40% of people treated with chemotherapy develop persistent, severe nerve pain
Key takeaways:
- Patients treated with platinum-based chemotherapies and taxanes exhibited higher risk for CIPN.
- Patients with lung cancer also had higher risk for chronic, painful CIPN.
Chronic chemotherapy-induced peripheral neuropathy is a substantial burden among people with cancer treated with chemotherapy, according to results of a systematic review and meta-analysis published in Regional Anesthesia & Pain Medicine.
More than 40% of patients treated with chemotherapy develop persistent peripheral nerve pain, findings showed.
Prevalence of chronic chemotherapy-induced peripheral neuropathy (CIPN) varied by chemotherapy regimen and cancer type. Patients treated with platinum chemotherapy or taxanes — as well as those with lung cancer — exhibited the highest likelihood of experiencing painful neuropathy that lasted a least 3 months.
“From a research standpoint, this study points to the need for large-scale, multinational studies to look at the true prevalence of chronic, painful CIPN,” researcher Yeng F. Her, MD, PhD, pain physician at Mayo Clinic in Rochester, Minnesota, told Healio. “This may also represent an opportunity for us to look at preventive measures to stop these patients from developing pain after they have completed their chemotherapy.”
An ‘underreported’ condition
Her and colleagues — including Ryan S. D’ Souza, MD, anesthesiologist and pain medicine physician at Mayo Clinic — analyzed data from 77 studies that included 10,962 patients with CIPN from 28 countries.
Pooled prevalence of painful CIPN lasting 3 months or longer served as the primary outcome. Researchers also conducted a subgroup analysis that examined outcomes by geographic region, sex, chemotherapy regimen, primary cancer type and study funding source.
“The prior literature groups the symptoms of neuropathy — both painful and nonpainful — together, and our study takes it one step further,” D’Souza told Healio. We’re looking at the proportion of patients who are talking about chronic pain, because we know that is what impacts patients the most. We also looked at global prevalence, rather than just the United States.”
Researchers calculated an estimated pooled prevalence of chronic, painful CIPN of 41.22% (95% CI, 32.4-50.19), though they noted “substantial heterogeneity” across studies (I2 = 95.27; 95% CI, 94.58-95.86).
The subgroup analysis showed patients treated with platinum-based chemotherapies (40.44%) and taxanes (38.35%) had higher prevalence of chronic, painful CIPN than those treated with other types of chemotherapy. Patients with lung cancer had higher prevalence of chronic, painful CIPN (60.26%) than those with other cancer types.
“This study raises awareness about a chronic pain condition that is likely underreported in the literature,” study author Nasir Hussain, MD, specialist in anesthesiology and pain management at The Ohio State University, told Healio. “Now we know that these patients suffer from pain, but we can take this a step further. What we need to investigate is how this impacts their quality of life.”
‘Battle scars’
The research team wanted to understand the extent to which patients continue to struggle with pain or other symptoms after completing cancer treatment, D’Souza said.
“Oftentimes, when we think of cancer-related pain, we think about pain directly associated with the cancer or postsurgical pain,” he said. “However, we often ignore the sequelae of symptoms that occur after a patient has been cured of cancer. If we think of it as ‘a war,’ they have ‘won’ in that they are cured of cancer, but these patients have battle scars that can stay with them for the rest of their lives.”
Results of the subgroup analysis revealed potentially valuable information to identify patients who may be most likely to develop chronic, painful CIPN based on chemotherapy regimen or cancer type, D’Souza said.
“This wasn’t a mechanism study, but we were curious about what mechanism could explain these differences,” he said. “There are studies showing that platinum-based agents and taxanes are a bit more neurotoxic compared with other chemotherapy agents. Also, patients with lung cancer tend to have more aggressive therapy, so it makes sense that they might have gone through several different chemotherapy cycles.”
D'Souza and colleagues have several trials underway to evaluate different treatment approaches to CIPN. Commonly used interventions include medications such as opioids, or neuropathic agents like duloxetine and gabapentin.
“Neuromodulation is an up-and-coming therapy, as is spinal cord stimulation and peripheral neurostimulation,” D’Souza said. “These are advanced therapies that pain physicians commonly offer in our practices and are offering to patients with CIPN, but that many oncologists and primary care doctors don’t know about.”
Although this analysis encompassed data from patients around the world, most countries were not represented due to lack of published studies, D’Souza said.
He said he would like to see a global database in which all countries could collaborate to report CIPN outcomes. He also hopes this research prompts oncologists and primary care physicians to place more focus on CIPN.
“Chronic pain is associated with reduced quality of life,” D’Souza said. “It’s associated with higher burden on mental health, including depression and anxiety. There is hope for patients with CIPN in the long term. This can be treated.”
References:
For more information:
Ryan S. D’Souza, MD, can be reached at dsouza.ryan@mayo.edu.
Yeng F. Her, MD, PhD, can be reached at her.yeng@mayo.edu.
Nasir Hussain, MD, can be reached at nasir.hussain@osumc.edu.
Collapse
Healio Interviews