Improving symptoms and balance in cancer survivors with chemotherapy-induced peripheral neuropathy: the CanSTEP trial

Background: More than 30% of cancer survivors are affected by chemotherapy-induced peripheral neuropathy (CIPN) six months post-neurotoxic treatment. Despite the ever-increasing burden of CIPN-related disability in cancer survivors, current management is inadequate. Small-scale trials have demonstrated the benefits of exercise, particularly balance training, on CIPN symptom severity. However, no studies have concurrently addressed the cognitive complaints raised by 20-30% of patients caused by cancer and/or its treatments. We have demonstrated that home-based cognitive-motor step training delivered via exergames reduces falls in older people and improves balance and stepping in people with Multiple Sclerosis and Parkinson’s disease.

Aims: Building on our previous research, this randomised controlled trial will determine the effectiveness and cost-effectiveness from a health care system perspective of a 4-month cognitive-motor step training program (CanSTEP) compared with usual care, on neuropathy symptoms and balance in cancer survivors with CIPN.

Methods: As part of this trial (ACTRN12624000865516), 178 cancer survivors with CIPN symptoms affecting the lower limbs, will be recruited. Following a baseline assessment, participants will be randomised to either intervention or wait-list control group. The intervention will involve engaging stepping exergames played at home in several sessions totalling up to 120 minutes per week. CIPN symptoms (primary outcome), incremental cost-effectiveness ratio (economic outcome), quality of life, balance and mobility, executive function and physical activity patterns will be assessed at baseline and 4-months. Patient-reported outcomes and 1-week physical activity monitoring (wrist sensor) will also be completed at a 6-month follow-up. Interviews will be conducted in a sub-sample of intervention participants to explore barriers and motivations to take up the program.

Expected outcomes and significance: Participants’ recruitment is ongoing with fifty participants randomised to date. This trial has the potential to accelerate access to practitioners and cancer survivors with CIPN to an evidence-based rehabilitation program, ultimately reducing risks and costs associated with mobility impairment and falls.