Comparison of physical function and falls among women with persistent symptoms of chemotherapy-induced peripheral neuropathy.

Abstract

130 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a side effect of cancer treatment that may persist and impact physical function. Studies that quantify functional consequences associated with CIPN in post-treatment cancer survivors are rare, based on self-report, or use small samples. The purpose of this study was to compare objective and self-report measures of physical function, gait patterns, and falls between women cancer survivors with or without symptoms of CIPN. Methods: Baseline assessments from 678 women cancer survivors enrolled in exercise trials were available for analysis. Women who self-reported symptoms of CIPN (CIPN+) were compared to asymptomatic women (CIPN-) on the following: maximal leg press strength (LPmax); timed chair stand (CS), physical performance battery (PPB), gait patterns (speed (SP), step number (SN), stride length (SL), base of support (BOS), % time in double support (%DS)), self-report physical function (PF) and disability (DIS), and falls in the past year (% fallers). Group comparisons were made using analysis of covariance, adjusting for time since diagnosis and cancer site (breast or other). Results: After excluding women who had diabetes, were premenopausal at cancer diagnosis or had not received chemotherapy, 462 cases were analyzed (age: 62±6yrs; time since diagnosis: 5.8±4.1yrs). CIPN+ (N = 210) and CIPN- (N = 252) groups significantly differed on all measures (*p < 0.05; **p < 0.01), except maximal leg strength and base of support during a usual walk, with worse performance for CIPN+. Conclusions: In our sample of women cancer survivors, 45% had symptoms of CIPN an average of 6 years post treatment and significantly worse physical function, altered gait patterns and more falls than asymptomatic women. CIPN should be addressed early in treatment and strategies to improve function and mobility and prevent falls need to be tested. [Table: see text]

Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk

“…Our study assessed CIPN prevalence in a mean follow-up time of 5.6 years and found that 58.4% of patients reported persistent PN. This is consistent with a recent study of 462 women cancer survivors enrolled in an exercise trial in which 208 (45%) had CIPN symptoms an average of 6 years after treatment[18]. The data suggest the CIPN persists rather than resolving as expected for a substantial population of women with breast cancer.…”

“…In a recent exercise trial of women cancer survivors (n=462), the 208 (45%) women with CIPN symptoms experienced worse physical functioning, altered walking patterns, and more falls than women without CIPN symptoms[18]. Although these two studies differ in patient populations, with our study focusing on breast cancer survivors who have taken or are taking aromatase inhibitors enrolled in an ambulatory clinical care setting, whereas this study focused on breast cancer survivors participating in an exercise clinical trial with function assessments as its primary aim, the results are similar[18]. Our study found that moderate to severe CIPN not only doubled the fall rate, but could also be detrimental to aging breast cancer survivors’ quality of life and functional independence.…”

Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients

“…Cancer survivors are at an increased risk of falling and the incidence of falling after chemotherapy is a concern for survivors’ long-term quality of life [19,31,12,10,8]. This study aims to provide clinicians with a more comprehensive understanding of the development of adverse effects associated with taxane therapy including the timing of symptom onset during taxane-based chemotherapy.…”

“…Patients who undergo treatment with taxane drugs and/or develop CIPN often present with decreased postural stability [13–18,11]. Recent research suggests that CIPN may also be associated with functional impairments during ambulation [19]. Isolated studies of the natural histories of patient-reported outcomes [20] and balance impairments [21] have previously been reported in breast cancer patients undergoing taxane-based chemotherapy; however, little is known about the development of gait impairments in this population or the concomitant development of these varied quality-of-life impairing adverse effects.…”

The prevention of chemotherapy induced peripheral neuropathy by concurrent treatment with drugs used for bipolar disease: a retrospective chart analysis in human cancer patients

“…CIPN is associated with symptoms that include tingling, numbness, neuropathic pain and ataxia. More recently, in a cohort study of 462 women almost half of the patients continued to report symptoms of CIPN after an average of 5.8 years out from their diagnosis [ 2 ]. At this time there are limited treatment options for the treatment of CIPN and no treatment options for the prevention of CIPN [ 3 ].…”