Falls, Functioning, and Disability Among Women With Persistent Symptoms of Chemotherapy-Induced Peripheral Neuropathy

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) may persist after treatment ends and may lead to functional decline and falls. This study compared objective and self-report measures of physical function, gait patterns, and falls between women cancer survivors with and without symptoms of CIPN to identify targets for functional rehabilitation. MethodsA secondary data analysis of 512 women cancer survivors (age, 62 6 6 years; time since diagnosis, 5.8 6 4.1 years) categorized and compared women self-reporting symptoms of CIPN (CIPN+) with asymptomatic women (CIPN2) on the following: maximal leg strength, timed chair stand, physical function battery, gait characteristics (speed; step number, rate, and length; base of support), selfreport physical function and disability, and falls in the past year. ResultsAfter an average of 6 years after treatment, 47% of women still reported symptoms of CIPN. CIPN+ had significantly worse self-report and objectively measured function than did CIPN2, with the exception of maximal leg strength and base of support during a usual walk. Gait was slower among CIPN+, with those women taking significantly more, but slower and shorter, steps than did CIPN2 (all P , .05). CIPN+ reported significantly more disability and 1.8 times the risk of falls compared with CIPN2 (P , .0001). Increasing symptom severity was linearly associated with worsening function, increasing disability, and higher fall risk (all P , .05). ConclusionThis work makes a significant contribution toward understanding the functional impact of CIPN symptoms on cancer survivors. Remarkably, 47% of women in our sample had CIPN symptoms many years after treatment, together with worse function, greater disability, and more falls. CIPN must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to improve function must be included in clinical and survivorship care plans.J Clin Oncol 35.

Lived experiences and support needs of women who developed chemotherapy‐induced peripheral neuropathy following treatment for breast and ovarian cancer

“…Functional limitations because of symptoms involving their hands and feet resulted in challenges performing household and work activities. Recent studies showed CIPN was associated with falls and injuries (Winters‐Stone et al, ). Participants in our study described that they felt unsafe and worried that they may fall, with some who reported they had fallen because of CIPN symptoms.…”

Risk of incident claims for chemotherapy‐induced peripheral neuropathy among women with breast cancer in a Medicare population

“…Recent literature reviews also address the consequences of CIPN, which can limit the chemotherapy dose, interfere with recovery (eg, because of pain, sensory loss, functional impairment, and falls), and lead to a significant health‐economic burden . In a recent study, 47% of breast cancer survivors reported experiencing CIPN side effects an average of 6 years after treatment …”

Prevention and Management of Chemotherapy-Induced Polyneuropathy

“…Typical symptoms include numbness, paresthesia, lancinating pain, abnormal gait, and motor weakness. It is important to consider that CIPN may persist for many years beyond antineoplastic therapy and is associated with an increased risk of falls [3]. After completion of paclitaxel chemotherapy, approximately one-half of patients improve over a period of 4–6 months [4].…”

“…It would be advisable to initiate exercise at the time potentially neurotoxic cancer treatment is initiated [6]. Improvement of physical function is particularly important in the prevention of malnutrition and improvement of physical function in order to prevent disability and falls, especially in elderly patients [3]. …”