Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients

Abstract

BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several commonly used chemotherapy drugs including taxanes, vinca alkaloids, and platinum compounds. Development of CIPN is highly variable, both in self-reported symptoms and functional consequences, and can be severe enough to alter dose intensity. PURPOSE To describe the natural histories of both patient-reported symptoms of chemotherapy-induced peripheral neuropathy (CIPN) and functional impairments in breast cancer patients undergoing taxane-based chemotherapy. METHODS Thirty-three breast cancer patients (32 female/1 male; 47.8 ± 11.2 years; n=17 stage II/n=16 stage III) were enrolled. Patients completed self-reports of symptoms and function (e.g., EORTC QLQ-CIPN20) and objective measures of physical function (i.e., balance and gait testing) in an outpatient oncology clinic at five timepoints: (1) baseline - prior to starting chemotherapy, (2–4) before starting subsequent chemotherapy cycles, and (5) 1–3 months after receiving their last taxane infusion. RESULTS Significant negative changes in both patient-reported outcomes and objective functional measures were observed. Decreased balance was observed after the first chemotherapy cycle (28% increase in medial-lateral excursion of the center of pressure, p=0.016) and progressed with cumulative exposure (43% increase, p<0.001). Patients also demonstrated slower walking speeds (5% decrease, p=0.003) as they progressed through treatment. These functional deficits were mirrored with increased patient-reported symptom severity for all EORTC QLQ-CIPN20 subscales (all p<0.05). CONCLUSION This study longitudinally assessed patient-reported outcomes concurrently with balance and gait testing in patients undergoing taxane therapy. Taxane treatment was associated with the development of clinically-relevant problems in both CIPN symptoms and patient function.

Impaired Postural Control and Altered Sensory Organization During Quiet Stance Following Neurotoxic Chemotherapy: A Preliminary Study

“…These results suggest that chemotherapy may have detrimental effects on postural stability even in survivors without perceived symptoms of CIPN, which is consistent with findings in a prospective breast cancer cohort. 4,5 The presence of detectable balance impairments without significant self-reported symptoms may be clinically relevant in the context of early identification of cancer survivors at an increased risk of falling. As the current study did not prospectively track falls, future research is needed to verify the extent to which fall-relevant interpretations of these CoP parameters extend to cancer survivors.…”

A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention

“…Postural stability; chemotherapy-induced peripheral neuropathy; motor control; sensory weighting; model and limit patients' everyday life considerably. Additionally, CIPN patients often suffer from postural instability (9)(10)(11)(12)(13)(14)(15)(16)(17), contributing to a lower quality of life (5,18), a higher risk of mortality (19)(20)(21)(22) and increased healthcare costs (23,24).…”

A new approach to characterize postural deficits in chemotherapy-induced peripheral neuropathy and to analyze postural adaptions after an exercise intervention

“…As postural instability is a momentous symptom of CIPN (9)(10)(11)(12)(13)(14)(15)(16), the first aim of this study was to assess the specific set of postural control deficits associated with CIPN compared to healthy subjects.…”

“…Symptoms of CIPN primarily include paraesthesia, dysesthesia, numbness and pain with a symmetric, distal, length-dependent "glove and stocking" distribution (3,8) and limit patients' everyday life considerably. Additionally, CIPN patients often suffer from postural instability (9)(10)(11)(12)(13)(14)(15)(16)(17), contributing to a lower quality of life (5,18), a higher risk of mortality (19)(20)(21)(22) and increased healthcare costs (23,24).…”