(Editor's note: This is an informal review of recent news related to chemotherapy-induced peripheral neuropathy [CIPN]. Please be sure to read the comprehensive and scientific CE activity in this issue on page 1, "Neuropathic Pain-A Review of Pathophysiology, Presentation, and Management.")

In the search for ways to manage the painful side effects of chemotherapy, 2 recent studies shine the light on the age-old modalities of massage and cannabis. Although these treatments are symptom management, the importance lies in managing symptoms so that patients do not drop out of chemotherapy, which means symptom management has the potential of increasing long-term survival.

Women Breast Cancer Patients Seek Cannabis for Pain More Than for Nausea

First of all, the need for more and better ways to manage CIPN and other oncology-related pain is quite evident in a study by Philadelphia oncologist Marisa Weiss, MD, the founder and president of breastcancer.org, based on her own practice at Lankenau Medical Center, and described in an article in Forbes magazine.1

The Forbes article reports that Weiss recently conducted what she described as the first study ever to evaluate the underlying reasons that women with breast cancer use cannabis as part of their treatment regimen. Weiss had incorporated cannabis into her pain management program in 2018 after Pennsylvania established a medical marijuana program.

Nausea had commonly been believed to be the main reason, and science has strongly supported the improvement of those symptoms with cannabis use.

However, it turned out that pain-not nausea-was the No. 1 reason that women with breast cancer sought cannabis in Weiss's practice. This should not be a surprise, however, Weiss said, considering that more than half the women diagnosed with breast cancer are older than 50 years. Conditions of older age-such as arthritis-can exacerbate the muscle and joint side effects of treatment. Neuropathy can interfere with their ability to perform simple functions and their mobility.

The median age of Weiss's study group was 64 years, of which 22 women had early-stage breast cancer, and 9 had metastatic disease. She presented at the recent San Antonio Breast Cancer Symposium about the symptoms for which these patients sought cannabis during the first 10 months of Pennsylvania's medical marijuana program.

Weiss reported that women with early-stage and metastatic disease sought medical cannabis for these reasons:

* Symptomatic management of pain (73% of those with early stage and 89% of those with late stage);

* Anxiety (45% and 89%, respectively);

* Insomnia (50% and 33%, respectively);

* Nausea (4% and 33%, respectively); and/or

* Anorexia (0% and 33%, respectively).

Weiss also reported that patients suffered an average of 3 symptoms, and that pain was rarely experienced alone. Insomnia and anxiety were frequently experienced together with pain.

She noted that, beyond symptomatic management, other benefits of medical cannabis included safer products, for example, with less fungus, heavy metals, and pesticides than unregulated sources; and safer methods of delivery, for example, sublingual preparations instead of smoking or vaping, especially in patients receiving breast/lymph node radiation and chemotherapy. She also reported that fear of addiction motivated many patients to avoid, reduce, or stop opioid therapy for pain.

Intensive Schedule of Oncology Massage Helped Patients With Chemo-Induced Neuropathy

A new pilot study reported at a scientific meeting in October 2019 suggests that massage therapy-a lot of it, like every other day, and specifically oncology massage therapy-can make a big difference for patients with CIPN.2,3

The study shows a statistically and clinically significant improvement in pain scores among patients who received oncology massage therapy 3 times a week-compared with those who received it only twice a week.

The 71 patients in the study scored their pain using the Pain Quality Assessment Scale. The patients in the group who received the most intensive regimen showed sustained improvement at 10 weeks, according to the study.

"This study builds upon integrative oncology methods to improve the quality of life for cancer survivors, and there are currently limited options for the relief of CIPN pain," study author Gabriel Lopez, MD, as reported by Medscape Medical News from the Supportive Care in Oncology Symposium (SCOS) in October 2019, where Lopez reported his results. Lopez is an associate professor and medical director of the Integrative Medicine Center at the University of Texas MD Anderson Cancer Center in Houston.2,3

"These findings introduce oncology massage as an additional option to help with symptom control and offer new insight into which massage treatment schedule may provide patients with the greatest benefit," Lopez said.

The SCOS meeting was organized by the American Society of Clinical Oncology and previously known as the Palliative Care in Oncology Symposium. The name change is intended to expand the approach beyond end-of-life care to include more supportive care and symptom management in oncology.

In this vein, Lopez and his team decided to investigate the effects of massage for symptomatic relief of chronic CIPN in a pilot study that examined the optimum treatment schedule and initial efficacy of a standardized Swedish massage technique in treating symptoms associated with CIPN of the lower extremities.

The primary aim of the study was the feasibility-to see whether patients would attend massage therapy 2 or 3 times a week. The secondary goal was to compare outcomes of 2 versus 3 times per week.

All massages were given by therapists trained in oncology massage, which refers to a specific set of techniques provided by therapists who have special training and who are familiar with the unique needs of cancer patients, said Lopez.

The cohort included 71 patients with CIPN that developed after exposure to oxaliplatin, paclitaxel, or docetaxel. Of the cohort, 77.5% were women; 57.7% of the patients had breast cancer; and 42.3% had gastrointestinal cancer. The mean age was 60.3 years.

The patients self-reported a neuropathy score of at least 3 on a scale of 0 to 10 points, and their last chemotherapy treatment had occurred at least 6 months before the study period. The average time since the end of chemotherapy was more than 3 years.

Patients were randomly assigned to 1 of 4 regimens:

1. Lower extremity massage 3 times a week for 4 weeks;

2. Massage 2 times a week for 6 weeks;

3. Head/neck/shoulder massage 3 times a week for 4 weeks (control group); or

4. Control massage 2 times a week for 6 weeks.

As reported by Medscape, Lopez noted that the team will move toward conducting a larger randomized trial "where we have a proper control group that doesn't receive massage therapy."

Further validation may be needed before any firm recommendations can be made to patients about a massage schedule and for justifying insurance coverage for this frequency, commenters in the Medscape article said.

References