Lagged Relationships Among Chemotherapy-Induced Peripheral Neuropathy, Sleep Quality, and Physical Activity During and After Chemotherapy

Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Narrative Review and Proposed Theoretical Model

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating symptom experienced by cancer survivors. Despite the burden of CIPN-related symptoms, interventions remain limited.

OBJECTIVES

This narrative review seeks to propose a framework for CIPN predisposing, precipitating, and perpetuating factors (3Ps), which will provide a foundation for future research and clinical interventions aimed at mitigating CIPN-related symptoms and morbidity.

METHODS

A comprehensive literature search was performed using PubMed, guided by keywords related to "chemotherapy-induced peripheral neuropathy." Studies were limited to those with full text available in English.

RESULTS

Predisposing factors outlined in this framework, such as older age and comorbid conditions, can be used to identify patients who have a higher risk of developing CIPN. The major precipitating factor of CIPN is the delivery of chemotherapy to peripheral nerves, which may be mitigated via cryotherapy or compression therapy during chemotherapy. Perpetuating factors can offer insight into psychological, cognitive, and behavioral modifications that could be treatment targets for CIPN management.

CONCLUSION

The proposed 3P model can guide the development of effective interventions for CIPN by suggesting modifiable psychological and behavioral treatment targets that may mitigate the impact of CIPN for cancer patients.

Naphthalene Diimide-Based Polycyclic Conjugated Molecule Composite CoFe2O4 Nanohybrids for Photoacoustic Imaging-Mediated Photo-/Sonic Therapy

The complex and harsh tumor microenvironment imped the efficacy of single-modality tumor therapy. With the advantages of biosafety, organic/inorganic nanohybrids have attracted more and more interest of researchers, and it is critical to investigate the development of highly efficient nanohybrids for multimodality combination therapy of cancers. Herein, a naphthalene diimide-based polycyclic conjugated molecule (NDI-S) is designed and synthesized, which has broader light absorption in the near infrared (NIR) region, outstanding photothermal conversion ability, and excellent photostability. Inorganic CoFe2O4 is synthesized via a solvothermal technique, which can produce much more reactive oxygen species (ROS) as a sonosensitizer when activated by ultrasonic (US). NDI-S and CoFe2O4 are then nanoprecipitated to create the organic/inorganic nanohybrids, NDI-S@CoFe2O4. According to the results of in vitro and in vivo experiments, NDI-S@CoFe2O4 can serve as a multifunctional nanoplatform for multimodal treatment of tumors in combination with photothermal/photodynamic/sonodynamic- therapy under the guidance of photoacoustic imaging, which provides a new vision of the development of organic/inorganic nanohybrids for cancer theranostics.

Relationship between chemotherapy-induced peripheral neuropathy and physical activity in cancer survivors: A prospective longitudinal study

Objective

The purpose of this research is to evaluate the relationship between the degree of peripheral neuropathy associated with treatment and physical activity through the use of objective indicators such as wristband activity tracker and subjective evaluations obtained through interviews.

Methods

This study included 11 patients with gynecological cancer, gastrointestinal cancer, and malignant lymphoma. Participants were requested to wear a wristband activity meter at two time points: early and mid-treatment. Activity-meter step counts were compared with factors such as energy expenditure and Functional Assessment of Cancer Therapy-General during early and mid-treatment. Interviews were analyzed qualitatively and inductively.

Results

There was no difference in the number of steps taken by participants in the early and mid-treatment periods (P = 0.050), but they took more steps in the mid-treatment period than in the early period. Participants expended more energy during mid-treatment than early treatment, but these differences were not significant. We noted a correlation between the number of steps and energy expenditure in the mid-treatment period (r = 0.883). Comparisons between measures showed significant differences in "Impact" between early and mid-treatment on Distress and Impact Thermometer (P = 0.034). The impact of numbness on activity was assigned to three categories: loss of routine caused by numbness, coping with the numbness-related inconvenience using various resources, and acceptance of life with numbness with the support of others and self-strength.

Conclusions

The participants devised strategies to maintain activities despite experiencing chemotherapy-induced peripheral neurotoxicity. The use of activity meters may enhance patient motivation, which in our opinion, is beneficial for self-care education.

Trajectories and influencing factors of social anxiety in postoperative breast cancer patients

BACKGROUND

Social anxiety among postoperative breast cancer patients is a prevalent concern, with its intensity fluctuating throughout the course of treatment. The study aims to describe the trajectory of social anxiety in postoperative breast cancer patients, explore the influencing factors, and provide theoretical support for the construction of future intervention programs.

METHODS

This study was conducted from June 2022 to January 2023, encompassing 213 breast cancer patients from three first-class hospitals in China. Data collection occurred at four distinct time points. A growth mixture model was employed to identify latent categories representing the trajectories of social anxiety changes among patients. A multiple regression analysis was utilized to explore predictive factors associated with different latent trajectory categories.

RESULTS

The trajectory of social anxiety changes in postoperative breast cancer patients includes five potential categories: maintaining mild social anxiety group, changing from mild to moderate social anxiety group, maintaining moderate social anxiety group, changing from moderate to severe social anxiety group, and maintaining severe social anxiety group. Cluster analysis results indicated three types: positive, negative, and low. Logistic regression analysis revealed that younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination were factors that influenced patients' social anxiety (P < 0.05).

CONCLUSION

The trajectory of social anxiety in postoperative breast cancer patients comprises five potential categories. In clinical practice, it is essential to strengthen the management of high-risk populations susceptible to experiencing social anxiety emotions, including younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination.

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.

Peripheral neuropathy and lifestyle factors in women with breast cancer receiving taxane-based chemotherapy: Pathway analysis

PURPOSE

Peripheral neuropathy adversely affects the treatment process of cancer, and thus it is important to reveal the factors leading to peripheral neuropathy and to take the necessary precautions to avoid it. This study was conducted to investigate the relationship between chemotherapy-induced peripheral neuropathy (CIPN) and lifestyle factors (nutrition, physical activity and sleep quality).

METHODS

This descriptive and correlational study was conducted with 108 individuals who were treated in the chemotherapy unit of a hospital between April 2021 and April 2022 in Turkey. Data were collected using the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT), the International Physical Activity Questionnaire (IPAQ), the Mini Nutritional Assessment Test (MNA), and the sleep level Visual Analog Scale. Number, percentages, means, and standard deviations were calculated, and multiple linear regression analysis and path analysis were conducted to analyze the data.

RESULTS

The results indicate that the total MET score significantly and positively predicted the sleep scale score (β = 0.24, p < 0.01), while it negatively and significantly predicted the CIPNAT score (β = -0.30, p < 0.001). In addition, both the MNA screening score and the sleep scale score significantly and negatively predicted the CIPNAT score (β = -0.25, p < 0.01, β = -0.29, p < 0.001, respectively).

CONCLUSIONS

Lifestyle factors (exercise, nutrition, sleep) were found to have an effect on peripheral neuropathy. It is thought that increasing the level of exercise improves sleep quality, and regular nutrition, quality sleep and increased physical activity may be effective in reducing peripheral neuropathy.

Relationships among Inflammatory Biomarkers and Objectively Assessed Physical Activity and Sleep during and after Chemotherapy for Gynecologic Malignancies

Little is known regarding associations between inflammatory biomarkers and objectively measured physical activity and sleep during and after chemotherapy for gynecologic cancer; thus, we conducted a longitudinal study to address this gap. Women with gynecologic cancer (patients) and non-cancer controls (controls) completed assessments before chemotherapy cycles 1, 3, and 6 (controls assessed contemporaneously), as well as at 6- and 12-month follow-ups. Physical activity and sleep were measured using wrist-worn actigraphs and sleep diaries, and blood was drawn to quantify circulating levels of inflammatory markers. Linear and quadratic random-effects mixed models and random-effects fluctuation mixed models were used to examine physical activity and sleep over time, as well as the associations with inflammatory biomarkers. On average, patients (n = 97) and controls (n = 104) were 62 and 58 years old, respectively. Compared to controls, patients were less active, more sedentary, had more time awake after sleep onset, and had lower sleep efficiency (p-values < 0.05). Across groups, higher levels of TNF-α were associated with more sedentary time and less efficient sleep (p-values ≤ 0.05). Higher levels of IL-1β, TNF-α, and IL-6 were associated with lower levels of light physical activity (p-values < 0.05). Associations between inflammatory biomarkers, physical activity, and sleep did not differ between patients and controls. Given these results, we speculate that inflammation may contribute to less physical activity and more sleep problems that persist even 12 months after completing chemotherapy.

Perioperative Sleep Disturbance Following Mastectomy: A Longitudinal Investigation of the Relationship to Pain, Opioid Use, Treatment, and Psychosocial Symptoms

OBJECTIVES

Sleep disturbance negatively impacts the quality of life and recovery. Our objective was to evaluate the relationship between the individual patient and surgical factors with greater sleep disturbance following breast surgery.

METHODS

In this prospective longitudinal study, patients completed validated measures regarding sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Univariable and multivariable generalized estimating equations evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after breast surgery.

RESULTS

Female patients (n=259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain and psychosocial factors (eg, anxiety, depression, and affect). Independent preoperative predictors of worse sleep disturbance included younger age (B=-0.09, P =0.006), opioid use (B=3.09, P =0.02), and higher pain (B=0.19, P =<0.001) and anxiety (B=0.45, P =<0.001) at baseline. In addition, higher baseline positive affect (B=-0.14, P =<0.012) and the surgical category total mastectomy without reconstruction (B=-2.81, P =<0.006) were independently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks postsurgery was associated with disturbed sleep.

DISCUSSION

Certain patient characteristics, including younger age and baseline anxiety, positive affect, pain, and opioid use, were associated with greater sleep disturbance in the first year after breast surgery. Sleep disturbance was also associated with the greater perioperative and postoperative opioid requirements. Preoperative interventions (eg, anxiety management, cultivating positive affect, and multimodal pain management) in high-risk individuals may enhance sleep and recovery postoperatively, and allow more moderate and less prolonged opioid use.

Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side effect of many common anti-cancer agents that can lead to dose reduction or treatment discontinuation, which decrease chemotherapy efficacy. Long-term CIPN can interfere with activities of daily living and diminish the quality of life. The mechanism of CIPN is not yet fully understood, and biomarkers are needed to identify patients at high risk and potential treatment targets. Metabolomics can capture the complex behavioral and pathophysiological processes involved in CIPN. This chapter is to review the CIPN metabolomics studies to find metabolic pathways potentially involved in CIPN. These potential CIPN metabolites are then investigated to determine whether there is evidence from studies of other neuropathy etiologies such as diabetic neuropathy and Leber hereditary optic neuropathy to support the importance of these pathways in peripheral neuropathy. Six potential biomarkers and their putative mechanisms in peripheral neuropathy were reviewed. Among these biomarkers, histidine and phenylalanine have clear roles in neurotransmission or neuroinflammation in peripheral neuropathy. Further research is needed to discover and validate CIPN metabolomics biomarkers in large clinical studies.

Assessing chemotherapy-induced peripheral neuropathy with patient reported outcome measures: a systematic review of measurement properties and considerations for future use

PURPOSE

Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity of cancer treatment, with potential to significantly impact cancer survivors' long-term quality of life. Patient reported outcome measures (PROMs) are increasingly utilised to evaluate CIPN. However, guidance remains lacking on how to identify fit for purpose PROMs with considerations necessarily differing when used in various research and in-clinic contexts. This study aimed to evaluate evidence about CIPN PROMs measurement properties and propose considerations to optimize CIPN PROM selection for each purpose.

METHODS

A systematic review was conducted to identify literature assessing measurement properties of CIPN PROMs. These were evaluated against Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria and International Society for Quality of Life minimum standards. Risk of Bias (RoB) was assessed using the COSMIN RoB checklist.

RESULTS

Thirty-nine papers evaluating measurement properties of 13 PROMs were included. The European Organization for Research and Treatment of Cancer Quality of Life Chemotherapy-Induced Peripheral Neuropathy Questionnaire (QLQ-CIPN20) and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) were the most commonly investigated PROMs and had the most measurement properties meeting established criteria.

CONCLUSION

The use of the QLQ-CIPN20 and FACT/GOG-Ntx to assess CIPN in research settings has the most supporting evidence. However other considerations including study aims, endpoints and target population also factor into PROM selection and need to be considered more often when determining the most suitable outcome measure. Evidence of CIPN PROMs use in clinical practice is limited and their adoption to individual-patient level management requires more evaluation.

Pharmacological and Nonpharmacological Management of Chemotherapy-Induced Peripheral Neuropathy: A Scoping Review of Randomized Controlled Trials

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment with no effective preventative strategy or definitive treatment. Purpose: To synthesize empiric literature from randomized controlled trials (RCTs) of pharmacological and nonpharmacological management of CIPN. Data Sources: Articles published between January 1, 2010, and February 28, 2021, were identified using keywords searching Medline, PubMed, CINAHL, Web of Science, Cochrane Library, and Embase. Study Selection: RCTs that recruited individuals who were post-chemotherapy and experienced persistent CIPN symptoms. Data Extraction and Synthesis: Three independent reviewers screened a total of 2023 abstracts. After screening, full-text review, and quality appraisal, 22 articles were included in this review. Data related to study design, participant characteristics, interventions, controls, outcome measures, and relevant findings were extracted from full texts. Descriptive quantitative summaries were calculated and narrative analysis was performed. Results: Of the 22 studies, 4 investigated pharmacologic treatments, 2 compared acupuncture to pharmacologic treatments, and 16 studies examined nonpharmacologic treatments. Pharmacologic studies reported mixed results with evidence of participant response varying by history of chemotherapeutic agent. Acupuncture, exercise/physical therapy, and neurofeedback appear to be effective treatments for CIPN. Evidence regarding biophysical agents and cognitive-behavioral therapy is equivocal. Scrambler therapy is not supported. Limitations: Studies included in this review share several limitations, including widely variable outcome measures, small and demographically homogenous samples, and nonstandardized treatment protocols. Conclusion: This scoping review summarized the current body of high-quality RCTs investigating treatment for CIPN. The majority of studies in this review reports benefits of pharmacologic and nonpharmacologic interventions, although management may require a multipronged approach and should be tailored to the individual. Clinical implications are proposed and suggestions made for future research include implementation of standardized intervention protocols, use of outcome measures representative of the spectrum of CIPN symptoms, and stratification by the chemotherapeutic agent.

Therapeutic effect of opioid analgesics combined with non-steroidal anti-inflammatory drugs on peripheral neuropathy and its influence on inflammatory factors

OBJECTIVE

To study the therapeutic effect of opioid analgesics combined with non-steroidal anti-inflammatory drugs on peripheral neuropathy and inflammatory factors.

METHODS

Clinical data of 60 patients with peripheral neuropathy were collected and studied retrospectively. The patients were divided into Group A (30 cases, treated with tramadol combined with ibuprofen) and Group B (30 cases, treated with tramadol alone). The visual analogue scale (VAS) and numerical rating scale (NRS) pain scores were recorded before and 3, 7, 14 and 21 days after taking the medicine. The adverse reactions of nausea, vomiting, gastrointestinal disorder, dizziness, rash and lethargy were recorded within 21 days after taking the medicine. Blood samples were obtained from patients before and 3, 7, 14 and 21 days after taking medicine to detect the inflammatory factors IL-6, IL-1β and TNF-α.

RESULTS

VAS and NRS scores of patients in Group A were significantly lower than those of patients in Group B after 7, 14 and 21 days of treatment (all P<0.05), but there was no significant difference in VAS and NRS scores between the two groups after 3 days of treatment (all P>0.05). The incidence of gastrointestinal disturbance in Group A was significantly higher than that in Group B (P<0.001). There was no significant difference in IL-6, IL-1β and TNF-α between the two groups 3 days after treatment (all P>0.05), but after 7, 14 and 21 days of treatment, the levels of IL-6, IL-1β and TNF-α in Group A were significantly lower than those in Group B (all P<0.05).

CONCLUSION

Opioid analgesics combined with non-steroidal anti-inflammatory drugs is better than opioid analgesics alone in the treatment of peripheral neuropathy, and brings no more adverse reactions except gastrointestinal disorders, so the combined treatment can be further promoted for clinical use.

Chronic pain severity, impact, and opioid use among patients with cancer: An analysis of biopsychosocial factors using the CHOIR learning health care system

BACKGROUND

Despite the biopsychosocial underpinnings of chronic noncancer pain, relatively little is known about the contribution of psychosocial factors to chronic cancer pain. The authors aimed to characterize associations between biopsychosocial factors and pain and opioid use among individuals with chronic pain and cancer.

METHODS

The authors conducted a retrospective, cross-sectional study of 700 patients with chronic pain and cancer seeking treatment at an academic tertiary pain clinic. Patients completed demographic questionnaires and validated psychosocial and pain measures. Multivariable, hierarchical linear and logistic regressions assessed the relative contributions of biopsychosocial factors to the primary dependent variables of pain severity, pain interference, and opioid use.

RESULTS

Participants were 62% female and 66% White with a mean age of 59 ± 15 years, and 55% held a college degree or higher. Older age, African American or "other" race, sleep disturbance, and pain catastrophizing were significantly associated with higher pain severity (F(5,657) = 22.45; P ≤ .001; R2 = 0.22). Depression, sleep disturbance, pain catastrophizing, lower emotional support, and higher pain severity were significantly associated with pain interference (F(5,653) = 9.47; P ≤ .001; R2 = 0.44). Lastly, a poor cancer prognosis (Exp(B) = 1.62) and sleep disturbance (Exp(B) = 1.02) were associated with taking opioids, whereas identifying as Asian (Exp(B) = 0.48) or Hispanic (Exp(B) = 0.47) was associated with lower odds of using opioids.

CONCLUSIONS

Modifiable psychological factors-specifically sleep disturbance, depression, and pain catastrophizing-were uniquely associated with pain and opioid use in patients with chronic pain and diverse cancer diagnoses. Future behavioral pain interventions that concurrently target sleep may improve pain among patients with cancer.

LAY SUMMARY

Feeling depressed, worrying about pain, and bad sleep are related to higher pain symptoms in individuals with chronic pain and cancer. Specifically, those who struggle to sleep have worse pain and use more opioids. Also, individuals who have a bad prognosis for their cancer are more likely to be using opioid pain medications. Although race and cancer are related to chronic pain in patients, psychological well-being is also strongly related to this same pain.