内容紹介
Summary
Taxanes, which are used to treat breast cancer, damage the microtubules of normal nerve cells, causing numbness of the fingers related to chemotherapy-induced peripheral neuropathy(CIPN); therefore, effective methods for reducing numbness are needed. In 2017, it was reported that physical stimuli related to massage improved finger blood flow volumes, contributing to the regeneration of damaged nerves. We developed a method of hand therapy for breast cancer patients complaining of numbness related to anticancer drug administration, and examined its effects on numbness. Hand therapy was performed by a single therapist who received lectures at the Sophia Phytotherapy College, which is accredited by the Japan Handcare Association. The fingertips to wrist, ankle, metacarpal bones, palm, and elbow were massaged using the bilateral arms/fingers for 15 minutes. We investigated the influences of daily living status(Support Team Assessment Schedule-Japan: STAS-J), age, body mass index(BMI), severity/site of numbness, type of numbness, type of drug, duration of breast cancer, duration of numbness, and presence or absence of lymph node dissection, and evaluated the severity of numbness using a 10-cm Visual Analog Scale(VAS). The study included 51 breast cancer patients complaining of numbness of the fingers, with a mean age of 59 years. In patients with relatively mild numbness(STAS-J 1), the VAS scores before and after hand therapy were 4.7±1.8 and 1.9±1.3, respectively, showing a marked decrease. In STAS-J 2 patients, the values were 4.9±1.4 and 2.1±1.3, respectively, also showing a marked decrease. Thus, this hand therapy reduced numbness in mild- and moderate-status patients. Statistical comparisons were performed between the STAS-J 1/2(mild/moderate numbness)and STAS-J 3/4(severe numbness)groups. Although the severity of numbness was not correlated with age, BMI, type of drug, lymph node dissection, or duration of breast cancer, the proportion of patients with a ≥1-year history of numbness was significantly larger in the STAS-J 1/2 group. The most frequent site of numbness was from the proximal interphalangeal joints to the fingertips. Concerning the severity of numbness, many patients complained of severe numbness, as represented by that after sitting straight. These results suggest that this hand therapy is effective for reducing numbness in patients receiving taxanes and complaining of mild to moderate numbness.
要旨
乳がん患者に用いられるタキサン系抗がん剤は正常な神経細胞の微小管を傷つけ,化学療法誘発性末梢神経障害(CIPN)の手指のしびれを引き起こすため,しびれ改善に有効な対処方法が強く望まれている。2017年,マッサージの物理的刺激は手指の血流量を改善し傷ついた神経を再生させることが報告されたことから,われわれは抗がん剤投与によりしびれを感じる乳がん患者を対象にマッサージ法であるハンドセラピー施術を独自に考案し,しびれの改善効果について検討を行った。ハンドセラピーは,一般社団法人日本フィトセラピー協会直営校のソフィアフィトセラピーカレッジにて講習を受けたセラピスト1名が行い,指先から手首,くるぶし,中手骨,手のひら,肘まで両腕手指で15分間さする手法で実施した。日常生活への影響(Support Team Assessment Schedule-Japan: STAS-J),年齢,BMI,しびれの強さと部位,しびれの性状,治療薬の種類,乳がん発病経年,しびれ発症経年,リンパ節郭清の有無を調べ,しびれの強さは10 cmのVisual Analog Scale(VAS)によって評価した。対象は手指のしびれを訴える乳がん患者51名,平均年齢59歳,ハンドセラピー施術前後のVAS評価はしびれの度合いが比較的軽度なSTAS-J 1で4.7±1.8から1.9±1.3,STAS-J 2で4.9±1.4から2.1±1.3と有意に低下し,しびれの度合いが軽度および中程度でしびれが改善したことを示した。軽度および中程度のSTAS-J 1/2と,重度のSTAS-J 3/4のグループで統計解析を行ったところ,年齢,BMI,薬の種類,リンパ節郭清,乳がん発病経年とは相関がなかったが,しびれ発症経年はSTAS-J 1/2で1年以上しびれを感じる人数が有意に高いことが明らかとなった。しびれの部位は近位指節間関節から指先が多く,しびれの性状は正座後のような強いしびれ感を訴える人数が多かった。以上のことから,タキサン系抗がん剤を使用し軽度から中程度のしびれを感じる患者にハンドセラピー施術はしびれ改善に有効であることが示唆された。
目次
Taxanes, which are used to treat breast cancer, damage the microtubules of normal nerve cells, causing numbness of the fingers related to chemotherapy-induced peripheral neuropathy(CIPN); therefore, effective methods for reducing numbness are needed. In 2017, it was reported that physical stimuli related to massage improved finger blood flow volumes, contributing to the regeneration of damaged nerves. We developed a method of hand therapy for breast cancer patients complaining of numbness related to anticancer drug administration, and examined its effects on numbness. Hand therapy was performed by a single therapist who received lectures at the Sophia Phytotherapy College, which is accredited by the Japan Handcare Association. The fingertips to wrist, ankle, metacarpal bones, palm, and elbow were massaged using the bilateral arms/fingers for 15 minutes. We investigated the influences of daily living status(Support Team Assessment Schedule-Japan: STAS-J), age, body mass index(BMI), severity/site of numbness, type of numbness, type of drug, duration of breast cancer, duration of numbness, and presence or absence of lymph node dissection, and evaluated the severity of numbness using a 10-cm Visual Analog Scale(VAS). The study included 51 breast cancer patients complaining of numbness of the fingers, with a mean age of 59 years. In patients with relatively mild numbness(STAS-J 1), the VAS scores before and after hand therapy were 4.7±1.8 and 1.9±1.3, respectively, showing a marked decrease. In STAS-J 2 patients, the values were 4.9±1.4 and 2.1±1.3, respectively, also showing a marked decrease. Thus, this hand therapy reduced numbness in mild- and moderate-status patients. Statistical comparisons were performed between the STAS-J 1/2(mild/moderate numbness)and STAS-J 3/4(severe numbness)groups. Although the severity of numbness was not correlated with age, BMI, type of drug, lymph node dissection, or duration of breast cancer, the proportion of patients with a ≥1-year history of numbness was significantly larger in the STAS-J 1/2 group. The most frequent site of numbness was from the proximal interphalangeal joints to the fingertips. Concerning the severity of numbness, many patients complained of severe numbness, as represented by that after sitting straight. These results suggest that this hand therapy is effective for reducing numbness in patients receiving taxanes and complaining of mild to moderate numbness.
要旨
乳がん患者に用いられるタキサン系抗がん剤は正常な神経細胞の微小管を傷つけ,化学療法誘発性末梢神経障害(CIPN)の手指のしびれを引き起こすため,しびれ改善に有効な対処方法が強く望まれている。2017年,マッサージの物理的刺激は手指の血流量を改善し傷ついた神経を再生させることが報告されたことから,われわれは抗がん剤投与によりしびれを感じる乳がん患者を対象にマッサージ法であるハンドセラピー施術を独自に考案し,しびれの改善効果について検討を行った。ハンドセラピーは,一般社団法人日本フィトセラピー協会直営校のソフィアフィトセラピーカレッジにて講習を受けたセラピスト1名が行い,指先から手首,くるぶし,中手骨,手のひら,肘まで両腕手指で15分間さする手法で実施した。日常生活への影響(Support Team Assessment Schedule-Japan: STAS-J),年齢,BMI,しびれの強さと部位,しびれの性状,治療薬の種類,乳がん発病経年,しびれ発症経年,リンパ節郭清の有無を調べ,しびれの強さは10 cmのVisual Analog Scale(VAS)によって評価した。対象は手指のしびれを訴える乳がん患者51名,平均年齢59歳,ハンドセラピー施術前後のVAS評価はしびれの度合いが比較的軽度なSTAS-J 1で4.7±1.8から1.9±1.3,STAS-J 2で4.9±1.4から2.1±1.3と有意に低下し,しびれの度合いが軽度および中程度でしびれが改善したことを示した。軽度および中程度のSTAS-J 1/2と,重度のSTAS-J 3/4のグループで統計解析を行ったところ,年齢,BMI,薬の種類,リンパ節郭清,乳がん発病経年とは相関がなかったが,しびれ発症経年はSTAS-J 1/2で1年以上しびれを感じる人数が有意に高いことが明らかとなった。しびれの部位は近位指節間関節から指先が多く,しびれの性状は正座後のような強いしびれ感を訴える人数が多かった。以上のことから,タキサン系抗がん剤を使用し軽度から中程度のしびれを感じる患者にハンドセラピー施術はしびれ改善に有効であることが示唆された。