Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk

Abstract

Purpose CIPN is a common toxicity associated with chemotherapy, but researchers rarely study its risk factors, fall risk, and prevalence in long-term breast cancer survivors. We aimed to determine CIPN prevalence, risk factors, and association with psychological distress and falls among long-term breast cancer survivors. Methods We conducted cross-sectional analyses among postmenopausal women with a history of stage I–III breast cancer who received taxane-based chemotherapy. Participants reported neuropathic symptoms of tingling/numbness in hands and/or feet on a 0–10 numerical rating scale. We conducted multivariate logistic regression analyses to evaluate risk factors associated with the presence of CIPN and the relationship between CIPN and anxiety, depression, insomnia, and patient-reported falls. Results Among 296 participants, 173 (58.4%) reported CIPN symptoms, 91 (30.7%) rated their symptoms as mild and 82 (27.7%) rated them moderate to severe. Compared with women of normal weight, being obese was associated with increased risk of CIPN, (adjusted OR 1.94, 95% CI: 1.03–3.65). Patients with CIPN reported greater insomnia severity, anxiety, and depression than those without (all p<0.05). Severity of CIPN was associated with higher rates of falls, with 23.8%, 31.9%, and 41.5% in the “no CIPN,” “mild,” and “moderate-to-severe” groups, respectively, experiencing falls (p=0.028). Conclusions The majority of long-term breast cancer survivors who received taxane-based chemotherapy reported CIPN symptoms; obesity was a significant risk factor. Those with CIPN also reported increased psychological distress and falls. Interventions need to target CIPN and comorbid psychological symptoms, and incorporate fall prevention strategies for aging breast cancer survivors.

Muscle mass at the time of diagnosis of nonmetastatic colon cancer and early discontinuation of chemotherapy, delays, and dose reductions on adjuvant FOLFOX: The C‐SCANS study

“…Obesity has been associated with higher odds of peripheral neuropathy, a common side effect of oxaliplatin, in colon and breast cancer. 19, 35, 36 Greater vulnerability to neuropathy and lower dosing (obese patients in our study had lower drug mg/cm 2 muscle) are also potential explanations for the non-significant association of low muscle with dose reductions on oxailplatin. However, since low muscle was associated with early discontinuation and treatment delay regardless of the drug examined, another possibility is that the type of toxicity experienced determines the outcome: peripheral neuropathy on oxaliplatin could lead to early discontinuation and treatment delay but less often to dose reduction, whereas diarrhea, nausea, and neutropenia on 5-fluorouracil might lead to all three outcomes.…”

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

“…Our data may or may not generalize to male cancer survivors, although sex is not a known risk factor for CIPN. 6 Our findings suggest that a high proportion of women treated with chemotherapy for a variety of cancers may experience persistent symptoms of CIPN many years after their treatment ends and that these women have abnormal gait patterns and more functional deficits, patient-reported disability, and falls compared with women with no symptoms. Falls are disabling and life threatening and lead to health care costs of approximately $17,000 per event, 35 and poor self-report physical function has been linked to shorter survival times in cancer survivors.…”

“…5 CIPN may occur in up to 90% of patients during chemotherapy 4 and can persist in a proportion of survivors in the long term. 6,7 CIPN is consistently associated with lower self-report physical function and QOL during or after chemotherapy. 8 In older adults 9 and in patients with diabetes, 10,11 neuropathies are associated with poor mobility, balance impairments, and falls.…”

Falls-risk in senior women after radical treatment of breast cancer

“…Many authors highlight that the treatment of breast cancer causes many side effects, which may hamper overall coordination of the systems involved in physical activity, thus significantly reducing individual ability to perform physical actions. The reasons for reduced physical performance include pain, swelling of the lymphs, decreased mobility, and decreased muscle strength leading to a reduction in physical activity and an energy-limiting lifestyle [6][7][8][9][10][11][12].…”