Subclinical Peripheral Neuropathy Is a Common Finding in Colorectal Cancer Patients Prior to Chemotherapy

Abstract

Purpose Of the numerous complications associated with cancer and cancer treatment, peripheral neuropathy is a deleterious and persistent patient complaint commonly attributed to chemotherapy. The present study investigated the occurrence of subclinical peripheral neuropathy in patients with colorectal cancer prior to the initiation of chemotherapy. Experimental Design Fifty-two (52) patients underwent extensive quantitative sensory testing (QST) prior to receiving chemotherapy. Changes in multiple functions of primary afferent fibers were assessed and compared to a group of healthy control subjects. Skin temperature, sensorimotor function, sharpness detection, and thermal detection were measured, as was touch detection, using both conventional (von Frey monofilaments) and novel (Bumps detection test) methodology. Results Patients had subclinical deficits, especially in sensorimotor function, detection of thermal stimuli, and touch detection that were present prior to the initiation of chemotherapy. The measured impairment in touch sensation was especially pronounced when using the Bumps detection test. Conslusions The colorectal cancer patients in this study exhibited deficits in sensory function prior to undergoing chemotherapy treatment, implicating the disease itself as a contributing factor in chemotherapy induced peripheral neuropathy. The widespread nature of the observed deficits further indicated that cancer is affecting multiple primary afferent subtypes. Specific to the finding of impaired touch sensation, results from this study highlight the use of newly employed methodology, the Bumps detection test, as a sensitive and useful tool in the early detection of peripheral neuropathy.

A Quantitative Sensory Analysis of Peripheral Neuropathy in Colorectal Cancer and Its Exacerbation by Oxaliplatin Chemotherapy

“…A key finding from this approach was the detection of pre-existing subclinical sensory deficits in a large cohort of colorectal cancer patients prior to treatment that appears to be disease driven and that when present appears to increase the risk for the later development of clinical CIPN. This observation therefore provides a generalization of a correlation between apparent subclinical pretreatment neuropathy and risk for CIPN as previously suggested in multiple myeloma patients (10'11'15). A caveat however, is that QST was not performed on the feet for convenience of the patients, yet CIPN often first presents in the feet.…”

“…Bumps detection was used to assess low threshold mechanosensation (11'12). Participants used their index finger to probe a smooth plate that was divided into nine blocks, with each block marked by five colored circles.…”

Chemotherapy-induced peripheral neuropathy after neoadjuvant or adjuvant treatment of breast cancer: a prospective cohort study

“…However, this is the largest hospital providing care to oncological patients in the north of Portugal, treating patients from a wide geographical area, which may help to mitigate the latter limitation. Previous studies have shown that subclinical deficits in sensory function may be present among patients with colorectal cancer [38,39] and myeloma [40,41] even before initiating any therapy, and CIPN may correspond to an exacerbation of this preexisting condition. In our study, although all patients underwent a neurological examination before breast cancer treatment, to exclude clinical neuropathy, we did not perform quantitative sensory testing, and therefore, we cannot exclude the presence of subclinical deficits in sensory function before treatments.…”

Prechemotherapy Touch Sensation Deficits Predict Oxaliplatin-Induced Neuropathy in Patients with Colorectal Cancer

“…Using patient-reported ratings of CIPN symptoms, we characterized the prevalence and developmental trajectory of these symptoms over time. We hypothesized, on the basis of previous research by our group [22], that prechemotherapy evidence of peripheral nerve deficits would predict the emergence of CIPN symptoms during oxaliplatin-based chemotherapy and the persistence of symptoms posttreatment.…”