Associations Between Perceived Stress and Chemotherapy-Induced Peripheral Neuropathy and Otoxicity in Adult Cancer Survivors

Miaskowski, Christine; Paul, Steven M.; Mastick, Judy; Abrams, Gary; Topp, Kimberly; Smoot, Betty; Kober, Kord M.; Chesney, Margaret A.; Mazor, Melissa; Mausisa, Grace; Schumacher, Mark; Conley, Yvette P.; Sabes, Jennifer Henderson; Cheung, Steven W.; Wallhagen, Margaret; Levine, Jon D.

doi:10.1016/j.jpainsymman.2018.02.021

Cited by 37 publications

(39 citation statements)

References 92 publications

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“…In the current study, global stress uniquely explained approximately 6.9% of the variance in symptom burden. As noted in our previous study, the mean PSS score reported by survivors in the current study (ie, 17.3 [±8.9]) was similar to that reported by survivors of breast cancer (11.6 [±7.9]) and prostate cancer (17.9 [±8.1]) . Moreover, the findings of the current study are consistent with a longitudinal study of survivors of breast cancer that found that higher levels of general stress were associated with greater physical symptom bother up to 16 months after the cancer diagnosis …”

Section: Discussionsupporting

confidence: 90%

“…A growing body of evidence has suggested that stress is a common experience among cancer survivors and is associated with a higher symptom burden. Although adaptive in the acute setting, chronic stress can lead to persistent and more severe anxiety, depression, and pain . Recent evidence has suggested that increased levels of perceived stress were associated with the occurrence of CTX‐induced peripheral neuropathy, hearing loss, and tinnitus .…”

Section: Introductionmentioning

confidence: 99%

“…Although adaptive in the acute setting, 13 chronic stress can lead to persistent and more severe anxiety, 14 depression, 14 and pain. 15,16 Recent evidence has suggested that increased levels of perceived stress were associated with the occurrence of CTX-induced peripheral neuropathy, hearing loss, and tinnitus. 16 These preliminary findings suggested that the relationships between global and cancer-related stress and symptom burden in cancer survivors warrant additional evaluation.…”

Section: Introductionmentioning

confidence: 99%

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Perceived stress is associated with a higher symptom burden in cancer survivors

Mazor

Paul

Chesney

et al. 2019

Cancer

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Background Although multiple co‐occurring symptoms are a significant problem for cancer survivors, to the authors' knowledge little is known regarding the phenotypic characteristics associated with a higher symptom burden. The objectives of the current study were to evaluate the occurrence, severity, and distress associated with 32 symptoms and examine the phenotypic and stress characteristics associated with a higher symptom burden. Methods A total of 623 cancer survivors completed a demographic questionnaire, as well as measures of functional status, comorbidity, and global (Perceived Stress Scale) and cancer‐related (Impact of Event Scale–Revised) stress. The Memorial Symptom Assessment Scale was used to evaluate symptom burden. Multiple linear regression analysis was used to determine the phenotypic characteristics associated with a higher symptom burden. Results The mean number of symptoms was 9.1 (±5.2). The most common, severe, and distressing symptoms were lack of energy, problems with sexual interest/activity, and hair loss, respectively. Poorer functional status, a higher level of comorbidity, and a history of smoking as well as higher Perceived Stress Scale and Impact of Event Scale–Revised scores were associated with a higher symptom burden. The overall model explained approximately 45.6% of the variance in symptom burden. Conclusions Although cancer survivors report a high number of co‐occurring symptoms of moderate severity and distress, in the current study, no disease or treatment characteristics were found to be associated with a higher symptom burden. Clinicians need to assess for general and disease‐specific stressors and provide referrals for stress management interventions. Future studies need to examine the longitudinal relationships among symptom burden, functional status, and level of comorbidity, as well as the mechanisms that underlie the associations between stress and symptom burden.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perceived stress is associated with a higher symptom burden in cancer survivors

Mazor

Paul

Chesney

et al. 2019

Cancer

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“…Furthermore, cancer survivors with hearing loss, tinnitus, and neuropathy are more likely to report poorer quality of life than those with neuropathy only (26). Another investigation reported worse perceived stress among cancer survivors with tinnitus (27).…”

Section: Ototoxicitymentioning

confidence: 99%

Genetic and Modifiable Risk Factors Contributing to Cisplatin-induced Toxicities

Trendowski

Charif

Dinh

et al. 2019

Clinical Cancer Research

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Effective administration of traditional cytotoxic chemotherapy is often limited by off-target toxicities. This clinical dilemma is epitomized by cisplatin, a platinating agent, which has potent antineoplastic activity due to its affinity for DNA and other intracellular nucleophiles. Despite its efficacy against many adult-onset and pediatric malignancies, cisplatin elicits multiple off-target toxicities that can not only severely impact a patient's quality of life but also lead to dose reductions or the selection of alternative therapies that can ultimately affect outcomes. Without an effective therapeutic measure by which to successfully mitigate many of these symptoms, there have been attempts to identify a priori those individuals who are more susceptible to developing these sequelae through studies of genetic and nongenetic risk factors. Older age is associated with cisplatin-induced ototoxicity, neurotoxicity, and nephrotoxicity. Traditional genome-wide association studies have identified single-nucleotide polymorphisms in ACYP2 and WFS1 associated with cisplatin-induced hearing loss. However, validating associations between specific genotypes and cisplatin-induced toxicities with enough stringency to warrant clinical application remains challenging. This review summarizes the current state of knowledge with regard to specific adverse sequelae following cisplatin-based therapy, with a focus on ototoxicity, neurotoxicity, nephrotoxicity, myelosuppression, and nausea/emesis. We discuss variables (genetic and nongenetic) contributing to these detrimental toxicities and currently available means to prevent or treat their occurrence.

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“…These included: Diagnosis with acquired or hereditary neuropathy such as diabetes, renal disease, hypothyroidism, connective tissue disease. Prior history of neuropathy or family history of neuropathy; vitamin deficiencies (Hershman et al, ; Ottaiano et al, ; Seretny et al, ). Diagnosis with current or previous infectious diseases (HIV; Poliomyelitis; Hepatitis B or C; Armstrong et al, ; Kaley & DeAngelis, ; Seretny et al, ). Neurotoxic medication history (a list of 51 medications linked with neurotoxicity, such as cyclosporine, vancomycin, cimetidine, etc; Hauseer et al, ; Kaley & DeAngelis, ; Quasthoff & Hartung, ). Personal and treatment characteristics: oAge (Lewis et al, ; Miaskowski et al, , ). oDisease site (Quasthoff & Hartung, ; Seretny et al, ; Simon et al, ). oChemotherapy type (taxanes; platinum‐based chemotherapy; combination of taxanes and platinum‐based chemotherapy), number of chemotherapy cycles, and cumulative dosage of each neurotoxic chemotherapy drug (Kaley & DeAngelis, ; Quasthoff & Hartung, ; Simon et al, ). oSmoking history (never smoked; current smoker; ex‐smoker; Kawakami et al, ; Seretny et al, ). oHistory of alcohol intake (Pereira et al, ) (drinks per day (number) using an explanatory diagram on quantity (i.e., small glass of wine (120 ml) = 1 drink, etc). oDietary history (servings of fruits and vegetables per day with explanations, i.e., 1 serve = 1 fruit) (Greenlee et al, ). …”

Section: Outcome Measuresmentioning

confidence: 99%

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

Molassiotis

Cheng

Leung³

et al. 2019

Brain and Behavior

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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.

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Associations Between Perceived Stress and Chemotherapy-Induced Peripheral Neuropathy and Otoxicity in Adult Cancer Survivors

Abstract: These findings suggest that increased levels of perceived stress are associated with the most common chemotherapy-induced neurotoxicities.

Cited by 37 publications

References 92 publications

Perceived stress is associated with a higher symptom burden in cancer survivors

Perceived stress is associated with a higher symptom burden in cancer survivors

Genetic and Modifiable Risk Factors Contributing to Cisplatin-induced Toxicities

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

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