Clinical and Practical Recommendations in the Use of Exercise, Physical Therapy, and Occupational Therapy for Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a highly prevalent, severe, and dose-limiting toxicity of several chemotherapy regimens for the treatment of multiple cancers including lung, breast, prostate, gastrointestinal, blood, and others. Patients with CIPN may experience numbness, tingling, pain, and cramping in the hands and feet, as well as problems with balance and gait that increase the risk of falls, reduce physical function, and hinder activities of daily living. At this point there are extremely limited treatment options for CIPN. Fortunately, a growing body of preliminary evidence suggests that exercise, physical therapy, and occupational therapy may help prevent, treat, and manage CIPN. Although there is not definitive evidence for the benefits of exercise on CIPN due to lack of Phase III randomized controlled trials, exercise is generally helpful in the cancer treatment continuum and poses low risk for patients with the help of a qualified professional. Therefore, we present clinical suggestions in the use of exercise for CIPN, including assessments of patient risk factors and other considerations. We conclude with an example exercise prescription that a qualified exercise professional can adapt for the specific needs, risks, and abilities of each individual patient.