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The Japanese Journal of Rehabilitation Medicine Volume 57, Issue 6 （June 2020）

The Japanese Journal of Rehabilitation Medicine 57巻6号（2020年6月発行）

Japanese English

症例報告

化学療法誘発性末梢神経障害に対して16週間の外来リハビリテーション治療を実施し，症状緩和と身体機能改善が得られた1症例 Effect of 16-week Outpatient Rehabilitation on Symptom Burden and Physical Function in a Patient with Plasmacytoma Diagnosed with Chemotherapy-induced Peripheral Neuropathy : A Case Report 牧浦大祐 ¹ , 斎藤貴 ^1,2 , 井上順一朗 ¹ , 土井久容 ³ , 薬師神公和 ⁴ , 酒井良忠 ⁵ Daisuke Makiura ¹ , Takashi Saito ^1,2 , Junichiro Inoue ¹ , Hisayo Doi ³ , Kimikazu Yakushijin ⁴ , Yoshitada Sakai ⁵ ¹神戸大学医学部附属病院リハビリテーション部 ²神戸大学大学院保健学研究科地域保健学領域 ³神戸大学医学部附属病院看護部 ⁴神戸大学医学部附属病院腫瘍・血液内科 ⁵神戸大学医学部附属病院リハビリテーション科 ¹Department of Rehabilitation, Kobe University Hospital ²Department of Community Health Sciences, Kobe University Graduate School of Health Sciences ³Division of Nursing, Kobe University Hospital ⁴Division of Medical Oncology and Hematology, Kobe University Hospital ⁵Division of Physical Medicine and Rehabilitation, Kobe University Hospital キーワード：化学療法誘発性末梢神経障害 , chemotherapy-induced peripheral neuropathy , 外来リハビリテーション , outpatient rehabilitation , 運動療法 , exercise therapy , 有害事象 , adverse event , 形質細胞腫 , plasmacytoma Keyword: 化学療法誘発性末梢神経障害 , chemotherapy-induced peripheral neuropathy , 外来リハビリテーション , outpatient rehabilitation , 運動療法 , exercise therapy , 有害事象 , adverse event , 形質細胞腫 , plasmacytoma pp.565-570

発行日 2020年6月18日 Published Date 2020/6/18

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Abstract 文献概要
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はじめに

　化学療法誘発性末梢神経障害（chemotherapy-induced peripheral neuropathy：CIPN）は，がん薬物療法に伴う一般的な有害事象であり，がん患者の身体機能の低下や転倒¹⁾，健康関連quality of life（QOL）の低下²⁾を引き起こすが，有効な治療法が確立されていないのが現状である³⁾．運動療法は，がん患者の身体機能と精神・心理機能，健康関連QOLの改善に有効であることが報告されているが⁴⁾，CIPNへの効果を示した報告は少ない．

　今回，CIPN患者に対して運動療法を行い，CIPNの症状緩和と身体機能の改善が得られた症例を経験したので報告する．症例には，本報告の目的と内容について説明し，書面にて同意を得た．

This case report describes the effect of exercise therapy on a patient with plasmacytoma diagnosed with chemotherapy-induced peripheral neuropathy (CIPN). A man in his mid 70s was diagnosed with plasmacytoma and received outpatient chemotherapy. He developed glove-and-stocking numbness and balance disorder and underwent 16-week multimodal exercise therapy consisting of resistance and balance training, and aerobic exercise. He attended one session per week of exercise therapy at a hospital under the supervision of a physical therapist and completed five sessions of home-based exercise. His symptoms and physical function were evaluated at baseline and after intervention using the Common Terminology Criteria for Adverse Events version 5.0 (CTCAE), Functional Assessment of Cancer Therapy-Neurotoxicity subscale (FACT-Ntx), modified Total Neuropathy Score (mTNS), Stand-up test, and Berg Balance Scale (BBS). After the 16-week intervention, clinician-assessed CIPN symptoms were stable (CTCAE：Grade 2 at baseline, Grade 2 after intervention), whereas patient-reported CIPN symptoms improved beyond the minimal clinically important difference (FACT-Ntx score increased from 22 to 29 points). Although the components of mTNS such as motor symptoms and strength improved, the total mTNS score remained stable. The Stand-up test and BBS scores improved, and better physical function led to improvements in activities of daily living. Thus, exercise therapy may effectively reduce the symptom burden and improve physical function in patients with CIPN.