Effect of chemotherapy-induced peripheral neuropathy on postural control in cancer survivors.

Abstract

128 Background: Advances in screening and treatment have significantly improved the survival of cancer patients. However, chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting toxicity of curative treatment; many patients either cannot complete planned course of treatment or have long standing effects on quality of life. CIPN has been shown to lead to pain, falls, and difficulty walking. Balance changes have been reported with other neuropathies but have not been investigated in depth in cancer patients. This study aims to improve our understanding of changes in postural control associated with CIPN. We hypothesize that patients who report more significant CIPN symptoms will perform more poorly on balance testing. Methods: Eleven cancer patients were enrolled (9 female/ 2 male; 9 breast cancer/ 2 GI cancer; 1.67 ± 0.05 m; 85.8 ± 19.3 kg; 56.5 ± 14.5 yrs). These patients included cases (n = 7), tested within 6 weeks of finishing taxane or oxaliplatin chemotherapy, and controls (n = 4) who did not receive chemotherapy. Patients’ sensory symptoms were assessed by EORTC QLQ-CIPN20. Standing on a balance plate, patients were instructed to close their eyes and remain still while their center of pressure (CoP) was recorded. Medial-lateral root mean squared CoP excursion (RMS) was calculated to provide a measure of postural stability, with higher values indicating poorer control of CoP position and being predictive of falls. Results: Groups were not statistically different in terms of height, mass, or age (p > 0.1). Cases had an average of 3.8 mm (95% CI: 1.7 mm, 6.0 mm) increase in RMS over controls (p = 0.004). Furthermore, cases scored an average of 37.6 points (95% CI: 19.5 points, 55.7 points) lower on a normalized CIPN 20 scale, suggesting worse sensory symptoms (p = 0.002). Conclusions: Patients with CIPN symptoms displayed significantly poorer control of their CoP. This supports the hypothesis that CIPN symptoms associate with poorer balance. The balance deficits reported here are consistent with increased risk of falls and negative post-treatment sequelae. This further suggests a need for closer monitoring and even targeted balance-focused rehabilitation following chemotherapy.