Preventing sensory and motor dysfunctions in children receiving neurotoxic chemotherapy: PrepAir study - an update

Abstract

Introduction Thanks to modern therapy, the survival rate for children with cancer is constantly improving. However, the strong treatment with chemotherapy also takes its toll. It leads to delays in motor milestones (e.g. running, climbing), which limits social reintegration as well as quality of life (Bjornard et al. 2018). Peripheral neuropathy (CIPN) is a common side effect of chemotherapy and a crucial cause of many functional disorders. It causes severe symptoms such as loss of sensation, pain, numbness, absent reflexes as well as loss of balance control. Depending on the neurotoxic agent, 52-100% of children are affected by CIPN (Kandula et al. 2016). We hypothesize that CIPN plays a crucial role for childrens well-being and reintegration and its prevention is of utmost importance. The PrepAir study therefore investigates the potential of preventive sensorimotor training to prevent CIPN. The aim is to preserve relevant sensory and motor functions in children so that they receive their planned medical therapy and become fitter and more socially integrated survivors.

Methods We are thefore currently running a large, prospective, multicenter, randomized and controlled study in six hospital centers (Basel, Bern, Aarau, St. Gallen, Freiburg (D), Berlin (D)). N=131 children between 6-18 years, undergoing neurotoxic chemotherapy, will be assigned to an intervention group or a treatment-as-usual group. After therapy, the control group will also receive the training. The primary endpoint of the study is the onset of CIPN. In addition, numerous secondary endpoints such as postural control, strength of the lower limbs, CIPN-related pain, movement-related leisure activities, physical self-concept and quality of life are assessed.

Results The study has so far been implemented in four centers (Basel, Freiburg, Bern and Berlin). We have so far recruited N=19/131 children and adolescents (Basel: N=6, Freiburg: N=12, Bern: N=1; %f=47.4; mean age= 16.44 years; cancer type 42.1% leukemia ALL, 42.1% lymphoma, 15.8% solid tumor).

Discussion/Conclusion We hypothesize that less children in the intervention group will develop symptoms of CIPN and will be able to maintain relevant motor and sensory functions which will enable them to receive their planned medical therapy but also to stay on the age-appropriate motor development level, improve their quality life and enhance social reintegration after therapy. This would show that specific exercise therapy is more than just a lifestyle intervention, it could be a therapy option without further side- effects, changing supportive care in oncology.

References

Bjornard, K. L., Gilchrist, L., Inaba, H., Diouf, B., Hockenberry, M. J., Kadan-Lottick, N. S., Bowers, D. C., Dolan, M. E., Ullrich, N. J., Evans, W. E., & Ness, K. K. (2018). Peripheral neuropathy in children and adolescents treated for cancer. The Lancet Child & Adolescent Health, 2(10), 744–754. https://doi.org/10.1016/S2352-4642(18)30236-0

Kandula, T., Park, S. B., Cohn, R. J., Krishnan, A. V., & Farrar, M. A. (2016). Pediatric chemotherapy-induced peripheral neuropathy: A systematic review of current knowledge. Cancer Treatment Reviews, 50, 118–128. https://doi.org/10.1016/j.ctrv.2016.09.005