Effects of Integrative Approaches for the Management of Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer Patients: A Systematic Review of Randomized Controlled Trials and Quasi-Experimental Studies

Purpose: Integrative approaches are widely used to manage chemotherapy-induced peripheral neuropathy (CIPN). This review aimed to evaluate the effects of various integrative approaches on CIPN, quality of life (QoL), pain, and balance in patients with colorectal cancer (CRC), and to assess any associated adverse effects. Patients and Methods: A comprehensive search was conducted using eight English and Chinese databases, from inception to January 2025. Randomized controlled trials and quasi-experimental studies were included in data analysis and synthesis. A narrative synthesis was used to present the findings, and the pooled effect size was calculated when there were two or more randomized controlled trials of the same type of intervention. Methodological quality assessment was assessed by the Effective Public Health Practice Project (EPHPP). Results: Thirteen studies involving 638 patients were included in this review. In two randomized controlled trials, multimodal exercise programs significantly reduced CIPN severity in patients with colorectal cancer (CRC) at post-intervention (SMD = − 0.70, 95% CI − 1.36 to − 0.07, p =0.03). One trial also reported sustained effects up to four weeks post-intervention (Cohen’s d = 0.58, p =0.031). Additionally, a low methodological quality pilot study (7 participants) showed improvements in CIPN following multimodal exercise. Furthermore, hand-foot exercise (Number of study, N=1), massage therapy (N=2) and henna application (N=1) demonstrated significant positive effects on neuropathy (p < 0.05) immediately post-intervention, while Goshajinkigan (N=2) suggested a significant effect of prevention of worsening of CIPN instead of the improvement of CIPN symptoms (p< 0.05). Aerobic exercise (N=2), acupuncture (N=1), and therapeutic ultrasound (N=1) did not demonstrate significant benefits in CIPN management in patients with CRC. Only exercise interventions demonstrated significant benefits for pain, balance, and QoL in patients with CRC experiencing CIPN (p< 0.05). No existing studies have examined psychological interventions for CIPN in patients with CRC. Conclusion: Multimodal exercise programs showed promising improvements in CIPN, while exercise interventions improve QoL, balance, and pain in patients with CRC. The heterogeneity of the reviewed studies limited the evaluation of the pooled effect sizes of different interventions. Additionally, small sample sizes in the reviewed studies and studies lacking long-term outcome evaluation limited the overall findings of this review. Therefore, high-quality studies with larger sample sizes are required to investigate the long-term effects of integrative interventions on CIPN management in patients with CRC. Registration number in PROSPERO: : CRD42025644115 Keywords: integrative approaches, complementary therapies, lifestyle modifications, chemotherapy-induced peripheral neuropathy, colorectal cancer, systematic review