Therapeutic ultrasound was a tool in Janice Yurick's treatment arsenal for 15 years. Yurick, a now retired physical therapist and former manager of supportive care services at the Cross Cancer Institute, had more than two decades of experience in oncology rehabilitation. She used the technology with patients and saw results, despite no actual studies to prove the effectiveness of the treatment. That may soon change.
Results from a recently published study led by Yurick, a graduate of the University of Alberta's Faculty of Rehabilitation Medicine, and Margaret McNeely, professor of physical therapy in the faculty and a member of the Cancer Research Institute of Northern Alberta, showed participants had improvements in symptoms of pain and sensory disturbance after two weeks of treatment with therapeutic ultrasound. Although no significant difference was found between those who received ultrasound and those who did not at a later six-week followup, the findings warrant a larger study to test the effectiveness of the treatment.
For the study, Yurick and McNeely looked at therapeutic ultrasound in a particular group: cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). The condition involves damage to the nerves and nerve endings that is sparked by chemotherapy. It is common across cancer types and often begins as a slight burning sensation or "pins and needles" feeling in the hands and feet. Eventually, it can advance to a point where it interferes with a person's basic functions, such as holding items or even maintaining their balance.
Currently, the only treatment for CIPN is managing symptoms with options including education, home-based therapeutic exercise programs and various drugs, although patients are often reluctant to add more drugs to their treatment regimen.
McNeely and her team maintained consistency in the small sample of patients by studying patients with colorectal cancer who were all given the same chemotherapy drug. The trial aimed to verify the logistics and efficacy of incorporating therapeutic ultrasound in patients' treatment plans.
"With [therapeutic] ultrasound, it has been used in physiotherapy mostly for musculoskeletal conditions, for tendonitis, so we don't have a lot of evidence supporting its use with CIPN or sensory issues," said Mona M. Al Onazi, first author on the paper and a graduate student in the Faculty of Rehabilitation Medicine. "We need more research in this area, and this was a great first step."
Though the feasibility trial focused on patients with colorectal cancer, the treatment could potentially be used for individuals with a wide range of cancer types, as well as those suffering CIPN from a variety of chemotherapeutic agents.
Another major benefit is accessibility—a therapeutic ultrasound machine is a common tool in most physiotherapy clinics.
"If this treatment proved to be beneficial, it would be easy for patients to access because of how widely available it is," said McNeely.
The feasibility trial gave McNeely and her team some insight as to the most effective time to deliver the treatment. Significantly, she found that most patients were more interested in taking part in the ultrasound treatments after their chemotherapy treatments, rather than attempting to combine them. The next steps involve recruiting a larger number of patients and testing the intervention in a placebo-controlled trial.
McNeely noted that a partnership between the U of A and Physiotherapy Alberta provided the perfect opportunity for the collaboration, offering funding for clinician-led questions and pairing clinicians with researchers to aid in the process.
"I think this type of partnership is valuable," she said. "A clinician has a front-line question that needs to be answered but doesn't have the background to perform the research or the training to do the research."
The study, "Therapeutic Ultrasound for Chemotherapy-Related Pain and Sensory Disturbance in the Hands and Feet in Patients With Colorectal Cancer: A Pilot Randomized Controlled Trial," was published in the Journal of Pain and Symptom Management.
