Abstract P4-16-11: A modest proposal for classical massage on chemotherapy-induced peripheral neuropathy in breast cancer patients receiving adjuvant paclitaxel: A randomized controlled trial using electromyography
Authors: Demirci U , Izgu N , Gok Metin Z , Karadas C , Ozdemir L , Çetin N 
Published: May 2019

Background: Oncology professionals face challenges to find out a complete solution in prevention or alleviation of chemotherapy induced peripheral neuropathy (CIPN). Current pharmacological treatments used for CIPN have limited effects and pose major side effects. At this point, management of CIPN by a multidisciplinary team approach is very crucial. Therefore, this randomized controlled study aimed to examine the effect of classical massage on CIPN using objective and subjective measurements in breast cancer patients receiving adjuvant paclitaxel.

Method:The study was conducted at Dr. Abdurrahman Yurtaslan Ankara Training and Research Hospital in Turkey between July 2017 and June 2018. The study was approved by a local ethical committee. Eligible patients with breast cancer included those who (a) were 18 years and older; (b) had no documented diagnosis of CIPN; (c) had receiving the first cycle of adjuvant paclitaxel. Exclusion criteria were (a) history of severe psychiatric disorder; (b) history of peripheral neuropathy due to any cause; (c) had lesion on hands or feet; (d) had bleeding or coagulation disorders. Simple randomization method was utilized to allocate patients to an intervention group (n=18) and a control group (n=19). Patients in the intervention group (IG) received totally 12 sessions classical massage, on the days of chemotherapy cycles. The duration of each massage was 30 min, with 20 min for the feet and 10 min for the hands. The CG received only routine care. After completion of paclitaxel regimen no intervention was applied to neither the IG nor the CG, and patients were followed at week 16. Subjective measurement tools included the Self-Leeds Assessment of Neuropathic Symptoms and Sign (S-LANSS); and the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (EORTC QLQ-CIPN20). Electromyography (EMG) was applied as an objective measurement at baseline and week 12 for all patients by the same neurologist. The data were collected at five time points including baseline (T1), week 4 (T2) week 8 (T3), week 12 (T4) and week 16 (T5). To analyze data repeated measures ANOVA and Mann Whitney U tests were used.

Results: The S-LANSS scores were significantly lower in the IG when compared the CG (p&lt;.05). Motor sub-dimension scores of EORTC QLQ-CIPN20 were significantly lower in favor of the IG compared to the CG. As for sensorial and autonomic sub-dimensions of the EORTC QLQ CIPN20 showed no significant difference. Regarding EMG outcomes, compound muscle action potentials of ulnar nerve and posterior tibial nerve in the IG were significantly higher than the CG at week 12.

Conclusion: In this study, classical massage initiated concurrently with adjuvant paclitaxel regimen decreased neuropathic pain severity and prevented motor axonal neuropathy in the IG when compared to the CG. Accordingly, classical massage had promising effects on prevention and alleviation of CIPN. Based on the results, classical massage can be recommended as a preventive complementary option for breast cancer patients receiving adjuvant paclitaxel.

Citation Format: Demirci U, Izgu N, Gok Metin Z, Karadas C, Ozdemir L, Çetin N. A modest proposal for classical massage on chemotherapy-induced peripheral neuropathy in breast cancer patients receiving adjuvant paclitaxel: A randomized controlled trial using electromyography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-16-11.