Abstract
Introduction
Dose-limiting neurotoxicity is a major side effect of oxaliplatin treatment, producing initial acute neurotoxicity and chronic neuropathy with increasing exposure. The improvement in survival for patients with early-stage colorectal cancer treated with oxaliplatin has highlighted the need for valid and reliable assessment of peripheral neuropathy.
Objectives
The objective of this paper was to explore neuropathic symptoms in oxaliplatin-treated patients as assessed using different methods.
Methods
Consecutive symptomatic patients reporting peripheral neuropathy after oxaliplatin chemotherapy for colorectal cancer were interviewed using a semi-structured clinical interview. Neurotoxicity was also assessed using the National Cancer Institute Common Toxicity Criteria scale (clinician-rated), patient ‘self-report’ questionnaires (PNQ), nerve conduction and clinical assessment.
Results
Twenty patients were assessed, 12.6 ± 2.8 months after treatment cessation (mean cumulative oxaliplatin dose, 789 mg/m2). In 40% of patients, neurotoxicity necessitated early cessation of treatment. Only 10% of patients were designated by clinicians with severe neurotoxicity, whilst, in contrast, patient interviews and self-report questionnaires described significant physical limitations due to neuropathic symptoms in 60% of patients. The majority (85%) of patients had objective evidence of sensory neuropathy with nerve conduction studies. Reports from clinical interviews were strongly correlated with patient self-assessment (Pearson coefficient = 0.790, p < 0.0005).
Conclusion
Given the discrepancies in symptom prevalence highlighted by these findings, the monitoring of oxaliplatin-induced neurotoxicity would benefit from more informative clinical assessment, with inclusion of patient-reported outcome measures. Such an approach would be beneficial in a clinical trial setting to monitor the efficacy of interventions and in prospective studies of survivorship to determine the true burden of peripheral neuropathy in oxaliplatin-treated patients.
Similar content being viewed by others
Abbreviations
- NCI:
-
National Cancer Institute Common Toxicity Criteria for Adverse Events
- PNQ:
-
Patient Neurotoxicity Questionnaire
- PRO:
-
Patient-reported outcome
References
Andre T, Boni C, Mounedji-Boudiaf L et al (2004) Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 350:2343–2351 (see comment)
Cavaliere R, Schiff D (2006) Neurologic toxicities of cancer therapies. Curr Neurol Neurosci Rep 6:218–226
Park SB, Krishnan AV, Lin CSY et al (2008) Mechanisms underlying chemotherapy-induced neurotoxicity and the potential for neuroprotective strategies. Curr Med Chem 15:3081–3094
Coleman MP, Quaresma M, Berrion F et al (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9:730–756
Cersosimo RJ (2005) Oxaliplatin-associated neuropathy: a review. Ann Pharmacother 39:128–135
André T, Boni C, Navarro M et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27:3109–3116
Grothey A (2003) Oxaliplatin-safety profile: neurotoxicity. Semin Oncol 30:5–13
Gamelin E, Gamelin L, Bassi L, Quasthoff S (2002) Clinical aspects and molecular basis of oxaliplatin neurotoxicity: current management and development of preventive measures. Semin Oncol 29:21–33
Argyriou AA, Polychronopoulos P, Iconomou G et al (2008) A review on oxaliplatin-induced peripheral nerve damage. Cancer Treat Revi 34:368–377
Hausheer FH, Schilsky RL, Bain S et al (2006) Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Semin Oncol 33:15–49
de Gramont A, Figer A, Seymour M et al (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18:2938–2947
Park SB, Goldstein D, Lin CS-Y et al (2009) Acute abnormalities of sensory nerve function associated with oxaliplatin-induced neurotoxicity. J Clin Oncol 27:1243–1249
Park SB, Lin CS, Krishnan AV et al (2009) Oxaliplatin-induced neurotoxicity: changes in axonal excitability precede development of neuropathy. Brain 3:2712–2723
Park SB, Lin CSY, Krishnan AV et al (2011) Long-term neuropathy after oxaliplatin treatment: challenging the dictum of reversibility. Oncologist 16:708–716
Land SR, Kopec JA, Cecchini RS et al (2007) Neurotoxicity from oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: NSABP C-07. J Clin Oncol 25:2205–2211
Pietrangeli A, Leandri M, Terzoli E et al (2006) Persistence of high-dose oxaliplatin-induced neuropathy at long-term follow-up. Eur Neurol 56:13–16
Ganz PA (2003) Why and how to study the fate of cancer survivors: observations from the clinic and the research laboratory. Eur J Cancer 39:2136–2141
Postma TJ, Heimans JJ, Muller MJ et al (1998) Pitfalls in grading severity of chemotherapy-induced peripheral neuropathy. Ann Oncol 9:739–744
Cavaletti G, Frigeni B, Lanzani F et al (2010) Chemotherapy-induced peripheral neurotoxicity assessment: a critical revision of the currently available tools. Eur J Cancer 46:479–494
Basch E, Iasonos A, McDonough T et al (2006) Patient versus clinical symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol 7:903–909
Dunlap B, Paice JA (2006) Chemotherapy-induced peripheral neuropathy: a need for standardization in measurement. J Support Oncol 4:398–399
Postma TJ, Heimans JJ (2000) Grading of chemotherapy-induced peripheral neuropathy. Ann Oncol 11:509–513
Shimozuma K, Ohashi Y, Takeuchi A et al (2009) Feasibility and validity of the Patient Neurotoxicity Questionnaire during taxane chemotherapy in a phase III randomized trial in patients with breast cancer: N-SAS BC 02. Support Care Cancer 17:1483–1491
Kopec JA, Land SR, Cecchini RS et al (2006) Validation of a self-reported neurotoxicity scale in patients with operable colon cancer receiving oxaliplatin. J Support Oncol 4:W1–W8
Mays N, Pope C (1995) Qualitative research: rigour and qualitative research. BMJ 311:109–112
Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13:176–181
Cleeland CS, Farrar JT, Hausheer FH (2010) Assessment of cancer-related neuropathy and neuropathic pain. Oncologist 15(Suppl 2):13–18
Kuroi K, Shimozuma K, Ohashi Y et al (2009) Prospective assessment of chemotherapy-induced peripheral neuropathy due to weekly paclitaxel in patients with advanced or metastatic breast cancer (CSP-HOR 02 Study). Support Care Cancer 17:1071–1080
Riebandt G, Rodabaugh KJ, Pietkiewicz J et al (2011) Prospective analysis of chemotherapy-induced neuropathy in patients with gynecologic malignancies. J Clin Oncol 29(suppl) abstract e 19737
Bennett B, Goldstein D, Friedlander M et al (2007) The experience of cancer-related fatigue and chronic fatigue syndrome: a qualitative and comparative study. J Pain Symptom Manag 34:126–135
Kimura J (1983) Electrodiagnosis in diseases of nerve and muscle. F.A. Davis, Philadelphia
NVivo (2006) Qualitative data analysis software (version 7). In Edition QSR International Pty, Ltd.
Lim J, Macluran M, Price M et al (2004) Short- and Long-term impact of receiving genetic mutation results in women at increased risk for hereditary breast cancer. J Genet Couns 13:115–133
Bakitas MA (2007) Background noise: the experience of chemotherapy-induced peripheral neuropathy. Nurs Res 56:323–331
Tofthagen C (2010) Surviving chemotherapy for colon cancer and living with the consequences. J Palliat Med 13:1389–1391
Tofthagen C (2010) Patient perceptions associated with chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 14:22–28
Hile ES, Fitzgerald GK, Studenski SA (2010) Persistent mobility disability after neurotoxic chemotherapy. Phys Ther 90:1649–1657
Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA, The J Am Med Assoc 273:59–65
Williams JBW, Kobak KA, Bech P et al (2008) The GRID-HAMD: standardization of the Hamilton Depression Rating Scale. Int Clin Psychopharmacol 23:120–129
Cavaletti G, Frigeni B, Lanzani F et al (2007) The Total Neuropathy Score as an assessment tool for grading the course of chemotherapy-induced peripheral neurotoxicity: comparison with the National Cancer Institute-Common Toxicity Scale. J Peripher Nerv Syst 12:210–215
Extra JM, Marty M, Brienza S, Misset JL (1998) Pharmacokinetics and safety profile of oxaliplatin. Semin Oncol 25:13–22
Blinman P, Duric V, Nowak AK et al (2010) Adjuvant chemotherapy for early colon cancer: what survival benefits make it worthwhile? Eur J Cancer 46:1800–1807
Acknowledgements
We wish to acknowledge the support of clinicians and staff of the Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia. We wish to thank all the patients who participated in the study.
Funding
Dr. Bennett is supported by a National Breast Cancer Foundation (Australia) Postdoctoral Fellowship (no. PF-08-01).
Conflict of interest statement
None of the authors have any conflicts of interest or financial disclosures in relation to this manuscript or the work described in this manuscript.
Data responsibility
The first author (Dr. Bennett), Susanna Park and senior author (Dr. Goldstein) had full access to all primary study data and take responsibility for the integrity of the data and accuracy of the data analyses. The authors agree to allow the journal to review their data if requested.
Author information
Authors and Affiliations
Corresponding author
Additional information
This is an original work and all the authors meet criteria for authorship.
Rights and permissions
About this article
Cite this article
Bennett, B.K., Park, S.B., Lin, C.SY. et al. Impact of oxaliplatin-induced neuropathy: a patient perspective. Support Care Cancer 20, 2959–2967 (2012). https://doi.org/10.1007/s00520-012-1428-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-012-1428-5