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Impact of exercise on chemotherapy-induced peripheral neuropathy in survivors with post-treatment primary breast cancer

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Abstract

Purpose

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating side effect of neurotoxic chemotherapy. Exercise activates neuromuscular function and may improve CIPN. We examined the association between exercise and CIPN symptoms in breast cancer survivors.

Methods

In a retrospective cross-sectional study, we included patients completing a survey assessing exercise exposure and neuropathy symptoms in a tertiary cancer center survivorship clinic. We evaluated exercise duration and intensity using a standardized questionnaire quantified in metabolic equivalent tasks (MET-h/wk). We defined exercisers as patients meeting the National Physical Activity Guidelines’ criteria. We used multivariable logistic regressions to examine the relationship between exercise and CIPN and if this differed as a function of chemotherapy regimen adjusting for age, gender, and race.

Results

We identified 5444 breast cancer survivors post-chemotherapy (median age 62 years (interquartile range [IQR]: 55, 71); median 4.7 years post-chemotherapy (IQR: 3.3, 7.6)) from 2017 to 2022. CIPN overall prevalence was 34% (95% confidence interval [CI]: 33%, 36%), 33% for non-taxane, and 37% for taxane-based chemotherapy. CIPN prevalence was 28% (95% CI: 26%, 30%) among exercisers and 38% (95% CI: 37%, 40%) among non-exercisers (difference 11%; 95% CI: 8%, 13%; p < 0.001). Compared to patients with low (<6 MET-h/wk) levels of exercise (42%), 11% fewer patients with moderate (6–20.24 MET-h/wk) to high (>20.25 MET-h/wk) levels of exercise reported CIPN. Exercise was associated with reduced prevalence of all CIPN symptoms regardless of chemotherapy type.

Conclusion

CIPN may persist several years following chemotherapy among patients with breast cancer but is significantly reduced by exercise in a dose-dependent manner.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The underlying code for this study [and training/validation datasets] is not publicly available but may be made available to qualified researchers on reasonable request from the corresponding author.

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Acknowledgements

The authors thank the study participants for their time. Please see “Statements and Declarations” section below for funding and grant information.

Funding

This work is supported in part by a National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center. Dr. Bao is supported by NCI R37 CA248563 and R01 CA251470. Alexie Lessing is supported in part by NIH/NCI award number 5R25 CA020449. The funder played no role in study design, data collection, analysis and interpretation of data, or the writing of this manuscript.

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Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Kirin Saint

  2. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    David Nemirovsky, Yuan Chen, Whitney P. Underwood & Lee W. Jones

  3. Stony Brook University, Stony Brook, NY, USA

    Alexie Lessing

  4. Dana-Farber Cancer Institute, Boston, MA, USA

    Mingxiao Yang

  5. Stockton University, Galloway, NJ, USA

    Mary Lou Galantino

  6. University of Witwatersrand, Johannesburg, South Africa

    Mary Lou Galantino

  7. Weill Cornell Medicine, New York, NY, USA

    Mary Lou Galantino & Lee W. Jones

  8. Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA

    Ting Bao

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Contributions

AL, WPU, LWJ, and TB created the initial study design. KS, DN, AL, YC, MY, MLG, LWJ, and TB helped with collection and/or assembly of data. KS, AL, DN, YC, MY, LWJ, and TB completed data analysis and interpretation. AL and KS were major contributors in writing the initial manuscript. All authors contributed to drafting the manuscript, providing edits, and approval of the final draft. All authors agree to be accountable for all aspects of the final work.

Corresponding author

Correspondence to Ting Bao.

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Conflict of interest

Dr. Jones reports stock ownership in Pacylex Inc. and Illumisonics Inc. Dr. Bao reports a consultation role in Eisai Inc. All other authors declare no financial or non-financial competing interests.

Ethics approval

The protocol was approved by the MSK Institutional Review Board (IRB#20-101).

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Written informed consent was waived as the MSK Institutional Review Board identified our study involved minimal risk to the participants.

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Saint, K., Nemirovsky, D., Lessing, A. et al. Impact of exercise on chemotherapy-induced peripheral neuropathy in survivors with post-treatment primary breast cancer. Breast Cancer Res Treat 206, 667–675 (2024). https://doi.org/10.1007/s10549-024-07342-6

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