Risk factors for chemotherapy‐induced peripheral neuropathy in patients receiving taxane‐ and platinum‐based chemotherapy

Abstract

Background Chemotherapy‐induced peripheral neuropathy (CIPN) is a significant and difficult to manage side effect of neurotoxic chemotherapies. Several risk factors for CIPN have been identified to date, but inconsistencies and methodological limitations exist in past research. Also, a limited number of potential risk factors has been investigated in the past. Aim The objective of this study was to assess the relative contribution of a wider range of risk factors in the development of CIPN. Methods This analysis used the 6‐month data after starting chemotherapy from a larger prospective observational study on CIPN risk, prevalence, and quality of life. Patients were assessed at recruitment for possible CIPN risk factors, including prior history of neuropathies, current/past infectious diseases; neurotoxic medication history; personal and treatment characteristics; smoking history, alcohol use, and vegetable/fruit intake. Neuropathy was assessed at 6‐months after starting chemotherapy with the neuropathy (motor/sensory) items of the NCI‐CTCAE scale and the WHO criterion for neuropathy. Data on symptom burden were also collected. Results Data were available from 255 patients from three cancer centers in Hong Kong, Singapore, and UK. The use of different scales did not always identify the same predictor variables. Key risk factors in multivariate regression models included older age (highest OR = 1.08, p < 0.01 with the WHO scale), chemotherapy (platinum‐based chemotherapy had OR = 0.20–0.27 in developing CIPN compared to taxane‐based chemotherapy), history of neuropathy (for motor CIPN only, OR = 8.36, p < 0.01), symptom burden (OR = 1.06, p < 0.05), number of chemotherapy cycles received (OR = 1.19–1.24, p < 0.01), and alcohol intake (OR = 0.32, p < 0.05). In univariate analysis, the use of statins was implicated with CIPN ( p = 0.03–0.04 with different assessments) and diabetes showed a trend ( p = 0.09) in the development of CIPN. Conclusion This study confirmed the CIPN risk related to certain variables and identified new ones. This knowledge can assist with treatment decisions and patient education.

Involving patients and nurses in choosing between two validated questionnaires to identify chemotherapy‐induced peripheral neuropathy before implementing in clinical practice—A qualitative study

“…This is in accordance with Mooney, Berry, Whisenant, and Sjoberg (2017) who demonstrated that using a questionnaire may contribute to intensifying symptom care and improve quality of life among the patients (Mooney et al, 2017). However, the outcome may rely on the ability to narrow or close the gap between the patients' and the professionals' estimation and grading of symptoms, a gap which in other studies is articulated as a crucial problem (Molassiotis et al, 2019;Mooney et al, 2017;Nyrop et al, 2019).…”

“…Multiple instruments have been developed to identify CIPN but no gold standard has been established, although it is common for physicians to use the scales of National Cancer Institute-Common Terminology Criteria Adverse Events (NCI-CTCAE) in their assessments of patients' adverse events. However, comparing a clinician-based grading system like the CTCAE scale with patient-reported outcome measures shows that professionals score patients' conditions lower than patient' themselves and thus identify fewer patients with CIPN (Molassiotis et al, 2019;Nyrop et al, 2019).…”

Biological predictors of chemotherapy-induced peripheral neuropathy (CIPN): MASCC neurological complications working group overview

“…While there are established clinical risk factors for CIPN, none accurately predicts the severity of CIPN that an individual patient will have [4]. Cumulative dose is a strong risk factor for the development of CIPN with most neurotoxic antineoplastic drugs.…”

Taxane and epothilone‐induced peripheral neurotoxicity: From pathogenesis to treatment

“…Several demographic risk factors have been reported, including older age, obesity, and race. Older age was associated to longer paclitaxel‐induced peripheral neuropathy duration or increased severity in breast cancer, with the risk of severe neuropathy increasing by 5% per additional year in age in breast/ovarian cancer or by 13% per decade of life . A higher risk of TIPN has been identified in metastatic breast cancer patients aged >65 years .…”