Supportive care: Comparing exercise interventions for upper extremity polyneuropathy induced by chemo- or...

Chemotherapy and immunotherapy-induced peripheral neuropathy affects up to 68% of cancer patients and may persist long after treatment, substantially impairing daily functioning and quality of life. While exercise therapy has demonstrated benefits in lower-limb polyneuropathy (PNP), evidence for upper-extremity symptoms remains scarce. The VISCIPH B pilot study investigated the effect of two supervised exercise interventions for PNP of the upper extremities using exploratory analyses of symptom response.

In this single-center randomized controlled pilot trial (DRKS00023287), 61 cancer patients with symptomatic upper-extremity PNP were randomized (1:1) to either (a) combined sensorimotor plus vibration exercise (PNPEX) or (b) moderate resistance exercise (MREX). Both interventions were carried out supervised twice weekly over 12 weeks. Feasibility outcomes included adherence, retention, assessment completeness, and safety of the exercise interventions. Symptom outcomes were assessed with the FACT/GOG-Ntx questionnaire, measures of pain (NRS), depth sensitivity (Rydel-Seiffer tuning fork), and quality of life (EORTC QLQ-C30).

Feasibility criteria showed high adherence (86%) and retention (69%) rates. A total of 42 patients (mean age 53.3 years, 36% male) completed the intervention with no reported intervention-related adverse events. In the exploratory effect analyses, 50% of PNPEX participants (10/20) were classified as responders, compared to 14% (3/21) in MREX (OR = 5.45, p = 0.043). FACT/GOG-Ntx scores improved significantly in PNPEX (p = 0.017) but not in MREX (p = 0.46), resulting in a significant difference between the two groups (p = 0.05). Patient-reported outcomes revealed significant improvements in the PNPEX group regarding numbness and tingling (NRS), depth sensitivity at four of the eight tested bone sites and global health (p = 0.001).

The VISCIPH B pilot trial confirmed the feasibility, safety, and acceptance of supervised exercise for upper-extremity PNP in cancer patients. Significant improvements in patient-reported and functional outcomes indicate that combined sensorimotor and vibration exercise can meaningfully reduce PNP symptoms and should be evaluated in larger trials.