferation and invasion. The literature for this review was mainly searched in PubMed during the years 2014 to 2018 by using the keywords, 'breast cancer', 'breast cancer and its current treatments', 'breast cancer and vesicular trafficking', 'Rab family proteins in breast cancer', etc. Targeting proteins involved in vesicular transport like Rab GTPases, the neural precursor cell-expressed developmentally downregulated protein 9 (NEDD9), runt-related transcription factor 2 (RUNX2), human rhomboid family-1 (RHBDF1), monocarboxylate transporter 4, etc., would aid in designing improved therapeutics for the treatment of breast cancer.

Integrative Approaches to Chemotherapy-Induced Peripheral Neuropathy

PURPOSE OF REVIEW

Chemotherapy-induced peripheral neuropathy (CIPN) is a common complication of cancer treatment, with conventional treatment limited in its ability for prevention or treatment of symptoms. This review addresses the research assessing the effectiveness and safety of complementary and integrative medicine (CIM) in preventing and treating CIPN-related symptoms.

RECENT FINDINGS

The CIM modalities acupuncture, classical massage, omega-3 fatty acids, and the Japanese Kampo medicine Goshanjishen may be of benefit in preventing or treating CIPN. Vitamin E (alpha-tocopherol), glutamine/glutamate, alpha-lipoic acid, and acetyl-L-carnitine (ALCAR) are not, with ALCAR increasing symptom severity and vitamin E the risk for developing prostate cancer. CIM therapies with a potential for preventing or treating CIPN-related symptoms should be further investigated. CIM is considered safe when provided within an integrative oncology setting, under the guidance and supervision of an integrative physician.

A systematic review of complementary and alternative medicine in oncology: Psychological and physical effects of manipulative and body-based practices

Background

Complementary and Alternative Medicines (CAM) are widely used by cancer patients, despite limited evidence of efficacy. Manipulative and body-based practices are some of the most commonly used CAM. This systematic review evaluates their benefits in oncology.

Method

A systematic literature review was carried out with no restriction of language, time, cancer location or type. PubMed, CENTRAL, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection and SOCindex were queried. Inclusion criteria were adult cancer patients and randomized controlled trials (RCT) assessing manipulative and body-based complementary practices on psychological and symptom outcomes. Effect size was calculated when applicable.

Results

Of 1624 articles retrieved, 41 articles were included: massage (24), reflexology (11), acupressure (6). Overall, 25 studies showed positive and significant effects on symptom outcomes (versus 9 that did not), especially pain and fatigue. Mixed outcomes were found for quality of life (8 papers finding a significant effect vs. 10 which did not) and mood (14 papers vs. 13). In most studies, there was a high risk of bias with a mean Jadad score of 2, making interpretation of results difficult.

Conclusion

These results seem to indicate that manipulative CAM may be effective on symptom management in cancer. However, more robust methodologies are needed. The methodological requirements of randomized controlled trials are challenging, and more informative results may be provided by more pragmatic study design.

Prevention of chemotherapy-induced peripheral neuropathy with classical massage in breast cancer patients receiving paclitaxel: An assessor-blinded randomized controlled trial

PURPOSE

This assessor-blinded, prospective, randomized controlled clinical trial aimed at investigating the effect of classical massage on chemotherapy induced peripheral neuropathy and the quality of life (QOL) in breast cancer patients receiving adjuvant paclitaxel.

METHODS

A total of 40 female breast cancer patients were randomly allocated to the classical massage group (CMG) or the control group (CG). Classical massage was applied to the patients in the CMG before each paclitaxel infusion. The CG received only usual care. Presence of peripheral neuropathic pain and QOL were assessed at baseline and weeks 4, 8, 12, and 16. Nerve conduction studies (NCS) findings were also recorded at baseline and week 12.

RESULTS

The peripheral neuropathic pain was lower in the CMG compared to the CG at week 12 (p < 0.05). The sensory and motor sub-scale scores of the QOL measure showed statistically significant differences over time in favor of the CMG (p < 0.05). Sensory action potential amplitude of the median nerve was significantly higher and the tibial nerve latency was significantly shorter in the CMG compared to the CG at week 12.

CONCLUSIONS

This study suggested that classical massage successfully prevented chemotherapy-induced peripheral neuropathic pain, improved the QOL, and showed beneficial effects on the NCS findings.

Care After Chemotherapy: Peripheral Neuropathy, Cannabis for Symptom Control, and Mindfulness

As cancer therapies improve, patients are living longer. With these improvements in therapy comes a responsibility to optimize patients' quality of life during cancer therapy and beyond. This report reviews three timely and important topics. The first section reviews the mechanism underlying chemotherapy-induced peripheral neuropathy and evaluates the evidence for interventions to prevent and treat peripheral neuropathy. It also provides a framework for approaching the diagnosis and management of this common and bothersome side effect. The second section addresses the controversial but effective use of cannabinoids for cancer and chemotherapy symptoms. Although clinical trials are difficult to conduct because of the political and social stigma of this class of drugs, this review provides evidence of the efficacy of cannabinoids for treatment of pain and nausea. The last section addresses the mind-body connection, with a focus on the negative emotions patients with cancer often experience. This section assesses the literature regarding mindfulness-based programs to improve cancer-related stress. These three topics may appear unrelated, but all address one common goal: treating the body and the mind to optimize quality of life during and after cancer therapy.