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

Abstract

Background Chemotherapy‐induced peripheral neuropathy (CIPN) is a common and disabling consequence of neurotoxic therapies, yet factors that modulate the development and clinical impact of CIPN are poorly understood. This epidemiological analysis identifies risk factors for the incidence of CIPN. Methods This retrospective analysis of Surveillance, Epidemiology, and End Results–Medicare data examined predictors of incident CIPN claims among 11,149 women aged 66 years or older with American Joint Commission on Cancer (AJCC) stage II to IV breast cancer (and no secondary cancer diagnosis or preexisting neuropathy) who received chemotherapy. Results Overall, new CIPN claims occurred for 8.3% of patients within 1 year of starting chemotherapy. Risk emerged approximately 3 months after the start of chemotherapy and increased throughout 1 year. Paclitaxel as part of first‐line therapy increased CIPN risk 2.7‐fold in comparison with nonneurotoxic agents (15.9% vs 5.0%), with lower incidence rates for carboplatin and paclitaxel (11.9%), carboplatin and docetaxel (9.3%), carboplatin alone (7.7%), and docetaxel alone (6.6%). The CIPN incidence rate was higher for women who at the time of their breast cancer diagnosis were relatively young (within this Medicare sample), were at AJCC stage II or III, were married or had an equivalent status, and had fewer comorbidities, but it did not differ by race/ethnicity or poverty level. Conclusions These Medicare claims database findings indicate that women aged 66 years or older with breast cancer are susceptible to CIPN from taxane and/or platinum compounds, with risk emerging approximately 3 months into treatment. Prospective studies of symptom emergence and clinical response (eg, stopping chemotherapy and adjunctive treatments) are indicated to determine how best to inform patients of this risk and to manage CIPN in this population.

Taxane and epothilone‐induced peripheral neurotoxicity: From pathogenesis to treatment

“…Some studies identified more severe TIPN in African‐American women with breast cancer, with some studies identifying race as the most significant TIPN predictor . However, this has not held in all studies, with no significant risk of TIPN by race in a multi‐cancer cohort aged >65 years or in a breast cancer cohort …”

“…Similarly, pre‐existing neuropathy was a risk factor for TIPN in some studies but not others . Large‐scale population‐based studies have not identified an association between pre‐existing neuropathy or diabetes and TIPN, but the identification of neuropathy was based on retrospective review of medical notes, which is likely to result in underestimation.…”

Physical Activity as an Imperative Support in Breast Cancer Management

“…Chemotherapy-induced peripheral neuropathy (PN) refers to a progressive, persistent, and sometimes irreversible condition that affects approximately 30–40% of patients with BC receiving chemotherapy, including paclitaxel, docetaxel, cisplatin, carboplatin, bortezomib, or vincristine [ 213 , 214 ]. This condition provokes structural deficits in Dorsal Root Ganglia, affecting sensory neurons in this region, satellite cells, Schwann cells, as well as neuronal and glial cells in the spinal cord.…”

Longitudinal Study of Inflammatory, Behavioral, Clinical and Psychosocial Risk Factors for Chemotherapy-Induced Peripheral Neuropath

“…Previously implicated risk factors for CIPN that have been consistently observed across studies include pre-existing or early-onset symptoms of neuropathy (e.g., [10][11][12][13][14]), anxiety or depression (e.g., [13,15]), and sedentary behavior (e.g., [16][17][18]); for a review see [2]. Some risk factors inconsistently observed across studies include older age (e.g., null ndings in [10][11][12]19]; positive ndings in [16,20]; opposite trend in [21]) and diabetes status (e.g., null ndings in [12,22,23]; positive ndings in [24]).…”