Study Compares Incidence and Severity of Treatment-Related Neuropathy in Patients With Colorectal Cancer vs Other Cancers
Patients with colorectal cancer experience significantly higher rates of numbness/tingling but comparable neuropathic pain relative to patients with other cancers, according to a study by Lewis et al in the Journal of Pain and Symptom Management. In addition, numbness/tingling was more likely to be rated as one of the top three symptoms causing difficulties for patients with colorectal cancer.
Platinum-based chemotherapies and taxanes are associated with a risk of neuropathic pain and numbness/tingling, and dose-limiting neurotoxicity can be a major side effect of treatment. However, few studies have examined the incidence and severity of treatment-induced neuropathic symptoms in patients with different cancer types.
Thus, Lewis and colleagues conducted a study focusing on the prevalence of neuropathic pain and numbness/tingling in patients with colorectal cancer and how it compared with the level of neuropathic symptoms seen in patients with other cancers. In addition, the researchers wanted to examine how disease stage, chemotherapy, the use of a glycemic control agent, and comorbidity might impact the prevalence of moderate-to-severe numbness/tingling in patients with colorectal cancer.
Study Details
Included in the study were 3,106 patients with any stage of colorectal, breast, lung, or prostate cancer. Of those, 718 patients had colorectal cancer, 1,544 had breast cancer, 320 had prostate cancer, and 524 had lung cancer.
Patient self-assessment questionnaires were used to grade the severity of neuropathic symptoms, and clinicians reported mechanism of pain and ranked the top three symptoms causing difficulties for each patient. The prevalence of moderate-to-severe numbness/tingling in patients with colorectal cancer was examined by clinical variables such as comorbidities, use of glycemic control agents, disease stage, and chemotherapy.
Numbness/Tingling Rates
A greater proportion of patients in the colorectal cancer group reported having moderate-to-severe numbness/tingling compared with patients in the other cancer groups (25.8% vs 17.1%; P < .001). A similar comparison was seen at follow-up, with 25.6% of patients in the colorectal cancer group reporting moderate-to-severe numbness/tingling vs 17.1% of patients in the other cancer groups (P < .001). Patients with colorectal cancer and other cancers had a comparable prevalence of neuropathic pain (P = .654)
Among clinicians, 25.1% rated numbness/tingling as one of the top three symptoms causing difficulties for patients with colorectal cancer vs 10.5% for patients with other cancers.
Among patients with colorectal cancer, the highest prevalence of moderate-to-severe numbness/tingling was seen in patients who were extremely bothered by comorbidities; those patients who were moderately bothered or not bothered by comorbidities reported progressively less numbness/tingling. Patients with metastatic disease who underwent concurrent chemotherapy reported the highest percentage of moderate-to-severe numbness/tingling compared with patients with localized disease who had not received chemotherapy (30.0% vs 11.8%).The use of a glycemic control agent was not significantly associated with increased levels of moderate-to-severe numbness/tingling.
Patients with colorectal cancer were significantly more likely to experience moderate-to-severe numbness/tingling compared with patients with other cancer types at initial assessment (adjusted odds ratio [OR] = 1.66; 95% confidence interval [CI] = 1.34–2.05; P < .001). Other statistically significant factors for this outcome included increasing age, greater number of years since diagnosis, black race, and a higher number of concurrent medications.
Conclusions and Implications
According to the investigators, patients with colorectal cancer experience significantly higher rates of chemotherapy-related moderate-to-severe numbness/tingling, but comparable neuropathic pain, relative to patients with breast, lung, or prostate cancer. In addition, numbness/tingling is more likely to be reported by clinicians as one of the top three symptoms causing difficulties for patients with colorectal cancer than for those with other cancer types.
The investigators concluded, “To our knowledge, this is one of the largest multicenter studies to present a comparative analysis of the prevalence and severity of treatment-induced neuropathic symptoms and their risk factors in patients with colorectal vs breast, lung, or prostate cancer, with data collected prospectively using patient-reported outcomes.”
They further commented, “Clinician awareness of patient differences in the severity of, and susceptibility to, neuropathic symptoms is crucial in order to inform appropriate treatment management strategies—and where possible, ameliorative interventions—for at-risk patients.”
Desiree Jones, PhD, of The University of Texas MD Anderson Cancer Center, is the corresponding author of this article in the Journal of Pain and Symptom Management.
The study was supported in part by grants from the National Cancer Institute, National Institutes of Health, and the Department of Health and Human Services. The authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
