Siebert Stefanie, Kersten Jane, Tomanek Annika, Heinz Sarina, Niels Timo, Baumann Freerk T
Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
University of Cologne, Cologne, Germany.
Support Care Cancer. 2025 Jul 22;33(8):712. doi: 10.1007/s00520-025-09712-2.
Chemotherapy- and immunotherapy-induced peripheral neuropathies (PNP) are common and often dose-limiting side effects of cancer treatment. Patients often experience pain, numbness, and tingling in their extremities. Pharmacological options such as duloxetine, which is recommended for chemotherapy-induced PNP (CIPN), offer limited relief [1]. Consequently, neuromuscular training incorporating sensorimotor elements is a promising non-pharmacological alternative. However, its effect on symptoms in the upper extremities remains unexplored. This study investigates the feasibility of combined sensorimotor and vibration training for the upper extremities before and during cancer treatment.
The VISCIPH A study is a two-arm, prospective, randomized controlled proof-of-principle trial. Within the overarching VISCIPH A/B research framework, this is an independently designed sub-study. The primary outcome was feasibility; secondary outcomes included patient-reported outcome measures (PROMs). Participants were randomized to either a sensorimotor and vibration training group (PNPEX) or a moderate resistance exercise group (MREX). Both interventions were supervised and performed twice weekly over 12 weeks. Fine motor skills, depth sensitivity, and temperature sensation were assessed pre- and post-intervention. PROMs (EORTC-QLQ-C30, FACT/GOG-Ntx, NRS (pain)) were collected at baseline, week 4, week 8, and week 12.
Of 50 enrolled cancer patients, 40 completed the study (32.5% male; mean age = 50.8 years). A total of 874 out of 960 planned sessions (91%) were completed. The dropout rate was 20%, with high patient adherence (98%) and successful implementation of the extensive test battery, exhibit feasibility of the study (proof of principle). Thirteen participants reported no numbness or tingling in the hands, and 18 reported no discomfort over the 12-week period. Both groups showed significant improvements in global health status (EORTC-QLQ-C30) at T3 (p = 0.001). However, the MREX group showed significant deterioration in depth sensitivity at 2 of 4 bone points after 12 weeks (I CP: p = 0.01; III CP: p = 0.046), whereas PNPEX outcomes remained stable.
While prior research has mainly focused on lower extremities, this study demonstrates the feasibility and potential protective effects of a combined vibration and sensorimotor training protocol for the upper limbs during neurotoxic cancer therapy. Given the limited efficacy of current pharmacological approaches, further research is warranted to explore the therapeutic potential of structured exercise interventions in the management of PNP.
化疗和免疫治疗引起的周围神经病变（PNP）是癌症治疗中常见且往往限制剂量的副作用。患者常出现四肢疼痛、麻木和刺痛。像度洛西汀这种被推荐用于化疗引起的周围神经病变（CIPN）的药物治疗选择，缓解效果有限[1]。因此，结合感觉运动元素的神经肌肉训练是一种有前景的非药物替代方法。然而，其对上肢症状的影响尚未得到探索。本研究调查了在癌症治疗前及治疗期间，针对上肢进行感觉运动与振动联合训练的可行性。
VISCIPH A研究是一项双臂、前瞻性、随机对照的原理验证试验。在总体的VISCIPH A/B研究框架内，这是一项独立设计的子研究。主要结局是可行性；次要结局包括患者报告的结局指标（PROMs）。参与者被随机分为感觉运动与振动训练组（PNPEX）或中等阻力运动组（MREX）。两种干预均由专人指导，每周进行两次，共12周。在干预前后评估精细运动技能、深度敏感性和温度感觉。在基线、第4周、第8周和第12周收集PROMs（欧洲癌症研究与治疗组织生活质量问卷C30（EORTC-QLQ-C30）、癌症治疗功能评估/妇科肿瘤神经毒性问卷（FACT/GOG-Ntx）、数字评分量表（疼痛）（NRS（pain）））。
在50名入组的癌症患者中，40名完成了研究（男性占32.5%；平均年龄 = 50.8岁）。在计划的960节课程中，共完成了874节（91%）。脱落率为20%，患者依从性高（98%），并且成功实施了广泛的测试项目，表明该研究具有可行性（原理验证）。13名参与者报告在12周内手部没有麻木或刺痛，18名报告没有不适。两组在T3时的总体健康状况（EORTC-QLQ-C30）均有显著改善（p = 0.001）。然而，12周后MREX组在4个骨点中的2个处深度敏感性显著恶化（I掌骨：p = 0.01；III掌骨：p = 0.046），而PNPEX组的结果保持稳定。
虽然先前的研究主要集中在下肢，但本研究证明了在神经毒性癌症治疗期间，针对上肢的振动与感觉运动联合训练方案的可行性和潜在保护作用。鉴于当前药物治疗方法的疗效有限，有必要进一步研究探索结构化运动干预在管理PNP方面的治疗潜力。
