Chemotherapy-induced Neuropathy Has Long-term Effect on Colorectal Cancer Survivors
In a study reported in Journal of Clinical Oncology, Floortje Mols, PhD, of the Center of Research on Psychology in Somatic Diseases, Tilburg University, and colleagues assessed the prevalence and severity of chemotherapy-induced neuropathy and its affect on health-related quality of life in colorectal cancer survivors at 2 to 11 years after diagnosis. They found that neuropathy-related symptoms continue to be reported, particularly sensory symptoms in the lower extremities among patients treated with oxaliplatin, and that these symptoms can have a negative impact on health-related quality of life.
Study Details
The study involved colorectal cancer survivors diagnosed between 2000 and 2009 who were registered in the Dutch population-based Eindhoven Cancer Registry and included in the PROFILES (Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship) Registry.
Of all eligible patients, 83% (n = 1,643) completed European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) C30 and the EORTC QLQ Chemotherapy-induced Peripheral Neuropathy (CIPN) 20 instrument. Of the total group of respondents, 500 patients (31%) had been treated with chemotherapy. These patients were significantly younger, diagnosed more recently, and more often diagnosed with colon instead of rectal cancer compared with patients not treated with chemotherapy; they also had a higher disease stage and grade at diagnosis, greater body mass index, and were more often employed at the time of the survey.
Neuropathy-related Symptoms
Among all respondents, the five neuropathy subscale–related symptoms that patients reported bothering them the most during the past week were erectile problems (42% of men), trouble hearing (11%), trouble opening jars or bottles (11%), tingling toes/feet (10%), and trouble walking stairs or standing up (9%). Logistic regression analyses among patients diagnosed from 2007 onward (ie, after the introduction of oxaliplatin) showed that those who received oxaliplatin more frequently reported tingling (29% vs 8%, P = .001), numbness (17% vs 5%, P = .0047), and aching or burning pain (13% vs 6%, P = .0293) in toes or feet compared with patients who did not receive chemotherapy and more frequently reported tingling toes or feet (29% vs 14%, P = .0127) compared with those who received chemotherapy other than oxaliplatin.
Analyses among patients with colon cancer diagnosed since 2007 showed that both patients treated with oxaliplatin and those receiving chemotherapy without oxaliplatin reported significantly higher scores on EORTC QLQ-CIPN20 sensory scale problems compared with patients not receiving chemotherapy, with the differences being clinically relevant. There were no differences between treatments on the motor and autonomic scales. Analyses among patients with rectal cancer showed that although patients treated with oxaliplatin had significantly higher scores on sensory and motor scales compared with patients receiving chemotherapy without oxaliplatin, the differences were not clinically relevant.
Health-related Quality of Life Outcomes
With regard to health-related quality of life, no significant differences were found on EORTC QLQ-C30 subscale scores between colorectal cancer survivors diagnosed since 2007 who were not treated with chemotherapy and those treated with chemotherapy with or without oxaliplatin. However, among the total group of patients with colorectal cancer, those with many neuropathy symptoms (upper 10%) reported significantly worse health-related quality of life scores on all EORTC QLQ-C30 subscales (all P < .01) compared with those with fewer symptoms, with the differences in scores reflecting clinically relevant differences in function, global health status, and symptoms.
The investigators concluded, “Two to 11 years after diagnosis of colorectal cancer, neuropathy-related symptoms are still reported, especially sensory symptoms in the lower extremities among those treated with oxaliplatin. Because neuropathy symptoms have a negative influence on health-related quality of life, these should be screened for and alleviated. Future studies should focus on prevention and relief of chemotherapy-induced neuropathy.”
The authors reported no potential conflicts of interest.
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