About

Dr. Robert Knoerl is an Assistant Professor at the University of Michigan School of Nursing, affiliated with the Department of Health Behavior and Clinical Sciences. His program of research focuses on developing effective management options for cancer treatment-related side effects, emphasizing interventions that are non-pharmacological, such as yoga, music therapy, and cognitive behavioral pain management. Dr. Knoerl has led clinical trials to explore these interventions' potential to reduce side effects and enhance the quality of life for cancer survivors, with particular attention to remote delivery methods and adolescent and young adult cancer survivors. He received his postdoctoral training at Dana-Farber Cancer Institute and holds both a BSN and PhD from the University of Michigan. His research has been supported by grants from the National Cancer Institute and the Rogel Cancer Center, among others. As an educator, Dr. Knoerl aims to create a welcoming learning environment, helping students master nursing and research skills and facilitating their application in professional settings. His professional service includes memberships in the Oncology Nursing Society and the Multinational Association of Supportive Care in Cancer, and he has received awards recognizing his contributions to dissemination and research.

Research topics

• Medicine
• Physical therapy
• Internal medicine
• Oncology
• Clinical psychology

Selected publications

• Abstract PS1-01-12: Preventing Chemotherapy-Induced Peripheral Neuropathy with Acupuncture: Preliminary Results of a Pooled Analysis of Three Parallel Randomized Trials

  Clinical Cancer Research · 2026-02-17

  article

  Abstract Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating side effect, adversely impacting quality of life (QoL) and treatment outcomes in breast cancer patients. Preventive strategies for CIPN remain limited. Acupuncture has shown promise in mitigating CIPN symptoms, but its role in prevention requires further investigation. This study evaluates acupuncture’s effectiveness in preventing CIPN in early-stage breast cancer patients through a pooled analysis of three coordinated international trials. Methods: Patients with stage I-III breast cancer, with no prior neuropathic symptoms, scheduled for taxane-based chemotherapy were randomized 1:1 to acupuncture or relaxation exercises with nature videos as the control in three parallel trials in the USA, China, and South Korea. Participants in the acupuncture group received 14 standardized sessions over 12 weeks, starting before the second chemotherapy cycle. Participants in the control group received nature video relaxation during chemotherapy infusions. Follow-up extended for an additional 12 weeks. The primary endpoint was the change in CIPN severity using EORTC CIPN-20 sensory subscale at 12 weeks. Secondary endpoints included CIPN incidence, pain intensity, and QoL at week 12 and week 24. Data were pooled and analyzed using longitudinal linear mixed-effects model, stratified by site and chemotherapy schedule (weekly vs. non-weekly). All analysis were intention to treat. Results: Of 129 patients who consented, 128 were randomized (USA: 88, China: 20, South Korea: 20) and 127 were analyzed (63 acupuncture, 64 control). Median age was 46 years (range: 30-80) in the acupuncture arm and 49 years (range: 26-77) in the control arm, with 58.2% White and 38.6% Asian. At baseline, patients reported similar CIPN-20 sensory scores between study arms [0.44 points (SE 0.77) vs. 1.29 (0.77), p=0.33]. At week 12, patients in both arms reported a statistically significant increase of mean sensory change score [7.23 (1.75), 95%CI: 3.76-10.70, p<0.0001; and 8.16 (1.67), 95%CI: 4.86-11.47, p<0.0001, respectively]. There are no statistically significant differences between the acupuncture arm vs. the control arm at week 12 and week 24 (Table). No acupuncture-related serious adverse events were observed. Conclusions: Acupuncture was safe and well-tolerated but did not significantly reduce the risk and severity of CIPN when compared to the nature video control in this pooled cohort. Secondary analyses are in progress and will be reported separately. Funding Source: The Ministry of Health & Welfare, Republic of Korea, Comprehensive and Integrative Medicine R&D project through the Korea Health Industry Development Institute (KHIDI) Grant Number: HI20C1753 Clinical Trial Registry Numbers: NCT05528263, ChiCTR2200066714, KCT0008470 Citation Format: W. Lu, A. Giobbie-Hurder, A. Tanasijevic, S. Baedorf Kassis, E. Diederich, A. J. Sahraoui, Y. J. Jeong, I. H. Shin, C. Yao, X. Zhang, N. Lee, Y. Yao, C. Bao, T. Bao, E. Yang, R. Knoerl, B. E. Bierer, J. A. Ligibel. Preventing Chemotherapy-Induced Peripheral Neuropathy with Acupuncture: Preliminary Results of a Pooled Analysis of Three Parallel Randomized Trials [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-01-12.

  PublisherDOI

• Association of Pain With Mental and Physical Function in Patients With Chemotherapy‐Induced Peripheral Neuropathy: A Secondary Analysis From Two Randomized Controlled Trials

  Muscle & Nerve · 2026-05-20

  article

  INTRODUCTION/AIMS: Chemotherapy-induced peripheral neuropathy (CIPN) affects 30%-60% of patients who receive neurotoxic chemotherapy. Multiple studies have shown that these symptoms negatively impact patients' quality of life. This study seeks to examine the association of the severity of pain in CIPN and different health outcomes after adjustment for non-painful symptoms. METHODS: Baseline data from two randomized clinical trials (RCTs) involving 595 participants with painful and non-painful CIPN were used to examine associations between pain severity and mental and physical function using linear regression models. Participants were grouped into four pain severity categories measured via the 0-10 numeric rating scale. The analyses were repeated with adjustment for non-painful symptoms. RESULTS: The proportions of participants reporting severe pain were similar between trials (41% vs. 48%). Participants with severe CIPN pain in both trials (N = 274) reported worse outcomes across all assessed domains than participants with non-painful CIPN (N = 70) (p < 0.02). However, this was not consistently observed when comparing to other pain groups (mild or moderate pain). When the analyses were repeated with the severity of numbness and tingling included as covariates for a proxy of overall neuropathy severity, the associations between pain and health domains were similar. DISCUSSION: Participants with CIPN experiencing severe pain have worse health outcomes than participants with non-painful CIPN, regardless of severity of other non-painful neuropathy symptoms. Research should focus on developing effective pharmacological and non-pharmacological interventions that target pain to reduce the symptom burden of CIPN and increase implementation of currently available interventions for pain in the context of CIPN.

  PublisherDOI

• Food groups and micronutrients associated with chemotherapy-induced peripheral neuropathy in survivors of cancer post-neurotoxic treatment

  Supportive Care in Cancer · 2025-08-22

  articleOpen accessSenior author

  PURPOSE: Determine the association of food group and micronutrient intake with chemotherapy-induced peripheral neuropathy (CIPN) among survivors of cancer. METHODS: In this cross-sectional study, participants completed the PRO-CTACE™ numbness and tingling severity item and VioScreen™ Research Food Frequency Questionnaire to determine CIPN status and dietary intake, respectively. Separate covariate-adjusted linear, logistic, and ordered logistic regression models were used to calculate the mean food group and micronutrient amounts and the associations with CIPN status and severity. As a secondary analysis of prior research that was not powered to detect these associations, we considered p ≤ 0.10 as an indicator of relevance for future study. RESULTS: A total of 136 participants completed the surveys and questionnaires. Participants with greater daily intake of refined grains (OR = 2.05; 95% CI, 1.22, 3.46) and less intake of tomatoes (OR = 0.10; 95% CI, 0.10, 1.14), fish (OR = 0.21; 95% CI, 0.06, 0.75), eggs (OR = 0.06; 95% CI, 0.01, 0.34), and selenium (OR = 0.96; 95% CI, 0.92, 1.00) were associated with increased odds of having CIPN. The odds of experiencing worse CIPN severity increased with each additional serving of refined grains (OR = 1.66; 95% CI, 1.11, 2.48) and decreased with each extra serving of poultry (OR = 0.58; 95% CI, 0.31, 1.08), fish (OR = 0.18; 95% CI, 0.05, 0.61), egg (OR = 0.08; 95% CI, 0.02, 0.39), legumes (OR = 0.04; 95% CI, 0.00, 1.49), and selenium (OR = 0.96; 95% CI, 0.93, 1.35). CONCLUSION: There are meaningful intake differences between participants with and without CIPN. Further research is needed to establish a dietary intervention using the findings in a larger population.

  PublisherOA PDFDOI

• Identifying Adolescent and Young Adults’ Preferences for Oncology Symptom Management Clinical Trial Participation

  Cancer Nursing · 2025-01-31

  articleOpen access1st authorCorresponding

  BACKGROUND: Most studies to date exploring facilitators and barriers to adolescent and young adults' (AYAs') participation in clinical trials have been focused on external factors to AYAs' participation or recruitment strategies. OBJECTIVE: The purpose of this mixed-methods study was to determine AYA cancer survivors' preferences for oncology symptom management clinical trial participation. METHODS: Semistructured interviews and conjoint analysis were conducted to clarify potential attributes (eg, characteristics) and levels (eg, value of the characteristic) that may be important to AYA cancer survivors when considering clinical trial participation (n = 19). The final list of attributes and levels was administered within a choice-based conjoint analysis survey (n = 52). The utility score for each level was analyzed using hierarchical Bayes estimation, and the feature importance for each attribute was quantified. RESULTS: The type of new treatment (22.9%) and perceived importance of study topic (19.5%) were the most important attributes identified by participants. The levels with the highest utility scores within each attribute included prescription medicine treatment with mild side effects, electronic surveys, under-30-minute study visits, no follow-up visits, 4-week treatment period, and once-a-week treatment frequency. CONCLUSION: The data support that study designs with low participant burden, interventions with few side effects, and the involvement of AYAs in determining the priority of the research topic are appealing to AYAs when considering participation in symptom management trials. IMPLICATIONS FOR PRACTICE: AYA participation in clinical trials is necessary to develop new symptom management modalities. Clinicians may use the results to introduce clinical trials containing trial characteristics that appeal to AYA cancer survivors.

  PublisherOA PDFDOI

• Association Between the CEP72 Genotype and Chemotherapy-Induced Peripheral Neuropathy Severity in Young Adults Receiving Vincristine or Paclitaxel

  Oncology nursing forum · 2025-08-24

  articleOpen access1st authorCorresponding

  OBJECTIVES: To determine the relationship between chemotherapy-induced peripheral neuropathy (CIPN) severity and centrosomal protein 72 (CEP72) genotype in young adults receiving paclitaxel or vincristine. SAMPLE &AMP; SETTING: 50 young adults aged 21-39 years who were expected to receive a cumulative dose of at least 7 mg vincristine or 700 mg/m2 paclitaxel for the treatment of cancer were recruited from Dana-Farber Cancer Institute. METHODS &AMP; VARIABLES: Participants completed a CIPN assessment tool and provided a blood sample before the first infusion. Participants completed the assessment tool at two additional time points. DNA was genotyped for CEP72 rs924607. CIPN scores were compared between those with the TT versus the CC or CT genotype over time using linear mixed-effects models. RESULTS: Young adults receiving vincristine with the TT CEP72 genotype experienced higher CIPN severity by the final time point, but the differences were not statistically significant (p > 0.05). IMPLICATIONS FOR NURSING: Future work to validate biomarkers like CEP72 may allow clinicians to identify patients who may benefit from altered chemotherapy dosages relative to CIPN risk.

  PublisherOA PDFDOI

• Describing the minimally clinically important difference of a chemotherapy-induced peripheral neuropathy patient-reported outcome measure in young adults

  Asia-Pacific Journal of Oncology Nursing · 2025-01-18

  articleOpen access1st authorCorresponding

  <h2>Abstract</h2><h3>Objective</h3> The purpose of this secondary analysis was to characterize the reliability, validity, and minimally clinically important difference (MCID) of change scores over time of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN-20 item (QLQ-CIPN20) in young adults receiving paclitaxel or vincristine. <h3>Methods</h3> Fifty young adults receiving vincristine or paclitaxel for the treatment of cancer completed the QLQ-CIPN20 at three time points associated with increasing cumulative chemotherapy dose. The Subject Significance Questionnaire was completed at T3. The analyses were focused on the calculation of floor and ceiling effects, internal consistency reliability, longitudinal validity, construct validity, and the MCID using an anchor-based approach for the QLQ-CIPN20 sensory and motor subscales. <h3>Results</h3> By T3, 50% and 52% of participants reported QLQ-CIPN20 sensory and motor subscale scores at the floor, respectively. The internal consistency reliability of the sensory (<i>α</i> ​= ​0.83) and motor (<i>α</i> ​= ​0.89) subscales was strong. The Cohen's <i>d</i> from T1 to T3 for the QLQ-CIPN20 sensory (<i>d</i> ​= ​−0.57) and motor (<i>d</i> ​= ​−0.47) subscales were small to moderate. There were low to moderate correlations between QLQ-CIPN20 sensory (<i>r</i> ​= ​0.45) and motor (<i>r</i> ​= ​0.27) subscale scores and vincristine cumulative dose. The MCID for worsening QLQ-CIPN20 sensory and motor subscale scores was 14.37 and 9.57, respectively (<i>P</i> ​< ​0.01). <h3>Conclusions</h3> Study results provided preliminary evidence surrounding the MCID for worsening of QLQ-CIPN20 scores using an anchor based on young adults' perceived change in CIPN severity. Further research is needed to develop psychometrically sound CIPN patient-reported outcome measures to effectively evaluate the impact of CIPN interventions among young adults.

  PublisherOA PDFDOI

• Exploring Chemotherapy‐Induced Peripheral Neuropathy Severity Patterns in Young Adult Women With Breast Cancer Receiving Weekly or Dose Dense Paclitaxel

  European Journal of Cancer Care · 2025-01-01

  articleOpen access1st authorCorresponding

  Purpose The purpose of this secondary analysis was to explore paclitaxel‐induced peripheral neuropathy severity patterns among women with breast cancer receiving weekly or dose dense paclitaxel regimens. Methods Young adult women with breast cancer (18–39 years) beginning cancer treatment with dose dense (175 mg/m 2 every 14 days) or weekly (80 mg/m 2 ) paclitaxel completed the QLQ‐CIPN20 before the first paclitaxel infusion (T1) and then at two time points during paclitaxel chemotherapy (T2: 350 mg/m 2 and T3: 700 mg/m 2 ). QLQ‐CIPN20 scores were compared between women receiving dose dense or weekly paclitaxel across the three time points using mixed‐effect linear regression models. Results Among women receiving dose dense paclitaxel ( n = 27), mean QLQ‐CIPN4 scores increased from 4.63 at T1 to 15.43 at T3, while among women receiving weekly paclitaxel ( n = 12), mean QLQ‐CIPN4 scores increased from 2.08 at T1 to 5.56 at T3. Similar trends were observed for changes in QLQ‐CIPN20 sensory and motor subscale scores among both groups. Overall, while CIPN severity was worse at each time point among women receiving dose dense paclitaxel relative to women receiving weekly paclitaxel, there were no statistically significant differences between groups for changes in QLQ‐CIPN4 ( p = 0.24), QLQ‐CIPN20 sensory ( p = 0.41), or QLQ‐CIPN20 motor score ( p = 0.68) over time. Conclusions The results may be used to promote awareness among patients and clinicians regarding potential trajectories of paclitaxel‐induced peripheral neuropathy for women with breast cancer.

  PublisherDOI

• Preliminary study exploring the association between amygdala-ventral medial prefrontal-cortex connectivity and anxiety among adolescent and young adult cancer survivors

  BMC Cancer · 2025-12-29

  articleOpen access1st authorCorresponding

  Up to 40% of adolescent and young adult cancer survivors (AYAs) experience anxiety after cancer treatment. Evidence from healthy controls suggests that the prefrontal cortex exerts a regulatory influence over the amygdala, facilitating reappraisal of fear-inducing stimuli and preventing maladaptive emotional responses. Increased anxiety severity has been associated with low amygdala–ventral medial prefrontal cortex (vmPFC) connectivity, but little is known about the neural correlates of anxiety in AYA cancer survivors. The purpose of this cross-sectional study was to explore the association between amygdala-vmPFC connectivity and anxiety severity among AYA cancer survivors. Seventeen post-treatment AYA cancer survivors were recruited from the University of Michigan. Participants completed an anxiety self-report and a 45-minute functional MRI scan that consisted of resting and task-based conditions (i.e., viewing pleasant, neutral, or unpleasant scenes). General linear models were constructed to investigate the effect of self-reported anxiety on the functional connectivity between the amygdala and vmPFC regions. Anxiety severity was positively associated with the functional connectivity between the right amygdala and vmPFC (MNI: -2, 54, 14; k = 323 voxels; peak t-statistic = 9.16; peak beta = 0.34; p = 0.04) while viewing pleasant images, but not other images or during rest. Analyses using the left amygdala as a seed region did not yield significant correlations. The positive association between anxiety severity and amygdala-vmPFC connectivity while viewing positive stimuli may suggest an overly active neural pathway linked to overall ineffective emotional regulation. Further understanding of amygdala-vmPFC connectivity as a potential mechanism underlying anxiety may provide evidence toward a viable target for intervention research.

  PublisherOA PDFDOI

• Exploring the reliability and validity of clinically-relevant outcome measures for chemotherapy-induced peripheral neuropathy

  Supportive Care in Cancer · 2024-09-19 · 2 citations

  articleOpen access1st authorCorresponding
  PublisherOA PDFDOI

• Exploring clinical markers of Axon degeneration processes in Chemotherapy-induced peripheral neuropathy among young adults receiving vincristine or paclitaxel

  BMC Neurology · 2024-09-28 · 6 citations

  articleOpen access1st authorCorresponding

  Abstract Background Approximately 70% of patients receiving neurotoxic chemotherapy (e.g., paclitaxel or vincristine) will develop chemotherapy-induced peripheral neuropathy. Despite the known negative effects of CIPN on physical functioning and chemotherapy dosing, little is known about how to prevent CIPN. The development of efficacious CIPN prevention interventions is hindered by the lack of knowledge surrounding CIPN mechanisms. Nicotinamide adenine dinucleotide (NAD + ) and cyclic-adenosine diphosphate ribose (cADPR) are potential markers of axon degeneration following neurotoxic chemotherapy, however, such markers have been exclusively measured in preclinical models of chemotherapy-induced peripheral neuropathy (CIPN). The overall objective of this longitudinal, observational study was to determine the association between plasma NAD + , cADPR, and ADPR with CIPN severity in young adults receiving vincristine or paclitaxel. Methods Young adults (18–39 years old) beginning vincristine or paclitaxel were recruited from Dana-Farber Cancer Institute. Young adults completed the QLQ-CIPN20 sensory and motor subscales and provided a blood sample prior to starting chemotherapy (T1) and at increasing cumulative vincristine (T2: 3–5 mg, T3: 7–9 mg) and paclitaxel (T2: 300–500 mg/m 2 , T3: 700–900 mg/m 2 ) dosages. NAD + , cADPR, and ADPR were quantified from plasma using mass spectrometry. Metabolite levels and QLQ-CIPN20 scores over time were compared using mixed-effects linear regression models and/or paired two-sample tests. Results Participants ( N = 50) were mainly female (88%), white (80%), and receiving paclitaxel (78%). Sensory and motor CIPN severity increased from T1–T3 ( p &lt; 0.001). NAD + ( p = 0.28), cADPR ( p = 0.62), and ADPR ( p = 0.005) values decreased, while cADPR/NAD + ratio increased from T1–T3 ( p = 0.50). There were no statistically significant associations between NAD + and QLQ-CIPN20 scores over time. Conclusions To our knowledge, this is the first study to measure plasma NAD + , cADPR, and ADPR among patients receiving neurotoxic chemotherapy. Although, no meaningful changes in NAD + , cADPR, or cADPR/NAD + were observed among young adults receiving paclitaxel or vincristine. Future research in an adequately powered sample is needed to explore the clinical utility of biomarkers of axon degeneration among patients receiving neurotoxic chemotherapy to guide mechanistic research and novel CIPN treatments.

  PublisherOA PDFDOI

Frequent coauthors

• Donna L. Berry

  37 shared

• Jennifer A. Ligibel

  Dana-Farber Cancer Institute

  24 shared

• Elizabeth Smith

  University of Miami

  22 shared

• Grace Kanzawa-Lee

  University of Michigan–Ann Arbor

  18 shared

• Celia M. Bridges

  University of Alabama at Birmingham

  17 shared

• Anita Giobbie‐Hurder

  14 shared

• Jeffrey A. Meyerhardt

  13 shared

• Juliana Berfield

  University of Washington

  12 shared

Labs

• University of Michigan School of NursingPI

Education

• PhD, School of Nursing

  University of Michigan

  2017

• BSN, School of Nursing

  University of Michigan

  2014

Awards & honors

• Victoria Mock New Investigator Award, Oncology Nursing Socie…
• The Excellence in Dissemination Award: Peer-Reviewed Publica…