The Association of Chemotherapy-Induced Peripheral Neuropathy Symptoms and the Risk of Falling

Abstract

Importance Chemotherapy induced peripheral neuropathy is a common side effect of neurotoxic chemotherapy resulting in pain, sensory loss and decreased quality of life. Few studies have prospectively examined the relationship between sensory neuropathy symptoms, falls and fall related injuries in those receiving neurotoxic chemotherapy. Objective Determine the association between the symptoms of chemotherapy induced peripheral neuropathy (CIPN) and fall risk in those receiving neurotoxic chemotherapy. Design Patients starting neurotoxic chemotherapy with a taxane or platinum called a novel automated phone system daily for one full course of chemotherapy. The phone system, “Symptom Care @ Home” utilized a series of relevant CIPN questions to track symptoms on a 0–10 ordinal scale and contained a questionnaire about falls. Those reporting a numbness and tingling severity of 3 or greater for at least 10 days were considered to have significant CIPN symptoms and were compared to those who did not. Setting Ambulatory participants at an academic cancer center. Participants A consecutive sample of breast, ovarian and lung cancer patients beginning neurotoxic chemotherapy was recruited from oncology clinics. The study population was largely female (94%) and Caucasian (96%). Exposures Chemotherapy with a neurotoxic taxane or platinum agent. Main Outcome Measure Patient reported fall events (falls or near falls) and fall related injuries. The hypothesis was generated after data collection but prior to data analysis. Results 32/116 patients met the predetermined criteria for CIPN symptoms. The mean duration of follow up was 62 days with 51 calls completed per participant. 74 fall events were reported. Those with CIPN symptoms were nearly 3 times more likely to have a fall event than those without (HR 2.67, CI 1.62–4.41, p<0.001). The CIPN group was more likely to obtain medical care for falls (25.0% vs. 7.1%, p=0.013). Conclusions and Relevance These findings suggest the sensory symptoms of CIPN are an indicator of increased fall risk and health care utilization. This study demonstrates the utility of a novel phone based system to track neuropathy symptoms. Careful monitoring and coaching of patients receiving neurotoxic chemotherapy for new sensory symptoms may facilitate more effective fall prevention strategies.

Feasibility of early multimodal interventions for elderly patients with advanced pancreatic and non‐small‐cell lung cancer

“…Regarding patients with PS 2, we excluded them from the study cohort to assure the safety of unsupervised exercise programme at home. Elderly patients with PS 2 are vulnerable to adverse events during systemic chemotherapy including neutropenia, infection, or peripheral neuropathy especially in the platinum‐based treatment, which might increase the risk of falls . Supporters who could monitor patients were also required in this study partially because of the same safety reason.…”

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.…”

“…Gait and balance deficits are well known to increase the risk of falls, including a 290% increase in elderly patients [7]. Decreased distal lower extremity strength and loss of sensation, including proprioception, are risk factors for increased falls and balance deficits [8–12]. Patients who undergo treatment with taxane drugs and/or develop CIPN often present with decreased postural stability [13–18,11].…”

Chemotherapy-Induced Neuropathy in Cancer Survivors

“…18,20,107–109 In terms of the effects of CIN on lower extremity function, in the one study that compared 20 breast cancer patients who had taxane-induced CIN to 20 healthy controls, TUG scores in the breast cancer patients (6.69 ± 0.99) were worse than in the healthy controls (5.85 ± 0.86). 108 While the survivors with CIN in the current study had worse TUG scores than survivors without CIN, both groups of survivors in the current study had worse TUG scores than the patients with breast cancer who had taxane-induced CIN.…”