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D'Andre S, Novotny P, Walters C, Lewis-Peters S, Thomé S, Tofthagen CS, Giridhar KV, Loprinzi C. Topical Cannabidiol for Established Chemotherapy-Induced Neuropathy: A Pilot Randomized Placebo-Controlled Trial. Cannabis Cannabinoid Res 2024. [PMID: 39016024 DOI: 10.1089/can.2023.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
Background: Patients have been known to use cannabinoids for treating established chemotherapy-induced peripheral neuropathy (CIPN) based on anecdotal information and retrospective reports suggesting that such might be beneficial. In response, a double-blinded, placebo-controlled, randomized, pilot clinical trial was developed to evaluate whether resultant data would support a phase III trial for testing whether a cannabidiol (CBD) cream might improve CIPN. Methods: Forty patients with established CIPN were randomized, in a double-blinded manner, to topical CBD or a placebo cream. The study product was applied for 2 weeks, followed by a crossover for 2 weeks. Neuropathy was evaluated using the European Organization of Research and Treatment of Cancer (EORTC)-CIPN20, the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, and the Global Impression of Change instruments. Side effects were recorded by symptom diaries. Results: The EORTC-CIPN20 scores were similar in the patients receiving CBD versus the placebo. Likewise, the toxicity scores were similar in patients who received the CBD versus the placebo. Conclusions: This pilot trial did not support that the studied CBD isolate cream improved painful established CIPN. It was well tolerated overall. Clinical Trial Registration Number: NCT05388058.
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Affiliation(s)
- Stacy D'Andre
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Novotny
- Department of Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Camille Walters
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stephan Thomé
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Charles Loprinzi
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Knoerl R, Ploutz-Snyder R, Smener L, Tofthagen C, Zick S. Association of Chemotherapy-Induced Peripheral Neuropathy with Diet Quality Among Post-Treatment Cancer Survivors. Nutr Cancer 2024; 76:717-725. [PMID: 38919034 PMCID: PMC11290979 DOI: 10.1080/01635581.2024.2364389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
Nutrition is essential for peripheral nerve function, yet dietary factors associated with chronic chemotherapy-induced peripheral neuropathy (CIPN) remain poorly characterized. The purpose of this cross-sectional study was to determine differences in diet quality and macronutrients for cancer survivors with and without CIPN. Cancer survivors (e.g., ≥3 months post platinum and/or taxane-based neurotoxic chemotherapy) with (i.e., ≥1/4 PRO-CTACE™ Numbness and Tingling Severity) and without CIPN completed the VioScreen Research Graphical Food Frequency Questionnaire. The association among diet (Healthy Eating Index [HEI]), macronutrient intake (average percent caloric intake), and CIPN severity were analyzed using generalized linear regression models, adjusting for caloric intake, body mass index, age, and sex. Results revealed that for each one-point increase in diet quality, PRO-CTCAE severity decreased by -0.06 (95% CI: -0.10, -0.02, P < 0.01). Participants without CIPN reported higher diet quality than those with CIPN (HEI mean: 70.11 vs 68.45) (OR = 0.94, P = 0.03, 95% CI: 0.89, 0.99). Participants with CIPN had significantly higher carbohydrate consumption than participants without CIPN (OR = 1.11, P = 0.04, 95% CI: 1.01, 1.22). There were no significant differences in consumption of proteins or fats between groups. Further research should be pursued to discover the potential benefits of dietary interventions for CIPN management among cancers survivors.
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Affiliation(s)
- Robert Knoerl
- University of Michigan School of Nursing, 400 North Ingalls St, Office 2350; Ann Arbor, MI, 48109
| | - Robert Ploutz-Snyder
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI 48109
| | - Liat Smener
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI 48109
| | - Cindy Tofthagen
- Department of Nursing, Mayo Clinic in Florida, Jacksonville, FL, 32224
| | - Suzanna Zick
- Department of Family Medicine, Michigan Medicine, and Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Lin KY, Chen PS, Lin CF. Physical function as a predictor of chemotherapy-induced peripheral neuropathy in patients with pancreatic cancer. BMC Gastroenterol 2024; 24:154. [PMID: 38711006 DOI: 10.1186/s12876-024-03227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND A growing body of research indicates that poor functional status before chemotherapy may be correlated with the severity of chemotherapy-induced peripheral neuropathy (CIPN) after the neurotoxic treatment. However, little is known about the associations between pre-chemotherapy physical function and CIPN in patients with pancreatic cancer. PURPOSE To identify the predictors of CIPN in relation to pre-chemotherapy physical function in patients with pancreatic cancer. METHODS This secondary analysis included data from patients with pancreatic cancer who participated in a longitudinal research study at National Cheng Kung University Hospital, Tainan, Taiwan. Four physical function tests (i.e., grip strength, Timed Up and Go (TUG), 2-minute step test (2MST), and Romberg test) and two questionnaires (The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 [EORTC QLQ-C30] and Chemotherapy-Induced Peripheral Neuropathy Module [CIPN20]) were assessed at baseline (i.e., before first chemotherapy session) and 2-, 3-, 4-, and 6-month follow-up. Multiple linear regression with adjustment for confounding factors was used to assess the associations between the four functional tests at baseline and the CIPN20 total score and individual subscale scores (sensory, motor, and autonomic) at 6-month follow-up. RESULTS Data from a total of 209 pancreatic cancer patients (mean age: 64.4 years, 54.5% male) were analyzed. The findings showed that the severity of CIPN at 6-month follow-up was significantly associated with the baseline TUG completion time (β = 0.684, p = 0.003). The TUG completion time was also positively correlated with the 6-month CIPN sensory and autonomic subscales. In addition, a baseline positive Romberg test (β = 0.525, p = 0.009) was a significant predictor of the severity of motor neuropathy at 6-month follow-up. CONCLUSION The TUG completion time and positive Romberg test before chemotherapy may be predictive factors of the CIPN severity 6 months after the commencement of chemotherapy. Accordingly, the incorporation of TUG and Romberg tests into the clinical assessment protocol emerges as imperative for individuals diagnosed with pancreatic carcinoma undergoing chemotherapy regimens.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan
- School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei, Taiwan
| | - Po See Chen
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Feng Lin
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan.
- Physical Therapy Center, National Cheng Kung University Hospital, Tainan, Taiwan.
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Gewandter JS, Culakova E, Davis JN, Gada U, Guido JJ, Bearden JD, Burnette B, Shah D, Morrow G, Mustian K, Sluka K, Mohile N. Wireless Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN): A Proof-of-Concept Randomized Clinical Trial. THE JOURNAL OF PAIN 2024; 25:104431. [PMID: 37993030 PMCID: PMC11058028 DOI: 10.1016/j.jpain.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) affects approximately 30 to 60% of people who receive neurotoxic chemotherapy. CIPN is associated with impaired quality of life and function and has few effective treatments. This 6-site, subject and assessor-blinded randomized clinical trial (RCT) was designed to assess 1) preliminary efficacy (ie, alpha pre-specified at .2) of a wearable, app-controlled, transcutaneous electrical nerve stimulation (TENS) device for chronic CIPN and 2) feasibility of conducting a confirmatory trial within the National Cancer Institute Community Oncology Research Program (NCORP) (NCT04367480). The primary outcome was the EORTC-CIPN20. The main secondary outcomes were individual symptoms assessed daily (via 0-10 numeric rating scales). The primary analysis was an analysis of covariance (outcome: EORTC-CIPN20, fixed effect: arm, covariates: baseline EORTC-CIPN20 and site). Secondary analyses used a similar analysis of covariance models (excluding site) for each symptom on subgroups of subjects with ≥4 out of 10 for that symptom at baseline. 142 eligible subjects were randomized and received a device; 130 (91%) completed the study. The difference between groups in the EORCT-CIPN20 at the endpoint (placebo-active) was 1.05 (95% Confidence Interval: -.56, 2.67; P = .199). The difference between groups for the individual symptoms was as follows: hot/burning pain: 1.37 (-.33, 3.08; P = .112), sharp/shooting pain: 1.21 (-.37, 2.79; P = .128), cramping: 1.35 (-.32, 3.02; P = .110), tingling: .23 (-.61, 1.08; P = .587), numbness: .27 (-.51, 1.05; P = .492). An RCT of an app-controlled TENS device for chronic CIPN with excellent retention is feasible in the NCORP. Preliminary efficacy evidence suggests that TENS is promising for pain and cramping from CIPN. A confirmatory RCT of TENS for painful CIPN is highly warranted. PERSPECTIVE: Daily, home-based TENS therapy demonstrates promising efficacy for painful CIPN symptoms in this proof-of-concept randomized clinical trial. Future confirmatory trial is warranted.
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Affiliation(s)
- Jennifer S. Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester NY
| | - Eva Culakova
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Jenae N. Davis
- Department of Medicine, University of Rochester Medical Center, Wilmot Cancer Institute, Rochester NY
| | - Umang Gada
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Joseph J. Guido
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - James D. Bearden
- Upstate Carolina Consortium Community Oncology Research Program (UPSTATE), Gibbs Cancer Center and Research Institute, Spartanburg SC
| | - Brain Burnette
- Cancer Research of Wisconsin and Northern Michigan NCORP, Green Bay, Wisconsin
| | - Dhaval Shah
- Helen F. Graham Cancer Center and Research Institute, Christiana Care, Newark, DE
| | - Gary Morrow
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Karen Mustian
- Department of Surgery, Supportive Care in Cancer, University of Rochester Medical Center, Rochester NY
| | - Kathleen Sluka
- Department of Physical Therapy & Rehabilitation Sciences, University of Iowa, Iowa City, IA
| | - Nimish Mohile
- Department of Neurology, University of Rochester Medical Center, Rochester NY
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Su YC, Lai YH, Hsieh ST, Teng CLJ, Lee YH. Acute, long-term or non-vincristine-induced peripheral neuropathy among non-Hodgkin lymphoma survivors: Symptoms, daily activities, functional status, and quality of life. Eur J Oncol Nurs 2024; 69:102540. [PMID: 38461728 DOI: 10.1016/j.ejon.2024.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/08/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE This study aimed to explore the incidence and severity of vincristine-induced peripheral neuropathy (VIPN) in non-Hodgkin lymphoma (NHL) survivors (primary aim) and its impact on daily life by comparing common cancer symptoms, functional status, and quality of life (QoL) among survivors with acute, long-term, and non-VIPN (secondary aim). METHODS This cross-sectional study examined 144 NHL survivors. Standardized questionnaires were used to assess common cancer symptoms, functional status, and QoL with the European Organization for the Research and Treatment of Cancer - Quality of Life Questionnaire (EORTC-QLQ-C30). VIPN (Chemotherapy-Induced Peripheral Neuropathy) status was classified using EORTC-QLQ-CIPN20. A self-designed interference scale was developed to determine the impact of the VIPN on daily activities. The Kruskal-Wallis test and Spearman rank correlation were used in this study. RESULTS Among the survivors of acute and long-term VIPN, the highest incidences and most severe symptoms were found for hand numbness and foot cramps. A significant moderate correlation was found between disturbances in daily activities and acute or long-term VIPN, including gait changes, going up or down the stairs, and imbalance-related falls. Acute and long-term VIPN survivors showed worse symptoms (fatigue, insomnia, and constipation) and lower QoL than non-VIPN survivors did. In acute VIPN, social function was significantly affected, whereas in long-term VIPN, emotional and cognitive functions were affected. CONCLUSION Numbness and cramps should be addressed in survivors of acute and long-term VIPN. Preventing falls is recommended for NHL survivors with VIPN, and psychological support is suggested for long-term VIPN survivors.
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Affiliation(s)
- Yu-Chen Su
- Division of Hematology/Medical Oncology, Department of Medicine, Taichung Veterans General Hospital, Taiwan; Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan; School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan.
| | - Sung-Tsang Hsieh
- Department of Anatomy and Cell Biology, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan; Center of Precision Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology, Taichung Veterans General Hospital, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Yun-Hsiang Lee
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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Kleckner IR, Manuweera T, Lin PJ, Chung KH, Kleckner AS, Gewandter JS, Culakova E, Tivarus ME, Dunne RF, Loh KP, Mohile NA, Kesler SR, Mustian KM. Pilot trial testing the effects of exercise on chemotherapy-induced peripheral neurotoxicity (CIPN) and the interoceptive brain system. RESEARCH SQUARE 2024:rs.3.rs-4022351. [PMID: 38559210 PMCID: PMC10980099 DOI: 10.21203/rs.3.rs-4022351/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Purpose Chemotherapy-induced peripheral neurotoxicity (CIPN) is a prevalent, dose-limiting, tough-to-treat toxicity involving numbness, tingling, and pain in the extremities with enigmatic pathophysiology. This randomized controlled pilot study explored the feasibility and preliminary efficacy of exercise during chemotherapy on CIPN and the role of the interoceptive brain system, which processes bodily sensations. Methods Nineteen patients (65±11 years old, 52% women; cancer type: breast, gastrointestinal, multiple myeloma) starting neurotoxic chemotherapy were randomized to 12 weeks of exercise (home-based, individually tailored, moderate intensity, progressive walking and resistance training) or active control (nutrition education). At pre-, mid-, and post-intervention, we assessed CIPN symptoms (primary clinical outcome: CIPN-20), CIPN signs (tactile sensitivity using monofilaments), and physical function (leg strength). At pre- and post-intervention, we used task-free ("resting") fMRI to assess functional connectivity in the interoceptive brain system, involving the salience and default mode networks. Results The study was feasible (74-89% complete data across measures) and acceptable (95% retention). We observed moderate/large beneficial effects of exercise on CIPN symptoms (CIPN-20, 0-100 scale: -7.9±5.7, effect size [ES]=-0.9 at mid-intervention; -4.8±7.3, -ES=0.5 at post-intervention), CIPN signs (ES=-1.0 and -0.1), and physical function (ES=0.4 and 0.3). Patients with worse CIPN after neurotoxic chemotherapy had lower functional connectivity within the default mode network (R2=40-60%) and higher functional connectivity within the salience network (R2=20-40%). Exercise tended to increase hypoconnectivity and decrease hyperconnectivity seen in CIPN (R2 = 12%). Conclusion Exercise during neurotoxic chemotherapy is feasible and may attenuate CIPN symptoms and signs, perhaps via changes in interoceptive brain circuitry. Future work should test for replication with larger samples. ClinicalTrials.gov identifier NCT03021174.
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Affiliation(s)
| | | | - Po-Ju Lin
- University of Rochester Medical Center
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Manuweera T, Wagenknecht A, Kleckner AS, Dorsey SG, Zhu S, Tivarus ME, Kesler SR, Ciner A, Kleckner IR. Preliminary evaluation of novel Bodily Attention Task to assess the role of the brain in chemotherapy-induced peripheral neurotoxicity (CIPN). Behav Brain Res 2024; 460:114803. [PMID: 38070689 PMCID: PMC10860373 DOI: 10.1016/j.bbr.2023.114803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common, sometimes dose-limiting side effect of neurotoxic chemotherapy. Treatment is limited because its pathophysiology is poorly understood. Compared to research on peripheral mechanisms, the role of the brain in CIPN is understudied and it may be important to develop better treatments. We propose a novel task that assesses brain activation associated with attention to bodily sensations (interoception), without the use of painful stimulation, to understand how CIPN symptoms may be processed in the brain. The goals of this preliminary study were to assess, 1) feasibility of the task, 2) sensitivity to changes in brain activity, and 3) suitability for assessing relationships between brain activation and CIPN severity. Eleven participants with varying types of cancer completed a brain fMRI scan and rated CIPN severity (CIPN-20) before and/or 12 weeks after starting neurotoxic chemotherapy. The Bodily Attention Task is a 7.5-min long fMRI task involving attentional focus on the left fingertips, the heart, or a flashing word "target" for visual attention (reference condition). Feasibility was confirmed, as 73% of all data collected were usable and participants reported feeling or focus during 75% of the trials. Regarding brain activity, finger attention increased activation in somatosensory regions (primary sensory cortex, insula) and sensory integration regions (precuneus, dorsolateral prefrontal cortex). Exploratory analyses suggested that brain activation may be associated with CIPN severity. A larger sample size and accounting of confounding factors is needed to test for replication and to identify brain and interoceptive biomarkers to help improve the prediction, prevention, and treatment of CIPN.
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Affiliation(s)
- Thushini Manuweera
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Amelia Wagenknecht
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Amber S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences and Department of Neuroscience University of Rochester Medical Center, Rochester, NY, USA
| | - Shelli R Kesler
- Department of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Aaron Ciner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
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Mahfouz FM, Li T, Joda M, Harrison M, Kumar S, Horvath LG, Grimison P, King T, Goldstein D, Park SB. Upper-limb dysfunction in cancer survivors with chemotherapy-induced peripheral neurotoxicity. J Neurol Sci 2024; 457:122862. [PMID: 38185015 DOI: 10.1016/j.jns.2023.122862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Upper-limb symptoms are often reported in the context of chemotherapy-induced peripheral neurotoxicity (CIPN), but objective quantification of functional deficits is often lacking. We examined and compared a range of neurophysiological and functional assessments of the upper-limb in the assessment of CIPN severity. METHODS Cross-sectional assessment of neurotoxic chemotherapy-treated patients was undertaken using patient-reported and clinically-graded CIPN measures. Upper-limb functional assessments comprised of assessing fine motor skills, sensory perception, and neurophysiological measures of the median nerve. Group comparisons between participants who reported absence or presence of upper-limb functional deficits were investigated. RESULTS 60 participants who were 11.5 (IQR = 4.0-26.0) months post-neurotoxic chemotherapy treatment reported CIPN. 65% (n = 39) reported upper-limb CIPN symptoms. Reduction in fine motor skills, sensory perception and median nerve SNAP amplitudes were associated with higher CIPN severity. Participants who self-reported presence of upper-limb functional deficits had worse CIPN severity across all measures, compared to participants who reported no upper-limb functional deficits. CONCLUSIONS Participants who reported upper-limb symptoms and functional deficits had worse CIPN severity and quality-of-life. There is a high burden of upper-limb dysfunction long after neurotoxic chemotherapy treatment cessation. Focus on research into supportive care and rehabilitation options to improve upper-limb function is warranted to improve patient quality-of-life.
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Affiliation(s)
- Fawaz Mayez Mahfouz
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Masarra Joda
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia
| | | | - Sanjeev Kumar
- Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Lisa G Horvath
- Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; Sydney Medical School, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Peter Grimison
- Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; Sydney Medical School, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Tracy King
- Cancer Nursing Research Unit, The University of Sydney, Camperdown, NSW 2050, Australia; Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - David Goldstein
- Prince of Wales Clinical School, Faculty of Medicine & Health, UNSW Sydney, Randwick, NSW 2031, Australia; Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Susanna B Park
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW 2050, Australia.
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Gehr NL, Karlsson P, Timm S, Christensen S, Hvid CA, Peric J, Hansen TF, Lauritzen L, Finnerup NB, Ventzel L. Study protocol: fish oil supplement in prevention of oxaliplatin-induced peripheral neuropathy in adjuvant colorectal cancer patients - a randomized controlled trial. (OxaNeuro). BMC Cancer 2024; 24:168. [PMID: 38308227 PMCID: PMC10837958 DOI: 10.1186/s12885-024-11856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Oxaliplatin-induced peripheral neuropathy (OIPN) in general and painful OIPN in particular is a debilitating late effect that severely affects cancer survivors' quality of life and causes premature cessation of potentially lifesaving treatment. No preventive treatments and no effective treatment for chronic OIPN exist despite many attempts. One of several suggested mechanisms includes neuroinflammation as a contributing factor to OIPN. Fish oil containing long-chain n-3 polyunsaturated fatty acids (n-3 LCPUFAs) are precursors to specialized proresolving mediators that mediate the resolution of inflammation. Our primary hypothesis is that a high supplementation of n-3 LCPUFAs will lower the prevalence and severity of OIPN. METHODS The OxaNeuro project is an investigator-initiated, multicenter, double-blinded, randomized, placebo-controlled clinical study. We will include 120 patients eligible to receive adjuvant oxaliplatin after colorectal cancer surgery. Patients will receive fish oil capsules containing n-3 LCPUFAs or corn oil daily for 8 months. The primary endpoint is the prevalence of OIPN at 8 months defined as relevant symptoms, including one of the following: abnormal nerve conduction screening, abnormal vibration threshold test, abnormal skin biopsy, or abnormal pinprick test. Additional endpoints include the intensity and severity of OIPN-related neuropathic pain, patient-reported OIPN symptoms, quality of life, mental health symptoms, body composition, and cognitive evaluation. Furthermore, we will evaluate inflammatory biomarkers in blood samples and skin biopsies, including the potential OIPN biomarker neurofilament light protein (NfL) which will be measured before each cycle of chemotherapy. DISCUSSION If readily available fish oil supplementation alleviates OIPN prevalence and severity, it will significantly improve the lives of both cancer survivors and palliative cancer patients receiving oxaliplatin; it will improve their quality of life, optimize chemotherapeutic treatment plans by lowering the need for dose reduction or premature cessation, and potentially increase survival. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT05404230 Protocol version: 1.2, April 25th. 2023.
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Affiliation(s)
- Nina Lykkegaard Gehr
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
| | - Páll Karlsson
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Signe Timm
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Signe Christensen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jana Peric
- Department of Oncology, Soenderborg Hospital, University Hospital of Southern Denmark, Soenderborg, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Brix Finnerup
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lise Ventzel
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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Parsons SK, Rodday AM, Pei Q, Keller FG, Wu Y, Henderson TO, Cella D, Kelly KM, Castellino SM. Performance of the FACT-GOG-Ntx to assess chemotherapy-induced peripheral neuropathy (CIPN) in pediatric high risk Hodgkin lymphoma: report from the Children's Oncology Group AHOD 1331 study. J Patient Rep Outcomes 2023; 7:113. [PMID: 37947987 PMCID: PMC10638179 DOI: 10.1186/s41687-023-00653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is an under-recognized complication of several chemotherapy agents used as part of curative-intent therapy for Hodgkin Lymphoma (HL). In the absence of validated self- or proxy-report measures for children and adolescents, CIPN reporting has relied on clinician rating, with grading scales often restricted to severe manifestations. In a proof-of-concept study, we assessed the feasibility and psychometric performance of the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx), a unidimensional CIPN symptom scale widely used adults with CIPN, in pediatric HL at risk for CIPN. METHODS Youth (11+ years) and parents of all children (5-17.9 years) with newly diagnosed high-risk HL enrolled on Children's Oncology Group AHOD1331 (NCT02166463) were invited to complete the FACT-GOG-Ntx and a health-related quality of life (HRQL) measure at pre-treatment (Time 1), and during cycles 2 (Time 2) and 5 (Time 3) of chemotherapy during the first half of study accrual. Clinical grading of CIPN by providers was also assessed using the Balis Pediatric Neuropathy Scale. We evaluated Cronbach's alpha, construct validity, and agreement between raters. Change in FACT-GOG-Ntx scores over time was assessed using a repeated measures model. RESULTS 306 patients had at least one completed FACT-GOG-Ntx with time-specific completion rates of > 90% for both raters. Cronbach's alpha was > 0.7 for youth and parent-proxy report at all time points. Correlations between FACT-GOG-Ntx and HRQL scores were moderate (0.41-0.48) for youth and parent-proxy raters across all times. Youth and parent-proxy raters both reported worse FACT-GOG-Ntx scores at Time 3 for those who had clinically-reported CIPN compared to those who did not. Agreement between raters was moderate to high. Compared to baseline scores, those at Time 3 were significantly lower for youth (β = - 2.83, p < 0.001) and parent-proxy raters (β = - 1.99, p < 0.001). CONCLUSIONS High completion rates at all time points indicated feasibility of eliciting youth and parent report. Psychometric performance of the FACT-GOG-Ntx revealed acceptable reliability, evidence of validity, and strong inter-rater agreement, supporting the use of this self- or proxy-reported measure of CIPN in youth with high-risk HL exposed to tubulin inhibitors, as part of a Phase 3 clinical trial. CLINICAL TRIAL INFORMATION Clinical Trials Registry, NCT02166463. Registered 18 June 2014, https://clinicaltrials.gov/ct2/show/study/NCT02166463.
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Affiliation(s)
- Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies and Tufts Cancer Center, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Qinglin Pei
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Frank G Keller
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
| | - Yue Wu
- Department of Biostatistics, Children's Oncology Group, Statistics and Data Center, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, USA
| | - Tara O Henderson
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Comer Children's Hospital, 5721 S Maryland Ave, Chicago, IL, 60637, USA
| | - David Cella
- Department of Medical Social Sciences, Institute for Public Health and Medicine, Center for Patient-Centered Outcomes, Northwestern University, 420 E. Superior St, Chicago, IL, 60611, USA
| | - Kara M Kelly
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 665 Elm St, Buffalo, NY, 14203, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA, 30322, USA
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11
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Li T, Kandula T, Cohn RJ, Kiernan MC, Park SB, Farrar MA. Prospective assessment of vincristine-induced peripheral neuropathy in paediatric acute lymphoblastic leukemia. Clin Neurophysiol 2023; 154:157-168. [PMID: 37633123 DOI: 10.1016/j.clinph.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Vincristine is a mainstay treatment for paediatric cancers, particularly acute lymphoblastic leukemia (ALL), with common toxicity including vincristine-induced peripheral neuropathy (VIPN). The present study comprehensively assessed VIPN outcomes in patients receiving vincristine treatment for ALL. METHODS Children diagnosed with ALL commencing vincristine treatment were prospectively evaluated (baseline, post-induction, pre-reinduction, post-reinduction, follow-up). VIPN was examined clinically using the Balis sensory/motor scale, neurophysiologically using axonal excitability techniques and quality-of-life using Pediatric Quality of Life Inventory. RESULTS Thirty-one patients were recruited to this study (age = 6.8 ± 4.4; 61.3% female). Incidence of motor VIPN (motor Balis grade > 0) symptoms were higher than sensory VIPN (sensory Balis grade > 0) at post-induction (92.0% vs 36.0%) and post-reinduction (81.8% vs 22.7%) vincristine treatment. Neurophysiological assessment also demonstrated greater change in motor axonal excitability parameters compared to sensory parameters including changes in depolarising threshold electrotonus (P < 0.0125), superexcitability and subexcitability parameters (all P < 0.0125). Follow-up assessment demonstrated persisting VIPN symptoms with reduced quality-of-life scores compared to baseline. CONCLUSIONS Clinical and neurophysiological evaluation of VIPN suggests vincristine produces a motor-prominent sensorimotor neuropathy in children which persisted at follow-up. SIGNIFICANCE VIPN signs and symptoms develop early in the treatment course, in line with axonal excitability profiles. Early detection of significant nerve changes may support timely implementation of neuroprotection strategies.
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Affiliation(s)
- Tiffany Li
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Tejaswi Kandula
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Richard J Cohn
- Kids Cancer Centre, Sydney Children's Hospital, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia.
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital, Sydney, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, New South Wales, Australia
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12
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Cavaletti G, Pizzamiglio C, Man A, Engber TM, Comi C, Wilbraham D. Studies to Assess the Utility of Serum Neurofilament Light Chain as a Biomarker in Chemotherapy-Induced Peripheral Neuropathy. Cancers (Basel) 2023; 15:4216. [PMID: 37686492 PMCID: PMC10486738 DOI: 10.3390/cancers15174216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common and disabling dose-limiting toxicities of chemotherapy. We report here the results of two separate non-interventional studies (49 patients), which evaluated blood neurofilament light chain (NfL) as a biomarker of CIPN in breast cancer patients treated with paclitaxel. All patients underwent a standard treatment protocol that was established independently of the present studies. NfL was measured in serum using an ultrasensitive single-molecule array and compared with the self-administered European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale (CIPN20) and Total Neuropathy Score clinical version (TNSc), a clinician-reported measure of neuropathy progression. The TNSc increased with cumulative dose compared with baseline, and the NfL concentrations were also strongly associated with the cumulative dose of chemotherapy. The analysis showed a correlation between TNSc and NfL. Both TNSc and NfL showed weak to moderate associations with CIPN20 subscores, with a better association for the CIPN20 sensory compared with motor and autonomic subscores. Data from the two studies provide evidence that serum NfL has the potential to be used as a biomarker to monitor and mitigate CIPN. However, studies with additional patients planned in the ongoing clinical trial will determine the universal application of NfL as a biomarker in CIPN.
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Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Chiara Pizzamiglio
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Albert Man
- Eli Lilly and Company, Indianapolis, IN 46285, USA (T.M.E.)
| | | | - Cristoforo Comi
- Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy
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13
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Mondaca S, Pinto MP, Briones J, Caire N, Peña J, Koch É, Muñiz S, Herrera ME, Sánchez C, Galindo H, Pizarro G, Acevedo F, Ibañez C, Balmaceda C, Norero E, Duran D, Garrido M, Nervi B. Impact of Adjuvant FOLFOX on Quality of Life and Peripheral Neuropathy Incidence in Patients With Gastric Cancer: A Prospective Cohort Study. Value Health Reg Issues 2023; 35:13-18. [PMID: 36805388 DOI: 10.1016/j.vhri.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/21/2022] [Accepted: 12/18/2022] [Indexed: 02/18/2023]
Abstract
OBJECTIVES Perioperative and adjuvant chemotherapy have demonstrated clinical benefits in localized gastric cancer. Nevertheless, the reports on their effects on patient's health-related quality of life (HRQoL) are scarce. Here, we prospectively assessed quality of life and the incidence of chemotherapy-induced peripheral neuropathy (CIPN) in a cohort of patients treated with adjuvant FOLFOX. METHODS Localized stomach or gastroesophageal junction adenocarcinoma patients who underwent curative resection were recruited at a single center. All patients received adjuvant FOLFOX6, and HRQoL and CIPN were assessed using the European organization for research and treatment of cancer quality life (EORTC) C30 and the EORTC CIPN20 questionnaires, respectively. Clinically significant deterioration of HRQoL was also assessed as a coprimary outcome in a longitudinal analysis. RESULTS We recruited a total of 63 patients. Median age was 62.5 years, and 75% had stomach tumors. Twenty-four weeks after the start of treatment, the probability of being free from HRQoL deterioration and CIPN was 29% (95% confidence interval [CI] 18%-42%) and 6% (95% CI 2%-17%), respectively. Five-year disease-free survival was 45% (95% CI 24%-64%) and 5-year overall survival was 63% (95% CI 48%-76%). CONCLUSIONS Adjuvant FOLFOX is associated with a high rate of long-term survival in localized gastric cancer; nevertheless, it has detrimental effects on patients' quality of life.
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Affiliation(s)
- Sebastián Mondaca
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Mauricio P Pinto
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Briones
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Nicole Caire
- Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - José Peña
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Érica Koch
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Hematology and Oncology Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Sabrina Muñiz
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Elisa Herrera
- Department of Hematology and Oncology, Clinica Alemana de Valdivia, Valdivia, Chile
| | - Cesar Sánchez
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Héctor Galindo
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Pizarro
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Acevedo
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Ibañez
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Balmaceda
- Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Enrique Norero
- Esophagogastric Surgery Unit, Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile; Department of Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Doris Duran
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Garrido
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Nervi
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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14
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Li T, Timmins HC, Trinh T, Mizrahi D, Harrison M, Horvath LG, Grimison P, Friedlander M, Kiernan MC, King MT, Rutherford C, Goldstein D, Park SB. Patient-Reported Outcome Measures in Chemotherapy-Induced Peripheral Neurotoxicity: Defining Minimal and Clinically Important Changes. J Natl Compr Canc Netw 2023; 21:125-132.e3. [PMID: 36791763 DOI: 10.6004/jnccn.2022.7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/09/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common complication of cancer treatment that produces functional disability. Increasingly, patient-reported outcome measures (PROMs) are used to assess CIPN, providing a broader symptom perspective than clinician-graded scales. Understanding when a reported change in CIPN symptoms meets the threshold for clinical significance is challenging. This study aimed to provide interpretation guidelines for validated CIPN PROMs, and thereby enable estimation of thresholds to identify clinically relevant symptoms. METHODS Patients commencing neurotoxic cancer treatments were assessed at 3 timepoints: baseline, midtreatment, and end-of-treatment. Trajectory of CIPN development was assessed by means of CIPN PROMs, EORTC Quality of Life - Chemotherapy-Induced Peripheral Neuropathy questionnaire (QLQ-CIPN20), and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group - Neurotoxicity questionnaire (FACT/GOG-NTX). Thresholds were estimated for CIPN PROMs using the NCI CTCAE sensory neuropathy scale as the clinical anchor by midtreatment and end-of-treatment. Patients were assigned to a clinical change group according to CIPN development: either no development; grade 1 neuropathy (minimally important difference [MID]); or grade 2 neuropathy (clinically important difference). Distribution-based estimates (SD, 0.5) were also evaluated as supportive evidence. RESULTS In total, 406 patients were recruited to the study, of whom 62% (n=199/320) developed CIPN by midtreatment and 80% (n=274/343) by end-of-treatment. Anchor-based MID estimates by midtreatment were 5.06 (95% CI, 4.26-5.86) for the QLQ-CIPN20 and 3.54 (95% CI, 2.87-4.20) for the FACT/GOG-NTX. End-of-treatment MIDs were estimated to be 7.32 (95% CI, 6.23-8.40) for the QLQ-CIPN20 and 4.84 (95% CI, 3.98-5.70) for the FACT/GOG-NTX. Distribution-based MID estimations yielded lower values than anchor-based methods, at 3.73 for the QLQ-CIPN20 and 2.64 for the FACT/GOG-NTX at midtreatment and 5.52 for the QLQ-CIPN20 and 3.64 for the FACT/GOG-NTX at end-of-treatment. CONCLUSIONS Findings from the present series aid meaningful interpretation for commonly used validated CIPN PROMs and provide thresholds that serve as guidance on how to interpret score changes, which will be useful for design and evaluation of clinical trials and clinical practice.
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Affiliation(s)
- Tiffany Li
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Hannah C Timmins
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - David Mizrahi
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,The Daffodil Centre, The University of Sydney, Sydney, Australia
| | | | - Lisa G Horvath
- Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Peter Grimison
- Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Matthew C Kiernan
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia
| | - Claudia Rutherford
- The Daffodil Centre, The University of Sydney, Sydney, Australia.,Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Susanna B Park
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Sydney, Australia
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15
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Chai Y, Zhao F, Ye P, Ma F, Wang J, Zhang P, Li Q, Wang J, Wang W, Li Q, Xu B. A Prospective, Randomized, Placebo-Controlled Study Assessing the Efficacy of Chinese Herbal Medicine (Huangqi Guizhi Wuwu Decoction) in the Treatment of Albumin-Bound Paclitaxel-Induced Peripheral Neuropathy. J Clin Med 2023; 12:jcm12020505. [PMID: 36675434 PMCID: PMC9863646 DOI: 10.3390/jcm12020505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Objective: This study aimed to evaluate the efficacy and safety of Huangqi Guizhi Wuwu decoction (HGWD), which is composed of five crude drugs (Astragali Radix, Cinnamomi Ramulus, Paeoniae Radix Alba, Zingiberis Rhizoma Recens, and Jujubae Fructus), in the treatment of albumin-bound paclitaxel (nab-PTX)-induced peripheral neuropathy (PN) in Chinese patients with breast cancer (BC). Methods: This trial was conducted at the National Cancer Center in China from January 2020 to June 2022. The eligible participants were assigned randomly in a 1:1 ratio to an HGWD group or a control group. The outcome measure was EORTC QLQ-CIPN20 questionnaire. Results: 92 patients diagnosed with BC were enrolled and randomized to either HGWD group (n = 46) or control group (n = 46). There were no significant differences in baseline characteristics between the two groups (p > 0.05). A statistical analysis of the sensory and motor functions of the EORTC QLQ-CIPN20 scores showed that patients in the HGWD group reported a larger decrease in CIPN sensory scores than those in the control group (p < 0.001). The EORTC QLQ-CIPN20 autonomic scores showed no statistical significance between the two groups (p > 0.05). Conclusions: HGWD packs could significantly improve patients’ nab-PTX-induced PN, increase the tolerance for nab-PTX-containing chemotherapy, and further improve the quality of life of patients with BC.
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Affiliation(s)
- Yue Chai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fang Zhao
- Nursing Department of the Cancer Hospital, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Peizhi Ye
- Chinese Medicine Department of the Cancer Hospital, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fei Ma
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiayu Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Pin Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qing Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiani Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenna Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qiao Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Correspondence: (Q.L.); (B.X.)
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Correspondence: (Q.L.); (B.X.)
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16
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The Ameliorative Effect of Thymoquinone on Vincristine-Induced Peripheral Neuropathy in Mice by Modulating Cellular Oxidative Stress and Cytokine. Life (Basel) 2022; 13:life13010101. [PMID: 36676049 PMCID: PMC9860544 DOI: 10.3390/life13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Thymoquinone (TQ), an active constituent of Nigella sativa, has been reported to exert a broad spectrum of pharmacological effects, including neuroprotective, anticancer, anti-inflammatory, antidiabetic, antiepileptic, antioxidant, and other modulatory roles in inflammation in experimental studies. The present study aims to evaluate the potential effects of TQ on vincristine-induced neuropathy in mice, as well as the possible role of oxidative stress, and pro- and anti-inflammatory cytokine in neuropathy development. A Swiss strain of male albino mice were randomly divided into seven groups, comprising of five animals each. Vincristine sulfate (0.1 mg/kg, i.p.) was administered for 10 consecutive days for the induction of peripheral neuropathy. The animals received their respective treatment of TQ (2.5, 5, and 10 mg/kg, p.o.) and pregabalin (10 mg/kg, p.o.) concurrently with vincristine for 10 days followed by 4 days post treatment. The animals were assessed for pain and related behavior on day 7 and 14 using hot and cold plates, and a rotarod test. TQ preventive treatment attenuated vincristine induced neuropathy in a dose dependent manner evidenced as a significant (p < 0.001) increase in reaction time on the hot plate and the cold plate, and a fall off time on the rotarod test. Further, TQ preventive treatment resulted in a significant (p < 0.001) reduction in the number of flinches and duration of paw elevation in a formalin test. Preventative treatment with TQ abolished the vincristine-induced rise in malondialdehyde and glutathione depletion in sciatic nerve tissue, as well as the blood IL-6 levels. In conclusion, TQ at 2.5, 5, and 10 mg/kg dose produced significant attenuation of neuropathic pain induced by vincristine which may be due to its antinociceptive, antioxidant, and anti-proinflammatory activity.
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17
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Li T, Park SB, Battaglini E, King MT, Kiernan MC, Goldstein D, Rutherford C. Assessing chemotherapy-induced peripheral neuropathy with patient reported outcome measures: a systematic review of measurement properties and considerations for future use. Qual Life Res 2022; 31:3091-3107. [PMID: 35596913 PMCID: PMC9546984 DOI: 10.1007/s11136-022-03154-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity of cancer treatment, with potential to significantly impact cancer survivors' long-term quality of life. Patient reported outcome measures (PROMs) are increasingly utilised to evaluate CIPN. However, guidance remains lacking on how to identify fit for purpose PROMs with considerations necessarily differing when used in various research and in-clinic contexts. This study aimed to evaluate evidence about CIPN PROMs measurement properties and propose considerations to optimize CIPN PROM selection for each purpose. METHODS A systematic review was conducted to identify literature assessing measurement properties of CIPN PROMs. These were evaluated against Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria and International Society for Quality of Life minimum standards. Risk of Bias (RoB) was assessed using the COSMIN RoB checklist. RESULTS Thirty-nine papers evaluating measurement properties of 13 PROMs were included. The European Organization for Research and Treatment of Cancer Quality of Life Chemotherapy-Induced Peripheral Neuropathy Questionnaire (QLQ-CIPN20) and Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) were the most commonly investigated PROMs and had the most measurement properties meeting established criteria. CONCLUSION The use of the QLQ-CIPN20 and FACT/GOG-Ntx to assess CIPN in research settings has the most supporting evidence. However other considerations including study aims, endpoints and target population also factor into PROM selection and need to be considered more often when determining the most suitable outcome measure. Evidence of CIPN PROMs use in clinical practice is limited and their adoption to individual-patient level management requires more evaluation.
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Affiliation(s)
- Tiffany Li
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia.
| | - Susanna B Park
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia
| | - Eva Battaglini
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia
| | - Matthew C Kiernan
- Faculty of Medicine and Health, School of Medical Sciences, Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, NSW, 2050, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
- Prince of Wales Hospital, Randwick, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Cancer Nursing Research Unit, The University of Sydney, Sydney, Australia
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18
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A preliminary, prospective study of peripheral neuropathy and cognitive function in patients with breast cancer during taxane therapy. PLoS One 2022; 17:e0275648. [PMID: 36206298 PMCID: PMC9543876 DOI: 10.1371/journal.pone.0275648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022] Open
Abstract
Dramatic improvements in cancer survival have occurred in the last decade, but the quality of life for many survivors is compromised due to severe, long-lasting, and often irreversible side effects of chemotherapy. The neurological side effects, chemotherapy induced peripheral neuropathy (CIPN) and cancer related/induced cognitive impairment (CRCI/CICI), are under-recognized and can occur after chemotherapy, immunotherapy, or radiation. The cellular mechanisms underlying these neurological side effects are poorly understood and there are no effective treatments or preventions, other than reduction or termination of cancer therapy. In our preliminary prospective, non-interventional study to examine the side effects of chemotherapy in patients with breast cancer (NCT03872141), patients with breast cancer who received standard of care single agent weekly taxane-based chemotherapy were assessed at baseline, midpoint, and end of treatment for neurological and cognitive changes and for blood levels of potential protein biomarkers (n = 13). CIPN and CRCI both showed an increase in severity with accumulating taxane and these changes were compared to protein alternations over the course of treatment. Using peripheral blood collected from patients (n = 10) during chemotherapy and tested with an antibody array curated by the MD Anderson RPPA Core), we found that 19 proteins were increased, and 12 proteins decreased over 12 weeks of treatment. Among those downregulate were proteins known to be critical for neuronal viability and function including GRB2 (growth factor receptor-bound protein 2) and NCS1 (neuronal calcium sensor 1). Concurrently, proteins associated with apoptosis, including BAK1 (Bcl-1 homologous antagonist/killer), were upregulated. These results support the proposal that CIPN and CRCI increase with increasing taxane exposure, and identified several proteins that are altered with taxane exposure that could be implicated in their pathogenesis. In conclusion, our study provides evidence for progressive neurological changes and the rationale to investigate the molecular basis for these changes with the goal of target identification for mitigation of these neurological side effects.
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Yang TT, Pai HC, Chen CY. Effect of cryotherapy on paclitaxel-induced peripheral neuropathy of the hand in female breast cancer patients: A prospective self-controlled study. Int J Nurs Pract 2022:e13094. [PMID: 35971279 DOI: 10.1111/ijn.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/20/2022] [Accepted: 07/23/2022] [Indexed: 11/29/2022]
Abstract
AIMS The purpose of this study was to examine the efficacy of cryotherapy with frozen gloves for the prevention of the chemotherapy-induced peripheral neuropathy of the hand. BACKGROUND Most breast cancer patients receive chemotherapy; consequently, patients frequently experience adverse effects of chemotherapy-induced peripheral neuropathy. METHODS A quasi-experimental and prospective self-controlled study was conducted. Breast cancer patients wore frozen glove on the dominant hand for 90 min during their weekly treatment with paclitaxel (80 mg/m2 ). Treatment of the dominant hand, the intervention group, was continued for 12 weeks. The non-dominant hand was considered the control group. RESULTS A total of 22 patients participated in this study, and only one patient did not reach the cumulative dose (960 mg/m2 ). Findings show that the incidences of sensory and motor symptoms of chemotherapy-induced peripheral neuropathies at the following times (Time 1 to Time 4) were significantly lower in the intervention group than in the control group. However, although the incidences of motor symptoms were lower in the experimental group than in the control group, a significant difference was shown only at Time 4. Additionally, both groups of patients reported that their incidence of sensory symptoms were higher than those of motor symptoms. CONCLUSION Cryotherapy with frozen gloves is useful in reducing both the sensory and motor symptoms of the chemotherapy-induced peripheral neuropathy of the hands.
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Affiliation(s)
- Ting-Ting Yang
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsiang-Chu Pai
- Department of Nursing, Chung-Shan Medical University, Research Consultant, Chung-Shan Medical University Hospital, Taichung, Taiwan
| | - Chiung-Yao Chen
- Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan
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20
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van de Graaf DL, Mols F, Trompetter HR, van der Lee ML, Schreurs KMG, Børøsund E, Nes LS, Smeets T. Effectiveness of the online Acceptance and Commitment Therapy intervention "Embrace Pain" for cancer survivors with chronic painful chemotherapy-induced peripheral neuropathy: study protocol for a randomized controlled trial. Trials 2022; 23:642. [PMID: 35945582 PMCID: PMC9361507 DOI: 10.1186/s13063-022-06592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND About 30% of cancer survivors suffer from chemotherapy-induced peripheral neuropathy (CIPN) ≥6 months after completion of chemotherapy. This condition, for which treatment options are scarce, comes with limitations in daily life functioning and decreased quality of life. The current study examines the effectiveness of an online self-help intervention based on Acceptance and Commitment Therapy (ACT) in comparison to a waiting list condition (WLC) to deal with CIPN. In addition, it examines which factors moderate effects and to what extent the effects differ between guided and unguided ACT intervention. METHODS A two-parallel, non-blinded randomized controlled trial (RCT) will be carried out. Adult cancer survivors who experience painful CIPN for at least 3 months and completed chemotherapy at least 6 months ago will be recruited (n=146). In the intervention condition, participants will follow an 8-week self-management course containing 6 modules regarding psychoeducation and ACT processes, including therapeutic email guidance. By means of text and experiential exercises, supplemented with illustrations, metaphors, and audio files, people will learn to carry out value-oriented activities in their daily life with pain. Participants will learn new ways of coping with pain, including reducing pain avoidance and increasing pain acceptance. Participants in the WLC will be invited to follow the intervention without therapeutic guidance 5 months after start. Pain interference is the primary outcome, while psychological distress, quality of life, CIPN symptom severity, pain intensity, psychological flexibility, mindfulness skills, values-based living, and pain catastrophizing will serve as secondary outcomes. All outcome measures will be evaluated at inclusion and baseline, early-intervention, mid-intervention, post-treatment, and 3- and 6-month post-treatment. Qualitative interviews will be conducted post-treatment regarding experiences, usage, usability, content fit, and satisfaction with the intervention. DISCUSSION This study will provide valuable information on the effectiveness of an online self-help intervention based on ACT versus WLC for chronic painful CIPN patients. TRIAL REGISTRATION ClinicalTrials.gov NCT05371158 . Registered on May 12, 2022. PROTOCOL VERSION version 1, 24-05-2022.
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Affiliation(s)
- Daniëlle L van de Graaf
- CoRPS - Center of Research on Psychological disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands. .,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - Floortje Mols
- CoRPS - Center of Research on Psychological disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Hester R Trompetter
- CoRPS - Center of Research on Psychological disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Marije L van der Lee
- CoRPS - Center of Research on Psychological disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands.,Centre for Psycho-Oncology, Scientific Research Department, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Karlein M G Schreurs
- Department of Psychology, Health & Technology, Centre for eHealth & Well-being Research, University of Twente, Enschede, The Netherlands
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.,Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tom Smeets
- CoRPS - Center of Research on Psychological disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
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21
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Chen CS, Smith EML, Stringer KA, Henry NL, Hertz DL. Co-occurrence and metabolic biomarkers of sensory and motor subtypes of peripheral neuropathy from paclitaxel. Breast Cancer Res Treat 2022; 194:551-560. [PMID: 35760975 PMCID: PMC9310087 DOI: 10.1007/s10549-022-06652-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is the major treatment-limiting toxicity of paclitaxel, which predominantly presents as sensory symptoms, with motor symptoms in some patients. Differentiating CIPN into subtypes has been recommended to direct CIPN research. The objective of this study was to investigate whether sensory and motor CIPN are distinct subtypes with different predictive biomarkers in patients with breast cancer receiving paclitaxel. METHODS Data were from a prospective cohort of 60 patients with breast cancer receiving up to 12 weekly infusions of 80 mg/m2 paclitaxel (NCT02338115). European Organisation for Research and Treatment of Cancer Quality of Life questionnaire CIPN20 was used to evaluate CIPN. Clusters of the time course of sensory (CIPNS), motor (CIPNM), and the difference between sensory and motor (CIPNS-CIPNM) were identified using k-means clustering on principal component scores. Predictive metabolomic biomarkers of maximum CIPNS and CIPNM were investigated using linear regressions adjusted for baseline CIPN, paclitaxel pharmacokinetics, and body mass index. RESULTS More sensory than motor CIPN was found (CIPNS change: mean = 10.8, ranged [-3.3, 52.1]; CIPNM change: mean = 3.5, range: [-7.5, 35.0]). Three groups were identified with No CIPN, Mixed CIPN, and Sensory-dominant CIPN (maximum CIPNS: mean = 12.7 vs. 40.9 vs. 74.3, p < 0.001; maximum CIPNM: mean = 5.4 vs. 25.5 vs. 36.1, p < 0.001; average CIPNS-CIPNM: mean = 2.8 vs. 5.8 vs. 24.9, p < 0.001). Biomarkers of motor CIPN were similar to previously identified biomarkers of sensory CIPN, including lower serum histidine (p = 0.029). CONCLUSION Our findings suggest that sensory and motor CIPN co-occur and may not have differentiating metabolic biomarkers. These findings need to be validated in larger cohorts of patients treated with paclitaxel and other neurotoxic agents to determine the optimal approach to predict, prevent, and treat CIPN and improve patients' outcomes.
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Affiliation(s)
- Ciao-Sin Chen
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Kathleen A Stringer
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA, NMR Metabolomics Laboratory, University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - N Lynn Henry
- University of Michigan Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA, University of Michigan Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
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22
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Pérez-Hernández C, Cánovas ML, Carmona-Bayonas A, Escobar Y, Margarit C, Mulero Cervantes JF, Quintanar T, Serrano Alfonso A, Virizuela J. A Delphi Study on the Management of Neuropathic Cancer Pain in Spain: The DOLNEO Study. J Pain Res 2022; 15:2181-2196. [PMID: 35942117 PMCID: PMC9356710 DOI: 10.2147/jpr.s365351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The objectives of this project were to assess the current situation and management of cancer-related neuropathic pain (CRNP) in Spain and to provide specific recommendations for the assessment, diagnosis and treatment of CRNP using a Delphi methodology. Methods This was a qualitative study that followed a Delphi methodology using a questionnaire with 56 statements that were grouped into 5 areas related to CRNP: prevalence and impact, pathophysiology, assessment and diagnosis, specific syndromes, treatment, and multidisciplinary approach. Based on the responses, the scientific committee prepared an algorithm and a recommended pathway for the management of CRNP. Results Seventy-nine physicians attended the meeting and completed the questionnaire. Consensus was reached for all statements relating to the prevalence and impact of CRNP. However, the perceptions of specialists from palliative care of the frequency and impact of CRNP differed from those of other specialists. A high degree of consensus was reached for all statements concerning the assessment and diagnosis of CRNP. Regarding specific syndromes, the only statement with a lack of consensus was that on the frequency of NP in patients undergoing radiotherapy. There were some disagreements regarding the multidisciplinary approach and referral criteria for the management of NP. Conclusion Our results show a large degree of agreement on the assessment, diagnosis and treatment of cancer-related neuropathic pain among the specialists involved in its management. There were, however, some disagreements regarding the multidisciplinary approach and referral criteria for the management of neuropathic pain.
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Affiliation(s)
- Concepción Pérez-Hernández
- Pain Unit, Hospital Universitario de la Princesa, Madrid, Spain
- Correspondence: Concepción Pérez-Hernández, Pain Unit, Hospital Universitario de la Princesa, Calle de Diego de León 62, Madrid, 28006, Spain, Tel +34 915 20 22 00, Email
| | - María Luz Cánovas
- Anesthesia, Complexo Hospitalario Universitario de Ourense (SERGAS), Ourense, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Yolanda Escobar
- Medical Oncology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - César Margarit
- Pain Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Teresa Quintanar
- Medical Oncology, Hospital General Universitario de Elche, Elche, Spain
| | - Ancor Serrano Alfonso
- Anesthesiology, Resuscitation and Pain Management, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Virizuela
- Medical Oncology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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23
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Kerckhove N, Tougeron D, Lepage C, Pezet D, Le Malicot K, Pelkowski M, Pereira B, Balayssac D. Efficacy of donepezil for the treatment of oxaliplatin-induced peripheral neuropathy: DONEPEZOX, a protocol of a proof of concept, randomised, triple-blinded and multicentre trial. BMC Cancer 2022; 22:742. [PMID: 35799138 PMCID: PMC9264497 DOI: 10.1186/s12885-022-09806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of oxaliplatin in digestive tract cancers could induce severe peripheral neuropathy (OIPN) decreasing the quality of life of patients and survivors. There is currently, no univocal treatment for these peripheral neuropathies. Donepezil, a reversible inhibitor of cholinesterase, used to treat Alzheimer’s disease and dementia, is reported to have a good safety profile in humans, and preclinical data have provided initial evidence of its effectiveness in diminishing neuropathic symptoms and related comorbidities in OIPN animal models. Methods The DONEPEZOX trial will be a proof-of-concept, randomised, triple-blinded, and multicentre study. It will be the first clinical trial evaluating the efficacy and safety of donepezil for the management of OIPN. Adult cancer survivors with OIPN that report sensory neuropathy according to QLQ-CIPN20 sensory score (equivalence of a grade ≥ 2), at least 6 months after the end of an oxaliplatin-based chemotherapy will be included. Eighty patients will be randomly assigned to receive either donepezil or placebo over 16 weeks of treatment. The primary endpoint will be the rate of responders (neuropathic grade decreases according to the QLQ-CIPN20 sensory score) in the donepezil arm. The severity of OIPN will be assessed by the QLQ-CIPN20 sensory scale before and after 16 weeks of treatment. The comparison versus the placebo arm will be a secondary objective. The other secondary endpoints will be tolerance to donepezil, the severity and features of OIPN in each arm before and after treatment, related-comorbidities and quality of life. Fleming’s one-stage design will be used for sample size estimation. This design yields a type I error rate of 0.0417 and power of 91% for a responder rate of at least 30% in donepezil arm. A total of 80 randomized patients is planned. Discussion This study will allow, in the case of positive results, to initiate a phase 3 randomized and placebo-controlled (primary endpoint) clinical study to assess the therapeutic interest of donepezil to treat OIPN. Trial registration NCT05254639, clincialtrials.gov, Registered 24 February 2022.
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Affiliation(s)
- Nicolas Kerckhove
- UMR 1107 NEURODOL, service de pharmacologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, 63000, Clermont-Ferrand, France.
| | - David Tougeron
- Service d'Hépato gastroentérologie, CHU Poitiers, 86000, Poitiers, France
| | - Côme Lepage
- Service d'Hépatogastroentérologie et oncologie digestive, CHU Dijon, Université de Bourgogne, Dijon, France.,UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France
| | - Denis Pezet
- Service de chirurgie digestive, U1071, M2iSH, USC-INRA 2018, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, INRA, 63000, Clermont-Ferrand, France
| | - Karine Le Malicot
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France.,Fédération Francophone de Cancérologie Digestive (FFCD), 21079, Dijon, France
| | - Manon Pelkowski
- UMR LNC 1231, EPICAD INSERM, Université de Bourgogne, Dijon, France.,Fédération Francophone de Cancérologie Digestive (FFCD), 21079, Dijon, France
| | - Bruno Pereira
- Direction de la recherche clinique et de l'innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - David Balayssac
- UMR 1107 NEURODOL, service de pharmacologie médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, INSERM, 63000, Clermont-Ferrand, France.,Direction de la recherche clinique et de l'innovation, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
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24
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Wen Y, Zhu W, Zhang X, Sun SK. Fabrication of gelatin Bi 2S 3 capsules as a highly sensitive X-ray contrast agent for gastrointestinal motility assessment in vivo. RSC Adv 2022; 12:13645-13652. [PMID: 35530383 PMCID: PMC9069310 DOI: 10.1039/d2ra00993e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022] Open
Abstract
Tiny BaSO4 rod-based X-ray imaging is the most frequently-used method for clinical diagnosis of gastrointestinal motility disorders. The BaSO4 rods usually have a small size to pass through the gastrointestinal tract smoothly, but suffer from unavoidably low sensitivity. Herein, we developed Bi2S3 capsules as a high-performance X-ray contrast agent for gastrointestinal motility assessment for the first time. The Bi2S3 capsules were synthesized by the encapsulation of commercial Bi2S3 powder into commercial gelatin capsules and subsequent coating of ultraviolet-curable resin. The prepared Bi2S3 capsules showed excellent biocompatibility in vitro and in vivo and superior X-ray attenuation ability due to the large atomic number and high K-edge value of Bi. The developed Bi2S3 capsules can serve as a small but highly sensitive X-ray contrast agent to quantitatively assess gastrointestinal motility in a vincristine-induced gastrointestinal motility disorder model in vivo by X-ray, CT and spectral CT imaging successfully, solving the intrinsic drawbacks of clinically used BaSO4.
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Affiliation(s)
- Ya Wen
- Department of Medical Imaging, Tianjin Medical University Tianjin 300203 China
| | - Wang Zhu
- Department of Radiographic Center, Wuhan Children's Hospital, Tongji Medical College of Huazhong University of Science and Technology Wuhan 430015 China
| | - Xuejun Zhang
- Department of Medical Imaging, Tianjin Medical University Tianjin 300203 China
| | - Shao-Kai Sun
- Department of Medical Imaging, Tianjin Medical University Tianjin 300203 China
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25
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Huehnchen P, Schinke C, Bangemann N, Dordevic AD, Kern J, Maierhof SK, Hew L, Nolte L, Körtvelyessy P, Göpfert JC, Ruprecht K, Somps CJ, Blohmer JU, Sehouli J, Endres M, Boehmerle W. Neurofilament proteins as potential biomarker in chemotherapy-induced polyneuropathy. JCI Insight 2022; 7:154395. [PMID: 35133982 PMCID: PMC8986065 DOI: 10.1172/jci.insight.154395] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Paclitaxel chemotherapy frequently induces dose-limiting sensory axonal polyneuropathy. As sensory symptoms are challenging to assess objectively in clinical routine, an easily accessible biomarker for chemotherapy-induced polyneuropathy (CIPN) holds the potential to improve early diagnosis. Here, we describe neurofilament light chain (NFL), a marker for neuroaxonal damage, as translational surrogate marker for CIPN. METHODS NFL concentrations were measured in an in vitro model of CIPN, exposing induced pluripotent stem cell-derived sensory neurons (iPSC-DSN) to paclitaxel. Breast and ovarian cancer patients undergoing paclitaxel chemotherapy, breast cancer control patients without chemotherapy and healthy controls were recruited in a cohort study and examined before chemotherapy (V1) and after 28 weeks (V2, after chemotherapy). CIPN was assessed by the validated Total Neuropathy Score reduced, which combines patient-reported symptoms with data from clinical examinations. Serum NFL (NFLs) concentrations were measured at both visits with single molecule array technology (SIMOA). RESULTS NFL is released from iPSC-DSN upon paclitaxel incubation in a dose- and time-dependent manner and inversely correlates with iPSC-DSN viability. NFLs strongly increased in paclitaxel-treated patients with CIPN, but not in chemotherapy patients without CIPN or controls, resulting in an 86 % sensitivity and 87 % specificity. A NFLs increase of +36 pg/ml from baseline was associated with a predicted CIPN probability of >0.5. CONCLUSION NFLs correlates with CIPN development and severity, which may guide neurotoxic chemotherapy in the future. TRIAL REGISTRATION NCT02753036FUNDING. DFG (EXC 257 NeuroCure), BMBF (01 EO 0801), AnimalFreeResearch Organization, EU Horizon 2020 Innovative Medicines Initiative 2 Joint Undertaking (TransBioLine, 821283).
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Affiliation(s)
- Petra Huehnchen
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Schinke
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nikola Bangemann
- Gynecology and Systemic Gynecology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany
| | - Adam D Dordevic
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Kern
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Smilla K Maierhof
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lois Hew
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Luca Nolte
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Körtvelyessy
- Department of Experimental Neurology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Jens C Göpfert
- Naturwissenschaftliches und Medizinisches Institut, Universität Tübingen, Reutlingen, Germany
| | - Klemens Ruprecht
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christopher J Somps
- Drug Safety Research and Development, Pfizer, Groton, United States of America
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang Boehmerle
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
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26
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Longitudinal Associations of Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Lifestyle Recommendations with Quality of Life and Symptoms in Colorectal Cancer Survivors up to 24 Months Post-Treatment. Cancers (Basel) 2022; 14:cancers14020417. [PMID: 35053579 PMCID: PMC8774035 DOI: 10.3390/cancers14020417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Using data from 459 colorectal cancer (CRC) survivors, we described how participants adhered to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and how this adherence was related to quality of life, level of functioning, symptoms of fatigue, and neuropathy symptoms. We found that increases in a lifestyle score was associated with better physical functioning and less fatigue. No relations with neuropathy symptoms were found. In addition, we observed that physical activity played an important role in the lifestyle score with regards to quality of life. In contrast, we observed that body composition and alcohol recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from overall adherence to the WCRF/AICR lifestyle recommendations in terms of quality of life and fatigue. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study. Abstract Post-treatment adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations were associated with health-related quality of life (HRQoL), fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer (CRC) survivors. In a prospective cohort among CRC survivors (n = 459), repeated home-visits were performed at 6 weeks, 6, 12, and 24 months post-treatment. Dietary intake, body composition, sedentary behaviour, and physical activity were assessed to construct a lifestyle score based on adherence to seven 2018 WCRF/AICR recommendations. Longitudinal associations of the lifestyle score with HRQoL, fatigue, and CIPN were analysed by confounder-adjusted linear mixed models. A higher lifestyle score was associated with better physical functioning and less activity-related fatigue, but not with CIPN. Adjustment for physical activity substantially attenuated observed associations, indicating its importance in the lifestyle score with regards to HRQoL. In contrast, adjustment for body composition and alcohol inflated observed associations, indicating that both recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from an overall adherence to the WCRF/AICR lifestyle recommendations in terms of HRQoL and fatigue, but not CIPN. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study.
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Ramnarine SR, Dougherty PM, Rolke R, Williams LJ, Alessi-Fox C, Coleman AJ, Longo C, Colvin LA, Fallon MT. OUP accepted manuscript. Oncologist 2022; 27:e671-e680. [PMID: 35706109 PMCID: PMC9355818 DOI: 10.1093/oncolo/oyac106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is a lack of standardized objective and reliable assessment tools for chemotherapy-induced peripheral neuropathy (CIPN). In vivo reflectance confocal microscopy (RCM) imaging offers a non-invasive method to identify peripheral neuropathy markers, namely Meissner’s corpuscles (MC). This study investigated the feasibility and value of RCM in CIPN. Patients and Methods Reflectance confocal microscopy was performed on the fingertip to evaluate MC density in 45 healthy controls and 9 patients with cancer (prior, during, and post-chemotherapy). Quantification was completed by 2 reviewers (one blinded), with maximum MC count/3 × 3 mm image reported. Quantitative Sensory Testing (QST; thermal and mechanical detection thresholds), Grooved pegboard test, and patient-reported outcomes measures (PROMS) were conducted for comparison. Results In controls (25 females, 20 males; 24-81 years), females exhibited greater mean MC density compared with males (49.9 ± 7.1 vs 30.9 ± 4.2 MC/3 × 3 mm; P = .03). Differences existed across age by decade (P < .0001). Meissner’s corpuscle density was correlated with mechanical detection (ρ = −0.51), warm detection (ρ = −0.47), cold pain (ρ = 0.49) thresholds (P < .01); and completion time on the Grooved pegboard test in both hands (P ≤ .02). At baseline, patients had reduced MC density vs age and gender-matched controls (P = .03). Longitudinal assessment of MC density revealed significant relationships with QST and PROMS. Inter-rater reliability of MC count showed an intraclass correlation of 0.96 (P < .0001). Conclusions The findings support the clinical utility of RCM in CIPN as it provides meaningful markers of sensory nerve dysfunction. Novel, prospective assessment demonstrated the ability to detect subclinical deficits in patients at risk of CIPN and potential to monitor neuropathy progression.
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Affiliation(s)
- Sabrina R Ramnarine
- Corresponding author: Sabrina R. Ramnarine MBChB, PhD, CLIMP, Guy’s and St. Thomas’ NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK. Tel: +44 207188 7188; ,
| | - Patrick M Dougherty
- Department of Pain Medicine, Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
| | - Linda J Williams
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Andrew J Coleman
- Clinical Imaging and Medical Physics, Guys’ and St. Thomas’ NHS Foundation Trust, London, UK
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - Lesley A Colvin
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Marie T Fallon
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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Kerckhove N, Selvy M, Lambert C, Gonneau C, Feydel G, Pétorin C, Vimal-Baguet A, Melnikov S, Kullab S, Hebbar M, Bouché O, Slimano F, Bourgeois V, Lebrun-Ly V, Thuillier F, Mazard T, Tavan D, Benmammar KE, Monange B, Ramdani M, Péré-Vergé D, Huet-Penz F, Bedjaoui A, Genty F, Leyronnas C, Busserolles J, Trévis S, Pinon V, Pezet D, Balayssac D. Colorectal Cancer Survivors Suffering From Sensory Chemotherapy-Induced Peripheral Neuropathy Are Not a Homogenous Group: Secondary Analysis of Patients' Profiles With Oxaliplatin-Induced Peripheral Neuropathy. Front Pharmacol 2021; 12:744085. [PMID: 34803689 PMCID: PMC8599933 DOI: 10.3389/fphar.2021.744085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Oxaliplatin, a pivotal drug in the management of colorectal cancer, causes chemotherapy-induced peripheral neuropathy (CIPN) in a third of cancer survivors. Based on a previous cross-sectional study assessing oxaliplatin-related sensory CIPN in colorectal cancer survivors, a secondary analysis was designed to explore the possibility that different clusters of patients may co-exist among a cohort of patients with oxaliplatin-related CIPN. Other objectives were to characterize these clusters considering CIPN severity, anxiety, depression, health-related quality of life (HRQOL), patients’ characteristics and oxaliplatin treatments. Among the 96 patients analyzed, three clusters were identified (cluster 1: 52, cluster 2: 34, and cluster 3: 10 patients). Clusters were significantly different according to CIPN severity and the proportion of neuropathic pain (cluster 1: low, cluster 2: intermediate, and cluster 3: high). Anxiety, depressive disorders and HRQOL alteration were lower in cluster 1 in comparison to clusters 2 and 3, but not different between clusters 2 and 3. This study underlines that patients with CIPN are not a homogenous group, and that CIPN severity is associated with psychological distress and a decline of HRQOL. Further studies are needed to explore the relation between clusters and CIPN management.
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Affiliation(s)
- Nicolas Kerckhove
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France.,Délégation à La Recherche Clinique et à L'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Marie Selvy
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Lambert
- Délégation à La Recherche Clinique et à L'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Coralie Gonneau
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Gabrielle Feydel
- Délégation à La Recherche Clinique et à L'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Caroline Pétorin
- Service Oncologie Digestive, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Agnès Vimal-Baguet
- Service Oncologie Digestive, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sergey Melnikov
- Service Chirurgie Générale et Viscérale, Centre Hospitalier de Saint-Flour, Saint-Flour, France
| | - Sharif Kullab
- Service Oncologie, Centre Hospitalier de Moulins Yzeure, Moulins, France
| | | | - Olivier Bouché
- Service Oncologie Digestive, CHU Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Florian Slimano
- Service Pharmacie, CHU Reims, BioSpect, SFR CAP-Santé, Université de Reims Champagne-Ardenne, Reims, France
| | - Vincent Bourgeois
- Service Oncologie Digestive, Centre Hospitalier de Boulogne sur Mer, Boulogne-Sur-Mer, France
| | | | | | | | - David Tavan
- Service Gastro-entérologie, Infirmerie Protestante de Lyon, Caluire et Cuire, France
| | | | - Brigitte Monange
- Service Oncologie, Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Mohamed Ramdani
- Service Gastro-entérologie, Centre Hospitalier de Béziers, Béziers, France
| | - Denis Péré-Vergé
- Service Hépato-gastro-entérologie, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Floriane Huet-Penz
- Service Gastro Entérologie, Centre Hospitalier Alpes Leman, Contamine sur Arve, France
| | - Ahmed Bedjaoui
- Service Gastro-entérologie, Centre Hospitalier Intercommunal Les Hôpitaux Du Léman, Thonon Les Bains, France
| | - Florent Genty
- Service Chirurgie Digestive et Viscérale, Centre Hospitalier de Vichy, Vichy, France
| | - Cécile Leyronnas
- Service Oncologie, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Jérôme Busserolles
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France.,Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Sophie Trévis
- Service Pharmacie, CHU Clermont-Ferrand, Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Pinon
- Service Pharmacie, CHU Clermont-Ferrand, Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Pezet
- INSERM, M2iSH, USC-INRA 2018, Université Clermont Auvergne, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - David Balayssac
- INSERM U1107 NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France.,Délégation à La Recherche Clinique et à L'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
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KENKHUIS MARLOUFLOOR, VAN ROEKEL ELINEH, BREEDVELD-PETERS JOSÉJL, BREUKINK STÉPHANIEO, JANSSEN-HEIJNEN MARYSKALG, KEULEN ERICTP, VAN DUIJNHOVEN FRÄNZELJB, MOLS FLOORTJE, WEIJENBERG MATTYP, BOURS MARTIJNJL. Longitudinal Associations of Sedentary Behavior and Physical Activity with Quality of Life in Colorectal Cancer Survivors. Med Sci Sports Exerc 2021; 53:2298-2308. [PMID: 34033619 PMCID: PMC8542069 DOI: 10.1249/mss.0000000000002703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Given the growing population of colorectal cancer (CRC) survivors, identifying ways to enhance health-related quality of life (HRQoL) and alleviate complaints of fatigue and chemotherapy-induced peripheral neuropathy (CIPN) is essential. PURPOSE We aimed to assess longitudinal associations of sedentary behavior (SB) and moderate to vigorous physical activity (MVPA) independently, as well as their joint association, with HRQoL, fatigue, and CIPN in CRC survivors. METHODS In a prospective cohort among stage I-stage III CRC survivors (n = 396), five repeated home visits from diagnosis up to 24 months posttreatment were executed. SB was measured using triaxial accelerometers, and MVPA, HRQoL, fatigue, and CIPN were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 months posttreatment. RESULTS Average time in prolonged SB (accumulated in bouts of duration ≥30 min) was 5.3 ± 2.7 h·d-1, and approximately 82% of survivors were classified as sufficiently active (≥150 min·wk-1 of MVPA) at 6 wk posttreatment. Decreases in SB and increases in MVPA were independently associated with better HRQoL and less fatigue over time. No associations were found for CIPN complaints. A synergistic interaction was observed between prolonged SB and MVPA in affecting functioning scales. Relative to CRC survivors with low prolonged SB and high MVPA, survivors with high prolonged SB and low MVPA reported a stronger decrease in physical functioning and role functioning over time than expected based on the independent associations of prolonged SB and MVPA. CONCLUSION Our longitudinal results show that less SB and more MVPA are beneficial for CRC survivors' HRQoL and fatigue levels. Our findings regarding interaction underscore that joint recommendations to avoid prolonged sitting and accumulate MVPA are important.
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Affiliation(s)
- MARLOU FLOOR KENKHUIS
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - ELINE H. VAN ROEKEL
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - JOSÉ J. L. BREEDVELD-PETERS
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - STÉPHANIE O. BREUKINK
- Department of Surgery, GROW School for Oncology and Developmental Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, THE NETHERLANDS
| | - MARYSKA L. G. JANSSEN-HEIJNEN
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
- Department of Clinical Epidemiology, Viecuri Medical Center, Venlo, THE NETHERLANDS
| | - ERIC T. P. KEULEN
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, THE NETHERLANDS
| | | | - FLOORTJE MOLS
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, THE NETHERLANDS
| | - MATTY P. WEIJENBERG
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
| | - MARTIJN J. L. BOURS
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, THE NETHERLANDS
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30
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Kenkhuis MF, van Duijnhoven FJB, van Roekel EH, Breedveld-Peters JJL, Breukink SO, Janssen-Heijnen ML, Keulen ETP, Mols F, Weijenberg MP, Bours MJL. Longitudinal associations of fiber, vegetable, and fruit intake with quality of life and fatigue in colorectal cancer survivors up to 24 months posttreatment. Am J Clin Nutr 2021; 115:822-832. [PMID: 34687207 PMCID: PMC8895214 DOI: 10.1093/ajcn/nqab360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing colorectal cancer (CRC) survivor population highlights the need for dietary recommendations in order to enhance health-related quality of life (HRQoL) and alleviate symptoms of fatigue, chemotherapy-induced peripheral neuropathy (CIPN), and gastrointestinal problems. OBJECTIVES Because of the therapeutic potential of dietary fiber on the gut, we aim to assess longitudinal associations of postdiagnostic dietary fiber, fruit, and vegetable intake, a major source of dietary fiber, with HRQoL, fatigue, CIPN, and gastrointestinal symptoms in CRC survivors from 6 wk to 24 mo posttreatment. METHODS In a prospective cohort among stage I-III CRC survivors (n = 459), 5 repeated study measurements between diagnosis and 24 mo posttreatment were executed. Dietary fiber intake and fruit and vegetable intake were measured by 7-d dietary records. HRQoL, fatigue, CIPN, and gastrointestinal symptoms were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 mo posttreatment and used hybrid models to disentangle the overall association into intraindividual changes and interindividual differences over time. RESULTS Higher dietary fiber intake and fruit and vegetable intake were longitudinally associated with statistically significant better physical functioning and less fatigue. Intraindividual analyses showed that an increase of 10 g/d in dietary fiber within individuals over time was associated with better physical functioning (β: 2.3; 95% CI: 0.1, 4.4), role functioning (ability to perform daily activities; 5.9; 1.5, 10.3), and less fatigue (-4.1; -7.7, -0.5). An average increase in fruit and vegetable intake of 100 g/d between individuals over time was predominantly associated with less fatigue (-2.2; -4.2, -0.3). No associations were found with CIPN and gastrointestinal symptoms. CONCLUSIONS Our results suggest that increasing dietary fiber, fruit, and vegetable intake is related to better physical and role functioning and less fatigue in the first 2 y after the end of treatment for CRC.
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Affiliation(s)
| | | | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - José J L Breedveld-Peters
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, GROW School for Oncology and Developmental Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maryska L Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands,Department of Clinical Epidemiology, Viecuri Medical Center, Venlo, The Netherlands
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Floortje Mols
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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31
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Müller J, Weiler M, Schneeweiss A, Haag GM, Steindorf K, Wick W, Wiskemann J. Preventive effect of sensorimotor exercise and resistance training on chemotherapy-induced peripheral neuropathy: a randomised-controlled trial. Br J Cancer 2021; 125:955-965. [PMID: 34226683 PMCID: PMC8476560 DOI: 10.1038/s41416-021-01471-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common, unpleasant and usually long-lasting side effect of neurotoxic chemotherapeutic agents. This study aimed to investigate the preventive potential of sensorimotor- (SMT) and resistance training (RT) on CIPN. METHODS Patients (N = 170) were randomised to SMT, RT or usual care (UC). Both exercise groups trained 3×/week for a total of 105 min/week during neurotoxic chemotherapy (mean length: 20 weeks). Before and 3 weeks after neurotoxic chemotherapy, CIPN signs/symptoms were assessed via Total Neuropathy Score (TNSr; primary endpoint) and EORTC QLQ-CIPN15 questionnaire. In addition, balance (centre of pressure), muscle strength (isokinetic), quality of life (QoL, EORTC QLQ-C30) and relative chemotherapy dose intensity (RDI) were investigated. The follow-up period covered 6 months after the end of chemotherapy. RESULTS Intention-to-treat analyses (N = 159) revealed no differences regarding CIPN signs/symptoms. Exploratory per-protocol analyses (minimum training attendance rate 67%; N = 89) indicated that subjectively perceived sensory symptoms in the feet increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) than in the UC group (-8.3 points (-16.1 to -0.4); P = 0.039, ES = 1.27). Furthermore, adherent exercisers received a higher RDI (96.6 ± 4.8 vs. 92.2 ± 9.4; P = 0.045), showed a better course of muscular strength (+20.8 Nm (11.2-30.4); P < 0.001, ES = 0.57) and QoL (+12.9 points (3.9-21.8); P = 0.005, ES = 0.64). During follow-up, CIPN signs/symptoms persisted in all groups. CONCLUSIONS This study demonstrates that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet and other clinically relevant cancer therapy-related outcomes, if an appropriate training stimulus is achieved. CLINICAL TRIAL REGISTRATION NCT02871284.
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Affiliation(s)
- Jana Müller
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Markus Weiler
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Division of Gynecological Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- grid.5253.10000 0001 0328 4908Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Karen Steindorf
- grid.7497.d0000 0004 0492 0584Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Wolfgang Wick
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Wiskemann
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
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Knoerl R, Mazzola E, Mitchell SA, Hong F, Salehi E, McCleary N, Ligibel JA, Reyes K, Berry DL. Measurement properties of brief neuropathy screening items in cancer patients receiving taxanes, platinums, or proteasome inhibitors. J Patient Rep Outcomes 2021; 5:101. [PMID: 34568984 PMCID: PMC8473487 DOI: 10.1186/s41687-021-00377-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely detection of chemotherapy-induced peripheral neuropathy (CIPN) is critical to effectively tailor chemotherapy dose levels and offer supportive care. The purpose of this secondary analysis was to determine the reliability and validity of the two Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) numbness and tingling severity and interference items to screen for CIPN in patients receiving taxanes, platinums, or proteasome inhibitors. METHODS Participants (N = 142) completed the two PRO-CTCAE items, a 0-10 numerical rating scale of worst CIPN pain intensity, and the Quality of Life Questionnaire-CIPN20 (QLQ-CIPN20) prior to three clinical visits (T1, T2, T3) during neurotoxic chemotherapy. Participants completed the two PRO-CTCAE items again following the T3 clinical visit (T4). In addition, study staff administered the modified Total Neuropathy Score-Clinical Version (TNSc©) at T3. We examined floor (i.e., no CIPN severity or interference) and ceiling effects, test-retest reliability, concurrent validity, longitudinal validity, construct validity of the response categories, and sensitivity and specificity of the two PRO-CTCAE items. RESULTS At T3, 29% of participants had PRO-CTCAE severity scores at the floor; 60.1% of participants reported interference item scores at the floor. Agreements between scores reported at T3 and T4 for PRO-CTCAE severity (ICC = 0.79) and interference (ICC = 0.73) were moderate to strong. The PRO-CTCAE severity and interference items correlated moderately-strongly with QLQ-CIPN20 sensory (Spearman's ρ-range = 0.53-0.72) and motor (Spearman's ρ-range = 0.50-0.58) subscale scores. The Cohen's d from T1 to T3 for the PRO-CTCAE items were small (severity: d = 0.32, interference: d = 0.40) and comparable to the effect sizes for change observed with the QLQ-CIPN20. The PRO-CTCAE severity (0-3) and interference (0-2) response categories distinguished respondents with significantly different levels of QLQ-CIPN20 sensory and motor subscale scores (p < 0.001 via Jonckheere-Terpstra tests). The sensitivity and specificity of the PRO-CTCAE severity item (cutoff > 0) to detect probable sensory peripheral neuropathy were 95.83% and 65.22%, while the sensitivity and specificity of the PRO-CTCAE™ interference item (cutoff > 0) were 51.39% and 73.91%. CONCLUSION Preliminary evidence supports the reliability and validity of the PRO-CTCAE numbness and tingling items for CIPN screening, although there may be floor effects and limitations in the capacity of the PRO-CTCAE items to identify the full range of CIPN sensory and motor features beyond numbness and tingling. Trial Registration ClinicalTrials.Gov, NCT03514680. Registered 21 April 2018. https://clinicaltrials.gov/ct2/show/NCT03514680.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA. .,University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Emanuele Mazzola
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Fangxin Hong
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nadine McCleary
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Kaitlen Reyes
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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Yoga for chronic chemotherapy-induced peripheral neuropathy pain: a pilot, randomized controlled trial. J Cancer Surviv 2021; 16:882-891. [PMID: 34524631 PMCID: PMC8442518 DOI: 10.1007/s11764-021-01081-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the feasibility of implementing a yoga intervention for cancer survivors with chronic CIPN pain, as well as the impact of the intervention on patient-reported outcomes. METHODS Cancer survivors with chronic CIPN pain were recruited from the breast, gastrointestinal, and gynecological oncology centers at Dana-Farber Cancer Institute. Participants were randomized (2:1) to receive an 8-week yoga intervention or usual care. After 21/50 of participants were enrolled, the COVID-19 pandemic required the yoga intervention to be delivered virtually (i.e., Zoom). Pre- and post-intervention, participants self-reported CIPN and co-occurring symptom severity. Adherence to the intervention was defined as practicing ≥ 12 yoga sessions over the 8-week intervention period. Changes in patient-reported outcomes between groups were compared using Wilcoxon's rank-sum tests. RESULTS Participants (n = 28 yoga, n = 16 control) were mainly female (96%) and diagnosed with stage III/IV disease (66%). Overall, 19/28 (67.8%) of yoga group participants were adherent to the yoga protocol. Yoga group participants experienced significant within-group improvements in all patient-reported outcomes, including worst CIPN pain (median change = - 1.7, p < 0.0001) and sensory CIPN (median change = - 14.8, p < 0.0001), but only improvements in fatigue (p = 0.05) and depression (p = 0.04) were significant compared to the control. There were no differences (p > 0.05) in changes in patient-reported outcomes between in-person (n = 6) or virtual (n = 15) yoga group participants. CONCLUSIONS Yoga is a feasible non-pharmacological modality for cancer survivors with CIPN, but more information is needed regarding its impact on CIPN and other symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03824860 IMPLICATIONS FOR CANCER SURVIVORS: Oncology clinicians may consider referring cancer survivors to yoga for chronic CIPN pain, but yoga cannot be currently recommended as an efficacious treatment.
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Efficacy of the Motivational Interviewing-Walk Intervention for Chemotherapy-Induced Peripheral Neuropathy and Quality of Life During Oxaliplatin Treatment: A Pilot Randomized Controlled Trial. Cancer Nurs 2021; 45:E531-E544. [PMID: 34483279 DOI: 10.1097/ncc.0000000000001003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oxaliplatin-induced peripheral neuropathy (OIPN) is prevalent among gastrointestinal cancer survivors and often impairs quality of life (QOL). OBJECTIVE This pilot randomized controlled trial aimed to explore the effect of an 8-week home-based brisk walking (the "MI-Walk") intervention on (1) OIPN severity and (2) QOL at 8 weeks, compared with physical activity (PA) education alone in oxaliplatin-receiving adults with gastrointestinal cancer. INTERVENTIONS/METHODS Participants (N = 57) recruited from 5 infusion sites received PA education at their second oxaliplatin visit, followed by phone assessments of adverse events over 8 weeks. Half (n = 29) received additional MI-Walk intervention motivational supports (eg, a Fitbit Charge 2 and motivational enhancement therapy sessions). Self-reported OIPN, QOL, and PA were measured before and after intervention. RESULTS The intervention compared with the control condition had no effect on sensory OIPN (mean difference [X¯[INCREMENT]] = -0.01; P > .99), motor OIPN (X¯[INCREMENT] = 2.39; P = .17), and QOL (X¯[INCREMENT] = -1.43; P > .99). Eight-week sensory (X¯ =11.48 ± 0.38) and motor OIPN severities (X¯ = 7.48 ± 0.36) were mild but higher than baseline (P ≤ .01). Self-reported PA level increased over time in both groups (X¯[INCREMENT] = 44.85; P = .01). Averaging ≥225 moderate to vigorous PA minutes per week led to less sensory OIPN, particularly finger/hand tingling (X¯[INCREMENT] = -26.35; P = .01). CONCLUSIONS This study failed to detect beneficial effects of the MI-Walk intervention; however, the findings suggest that aerobic walking may blunt but not completely prevent OIPN. Further research is necessary. IMPLICATIONS FOR PRACTICE Although the effectiveness of brisk walking in reducing OIPN is unclear, this study supports prior evidence that moderate to vigorous PA is beneficial and safe during chemotherapy treatment.
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Bulls HW, Hoogland AI, Small BJ, Kennedy B, James BW, Arboleda BL, Shahzad MMK, Gonzalez BD, Jim HSL. Lagged Relationships Among Chemotherapy-Induced Peripheral Neuropathy, Sleep Quality, and Physical Activity During and After Chemotherapy. Ann Behav Med 2021; 55:844-852. [PMID: 33196081 PMCID: PMC8382147 DOI: 10.1093/abm/kaaa101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is well-documented and can become chronic for up to a third of patients. CIPN management is hampered by limited pharmacological options. Thus, identifying modifiable behaviors that influence CIPN may help inform future interventions. PURPOSE The purpose of the current study was to examine bidirectional relationships between sleep quality, physical activity, and CIPN during and after chemotherapy. METHODS Participants were 138 women with gynecologic cancer (M age = 61, 94% white, 96% non-Hispanic), collected as part of an ongoing study. Assessments occurred at postcycle 1, postcycle 6, and 6- and 12-month postchemotherapy. CIPN (EORTC-CIPN20), sleep quality (PSQI), and physical activity (IPAQ) were assessed via self-report. Objective physical activity was assessed via wrist actigraphy. Latent change score models were used to examine lagged relationships between CIPN, sleep quality, and physical activity pairs. RESULTS Over the study period, sleep quality was found to contribute to CIPN (p = .001), but not the reverse (p > .05). Bidirectional relationships were observed between CIPN and both objective and subjective walking (ps ≤ .001). Illustrations of these relationships showed that patients with less CIPN early in treatment demonstrate more substantial increases in walking over time, while those with higher CIPN demonstrate more consistent levels of walking during and after treatment. CONCLUSIONS These findings suggest that worse sleep quality and lower walking levels may contribute to the course and maintenance of CIPN. Future investigation should evaluate the impact of early interventions aimed at improving sleep quality and encouraging physical activity in patients treated with chemotherapy.
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Persistent neuropathy among early-stage breast cancer survivors in a population-based cohort. Br J Cancer 2021; 125:445-457. [PMID: 34017086 PMCID: PMC8329002 DOI: 10.1038/s41416-021-01429-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/18/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The prevalence of persistent peripheral neuropathy (PN) in early-stage breast cancer (ESBC) survivors is largely unknown. We explored the occurrence and risk factors of PN among long-term ESBC survivors treated with taxane chemotherapy. METHODS A population-based cohort of 884 recurrence-free ESBC survivors diagnosed 2010-2015 in the South East Health Care region, Sweden and 1768 control women without prior cancer received a postal questionnaire that included the European Organisation for Research and Treatment of Cancer chemotherapy-induced peripheral neuropathy (CIPN20) items. Prevalence, relative risks (RRs) (Poisson regression) and risk factors (binomial regression) were calculated. Adjustments were made for confounding factors (e.g. age, body mass index, comorbidities). RESULTS The response rate was 79% for survivors and 59% for controls. The median time post taxane was 3.6 years (1.5-7.3 years). The adjusted RR was highest (RR 1.8) for "tingling/numbness of toes/feet". Individual sensory symptoms occurred in 8.9-48.4% and motor symptoms in 7.2-61.3% of survivors; the most prevalent symptoms were "difficulty opening jar" and "cramps in feet". Paclitaxel, older age, overweight, diabetes mellitus, vibrating hand tools, autoimmune disease and smoking were independent risk factors. CONCLUSIONS PN was more common among ESBC survivors than control women and many symptoms persisted over time. Risk factors should be considered when treatment decisions are made.
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Increases in adipose tissue and muscle function are longitudinally associated with better quality of life in colorectal cancer survivors. Sci Rep 2021; 11:12440. [PMID: 34127719 PMCID: PMC8203762 DOI: 10.1038/s41598-021-91709-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Colorectal cancer (CRC) survivors need evidence-based guidelines pertaining to post-treatment body composition, which could benefit health-related quality of life (HRQoL). We aimed to describe the course of several body composition measures, and to assess longitudinal associations of these measures with HRQoL, fatigue and chemotherapy-induced peripheral neuropathy (CIPN). In a prospective cohort among stage I–III CRC survivors (n = 459), five repeated home visits from diagnosis up to 24 months post-treatment were executed. Body mass index (BMI), waist circumference and fat percentage were assessed as measures of adiposity, and muscle arm circumference and handgrip strength as measures of muscle mass and function. We applied linear mixed-models to describe changes in body composition over time and to analyze overall longitudinal associations. Of included participants, 44% was overweight and 31% was obese at diagnosis. All body composition measures followed similar trends, decreasing from diagnosis to 6 weeks and then increasing up to 24 months post-treatment. In confounder-adjusted mixed models, increases in adipose tissue and muscle function were longitudinally associated with better HRQoL and less fatigue, regardless of pre-treatment body composition. With regards to improving HRQoL, decreasing fatigue and CIPN, clinical practice should also focus on restoring body tissues after CRC treatment. Trial registration: NTR7099.
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Al Onazi MM, Yurick JL, Harris C, Nishimura K, Suderman K, Pituskin E, Chua N, McNeely ML. Therapeutic Ultrasound for Chemotherapy-Related Pain and Sensory Disturbance in the Hands and Feet in Patients With Colorectal Cancer: A Pilot Randomized Controlled Trial. J Pain Symptom Manage 2021; 61:1127-1138. [PMID: 33137422 DOI: 10.1016/j.jpainsymman.2020.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT This proof-of-concept trial was undertaken as a first step in exploring the clinical benefit of therapeutic ultrasound for pain and sensory disturbance in patients with colorectal cancer. OBJECTIVES The aim of this study was to determine the feasibility and preliminary efficacy of adding therapeutic ultrasound to a home-based therapeutic exercise program (current standard of care) for patients presenting with oxaliplatin-related pain and sensory disturbance in the hands and feet. METHODS Thirty-one colorectal cancer patients with presenting symptoms of peripheral sensory neuropathy, based on a physician-rated grade 1, 2, or 3 on the National Cancer Institute Common Terminology Criteria for Adverse Events for sensory and motor neuropathy, were enrolled in the trial. Patients were randomized to either 10 sessions of ultrasound therapy intervention over two-week period (continuous ultrasound at an intensity of 0.7 to 0.8 w/cm2, and frequency of 3 MHz for 5 minutes) plus standard care (n = 16) or to standard care alone (n = 15). The feasibility of therapeutic ultrasound was determined by the recruitment rate, participants' adherence to the intervention, and the study completion rates. Assessments of pain, sensory disturbance, sensation, and balance were conducted at baseline, two and six weeks. RESULTS We achieved a recruitment rate of 84%, an adherence rate of 100% to the intervention, and a completion rate of 100%. Adding therapeutic ultrasound to standard care resulted in a statistically and clinically significant improvement in symptoms of pain and sensory disturbance (P = 0.003) at two weeks; however, no significance difference between the groups was found at the six-week follow-up. CONCLUSIONS The findings of this proof-of-concept study support the feasibility of the therapeutic ultrasound in addition to standard care as an intervention for colorectal cancer patients with oxaliplatin-related pain and sensory disturbance in the hands and feet. The findings warrant a large-scale placebo-controlled trial.
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Affiliation(s)
- Mona M Al Onazi
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Janice L Yurick
- Department of Rehabilitation Medicine, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Claire Harris
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kacy Nishimura
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kirsten Suderman
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Department of Oncology, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Neil Chua
- Department of Oncology, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - Margaret L McNeely
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of Rehabilitation Medicine, Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada.
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Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2-10 years post-diagnosis: a cross-sectional analysis. Br J Nutr 2021; 125:1188-1200. [PMID: 33087189 DOI: 10.1017/s0007114520003487] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I-III CRC survivors, 2-10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (β 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (-4·5; -7·6, -1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (-4·2; -7·1, -1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations.
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Impact of Chemotherapy-Induced Peripheral Neuropathy on Quality of Life in Patients with Advanced Lung Cancer Receiving Platinum-Based Chemotherapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115677. [PMID: 34073174 PMCID: PMC8199281 DOI: 10.3390/ijerph18115677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of neurotoxic anticancer drugs that may affect quality of life (QoL). Purpose: The purposes of this study were to: assess the levels of CIPN, anxiety, depression, CIPN–related QoL, and general QoL; and identify the factors related to CIPN–related QoL and general QoL in patients with advanced lung cancer (LC) receiving platinum-based chemotherapy. This cross-sectional study examined patients with advanced LC who received platinum-based chemotherapy from the thoracic oncology inpatient wards of a medical center in northern Taiwan. Structured questionnaires were used to measure patients’ CIPN (European Organization for Research and Treatment of Cancer quality of life questionnaire–chemotherapy–induced peripheral neuropathy 20), anxiety (Hospital Anxiety and Depression Scale Depression Scale [HADS]), depression (HADS), CIPN-related QoL (Functional Assessment of Cancer Therapy /Gynecologic Oncology Group-Neurotoxicity subscale [FACT/GOG–Ntx]), and general QoL (Functional Assessment of Cancer Therapy–General Input [FACT-G]). Of 93 patients with advanced LC, 53.8% reported CIPN–sensory impairment and 47.3% reported CIPN–motor impairment. The most common CIPN symptoms were difficulty getting or maintaining an erection (only for men > 65 years) and difficulty in climbing stairs or getting up out of a chair. Poor CIPN–related QoL (FACT/GOG–Ntx) was associated with more CIPN–sensory and more CIPN–motor impairment. Poor general QoL (FACT-G) was associated with a higher level of depression, a higher level of anxiety, and receipt of more chemotherapy cycles. More than half of LC patients report impairment related to CIPN, calling for holistic treatment to improve QoL.
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Abstract
The role of immune mediators, including proinflammatory cytokines in chemotherapy-induced peripheral neuropathy (CIPN), remains unclear. Here, we studied the contribution of interleukin-20 (IL-20) to the development of paclitaxel-induced peripheral neuropathy. Increased serum levels of IL-20 in cancer patients with chemotherapy were accompanied by increased CIPN risk. In mouse models, proinflammatory IL-20 levels in serum and dorsal root ganglia fluctuated with paclitaxel treatment. Blocking IL-20 with the neutralizing antibody or genetic deletion of its receptors prevented CIPN, alleviated peripheral nerve damage, and dampened inflammatory responses, including macrophage infiltration and cytokine release. Mechanistically, paclitaxel upregulated IL-20 through dysregulated Ca homeostasis, which augmented chemotherapy-induced neurotoxicity. Importantly, IL-20 suppression did not alter paclitaxel efficacy on cancer treatment both in vitro and in vivo. Together, targeting IL-20 ameliorates paclitaxel-induced peripheral neuropathy by suppressing neuroinflammation and restoring Ca homeostasis. Therefore, the anti-IL-20 monoclonal antibody is a promising therapeutic for the prevention and treatment of paclitaxel-induced neuropathy.
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Sohn EH, Lee JS, Jung MS, Kim JR. A Prospective Study of Taxane-Induced Neuropathy with Breast Cancer: Proper Assessment Tool for Taxane-Induced Neuropathy. South Asian J Cancer 2021; 10:58-63. [PMID: 34568215 PMCID: PMC8460343 DOI: 10.1055/s-0041-1731100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Many chemotherapeutic agents, especially taxanes, can induce peripheral neuropathy. Aim To evaluate the clinical characteristics of taxane-induced neuropathy (TIN) and determine the proper assessment tool for TIN in patients with breast cancer. Setting and Design Single-center, observational, prospective study. Methods and Material Forty-three patients with breast cancer treated with taxanes were prospectively enrolled. The reduced version of the Total Neuropathy Score (TNSr) was performed at baseline and 3 months after enrollment. TIN was diagnosed if the difference between the baseline and 3-month TNSr was greater than 1. In patients with TIN, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Chemotherapy-Induced Peripheral Neuropathy (20-item scale (EORTC-CIPN20) was also assessed 3 months after enrollment. Results Thirty-seven out of 43 (86.0%) patients were diagnosed with TIN. Sensory symptoms (64.9%) were the most frequent abnormality, followed by autonomic symptoms (54.1%). No patients reported motor symptoms or motor weakness. The TNSr sensory symptom score positively correlated with that of the EORTC-CIPN20. Nerve conduction studies showed reduced nerve conduction velocities and amplitudes after taxane treatment compared to those before chemotherapy in all tested nerves; however, only three (8.1%) patients had sural sensory nerve action potential amplitude outside normal limits. Conclusions TIN was predominantly sensory with normal nerve conduction studies which is the main feature of small fiber neuropathy. A combination scale comprising of a clinician-based scale and a patient-reported questionnaire and specialized tests for small nerve fibers should be considered as proper assessment tools to evaluate TIN.
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Affiliation(s)
- Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, Korea
| | - Jin Sun Lee
- Department of Surgery and Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Korea
| | - Mi Sook Jung
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Je Ryong Kim
- Department of Surgery and Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Korea
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Knoerl R, Mazzola E, Hong F, Salehi E, McCleary N, Ligibel J, Reyes K, Berry DL. Exploring the impact of a decision support algorithm to improve clinicians' chemotherapy-induced peripheral neuropathy assessment and management practices: a two-phase, longitudinal study. BMC Cancer 2021; 21:236. [PMID: 33676431 PMCID: PMC7937225 DOI: 10.1186/s12885-021-07965-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians' frequency of CIPN assessment documentation and adherence to evidence-based management. METHODS One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians' CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson's chi-squared test. RESULTS Clinicians' frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians' CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). CONCLUSIONS Implementation of a clinician-decision support algorithm did not significantly improve clinicians' CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. TRIAL REGISTRATION ClinicalTrials.Gov, NCT03514680 . Registered 21 April 2018.
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Affiliation(s)
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nadine McCleary
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Kaitlen Reyes
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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Chemotherapy-induced peripheral neuropathy (CIPN). MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2021. [DOI: 10.1007/s12254-021-00688-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bonomo R, Cavaletti G. Clinical and biochemical markers in CIPN: A reappraisal. Rev Neurol (Paris) 2021; 177:890-907. [PMID: 33648782 DOI: 10.1016/j.neurol.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
The increased survival of cancer patients has raised growing public health concern on associated long-term consequences of antineoplastic treatment. Chemotherapy-induced peripheral neuropathy (CIPN) is a primarily sensory polyneuropathy, which may be accompanied by pain, autonomic disturbances, and motor deficit. About 70% of treated cancer patients might develop CIPN during or after the completion of chemotherapy, and in most of them such complication persists after six months from the treatment. The definition of the potential risk of development and resolution of CIPN according to a clinical and biochemical profile would be certainly fundamental to tailor chemotherapy regimen and dosage on individual susceptibility. In recent years, patient-reported and clinician-related tools along with quality of life instruments have been featured as primary outcomes in clinical setting and randomized trials. New studies on metabolomics markers are further pursuing accurate and easily accessible indicators of peripheral nerve damage. The aim of this review is to outline the strengths and pitfalls of current knowledge on CIPN, and to provide a framework for future potential developments of standardized protocols involving clinical and biochemical markers for CIPN assessment and monitoring.
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Affiliation(s)
- R Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
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Physical exercise during adjuvant chemotherapy for colorectal cancer-a non-randomized feasibility study. Support Care Cancer 2020; 29:2993-3008. [PMID: 33030598 PMCID: PMC8062327 DOI: 10.1007/s00520-020-05789-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 12/26/2022]
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide, and a large proportion of the patients receive adjuvant oxaliplatin-based chemotherapy. Most of these experience chemotherapy-induced peripheral neuropathy (CIPN), affecting quality of life. Evidence to advise exercise to reduce CIPN is limited. The primary aim of this study was to investigate the feasibility of an exercise intervention and data collection among CRC patients during adjuvant chemotherapy. Material and methods This non-randomized feasibility study included CRC patients admitted to adjuvant chemotherapy to an intervention consisting of supervised aerobic endurance, resistance, and balance exercises twice a week at the hospital in addition to home-based exercise once a week. A physiotherapist supervised the patients, and the intervention lasted throughout the period of adjuvant chemotherapy (12–24 weeks). Participants performed physical tests and filled in questionnaires at baseline, 3, 6, 9, and 12 months. Results and conclusion Nineteen (63%) of 30 invited patients consented. A major barrier to recruit or consent to participation was long travel distance to the hospital. The completion rate of questionnaires and physical tests were near 100%. Seven participants dropped out, five before the intervention started. Median attendance to supervised exercise was 85%. There were no serious adverse events related to the intervention. Except for a planned higher intensity of endurance exercise, we found the intervention feasible and safe. Based on experiences in this study, some adjustments have been made for an upcoming randomized trial, including the supervised exercise taking place close to participants’ homes. Trial registration NCT03885817, March 22, 2019, retrospectively registered.
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Cisplatin-associated neuropathy characteristics compared with those associated with other neurotoxic chemotherapy agents (Alliance A151724). Support Care Cancer 2020; 29:833-840. [PMID: 32500206 DOI: 10.1007/s00520-020-05543-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The current project was developed to obtain natural history information regarding cisplatin-induced peripheral neuropathy in males with testicular/germ cell cancers and to compare such neuropathy data with similarly obtained data in patients receiving other chemotherapy drugs in similarly conducted clinical trials. METHODS Patients without baseline neuropathy symptoms, who were initiating cisplatin-based chemotherapy, completed the EORTC CIPN 20 patient-reported instrument to evaluate chemotherapy-induced peripheral neuropathy (CIPN). Results were compared with EORTC CIPN 20 data obtained from independent study sets regarding patients receiving (1) paclitaxel, (2) combined paclitaxel and carboplatin, (3) oxaliplatin, or (4) a combination of doxorubicin and cyclophosphamide (AC). The last study set of patients on AC was selected to evaluate the use of EORTC CIPN 20 data in patients receiving chemotherapy not known to cause CIPN. RESULTS Cisplatin-induced neuropathy was more similar to neuropathy in patients receiving oxaliplatin than in those receiving paclitaxel. The cisplatin and oxaliplatin groups exhibited the coasting phenomenon and more prominent upper extremity symptoms than lower extremity symptoms during chemotherapy administration weeks. In contrast, paclitaxel-treated patients did not, on average, exhibit the coasting phenomenon; additionally, lower extremity symptoms were more prominent during the weeks when paclitaxel was administered. Cisplatin-induced neuropathy was less severe than was seen in patients in the other two groups, potentially because the cisplatin-receiving patients were younger. Patients receiving AC did not report substantial EORTC CIPN 20 changes. CONCLUSION Understanding neuropathy similarities and differences with various chemotherapy agents may help elucidate CIPN processes and facilitate means to prevent and/or treat established CIPN. TRIAL REGISTRATION NCT02677727.
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Park SB, Alberti P, Kolb NA, Gewandter JS, Schenone A, Argyriou AA. Overview and critical revision of clinical assessment tools in chemotherapy-induced peripheral neurotoxicity. J Peripher Nerv Syst 2020; 24 Suppl 2:S13-S25. [PMID: 31647154 DOI: 10.1111/jns.12333] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a major toxicity of cancer treatment, leading to dose reduction and premature treatment cessation, potentially affecting patient function, and quality of life. The development of accurate and sensitive assessment tools for CIPN is essential to enable clinical monitoring during treatment, follow-up of long-term outcomes and measurement of toxicity in clinical trials. This review examines CIPN clinical assessment scales incorporating clinician-based, composite, and patient-reported outcomes (PROs), providing a systematic review of their properties and an updated critical analysis of recommendations on current evidence for their use. This systematic review of CIPN assessment tools identified 50 papers containing 41 assessment tools, across 4 categories (common toxicity criteria; composite neurological scale; PROs; pain scale). The majority of these tools were PROs, underscoring the importance of patient-based assessment of symptoms. While there has been considerable work in the field over the past 10 years, this review highlights significant gaps, including a lack of evaluation of responsiveness and problematic neuropathic pain evaluation. There remains a need for consensus on the best available tool and the need to modify existing instruments to improve utility.
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Affiliation(s)
- Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Noah A Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
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Psychometric Testing of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-Item Scale Using Pooled Chemotherapy-Induced Peripheral Neuropathy Outcome Measures Standardization and Alliance for Clinical Trials in Oncology A151408 Study Data. Cancer Nurs 2020; 42:179-189. [PMID: 29649081 DOI: 10.1097/ncc.0000000000000596] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND No criterion-standard patient-reported outcome measure of chemotherapy-induced peripheral neuropathy (CIPN) exists. OBJECTIVES The aims of this study were to reevaluate the sensitivity, reliability, and validity of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN (QLQ-CIPN20) measure and suggest possible revisions that could strengthen it. METHODS Cross-sectional QLQ-CIPN20 data from 8 European countries (n = 271) were pooled with data from 4 North American multisite CIPN intervention trials (n = 884). The combined sample (N = 1155) included patients with varied cancer diagnoses who had received neurotoxic chemotherapy. Item score ranges, Cronbach's α, and exploratory factor analysis were used to evaluate sensitivity, internal consistency, and structural validity. RESULTS Individual item mean scores ranged from 1.21 to 2.34 (SD range, 0.55-1.17). All item scores encompassed the entire 1 to 4 range. We recommend that 4 items be removed because of low item-item score correlations (r < 0.30). On the basis of the remaining 16 items, 88% of the variance was explained by 2 factors whose Cronbach's α coefficients were .90 and .85. However, items lacked conceptual alignment with previously published factor structures. CONCLUSION Using a large, diverse sample of European and North American participants, the reduced 16-item QLQ-CIPN20 is sensitive and internally consistent. However, factor analysis results revealed an unstable factor structure. IMPLICATIONS FOR PRACTICE The use of a reliable, valid, and sensitive criterion-standard QLQ-CIPN20 variant in clinical practice settings could improve function, quality of life, and CIPN symptom control by facilitating patient reporting and thereby clinician awareness of this underrecognized consequence of cancer therapy.
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50
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Vitamin D deficiency increases severity of paclitaxel-induced peripheral neuropathy. Breast Cancer Res Treat 2020; 180:707-714. [PMID: 32166478 DOI: 10.1007/s10549-020-05584-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/29/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Approximately 25% of patients receiving weekly paclitaxel for breast cancer require treatment disruptions to avoid severe, irreversible peripheral neuropathy (PN). Vitamin insufficiencies are PN risk factors in many diseases, but their relevance to chemotherapy-induced PN is unknown. METHODS We investigated whether baseline insufficiency of vitamin D, vitamin B12, folate, or homocysteine increased PN in patients with breast cancer receiving weekly paclitaxel in a retrospective analysis of a prospective observational study. Patient-reported PN was collected at baseline and during treatment on the Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy (CIPN20). The primary analysis tested associations between vitamin deficiency and the maximum increase from baseline in the CIPN20 sensory subscale (ΔCIPN8). Secondary analyses tested for association with PN-induced treatment disruptions and adjusted associations for treatment and clinical variables. RESULTS 25-hydroxy-vitamin D was the only nutrient with sufficient deficiency (< 20 ng/mL) for analysis (15/37 = 41%). Vitamin D-deficient patients had a greater mean PN increase than non-deficient patients (ΔCIPN8 ± SD, 36 ± 23 vs. 16 ± 16, p = 0.003) and a non-significant, approximately threefold increase in risk of treatment disruption (OR 2.98, 95% CI [0.72, 12.34], p = 0.16). In multivariable models adjusted for clinical and treatment variables, baseline vitamin D level was inversely associated with PN (β = - 0.04, p = 0.02). CONCLUSION Pre-treatment vitamin D deficiency was associated with PN in women receiving weekly paclitaxel for breast cancer. Vitamin D deficiency may be an easily detected PN risk factor that could be resolved prior to treatment to prevent PN, avoid treatment disruptions, and improve treatment outcomes.
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