Beyond P-Values: A Cross-Sectional Umbrella Review of Chemotherapy-Induced Peripheral Neuropathy Treatments

Alice Lily Ye Salahadin Abdi ^*

• University of Texas MD Anderson Cancer Center, Houston, United States

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic chemotherapy agents and impacts the daily lives of many cancer survivors. Despite thousands of articles published on CIPN, we remain no closer to a successful treatment regimen for the condition. In recent years, there have been several new clinical trials published, many of them exploring nonpharmaceutical interventions, with several new systematic reviews summarizing these trials. We discuss 19 systematic reviews published in 2023 that cite a wide variety of CIPN treatment trials, with an appraisal of the three most researched options – oral drugs, exercise, and acupuncture – through a review of randomized controlled trials not previously synthesized altogether before and identified using an umbrella review approach. We provide an effect sizes analysis of these trials, allowing readers themselves to interpret the existing literature beyond binary p-values and to better understand the current limitations in our knowledge. In short, for patients with CIPN after completing chemotherapy, evidence suggests that serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine) and acupuncture provide at least short-term relief for pain and sensory symptoms. For patients with CIPN and actively undergoing chemotherapy, home-based balance and strength training may provide symptom relief. Lastly, we describe challenges in clinical research methods in the development of effective CIPN interventions and opportunities for change that will impact the way future CIPN trials may be designed and reported.