Stay Up
to Date
Stay Up
to Date
Breaking News,
Updates, & More
Breaking News,
Updates, & More
Click Here to
Subscribe
Click Here to
Subscribe

Chemotherapy-Induced Peripheral Neuropathy Increases Risk of Falls and Physical and Functional Problems, Especially in Older Patients

TON - September 2012 VOL 5, NO 8 published on October 16, 2012 in Supportive Care
Alice Goodman

Motor toxicities of chemotherapy-induced peripheral neuropathy (CIPN) are likely to lead to falls, deficits in physical performance (PP), and functional losses, according to a substudy of a phase 3 clinical trial in patients with CIPN reported at the 2012 Annual Meeting of the American Society of Clinical Oncology.1

“This study suggests that cancer survivors who have received chemotherapy should be evaluated over time not only for CIPN toxicities, but also for physical functioning and falls,” cited Supriya Gupta Mohile, MD, of the University of Rochester Medical School in Rochester, New York. Mohile suggested that balance and mobility training should be considered during chemo­therapy to reduce the risk of falls.

Falls and PP problems are common in cancer patients, and older patients are more likely to fall than age-matched peers without cancer. Falls are a significant cause of morbidity. Prior to this study, data were limited on the relationships between CIPN and falls, PP deficits, and functional problems.

The study enrolled 461 patients who participated in a randomized, double-blind, placebo-controlled clinical trial to evaluate a topical cream in cancer survivors with CIPN. All participants had completed chemotherapy, were not on medications for pain or neuropathy, and had self-reported painful CIPN at baseline, as reflected by daily pain scores of >4 on an 11-point scale from 0 to 10 for severity. Patients also completed sensory and motor subscales of the European Organisation for Research and Treatment of Cancer quality-of-life questionnaire for neuropathy toxicities and self-reported falls.

A primary outcome measure was self-reported falls in the previous 3 months. A PP deficit was defined as finding it difficult or being unable to perform any of 6 physical tasks, including lifting objects, walking a quarter of a mile, reaching arms above shoulder level, and stooping, crouching, or kneeling. Functional losses were defined as having difficulty or being unable to perform any of 5 functional tasks: managing money, bathing, light housework, walking across the room, and shopping.

Patients who reported falls and/or PP deficits were compared with those who did not. A logistic regression analysis was performed to examine the association of baseline characteristics and CIPN toxicities with falls, PP deficits, and functional losses. Among the study population, 11.9% experienced recent falls, 58.6% reported a PP deficit, and 26.6% reported a functional loss.

Patients who reported falls and/or PP deficits were significantly more likely to be older (P = .02), female (P = .03), have less education (P <.01), and to have higher severity of CIPN toxicities: pain (P <.001), sensory (P <.001), and motor (P <.001) neuropathy (in an unadjusted analysis). Groups with falls and/or PP deficits and without these factors did not differ according to cancer and chemotherapy history.

An analysis adjusted for age, gender, race, ethnicity, marital status, education, history of taxane therapy, previous radiation therapy, cancer diagnosis, pain, and sensory neuropathy found factors independently and significantly associated with falls were a history of breast cancer (P = .045) and motor neuropathy (P = .006). Factors independently associated with having a PP deficit were previous surgery (P = .013) and motor neuropathy (P <.001). Factors that were significantly associated with functional losses included non-white race (P = .01), Hispanic ethnicity (P = .048), PP deficit (P <.0001), and motor neuropathy (P = .0001).

The study was limited by its heterogeneous cancer sample; its cross-sectional nature, which did not allow for assessment of causality and temporal relationships; and the self-reporting of CIPN toxicities. Nevertheless, the study confirmed that CIPN toxicities, primarily motor related, are significantly associated with falls, PP deficits, and functional losses.

Reference

  1. Mohile SG, Fan L, Gewandter JS, et al. Falls, physical performance deficits, and functional losses in cancer survivors with chemotherapy-induced neuropathy (CIPN): a University of Rochester CCOP study. Presented at: 2012 Annual Meeting of the American Society of Clinical Oncology; June 2012; Chicago, IL. Abstract 9014.
Related Items
Psychosocial Issues in Patients with Cancer: It’s Time for Real-World Interventions
Corbin Davis
TON - February 2020, Vol 13, No 1 published on February 5, 2020 in Supportive Care
Medical Cannabis in Patients with Advanced Cancer: Challenges Remain
Corbin Davis
TON - February 2020, Vol 13, No 1 published on February 5, 2020 in Supportive Care
Key Considerations for Implementing a Scalp Cooling Program
Dia Byrne, MSN, RN, ACNS-BC, OCN
TON - December 2019, Vol 12, No 6 published on December 5, 2019 in Supportive Care
What an Aging Population Means for Cancer Treatment
Saima Iqbal, Ishmam Khan
TON - April 2019, Vol 12, No 2 published on April 22, 2019 in Geriatric Cancer, Supportive Care
Supportive Care Updates from ASCO 2017 Highlighted at New Orleans Summer Cancer Meeting
Meg Barbor, MPH
TON - November 2017, Vol 10, No 6 published on November 27, 2017 in Supportive Care
Patient-Reported Outcomes Influence Radiation Guidelines
Alice Goodman
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Conference Correspondent
Hair Loss Seen in 1 of 3 Women with Breast Cancer Receiving Endocrine Therapy
Alice Goodman
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Conference Correspondent
Adverse Events Associated with Checkpoint Inhibitors
Alice Goodman
TON - September 2017, Vol 10, No 5 published on September 10, 2017 in Side-Effects Management, Side-Effects Management
Overcoming Cultural Barriers to Screening Access
Alice Goodman
TON - July 2017, Vol 10, No 4 published on July 6, 2017 in Conference Correspondent
CDK4/CDK6 Inhibitors Show Promise in Advanced Postmenopausal Breast Cancer
Alice Goodman
TON - July 2017, Vol 10, No 4 published on July 6, 2017 in Breast Cancer
Last modified: September 9, 2019