The efficacy and prescription of NMES in adult cancer survivors - a systematic review. by Dominic O'Connor It is anticipated that by 2030, annual cancer diagnosis rates will exceed 21million. Yearly cancer mortality rates are falling each year demonstrating improved screening and more effective treatments. However, cancer treatment can also be associated with the loss of muscle mass and functional capacity, and can lead to poor health related quality of life (HR-QoL). Exercise is currently recommended to help offset these side effects. However, voluntary exercise is not always possible. Pragmatic alternatives such as neuromuscular electrical stimulation (NMES) hold promise due to its ability to elicit involuntary muscle contractions similar to those which occur during voluntary aerobic and resistance exercise. However, NMES uptake clinically is poor, and currently no published, high level evidence supports its application in cancer survivorship.

1. The efficacy and prescription of NMES in adult
cancer survivors – a systematic review
Dominic O’Connor
ESR 5 – UCD
Prof. B.Caulfield, Dr. O.Lennon
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the
Marie Sklodowska-Curie grant agreement number 722012
Background
It is anticipated that by 2030, annual cancer diagnosis rates will exceed 21
million (1). Yearly cancer mortality rates are falling each year demonstrating
improved screening and more effective treatments. However, cancer treatment
can also be associated with the loss of muscle mass and functional capacity (2),
and can lead to poor health related quality of life (HR-QoL). Exercise is
currently recommended to help offset these side effects. However, voluntary
exercise is not always possible. Pragmatic alternatives such as neuromuscular
electrical stimulation (NMES) hold promise due to its ability to elicit
involuntary muscle contractions similar to those which occur during voluntary
aerobic and resistance exercise. However, NMES uptake clinically is poor (3),
and currently no published, high level evidence supports its application in
cancer survivorship.
Objectives
The objectives of this review were to;
• evaluate the published evidence investigating the use of NMES exercise in
adult cancer survivors;
• synthesise the evidence evaluating its application in improving physical
function and HR-QoL
• assess the safety of NMES exercise in cancer survivorship,
• determine if specific prescription and progression patterns could be
identified with NMES application in cancer survivorship
Methods
Search conducted in four databases up to March 2018: PubMed, EMBASE,
CINAHL, The Cochrane Library. Eligibility criteria included; 1) article/abstract
of original research, 2) adult cancer survivors, 3) NMES intervention, and 4)
measurements pre-NMES and post-NMES. No limit placed on study
methodology.
Results
• Current literature limited by studies of poor quality and a lack of adequately
powered RCT’s.
• NMES significantly improved HR-QoL (0.36, 95% CI 0.10, 0.62), with
notable gains identified under the subcategory QoL Function.
• Overall pooled effect favoured NMES over usual care for improving muscle
strength but the standardised mean difference was not significant (0.36,
95% CI -0.25, 0.96).
• NMES appears safe but the optimal parameters for safe use cannot be
determined from the included studies.
• Current NMES prescription is not standardised.
• NMES prescribed to target secondary complications of treatment.
References
1. Askoxylakis V, Thieke C, Pleger ST, et al (2010) Long-term survival of cancer patients compared to heart failure and
stroke: A systematic review. BMC Cancer 10:105.
2. Courneya KS, Friedenreich CM (2001) Framework PEACE: an organizational model for examining physical
exercise across the cancer experience. Ann Behav Med 23:263–272
3. Maffiuletti NA, Gondin J, Place N, et al (2017) The Clinical Use of Neuromuscular Electrical Stimulation for
Neuromuscular Rehabilitation: What Are We Overlooking? Arch Phys Med Rehabil.
Contact:
Email: dominic.oconnor@insight-centre.org
Twitter: @domdom2407
Linkedin: www.linkedin.com/in/dominicoconnorcatch
Website: www.catchitn.eu
Figure 1. PRISMA flow diagram of the
search and article selection
Conclusions
• NMES in cancer rehabilitation is an emerging field.
• Existing evidence suggests NMES is safe and may be more effective than
standard care for improving HR-QoL.
• There is a requirement for high quality RCTS’s where parameters chosen
and progression patterns are tailored for the individual and outcomes
desired.
Figure 2. Pooled analysis of NMES versus usual care in HR-QoL domains