Neurophysiological Assessments and Exercise Prehabilitation in Women with Breast Cancer Receiving Taxane-Based Chemotherapy

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of taxane chemotherapy, which is regularly used in breast cancer treatment. Accurate assessment and monitoring of CIPN are needed to improve understanding of its prevalence, incidence, and contributing factors. Preventive strategies and established treatment options remain limited. This thesis aimed to assess the acceptability and feasibility of monitoring objective and patient-reported CIPN symptoms before, during, and after taxane chemotherapy, and performing targeted exercise 24 hours before infusion as a potential mechanism of neuroprotection.
A systematic review found that exercise before and/or during chemotherapy is effective in limiting CIPN symptoms and improving quality of life for early-stage breast cancer patients receiving taxane-based chemotherapy regimens (Chapter 2). This review also identified considerable heterogeneity in measures of CIPN and exercise interventions. This thesis demonstrated that the H-reflex is a reliable measure of peripheral nerve function in a population demographically similar to those with early-stage breast cancer (Chapter 3), endorsing its usefulness in longitudinal studies in this population. Chapter 4 demonstrated that regular CIPN assessment during treatment was acceptable and feasible. The H-reflex also declined from baseline following taxane chemotherapy, mirroring sensory CIPN symptoms. Therefore, the H-reflex may act as a tool for CIPN measurement and could be assessed as part of routine clinical management via referral to neurology clinics.
The final clinical study indicated that performing exercise 24 hours before chemotherapy infusion is feasible, and participants gleaned significant benefits from participation (Chapter 5). Yet, high dropout rates and barriers identified by participants underscore the need for amendments to the study design before further research is pursued.
This thesis highlights the potential for reliable, longitudinal assessments to improve knowledge regarding CIPN development and management. It also endorses the feasibility of targeted exercise for CIPN management, while stressing the need for adaptable study designs and interventions.

Date of Award	30 Apr 2025
Original language	English
Awarding Institution	Northumbria University
Supervisor	Gabriel Cucato (Supervisor), John Temesi (Supervisor), John Saxton (Supervisor), Nicola Cresti (Supervisor) & Sam Orange (Supervisor)