Roxanne Nelson, BN, RN

January 14, 2016

Years after the completion of cancer therapy, 45% of female cancer survivors still experience symptoms of chemotherapy-induced peripheral neuropathy (CIPN), which is a common adverse event, according to a new study.

In addition, "women with peripheral neuropathy reported significantly lower physical functioning and significantly more difficulty with tasks of daily living, and nearly twice as many of the women with neuropathy experienced a fall in the previous year," said lead author Kerri Winters-Stone, PhD, a research professor at the School of Nursing at Oregon Health & Science University in Portland.

Neuropathy cannot be dismissed as an adverse event of treatment that goes away, because symptoms persisted for years in nearly half the women in this study, she noted.

Dr Winters-Stone spoke at a press conference held in advance of the Cancer Survivorship Symposium Advancing Care and Research in San Francisco, where she will present the findings.

"CIPN is often under-recognized and probably under-reported," said presscast moderator Merry-Jennifer Markham, MD, associate professor of medicine at the University of Florida in Gainesville. "Many of our chemotherapy treatments for a variety of cancers — such as lung cancer, lymphoma, ovarian cancer, breast cancer, and colon cancer, just to name a few — include agents that can cause CIPN."

 
The neuropathy our patients are experiencing is not just a bothersome symptom.
 

"This study is important because it highlights the fact that the neuropathy our patients are experiencing is not just a bothersome symptom," she said. "It not only impacts survivors' physical function for years to come, it also puts them at risk for falls and the associated morbidity."

Long-term Effects of CIPN

An estimated 57% to 83% of patients will have signs of CIPN at some point during or after their care, depending of the type of chemotherapy received, Dr Winters-Stone noted.

However, information on the long-term effects of CIPN are rare. "The studies that quantify the function consequences of CIPN among cancer survivors tend to use self-report of the symptom itself and of functional ability," she explained. "Other studies tend not to use objective measures or feature small sample sizes."

For their study, Dr Winters-Stone and her colleagues used baseline assessments from 678 female cancer survivors who were enrolled in exercise trials at their institution.

Women with symptoms of CIPN were compared with asymptomatic women on the following measures: maximal leg press strength; timed chair stand; physical performance battery; gait patterns; step number; stride length; base of support; percentage of time in double support; self-reported physical function and disability; and falls in the previous year. Group comparisons were made using analysis of covariance adjusted for time since diagnosis and cancer site (breast or other).

The final cohort involved 462 women (mean age, 62 ± 6 years; median time since diagnosis, 5.8 ± 4.1 years), 210 (45%) of whom reported experiencing CIPN symptoms and 252 (55%) of whom did not.

Women reported experiencing symptoms such as loss of feeling in hands and feet and difficulty undertaking activities of daily life.

There were significant differences between the two groups on all measures except maximal strength and base of support during a walk.

Table. Performance Status

Measure Symptomatic Women Asymptomatic Women P Value
Timed chair stand, s 12.7 11.4 <.01
Physical performance battery, points 10.5 11.1 <.01
Number of steps per minute 109 112 <.05
Stride length, cm 129 133 <.05
Time in double support, % 26.1 25.3 <.05
Physical function, points 66 71 <.01
Disability, points 75 82 <.01
Falls, % 31 19 <.01

 

The risk of falling was 31% for women with CIPN and 19% for those without symptoms. "That risk is nearly twice as high," Dr Winters-Stone pointed out.

The differences in physical function (5 points) and disability (7 points) were clinically meaningful, and a difference in chair stand time of more than 12 seconds in the CIPN group was associated with an increased risk for falls.

"Strategies to reduce the likelihood of developing the symptoms, and rehabilitation for those who have the symptoms, are sorely needed," Dr Markham said.

This study was funded by the National Cancer Institute, the American Cancer Society, and the Susan G. Komen for a Cure Foundation. Dr Winters-Stone and Dr Markham have disclosed no relevant financial relationships.

Cancer Survivorship Symposium (CSS) Advancing Care and Research: Abstract 130. To be presented January 15, 2016.

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