Chemotherapy-associated peripheral neuropathy is a common complication in patients undergoing taxane and platinum-based chemotherapy. Peripheral neuropathy may cause the patient's activities of daily living to be inhibited, deterioration of quality of life, reduction of treatment dose, and even discontinuation of treatment [1-3]. In the literature, different studies have been carried out using many pharmacological and non-pharmacological approaches to manage this problem, but no approach that has been shown to be effective in its management has not been clearly defined until now [4,5]. One of the approaches whose effectiveness is evaluated in management is exercise. Published case reports [6,7] and a few experimental studies examining small patient groups have been found to have significant benefits in the management of peripheral neuropathy [8-10]. This study was planned to determine whether exercise is effective in managing associated peripheral neuropathy in oncology patients.~General Information Cancer is one of the most important health problems in the world and our country [11, 12]. Despite significant developments in cancer treatment, treatment-related side effects can lead to adverse effects on the quality of life of patients, limitation of their activities, and even restriction of the treatment dose and discontinuation of the treatment, which may adversely affect the response of the patient to treatment [1,13].~Antineoplastic agents used in cancer treatment provide treatment of cancer or prevent its progression by preventing the division and proliferation of cancer cells. However, these drugs cause many important side effects such as anemia, diarrhea, nausea, vomiting, infections, fatigue, alopecia, infertility, pain, and peripheral neuropathy in the patient by affecting not only cancer cells but also normal cells and body structures [1, 2 ].~Peripheral neuropathy is a significant side effect that adversely affects patients' quality of life receiving taxane or platinum-based chemotherapy [1-3]. The incidence of chemotherapy-associated peripheral neuropathy varies between 19 and 85%, depending on the type of chemotherapy protocol administered, the drug dose used in the treatment, and the duration of administration [14,15]. The incidence of peripheral neuropathy, according to the type of antineoplastic agent applied, is between 70-100% in platinum-administered patients, 11-87% in taxane-administered patients, 20-60% in thalidomide-administered patients, and 60-65% in ixabepilone-administered patients [15]. The most common antineoplastic agents causing peripheral neuropathy are platinum (oxaliplatin and cisplatin), vinca alkaloids (vincristine and vinblastine), and taxanes (paclitaxel, docetaxel), proteasome inhibitors (bortezomib), and immunomodulatory drugs (thalidomide) [16-18]. These chemotherapeutic agents, which cross the blood-brain barrier, affect the dorsal root ganglia and peripheral axons in the spinal cord, causing changes in motor, sensory and autonomic neurons, causing the development of peripheral neuropathy [1,19,20].~Many factors such as age, concomitant diabetes mellitus history, microtubules or mitochondrial damage, oxidative stress, changes in ion channel activity, and damage to the myelin sheath play a role in the development of peripheral neuropathy [21]. Sensory, motor, and autonomic symptoms may develop in patients with chemotherapy-related peripheral neuropathy. First, patients develop sensory symptoms such as numbness in the hands and feet, tingling, change in the sense of touch, paresthesia, dysesthesia, and patients usually describe these sensory changes as a feeling of wearing gloves and socks. As the picture progresses, spontaneous burning, fever, electric shock, mechanical or thermal allodynia, and hyperalgesia may also develop in patients. In severe cases, these symptoms can go as far as loss of sensory perception. Muscle weakness, gait, and balance disorders that increase the risk of falling are frequently reported motor symptoms by patients. Orthostatic hypotension, constipation, urinary dysfunction, and sexual dysfunction are common autonomic symptoms in patients [1, 13, 22-24]. While these symptoms improve over time with the discontinuation of chemotherapy in some patients, they can be permanent because neuron damage occurs in most patients [13]. Therefore, approaches presented in the management of peripheral neuropathy in the literature are quite limited.~In a systematic review of the effectiveness of pharmacological approaches in the management of chemotherapy-associated peripheral neuropathy, it was reported that the use of pharmacological agents such as duloxetine, gabapentin, acetyl-L-carnitine (ALC), amitriptyline, cannabinoid, lamotrigine, and topical baclofen could be recommended in the management of this problem. However, studies evaluating the efficacy of these pharmacological agents were found to be insufficient in terms of evidence [5, 14].~Non-pharmacological approaches whose effectiveness has been evaluated in the management of chemotherapy-related peripheral neuropathy are acupuncture, acupressure, neurofeedback, scrambler therapy, cold application, reflexology, massage, exercise, relaxation techniques, physical therapy, and magnetic therapy [7, 27-34].~Exercise, one of these approaches, has been reported to be effective in reducing pain, numbness, tingling, loss of sensation, and increasing muscle strength and balance due to peripheral neuropathy in different patient groups [7-10]. In a quasi-experimental study conducted on patients with a modified neuropathy score (range 0-20) of 5 and above, it was observed that closed kinetic exercises decreased the neuropathy score and increased the balance [7]. A 10-week home-based exercise program for breast cancer patients has been shown to improve symptoms of peripheral neuropathy [8]. In a randomized controlled study with patients with metastatic colorectal cancer, resistance and balance exercises were applied to the experimental group for eight weeks. According to the results of the study, when the experimental group and the control group were compared, peripheral neuropathy symptoms remained the same, while a significant improvement was found in balance functions [10]. In the study of Bland et al., it was stated that exercise significantly improved the CIPN20 score and reduced peripheral neuropathy in patients with breast cancer receiving taxane therapy [9]. However, although the number of studies showing exercise efficacy in managing chemotherapy-associated peripheral neuropathy is quite limited, studies with small samples have low evidence strength [9, 23].~This study was planned to determine whether exercise is an effective approach in the management of chemotherapy-associated peripheral neuropathy in oncology patients.~References~Zajączkowska, R., Kocot-Kępska, M., Leppert, W., Wrzosek, A., Mika, J., & Wordliczek, J. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. International journal of molecular sciences 2019, 20(6), 1451.~National Cancer Institute: Chemotherapy Side Effects Sheets. Available online: http://www.cancer.gov/cancertopics/coping/physicaleffects/chemo-side-effects.Erişim: 31.05.2019.~Staff, N.P., Grisold, A., Grisold, W., Windebank, A.J. Chemotherapy-induced peripheral neuropathy: A current review. Ann Neurol. 2017 Jun; 81(6):772-81.~Cunningham, J. E., Kelechi, T., Sterba, K., Barthelemy, N., Falkowski, P., & Chin, S. H. Case report of a patient with chemotherapy-induced peripheral neuropathy treated with manual therapy (massage). Supportive Care in Cancer 2011, 19(9), 1473.~Hou, S., Huh, B., Kim, H.K., Kim, K.H., Abdi, S. Treatment of Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Recommendations. Pain Physician 2018 Nov;21(6):571-592.~Wampler, M. A., Hamolsky, D., Hamel, K., Melisko, M., & Topp, K. S. Case report: painful peripheral neuropathy following treatment with docetaxel for breast cancer. Clinical journal of oncology nursing, 2005 9(2), 189.~Fernandes, J., Kumar, S. Effect of lower limb closed kinematic chain exercises on balance in patients with chemotherapy-induced peripheral neuropathy: a pilot study. Int J Rehabil Res 2016; 39: 368-371.~Wonders, K.Y., Whisler, G., Loy, H., Holt, B., Bohachek, K., & Wise, R. Ten weeks of home-based exercise attenuates symptoms of chemotherapy-induced peripheral neuropathy in breast cancer patients. Health psychology research 2013, 1(3).~Bland, K. A., Kirkham, A. A., Bovard, J., Shenkier, T., Zucker, D., McKenzie, et al. Effect of exercise on taxane chemotherapy-induced peripheral neuropathy in women with breast cancer: a randomized control trial. Clinical Breast Cancer; 2019.~Zimmer, P., Trebing, S., Timmers-Trebing, U., Schenk, A., Paust, R., Bloch, W., et al. Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial. Supportive Care in Cancer 2018, 26(2), 615-624.~American Society of Clinical Oncology. The state of cancer care in America: A report by the American Society of Clinical Oncology. J. Oncol. Pract. 2014 10, 119-142.~World Health Organization. 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Erişim: 01.06.2019.~Starobova, H., Vetter, I. Pathophysiology of Chemotherapy-Induced Peripheral Neuropathy. Front. Mol. Neurosci. 2017; 10, 174.~Costa, T.C., Lopes, M., Anjos, A.C.Y., Zago, M.M.F. Chemotherapy-induced peripheral neuropathies: an integrative review of the literature. Rev. Esc. Enferm. Usp. 2015; 49, 332-341.~Boyette-Davis, J. A., Walters, E. T., & Dougherty, P. M. Mechanisms involved in the development of chemotherapy-induced neuropathy. Pain management 2015, 5(4), 285-296.~Park, S.B., Goldstein, D., Krishnan, A.V., Lin, C.S.; Friedlander, M.L., Cassidy, J., et al. Chemotherapy-induced peripheral neurotoxicity: A critical analysis. CA Cancer J. Clin. 2013, 63, 419-437.~Areti, A., Yerra, V.G., Naidu, V.G.M., Kumar, A. Oxidative stress and nerve damage: Role in chemotherapy induced peripheral neuropathy. Redox Biol. 2014, 2, 289-295.~Kanzawa-Lee, G. A., Knoerl, R., Donohoe, C., Bridges, C. M., & Smith, E. M. L. Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy. In Seminars in oncology nursing. 2019, WB Saunders.~Duregon, F., Vendramin, B., Bullo, V., Gobbo, S., Cugusi, L., Di Blasio, A., et al. Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: a systematic review. Critical reviews in oncology/hematology 2018, 121, 90-100.~Winters-Stone, K.M., Horak, F., Jacobs, P.G., Trubowitz, P., Dieckmann, N.F., Stoyles, S., et al. Falls, functioning, and disability among women with persistent symptoms of chemotherapy-induced peripheral neuropathy. J Clin Oncol. 2017, 35 (23): 2604.~Hershman, D. L., Lacchetti, C., Dworkin, R. H., Lavoie Smith, E. M., Bleeker, J., Cavaletti, G., et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. 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Magnetic field therapy in patients with cytostatics-induced polyneuropathy: a prospective randomized placebo-controlled phase-III study. Bioelectromagnetics 2017; 38:85-94.~Ben-Horin, I., Kahan, P., Ryvo, L., et al. Acupuncture and reflexology for chemotherapy-induced peripheral neuropathy in breast cancer. Integr Cancer Ther. 2017.~Majithia, N., Smith, T.J., Coyne, P.J., et al. Scrambler therapy for the management of chronic pain. Support Care Cancer 2016; 24:2807-2814.~Lee, S.C., Park, K.S., Moon, J.Y., et al. An exploratory study on the effectiveness of 'Calmare therapy' in patients with cancer-related neuropathic pain: a pilot study. Eur J Oncol Nurs 2016; 21:1-7.~Prinsloo, S., Novy, D., Driver, L., et al. Randomized controlled trial of neurofeedback on chemotherapy-induced peripheral neuropathy: a pilot study. Cancer 2017; 123:1989-1997.~Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, https://ctep.cancer.gov/protocolDevelopment/eloctronic_applications/docs/CTCAE_v5_Quick. Erişim Tarihi: 12.01.2019.~Tofthagen, C.S., McMillan, S.C., Kip, K.E. Development and psychometric evaluation of the chemotherapy-ınduced peripheral neuropathy assessment tool. Cancer Nurs. 2011; 34, 10-20.~Kutlutürkan, S., Öztürk, E. S., Arıkan, F., Kahraman, B. B., Özcan, K., & Uçar, M. A. (2017). The psychometric properties of the Turkish version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT). European Journal of Oncology Nursing 2017; 31, 84-89.~Postma TJ. The Development Of An EORTC Quality of Life Questionnaire to Assess Chemotherapy-Induced Peripheral Neuropathy: The QLQ-CIPN20. Eur J Cancer 2005; 11:1135-1139.~Önsüz, Ü. Taksan Bazlı Tedavi Alan Kanser Hastalarında Oluşan Periferal Nöropatinin Yönetiminde Hastaların Uyguladığı Girişimlerin Etkinliği (The Effectiveness of the Procedures Patients Perform in Managing the Peripheral Neuropathy Which Occurs in Cancer Patients Taking Taxane-based Treatment). Master's Thesis. İstanbul Üniversitesi. Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı İç Hastalıkları Hemşireliği Yüksek Lisans Tezi, İstanbul. 2015.~Hemşirelik Yönetmeliği, Çalışılan Birim/Servis/Ünite/Alanlara Göre Hemşirelerin Görev, Yetki Ve Sorumlulukları, Güncelleme Tarihi: 20/10/2016, https://www.saglik.gov.tr/TR,10533/hemsirelik-yonetmeligi.html. Erişim tarihi: 12.07.2019.
Chemotherapy-associated peripheral neuropathy is a common complication in patients receiving taxane and platinum-based chemotherapy. Peripheral neuropathy may cause the patient's daily life activities to be hindered, quality of life to deteriorate, treatment dose reduced, or even discontinuation of treatment. In the literature, different studies have been carried out using many pharmacological and non-pharmacological approaches in the management of this problem, but so far, any approach that has been shown to be effective in its management has not been clearly defined. One of the approaches whose effectiveness is evaluated in management is exercise. There have been published case reports and several experimental studies examining small patient groups on this subject, and it has been shown to have significant benefits in the management of peripheral neuropathy. This study was planned to determine whether exercise is an effective method in the management of chemotherapy-associated peripheral neuropathy in oncology patients.