Abstract
BackgroundThe aim of this study was to assess chemotherapy‐induced polyneuropathy (CIPN) 5 years after adjuvant chemotherapy in patients with breast and colorectal cancer. The association of CIPN with quality of life, anxiety, and depression was analyzed.MethodsOf a set of 100 patients with breast cancer and of 74 with colorectal cancer who had undergone surgery and adjuvant chemotherapy in 2011‐2012, 80 and 52 patients alive, respectively, were included together with two reference groups of 249 breast cancer patients and 83 colorectal cancer patients who had undergone surgery only. All patients were sent a questionnaire on alcohol consumption, smoking habits, comorbidity, medicine consumption, and oxaliplatin‐specific questions, as well as the Michigan Neuropathy Screening Instrument questionnaire (MNSIq), the Douleur Neuropathique 4 Questions (DN4q), the EQ‐5D, and the Hospital Anxiety and Depression Scale. Possible polyneuropathy was defined as the presence of numbness and/or tingling in the feet, secondly as a score of ≥4 on the MNSIq. Possible painful polyneuropathy was defined as pain in both feet and a score ≥3 on the DN4q.ResultsThe prevalence of possible polyneuropathy defined by numbness and/or tingling in the feet was 38.8% (28.1‐50.3) after adjuvant docetaxel and 57.7% (43.2‐71.3) after adjuvant oxaliplatin, with no significant difference from a previous 1‐year follow‐up (P >.35). Fewer had possible polyneuropathy as defined by the MNSIq. Patients with possible polyneuropathy after adjuvant chemotherapy reported significantly lower quality of life than patients treated with surgery only.ConclusionSymptoms of polyneuropathy following adjuvant docetaxel and oxaliplatin persist 5 years after treatment and affect quality of life negatively.
Highlights
Chemotherapy-induced polyneuropathy (CIPN) is one of the most common dose-limiting side effects and a leading cause of long-term morbidity and reduced quality of life (QoL) in cancer survivors.[1,2,3] It is prevalent after treatment with taxanes and platinum agents that are commonly used to treat many types of cancers, including breast, gastrointestinal, lung, ovarian, prostate, and testicular cancer
We have previously reported the development of neuropathic symptoms from baseline up to 1 year after adjuvant docetaxel for breast cancer and oxaliplatin for colorectal cancer.[20]
In a shorter term study in patients treated with oxaliplatin, Park et al reported that symptoms and clinical signs of neuropathy and neurophysiological deficits persisted at a 2-year follow-up,[28] and in a small study of 45 patients treated with cisplatin or oxaliplatin, Brouwers et al reported neuropathy symptoms in the feet for up to 6 years.[29]
Summary
Chemotherapy-induced polyneuropathy (CIPN) is one of the most common dose-limiting side effects and a leading cause of long-term morbidity and reduced quality of life (QoL) in cancer survivors.[1,2,3] It is prevalent after treatment with taxanes and platinum agents that are commonly used to treat many types of cancers, including breast, gastrointestinal, lung, ovarian, prostate, and testicular cancer. There are no accepted standardized diagnostic criteria for CIPN, and questionnaires are primarily designed to assess the severity of symptoms.[16] Robust epidemiological data on the long-term development of neuropathy are needed as most studies use a very rough scale for identifying neuropathy such as the National Cancer Institute – Common toxicity criteria (NCI-CTC),[17] have a short follow-up time, are not prospective,[10,14,18,19] and do not include a control group.[4]. Results: The prevalence of possible polyneuropathy defined by numbness and/or tingling in the feet was 38.8% (28.1-50.3) after adjuvant docetaxel and 57.7% (43.271.3) after adjuvant oxaliplatin, with no significant difference from a previous 1-year follow-up (P >.35). Patients with possible polyneuropathy after adjuvant chemotherapy reported significantly lower quality of life than patients treated with surgery only
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