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Persistent CIPN causes impaired physical functioning, falls in women cancer survivors
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Nearly half of women cancer survivors continued to experience symptoms of chemotherapy-induced peripheral neuropathy up to 6 years after treatment, according to research presented at the Cancer Survivorship Symposium.
Symptomatic women experienced significantly worse physical function — including falls and altered gait — than asymptomatic women.
Chemotherapy-induced peripheral neuropathy (CIPN) can persist after treatment and may impact physical function. However, studies designed to examine the functional consequences associated with CIPN in cancer survivors have been flawed, according to study background.
“The studies that quantify the function consequences of CIPN among cancer survivors tend to use self-report of the symptom itself and of the functional ability of the survivors,” Kerri M. Winters-Stone, PhD, MS, research professor at Oregon Health & Science University’s School of Nursing in Portland, Oregon, said during a press conference. “Other studies tend not to use objective measures or feature small sample sizes.”
Winters-Stone and colleagues sought to compare objective and self-reported measures of physical function, gait patterns and falls among women cancer survivors with or without symptoms of CIPN.
The researchers had access to baseline assessments from 678 women cancer survivors enrolled in exercise studies. They compared women who self-reported symptoms of CIPN with asymptomatic women in the areas of maximal leg press strength, timed chair stand, physical performance battery, gait problems, step number, stride length, base of support, percentage time in double support, self-reported physical function and disability, and falls during the prior year.
Winters-Stone and colleagues excluded women with diabetes, as well as women who were premenopausal at diagnosis and those who did not receive chemotherapy.
The study included data from 462 women (mean age, 62 ± 6 years; median time since diagnosis, 5.8 ± 4.1 years).
The majority (71%) of study participants had breast cancer. Other cancer types included ovarian cancer, lung cancer, colorectal cancer and blood cancers.
From this cohort, 210 women (45%) reported CIPN symptoms and 252 women (55%) reported being asymptomatic. Reported symptoms included loss of feeling in hands and feet, as well as self-reported difficulty when undertaking activities of daily life.
The function levels of symptomatic vs. asymptomatic women significantly differed on all measures with the exception of maximal leg strength and base of support during a usual walk.
Symptomatic women experienced worse performance status for timed chair stand (83.1 kg vs. 84.2 kg; P < .01), physical performance battery (10.5 vs. 11.1; P < .01), step number (number per minute, 129 vs. 133; P < .05), stride length (129 cm vs. 133 cm; P < .05), percentage time in double support (26.1 vs. 25.3; P < .05), physical function (66 vs. 71; P < .01), disability (75 vs. 82; P < .01) and falls (31% vs. 19%; P < .01).
Although men with cancer appear as likely to experience CIPN as women, little data exist on CIPN and physical functioning in men, the researchers wrote.
“We cannot dismiss neuropathy as a treatment side effect that goes away, because symptoms persist for years in nearly half of women,” Winters-Stone said in a press release. “While there are no effective treatments for this side effect, rehabilitative exercise programs may preserve physical functioning and mobility in the presence of neuropathy to help prevent falls and resulting injury.” – by Cameron Kelsall
Reference:
Winters-Stone KM, et al. Abstract 130. Presented at: Cancer Survivorship Symposium; Jan. 15-16, 2016; San Francisco.
Disclosure: The NCI, American Cancer Society and Susan G. Komen for a Cure Foundation provided funding for this study. The researchers report no relevant financial disclosures.
Perspective
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Merry-Jennifer Markham, MD, FACP
Chemotherapy-induced peripheral neuropathy (CIPN) affects many of our cancer survivors — not just women, but men as well. It is often underrecognized and probably underreported. Many of our chemotherapy treatments for a variety of cancers — including lung cancer, lymphoma, ovarian cancer, breast cancer and colon cancer, just to name a few — include agents that can cause CIPN.
This study is important because it highlights that the neuropathy our patients are experiencing is not just a bothersome symptom. It not only impacts our survivors’ physical function for years to come, but it puts them at risk for falls and the associated morbidity. As physicians and researchers, we owe it to our patients to take CIPN very seriously. Strategies to reduce the likelihood of developing the symptoms, and rehabilitation for those who have the symptoms, are sorely needed.
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