Epidemiology and clinical significance of chemotherapy-induced peripheral neuropathy in patients undergoing chemotherapy

Chemotherapy-induced peripheral neuropathy (CIPN) is a progressive and persistent condition that can significantly affect the quality of life of patients. Even after the cessation of chemotherapy, symptoms of CIPN may endure for an extended period. Despite its considerable impact, there is a paucity of research examining the effects of CIPN on patients. To investigate the current status of CIPN in patients with nasopharyngeal carcinoma (NPC) and accurately identify factors influencing neurotoxicity based on the Random Forest algorithm. A total of 289 patients with NPC were admitted to the Radiotherapy Department of the First Affiliated Hospital of Guangxi Medical University between August 2023 and April 2024 to investigate the current status of neurotoxicity, cognitive impairment, fatigue, and hand-foot syndrome. To rank the importance of the influencing factors of CIPN in NPC patients, a random forest model was constructed to analyze the influencing factors. The incidence of CIPN in NPC patients was 81.7%. The results of the random forest algorithm showed that age, chemotherapy cycle, tumor stage, chemotherapy regimen, concurrent chemoradiotherapy, BMI, hand and foot syndrome fatigue, and cognitive dysfunction were the main factors affecting CIPN in NPC patients (P<0.05). There is an urgent need to accurately identify the risk factors for CIPN in patients with NPC and develop multidisciplinary collaborative prevention and intervention measures to achieve effective prevention and comprehensive management.

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect persisting after completion of neurotoxic chemotherapies. This observational study was designed to evaluate the effectiveness of the dietary supplement OnLife® (patented mixture of specific fatty acids and palmitoylethanolamide) in improving symptoms of CIPN in breast and colon cancer patients. Methods: Improvement of CIPN was evaluated in adult patients, previously treated with (neo)adjuvant paclitaxel- (breast cancer) or oxaliplatin-based (colon cancer) therapies, receiving OnLife® for 3 months after completion of chemotherapy. The primary endpoint was to compare the severity of peripheral sensory neuropathy (PSN) and peripheral motor neuropathy (PMN) before and at the end of OnLife® treatment. Secondary endpoints included the assessment of patient-reported quality of life and CIPN symptoms as assessed by questionnaires. Results: 146 patients (n = 75 breast cancer patients and n = 71 colon cancer patients) qualified for analysis; 31.1% and 37.5% of breast cancer patients had an improvement of PSN and PMN, respectively. In colon cancer patients, PSN and PMN improved in 16.9% and 20.0% of patients, respectively. According to patient-reported outcomes, 45.9% and 37.5% of patients with paclitaxel-induced PSN and PMN, and 23.9% and 22.0% of patients with oxaliplatin-induced PSN and PMN experienced a reduction of CIPN symptoms, respectively. Conclusion: OnLife® treatment confirmed to be beneficial in reducing CIPN severity and in limiting the progression of neuropathy, more markedly in paclitaxel-treated patients and also in patients with oxaliplatin-induced CIPN.

BackgroundThe previous effects of acupuncture-related interventions in improving chemotherapy-induced peripheral neuropathy (CIPN) symptoms and quality of life (QoL) remain unclear in terms of pairwise comparisons.AimsThis systematic review and network meta-analysis aimed to determine the hierarchical effects of acupuncture-related interventions on symptoms, pain, and QoL associated with CIPN in cancer patients undergoing chemotherapy.MethodsNine electronic databases were searched, including PubMed, Embase, Cochrane Library, EBSCO, Medline Ovid, Airiti Library, China National Knowledge Infrastructure (CNKI), China Journal full-text database (CJFD), and Wanfang. Medical subject heading terms and text words were used to search for eligible randomized controlled trials published from database inception to May 2023.ResultsA total of 33 studies involving 2,027 participants were included. Pairwise meta-analysis revealed that acupuncture-related interventions were superior to usual care, medication, or dietary supplements in improving CIPN symptoms, CIPN pain, and QoL. Furthermore, network meta-analysis indicated that acupuncture plus electrical stimulation (acupuncture-E) had the greatest overall effect among the various interventions. The surface under the cumulative ranking curve (SUCRA) revealed that acupuncture-E ranked the highest in improving CINP symptoms. Acupuncture alone was most effective in reducing CIPN pain, and acupuncture plus moxibustion (acupuncture-M) ranked highest in enhancing QoL.ConclusionThis finding suggests that acupuncture-related interventions can provide patients with benefits in improving CIPN symptoms, pain, and QoL. In particular, acupuncture-E could be the most effective approach in which the provided evidence offers diverse options for cancer patients and healthcare professionals.Implication for the profession and/or patient careThese findings provide valuable insights into the potential benefits of acupuncture-related interventions for managing symptoms, pain, and QoL associated with CIPN in patients undergoing chemotherapy. Among the various interventions studied, overall, acupuncture-E had the most significant impact and was effective for a minimum duration of 3 weeks. On the other hand, transcutaneous electrical acupoint/nerve stimulation (TEAS) was identified as a noninvasive and feasible alternative for patients who had concerns about needles or the risk of bleeding. It is recommended that TEAS interventions should be carried out for a longer period, preferably lasting 4 weeks, to achieve optimal outcomes.Trial registrationThe study protocol was registered in the International Prospective Register of Systematic Reviews. Registration Number: CRD42022319871.

Body composition as a predictive factor for chemotherapy-induced peripheral neuropathy and dose-limiting toxicity in patients with endometrial cancer undergoing carboplatin and paclitaxel.

A longitudinal examination of associations between age and chemotherapy-induced peripheral neuropathy in patients with gynecologic cancer

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect in patients with breast cancer (BC) during treatment. Patients experiencing CIPN develop neuropathic symptoms, which could lead to the modification or discontinuation of chemotherapy. Nonpharmacological interventions can be simple and safe, but evidence of their effectiveness in patients with BC experiencing CIPN is currently insufficient. To compare and rank the effectiveness of nonpharmacologic interventions for CIPN in patients with BC. We conducted a systematic search of randomized controlled trials registered from database inception until October 2022 in 7 databases. We assessed studies that met the inclusion and exclusion criteria and evaluated the risk of bias. Network meta-analysis was conducted using Stata SE 17.0 (StataCorp, College Station, Texas). A total of 13 studies involving 9 nonpharmacologic interventions and comprising 571 participants were included. The results of the network meta-analysis showed that cryotherapy (standard mean difference, -1.22; 95% confidence interval, -2.26 to -0.17) exerted significant effects versus usual care. Cryotherapy (surface under the cumulative ranking area [SUCRA]: 0.74) was associated with the highest likelihood of effectively alleviating CIPN in patients with BC, followed by exercise (SUCRA: 0.62) and self-acupressure (SUCRA: 0.59). Cryotherapy was the most effective nonpharmacologic intervention for alleviating CIPN in patients with BC. Large-scale studies are required to verify the present findings. This study provides evidence regarding the effectiveness of nonpharmacologic interventions for CIPN. Physicians and nurses could incorporate cryotherapy into clinical practice to alleviate CIPN in patients with BC.

BackgroundFew studies have examined chemotherapy-induced peripheral neuropathy (CIPN) following the administration of eribulin as first- or second-line therapy in patients with breast cancer. We therefore assessed CIPN incidence by severity and risk factors for CIPN in patients treated with eribulin for HER2-negative inoperable or recurrent breast cancer, regardless of line therapy status.MethodsThis multicenter, prospective, post-marketing observational study enrolled patients from September 2014 in Japan and followed them for 2 years. For this interim analysis, the data cut-off point was in November 2017. CIPN severity was assessed based on the Japanese version of the Common Terminology Criteria for Adverse Events, version 4.0.ResultsAmong 634 patients included in the safety analysis, 374 patients did not have existing CIPN at baseline. CIPN was observed in 105 patients (28.1%), including 67 (17.9%), 34 (9.1%), and 4 (1.1%) patients with grade 1, 2, and 3 severity, respectively. Of the 105 patients, 85.7% patients continued, 7.6% reduced, interrupted or postponed, and 6.7% discontinued eribulin. The median time (min‒max) from baseline to CIPN onset was 60 (3‒337) days. Multivariate logistic regression identified a significant association between CIPN and hemoglobin level at baseline, starting dose of eribulin, and history of radiotherapy.ConclusionsOur findings indicate that, with respect to CIPN, eribulin is well-tolerated, as approximately one-quarter of patients developed CIPN, most cases were grade 1 or 2, and the majority of patients continued eribulin after CIPN onset.

Purpose: This study aimed to identify factors associated with the occurrence of chemotherapy-induced peripheral neuropathy (CIPN) and to study its impact on health-related quality of life (HRQoL) in patients with breast cancer. Methods: In total, 137 women with breast cancer who had undergone more than one cycle of chemotherapy were recruited for this descriptive study from the outpatient department of a university hospital in Incheon, Korea. Data were collected using a self-reported questionnaire, which included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 and EORTC QLQ-C30. Results: The mean CIPN score between patients was 13.57 on the sensory scale, 15.87 on the motor scale, and 25.06 on the autonomic scale. Of the studied socio-demographic, disease and treatment, and health behavior-related factors, only the chemotherapy regimen was significantly associated with CIPN (t = 2.50, p= .013). Taxane-based chemotherapy was significantly related to higher CIPN scores. Regression analyses revealed that CIPN was a factor that was significantly influential on HRQoL, adjusting for socio-demographic and clinical factors. Conclusion: This study suggests that oncology nurses need to be aware of the increased risk of CIPN in patients with breast cancer undergoing taxane-based chemotherapy. In addition, interventions for alleviating CIPN may be required to improve HRQoL among these patients.

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common chemotoxicities. However, no effective clinical CIPN screening methods have been reported. This study aimed to investigate whether changes in heart rate variability (HRV) could predict the development of CIPN for early symptom control in chemotherapy-prescribed patients with gastrointestinal (GI) cancer. Fifty-five GI cancer outpatients undergoing palliative chemotherapy including taxanes and/or platinum compounds were enrolled. CIPN was diagnosed using National Cancer Institute Common Toxicity Criteria for Adverse Event (NCI-CTCAE). HRV measures were derived from electrocardiogram signals. Twelve weeks after starting chemotherapy, 39 (70.9%) patients who complained of NCI-CTCAE grade 1-3 sensory changes were diagnosed with CIPN. Standard deviation of normal-to-normal R-R intervals (SDNN), high frequency (HF), low frequency (LF), and LF/HF ratio changed significantly during 3 assessment periods. Percentage changes in SDNN and HF were related to the occurrence of CIPN symptoms. A decision tree model indicated that patients with a rapid percentage change decrease in SDNN and HF were CIPN-positive. Using SDNN and HF, our decision tree predicted CIPN occurrence. The changes in HRV may occur earlier than sensory CIPN symptoms.

Background:Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent unfavorable side effects. CIPN refers to the loss of peripheral nerve function that certain types of chemotherapy can cause.Objective:This study investigated the effectiveness of cryotherapy in preventing CIPN and its effect on the quality of life (QoL) during chemotherapy.Methods:Eligible participants are cancer patients who began therapy with carboplatin, docetaxel, or paclitaxel in the Breast Oncology Unit between May 2022 and October 2022. Patients were distributed into intervention groups that utilized cryotherapy with ice gloves and ice boots and control groups that did not receive cryotherapy. Patient self-report questionnaires were used to quantify patients’ symptoms and QoL after treatment.Results:The intervention group exhibited significantly less cold sensitivity, hand and foot numbness, and hand tingling than the control group. Daily CIPN symptoms were substantially milder in the intervention group. Before and after treatment, nerve pain, balance, and muscle and joint discomfort were similar. Intervention and control groups have varied neurotoxicity adverse reaction scores. 2.4% of controls had grade 4 motor neurotoxicity impairment. Physical function and QoL improved in the intervention group.Conclusions:Cryotherapy relieves CIPN symptoms in breast cancer patients receiving carboplatin and paclitaxel chemotherapy. More thorough trials should be carried out to determine the best time limit and duration of cryotherapy.

Chemotherapy-induced peripheral neuropathy (CIPN), a common problem, can impair function and quality of life in patients, potentially limiting chemotherapy and adversely affecting outcomes. This trial compared investigational hand therapy intervention (Investigational) compared with a traditional occupational therapy approach (Traditional) to prevent CIPN in patients with pancreatic cancer receiving gemcitabine and albumin-bound paclitaxel containing regimens. forty-nine patients were enrolled with 40 evaluable for statistical analysis (21 Investigational/19 Traditional). CIPN in the hands was reported in 6 patients (28.6%) in Investigational, and 4 (21.1%) in Traditional P = .721. Kaplan-Meier analysis showed a mean time-to-event of 76.0 days (90% CI: 68.5, 83.6), and 75.8 (90% CI: 68.5, 83.2) days respectively, P = .614. Fifteen patients in each group (78.9% Traditional, 71.4% in Investigational) were censored as they did not develop CIPN. No correlation was found between CIPN risk and age, sex, BMI, disease stage, performance status, or chemotherapy dose. Seventy-four percent of patients receiving gemcitabine, albumin-bound paclitaxel, and cisplatin did not develop CIPN of the hands by day 84. There was no statistical difference in time to onset of CIPN between the two groups. Early adaption of occupational therapy may prevent early onset CIPN in chemotherapy patients. NCT05374876.

Chemotherapy-induced peripheral neuropathy (CIPN), one of the most common and severe adverse effects of chemotherapy, is associated with worse quality of life among survivors of ovarian cancer. Currently, there is no effective treatment for CIPN. To evaluate the effect of a 6-month aerobic exercise intervention vs attention-control on CIPN among women treated for ovarian cancer in the Women's Activity and Lifestyle Study in Connecticut (WALC) to provide evidence to inform the guidelines and recommendations for prevention or treatment of CIPN. This prespecified secondary analysis evaluated the Women's Activity and Lifestyle Study in Connecticut (WALC), a multicentered, open-label, population-based, phase 3 randomized clinical trial of an aerobic exercise intervention vs attention control for CIPN in patients who were diagnosed with ovarian cancer. Only WALC participants who received chemotherapy were included in this analysis. Participants were randomized 1:1 to either a 6-month aerobic exercise intervention or to attention control. All analyses were conducted between September 2022 and January 2023. The exercise intervention consisted of home-based moderate-intensity aerobic exercise facilitated by weekly telephone counseling from an American College of Sports Medicine/American Cancer Society-certified cancer exercise trainer. Attention control involved weekly health education telephone calls from a WALC staff member. Change in CIPN was the primary outcome in this secondary analysis. This outcome was represented by CIPN severity, which was self-measured by participants at baseline and 6 months using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity scale, with a score range of 0 to 44. A mixed-effects model was used to assess the 6-month change in CIPN between the exercise intervention and attention control arms. Of the 134 participants (all females; mean [SD] age, 57.5 [8.3] years) included in the analysis, 69 were in the exercise intervention arm and 65 were in the attention control arm. The mean (SD) time since diagnosis was 1.7 (1.0) years. The mean (SD) baseline CIPN scores were 8.1 (5.6) in the exercise intervention arm and 8.8 (7.9) in the attention control arm (P = .56). At 6 months, the self-reported CIPN score was reduced by 1.3 (95% CI, -2.3 to -0.2) points in the exercise intervention arm compared with an increase of 0.4 (95% CI, -0.8 to 1.5) points in the attention control arm. The between-group difference was -1.6 (95% CI, -3.1 to -0.2) points. The point estimate was larger among the 127 patients with CIPN symptoms at enrollment (-2.0; 95% CI, -3.6 to -0.5 points). Findings of this secondary analysis of the WALC trial indicate that a 6-month aerobic exercise intervention vs attention control significantly improved self-reported CIPN among patients who were treated for ovarian cancer. While replication of the findings in other studies is warranted, incorporating referrals to exercise programs into standard oncology care could reduce CIPN symptoms and increase quality of life in patients with ovarian cancer. ClinicalTrials.gov Identifier: NCT02107066.

Taxanes are essential chemotherapy agents for breast cancer treatment. However, patients frequently experience chemotherapy-induced peripheral neuropathy (CIPN) during their course of treatment. Cryotherapy is a non-pharmacological approach that has been explored for its potential effects on preventing or improving CIPN. However, although several studies have reported on the effects of cryotherapy, no comprehensive review has been conducted to confirm its benefits. This study was designed to investigate the potential benefits of cryotherapy in terms of alleviating CIPN in patients with breast cancer undergoing taxane-containing chemotherapy. This systematic review was conducted using databases including PubMed, Embase, Cochrane, CINAHL, Medline, and Airiti Library, focusing on female patients over 18 years old with breast cancer treated using taxane-containing regimen. Key words searched were based on the PICO (patient/problem, intervention, comparison, outcome) framework, and cover articles in the literature published up to December 2023. In this study, the Jadad Quality Scale was employed to evaluate the randomized controlled trials (RCTs), while methodological index for non-randomized studies was utilized for non-RCTs. The 11 studies used in this analysis included five RCTs comprising 198 patients and six non-RCTs comprising 1,930 patients. Five of the studies reported cryotherapy may help prevent CIPN, five reported cryotherapy may alleviate CIPN symptoms, and one study reported no significant prevention or alleviation effect. Cryotherapy shows promise as a practical and safe method the prevention / alleviation of CIPN symptoms during chemotherapy treatment. However, the related evidence is inadequate, indicating a need for more rigorous studies to establish stronger evidence.

Effectiveness of exercise therapy on chemotherapy-induced peripheral neuropathy in patients with ovarian cancer: A scoping review.

PurposeTo assess and describe chemotherapy-induced peripheral neuropathy (CIPN), a well-known complication to cancer treatment, using different methodologies in hematological patients.MethodsPatients scheduled for treatment with vincristine, bortezomib, or lenalidomide were included in this longitudinal observational study. The patients were examined for CIPN before treatment (baseline), before each chemotherapy cycle, one month after end of treatment, and one year after baseline using patient-reported outcomes (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Ntx-13 (FACT/GOG-Ntx-13)) and clinician-assessed outcomes (the Common Terminology Criteria for Adverse Events (CTCAE) and the Total Neuropathy Score-clinical version (TNSc©)).ResultsA total of 23 patients with 171 examination visits were included between 2020 and 2022. Four patients were treated with vincristine, five with bortezomib, and fourteen with bortezomib and lenalidomide combined. Defining CIPN as a ≥ 10% decrease in the FACT/GOG-Ntx-13, 11 patients (47.8%) developed CIPN during treatment and follow-up. CTCAE score for paresthesia increased from baseline throughout treatment until 1 month after the last treatment (p ≤ 0.045). Overall, the highest proportion of CIPN was present at cycle 3–4 and 1 month after last treatment.ConclusionThis study describes the course of CIPN in patients treated with vincristine, bortezomib, or lenalidomide using both patient-reported and clinician-assessed outcomes. The highest proportion of CIPN was present at cycle 3–4 and 1 month after treatment, at which timepoints clinicians must be especially aware of CIPN.Trial registrationRegistered at Clinicaltrials.gov (Trial Registration Number: NCT04393363) on March 19, 2020.