William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.
Massachusetts General Hospital Institute for Health Professionals, School of Rehabilitation Science, Boston, Massachusetts, USA.
J Palliat Med. 2022 Jun;25(6):964-995. doi: 10.1089/jpm.2021.0512. Epub 2022 Feb 4.
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment with no effective preventative strategy or definitive treatment. To synthesize empiric literature from randomized controlled trials (RCTs) of pharmacological and nonpharmacological management of CIPN. 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. RCTs that recruited individuals who were post-chemotherapy and experienced persistent CIPN symptoms. 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. 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. Studies included in this review share several limitations, including widely variable outcome measures, small and demographically homogenous samples, and nonstandardized treatment protocols. 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.
化疗引起的周围神经病（CIPN）是癌症治疗中常见且使人虚弱的副作用，目前尚无有效的预防策略或明确的治疗方法。本研究旨在综合 CIPN 的药理学和非药理学管理的随机对照试验（RCT）的经验文献。使用关键词在 Medline、PubMed、CINAHL、Web of Science、Cochrane Library 和 Embase 中搜索了 2010 年 1 月 1 日至 2021 年 2 月 28 日发表的文章。RCT 招募了接受化疗后出现持续性 CIPN 症状的个体。三名独立评审员共筛选了 2023 篇摘要。经过筛选、全文审查和质量评估，共有 22 篇文章纳入本综述。从全文中提取了与研究设计、参与者特征、干预措施、对照组、结局测量和相关发现相关的数据。计算了描述性定量总结并进行了叙述性分析。在这 22 项研究中，有 4 项研究了药物治疗，2 项研究比较了针灸与药物治疗，16 项研究检查了非药物治疗。药物研究的结果喜忧参半，有证据表明参与者对化疗药物的反应不同。针灸、运动/物理疗法和神经反馈似乎是治疗 CIPN 的有效方法。关于生物物理因子和认知行为疗法的证据尚无定论。 scrambler 疗法不受支持。本综述纳入的研究存在几个局限性，包括广泛的结果测量、样本量小且人口统计学同质以及非标准化的治疗方案。本综述总结了目前高质量 RCT 研究治疗 CIPN 的现状。本综述中的大多数研究报告了药物和非药物干预的益处，尽管管理可能需要多管齐下的方法，并应根据个体情况进行调整。提出了临床意义，并对未来研究提出了建议，包括实施标准化干预方案、使用代表 CIPN 症状谱的结局测量指标以及按化疗药物进行分层。
