減緩化學治療引起周邊神經病變之運動介入設計與成效－－系統性文獻回顧

The Effect of Exercise Interventions on Alleviating Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review

背景85%-95%癌症病人會因化學治療引起周邊神經病變（chemotherapy-induced peripheral neuropathy），而易造成神經性疼痛、情緒困擾、影響日常生活功能及人際關係。透過運動介入似乎可改善或預防周邊神經病變，但其成效仍不一致，目前國內缺乏探討運動對於化學治療引起周邊神經病變成效之系
統文獻探討。
目的系統性文獻探討運動介入緩解化學治療引起之周邊神經病變之成效。
方法採系統性文獻回顧法，搜尋從2002至2021年8月前，使用MEDLINE、PubMed、Cochrane Library、Embase、華藝線上圖書館、臺灣博碩士論文等資料庫，以PICO（patient, intervention, comparator, outcome）建立關鍵字，分別為P：「cancer, cancer survivor」、「癌症、癌症存活者」；I：「rehabilitation」、「exercise」、「復健」、「運動」；C：「usual care」、「常規照護」；O：「chemotherapy-induced peripheral neuropathy」、「化學治療引起周邊神經病變」、等進行搜尋，以運動為介入措施於癌症病人周邊神經病變之實驗性研究文章，共審閱141篇文獻，依排除與納入條件，共納入13篇文獻做研究分析。
結果回顧13篇隨機分派之實驗性研究，共909位癌症病人。結果發現，單一性或組合式運動措施對於預防或減緩化療引起之周邊神經病變都可能有效果。但受限於研究樣本數範圍差異大（19至355人），且運動種類（9種）、頻率（2-7天／週）、時間（5-60分鐘）不同，仍需更多研究探討何種運動劑量較有效、有無次族群效益等。
結論運動訓練可能預防或減緩化療引起之周邊神經病變。醫護人員可考慮在癌症病人身體功能穩定且未出現嚴重化療副作用時，鼓勵癌症個案自輕度活動開始增加運動量，以減少周邊神經病變對日常生活功能與生活品質之影響。

Background: 85%–95% of patients with cancer experience chemotherapy-induced peripheral neuropathy (CIPN), which may lead to neuropathic pain, emotional distress, functional difficulties, and interpersonal problems. Although exercise interventions have been proposed for improving and preventing CIPN, evidence regarding the efficacy of these interventions has been inconsistent and of inadequate quality. In addition, few domestic systematic reviews have examined the effects of exercise on CIPN.
Purpose: To examine the effects of exercise interventions in cancer patients with CIPN using a systematic review (SR) method.
Methods: An SR method was used in this paper by applying the concept of PICO using keywords P“cancer”, I“rehabilitation”,“exercise”, C“usual care, standard of care”, and O“chemotherapy-Induced peripheral neuropathy”in a search of the Ovid Medline, PubMed, Cochrane Library, EMBASE and Airiti Library databases for articles published from 2002 to 2021. Based on the inclusion and exclusion criteria, a total of 13 research articles were identified for review in this study.
Results: The 13 randomized controlled trials reviewed in this SR included 909 cancer patients during or after chemotherapy who were receiving exercise interventions. The results indicate that single or combined exercise protocols have consistent benefits in terms of improving CIPN symptoms. However, because of the relatively small sample sizes (n = 19-355) and the multiple types (n = 9), frequencies (1–7 day/week), and durations (5–60 minutes/ time) of exercise protocols used in these studies, future research is necessary to explore differences in the types and subgroup effects of exercise.
Conclusions: The results from this systematic review indicate that the combined exercise model has consistent benefits in terms of helping prevent and alleviate the symptoms of CIPN. In clinical practice, healthcare providers may consider encouraging cancer patients to initiate mild physical activity when their physical conditions are stable and