Edwards MA, Topp KS, Byl NN, Hamel K, Melisko, M; University of California and San Francisco State University, San Francisco, CA, USA. sendaimeredith@hotmail.com.

PURPOSE: The purpose of this case study was to document the effects of a physical therapy intervention on a woman who received docetaxel as a part of her treatment for breast cancer. FOUNDATION: Docetaxel is a chemotherapy drug commonly used in the treatment of early and late stage breast cancer. Taxanes are highly effective cytotoxic chemotherapies that are known to cause neurotoxicity in a moderate percentage of patients who receive them. Docetaxel acts by stabilizing microtubules in the polymerized state, thus inhibiting division of cancerous cells. Unfortunately, docetaxel also affects neuronal microtubules, and patients may present clinically with painful peripheral sensorimotor neuropathy, which may be reversible. DESCRIPTION: The patient was diagnosed with metastatic breast cancer, and underwent chemotherapy, partial mastectomy, removal of 18 lymph nodes, and radiation treatments. Her past medical history was significant for insulin-dependent diabetes 14 years in duration. A physical therapy evaluation was conducted 11 weeks after the last cycle of docetaxel. The evaluation included measurements of neuropathy severity, proprioception, vibration sense, and strength. Additional tests included force plate measurements, posturography, pain quality assessment, the Wolf Motor Function test, and the Timed Up and Go test. The patient’s most pronounced problems were pain in both feet and decreased balance. The physical therapy intervention included a functional center of mass retraining program, including static and dynamic standing exercises performed on progressively more challenging bases of support. The patient's pain syndrome related to taxane-induced neuropathy was managed by her medical oncologist, and included a combination of anti-inflammatory, narcotic and other pain modulating medicines. OBSERVATIONS: The patient underwent repeat testing of all evaluation items after the medical and physical therapy interventions. The testing indicated that there had been sensorimotor improvements after the interventions. CONCLUSION: To date, there have not been any studies that have analyzed the relationship between chemotherapy-induced neuropathy and function. The literature pertaining to diabetic neuropathy, however, has shown that there is a relationship between the severity of neuropathy and the frequency of balance, falls, and functional impairments. It is likely that in this case, the docetaxel-induced neuropathy contributed to the patient's balance problems and pain. Descriptive studies are needed to further clarify the functional impairments induced by neurotoxic chemotherapy. This is one of the first studies to outline physical therapy interventions that may address problems incurred secondary to neurotoxic cancer treatments. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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