オキサリプラチン系治療を受けている消化器系癌患者における化学療法誘発性末梢神経障害の管理における電気刺激と圧迫適用の神経障害症状および生活の質への効果

実験的：TENS Group

Participants received the TENS intervention at each scheduled session from Cycle 2 through Cycle 6 during oxaliplatin-based chemotherapy, in addition to usual care.

デバイス：TENS

TENS was delivered using the F. Bosch FB2405 TENS+EMS dual-channel device with four 5 × 5-cm surface electrodes placed bilaterally over PC6 and KI1. Program 4 provided a modulated pulse rate of 2-60 Hz and a pulse width of 156-260 microseconds. The device output was adjustable from 0-80 mA per channel into a 500-Ω load, but no fixed mA value was used. Intensity was individually titrated to a strong, comfortable, non-painful sensory level without visible muscle contraction. Each session lasted 180 minutes: 30 minutes before, throughout the 120-minute oxaliplatin infusion, and 30 minutes after the infusion. Sessions were administered every 14 days from Cycle 2 through Cycle 6, for five sessions.

実験的：Compression group

Participants received the compression intervention at each scheduled session from Cycle 2 through Cycle 6 during oxaliplatin-based chemotherapy, in addition to usual care.

デバイス：Compression Garments

Bilateral compression of the hands and feet was applied using Beybi Sensitive surgical gloves one size smaller than the participant's measured glove size and knee-high Varimed CCL II graduated compression stockings providing 23-32 mmHg. Each session lasted 180 minutes: 30 minutes before, throughout the 120-minute oxaliplatin infusion, and 30 minutes after the infusion. Sessions were administered every 14 days from Cycle 2 through Cycle 6, for five sessions. All applications were individually fitted and directly supervised by the same research nurse.

実験的：Sequential TENS Plus Compression Group

Participants received TENS followed by compression at each scheduled intervention session from Cycle 2 through Cycle 6 during oxaliplatin-based chemotherapy, in addition to usual care.

デバイス：Sequential TENS Plus Compression

Participants received 90 minutes of TENS followed immediately by 90 minutes of bilateral hand-and-foot compression, using the same devices, parameters, electrode placement, gloves, and stockings as in the monotherapy groups. TENS began 30 minutes before the oxaliplatin infusion and continued during the first 60 minutes of the 120-minute infusion. After TENS was stopped and the electrodes were removed, compression was applied during the remaining 60 minutes of the infusion and for 30 minutes afterward. The total sequential intervention lasted 180 minutes. Sessions were administered every 14 days from Cycle 2 through Cycle 6, for five sessions.

介入なし：Usual Care Control Group

Participants received usual care from Cycle 2 through Cycle 6 and received no study-specific TENS or compression intervention.

Baseline-Adjusted EORTC QLQ-CIPN20 Total Score Trajectory Across T1-T4

The EORTC QLQ-CIPN20 is a 20-item patient-reported questionnaire assessing sensory, motor, and autonomic symptoms associated with chemotherapy-induced peripheral neuropathy. Scores are linearly transformed to a 0-100 scale, with higher scores indicating greater CIPN-related symptom burden.

The primary outcome was the baseline-adjusted post-baseline trajectory of the EORTC QLQ-CIPN20 total score across T1-T4. The assessments before Cycles 3-6 (T1-T4) were modelled jointly, with the score obtained before Cycle 2 (T0) included as the baseline covariate. The overall Group-by-Time interaction constituted the primary treatment-effect test. Baseline-adjusted between-group contrasts at T4 constituted the primary endpoint pairwise comparisons.

Baseline-Adjusted EORTC QLQ-C30 Scale Score Trajectories Across T1-T4

The EORTC QLQ-C30 is a 30-item patient-reported questionnaire assessing health-related quality of life in patients with cancer. It includes five functional scales, three symptom scales, a global health status/quality-of-life scale, and six single-item symptom measures. Scores are linearly transformed to a 0-100 scale. Higher functional and global health status scores indicate better functioning and quality of life, whereas higher symptom scores indicate greater symptom burden.

For each EORTC QLQ-C30 scale, the assessments before Cycles 3-6 (T1-T4) were modelled jointly, with the corresponding score obtained before Cycle 2 (T0) included as the baseline covariate. The Group-by-Time interaction was evaluated as a secondary treatment-period effect.

NCI-CTCAE v5.0 Peripheral Sensory Neuropathy Grade Across T1-T4

Chemotherapy-induced peripheral sensory neuropathy severity was assessed by a medical oncologist using the clinician-rated National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0 (NCI-CTCAE v5.0). Peripheral sensory neuropathy was graded from 0 to 4, with higher grades indicating greater severity and functional impairment.

Because all participants were classified as Grade 2 at T0 and sparse or zero cells prevented stable repeated-measures categorical modelling, grade distributions were compared among the randomized groups separately at each post-baseline treatment-period assessment from T1 to T4.

DN4 Total Score Trajectory and DN4-Defined Neuropathic Pain Positivity Across T1-T4

Neuropathic pain was assessed using the Douleur Neuropathique en 4 Questions (DN4), a 10-item clinician-administered instrument comprising seven symptom-interview items and three clinical-examination items. The total score ranges from 0 to 10, with higher scores indicating a greater number of neuropathic pain features. A score of 4 or higher was classified as DN4-defined neuropathic pain positivity.

The DN4 total scores obtained before Cycles 3-6 (T1-T4) were modelled jointly, with the DN4 total score obtained before Cycle 2 (T0) included as the baseline covariate. The Group-by-Time interaction was evaluated as a continuous secondary treatment-period effect. DN4-defined neuropathic pain positivity was compared among the randomized groups separately at each T1-T4 assessment.

Exploratory QLQ-CIPN20 Total Scores at 6-Month Follow-up

The EORTC QLQ-CIPN20 total score was assessed at the prespecified 6-month follow-up. Scores range from 0 to 100, with higher scores indicating greater CIPN-related symptom burden. This assessment was analyzed separately as an exploratory follow-up outcome and was not included in the primary T0-T4 treatment-period analysis.

Exploratory EORTC QLQ-C30 Scale Scores at 6-Month Follow-up

EORTC QLQ-C30 scale scores were assessed exploratorily at the prespecified long-term follow-up. Scores range from 0 to 100. Higher functional and global health status scores indicate better functioning and quality of life, whereas higher symptom scores indicate greater symptom burden. This assessment was conducted to examine participants' health-related quality-of-life status after the extended follow-up interval.

Exploratory NCI-CTCAE v5.0 Peripheral Sensory Neuropathy Grade at 6-Month Follow-up

Peripheral sensory neuropathy severity was assessed exploratorily at the prespecified long-term follow-up using NCI-CTCAE v5.0. Neuropathy is graded from 0 to 5, with higher grades indicating greater severity and functional impairment. This assessment was conducted to examine participants' neuropathy status after the extended follow-up interval.

Exploratory DN4 Total Score and Neuropathic Pain Positivity at 6-Month Follow-up

Neuropathic pain was assessed exploratorily at the prespecified long-term follow-up using the DN4. Total scores range from 0 to 10, with higher scores indicating more neuropathic pain features. A score of 4 or higher was classified as positive for neuropathic pain. This assessment was conducted to examine participants' neuropathic pain status after the extended follow-up interval.