Home-Based Intervention for Chemotherapy-Induced Peripheral Neuropathy

PURPOSE: The number of cancer survivors in the United States is expected to reach 18 million by 2022. Treatment focus is shifting to assisting people to “live well” with cancer. Peripheral neuropathy (PN) is a common side effect in persons receiving neurotoxic chemotherapy. Incidence of PN ranges from 30%–40% to as high as 90%. Patients with PN may experience numbness, tingling, or a burning sensation in the hands and feet. These problems can cause difficulty with holding smaller items, walking, and wearing shoes. The purpose of this pilot study was to determine the effect of a home sensorimotor intervention on (1) reduction of hand and foot pain and numbness, (2) improvement in overall function, and (3) improvement in quality of life.

DESIGN: A quasi-experimental, pretest–posttest design was used for the study. Posttesting included follow-up at 2 wk and 4 wk postintervention. Participants met the following inclusion criteria: received a taxane-based chemotherapy for early-stage breast cancer, were diagnosed with at least Grade 1 peripheral neuropathy of the hands or feet, and had no history of diabetes mellitus or autoimmune conditions. Participants were recruited from the outpatient chemotherapy unit of a large comprehensive breast care center.

METHOD: Participants completed the McGill Pain Questionnaire–Short Form; the Chemotherapy-Induced Peripheral Neuropathy–20; the Quick Disabilities of the Arm, Shoulder and Hand; a brief demographic questionnaire; and a brief follow-up questionnaire addressing pain severity, quality of life, and overall function. Study participants met with study therapists for one visit to obtain baseline functional information and learn the sensorimotor home interventions. The sensorimotor kit was provided at that time and contained the items needed to perform the intervention at home. The kit included common household items, putty, and a resistance band. Additionally, participants received handouts with a description of the intervention and pictures to aid performance at home.

The intervention included four modules, including instructions for both hands and feet, as follows: manual therapy (tissue manipulation), desensitization (varying sensory items to assist in reducing heightened sensitivity of the nerves), range of motion (ankle–foot and wrist–hand movements), and strengthening (use of putty and resistance band to strengthen target areas). Participants received follow-up phone calls at 2 wk posttraining and 4 wk posttraining to assess pain, function, and quality of life.

RESULTS: At baseline, 87% of participants reported moderate to severe pain. At 2 wk postbaseline, 40% reported moderate to severe pain, and by 4 wk postbaseline, no participants reported moderate to severe pain. At 2 wk post, 40% of participants reported improved functioning and 33% reported improved quality of life, and at 4 wk post, 82% reported improved functioning and 73% reported improved quality of life.

DISCUSSION: Results are preliminary but indicate that a conservative, home-based intervention has the potential to reduce symptoms of chemotherapy-induced peripheral neuropathy, as well as improve both overall function and quality of life.

IMPACT STATEMENT: Evidence supporting rehabilitation interventions in oncology is desperately needed to better inform occupational therapists about options for patient treatment. While only an initial first step, the current study can help occupational therapy better define conservative interventions and provides preliminary data for larger, more rigorous studies.