Older patients with low hemoglobin and higher body mass index - particularly women - were more likely to experience chemotherapy-induced peripheral neuropathy (CIPN) in a cohort study. "The identification of these risk factors may allow for early identification of susceptible patients, so that long-lasting toxicity can be pre-empted through timely treatment modifications," Dr. David Goldstein of the University of New South Wales and Dr. Susanna Park of the University of Sydney told Reuters Health in a joint email. Awareness of the risks also "may assist clinicians in target at-risk patients with closer symptom surveillance or neurological monitoring." As reported in JAMA Network Open, the researchers assessed pretreatment blood-based clinical factors and demographic characteristics of 333 patients (median age, 58; 80% women) treated with paclitaxel (228) or oxaliplatin (105) chemotherapy at urban multicenter cancer clinics and academic institutions in Australia. The most common cancer types were breast (41.4%), colorectal (24.9%), and ovarian (11.1%); 5% of patients had received prior neurotoxic chemotherapy and 26% received paclitaxel and carboplatin concurrently. The median treatment duration was 13 weeks. Neuropathy assessments were done three to 12 months posttreatment. CIPN severity was compared with clinical factors within 30 days before starting chemotherapy. Most participants (71.5%) had grade 1 CIPN or higher. Those with low hemoglobin pretreatment had worse CIPN posttreatment: median composite neurological grading scale score, 5 versus 4; grooved pegboard mean time, 84.2 versus 72.9 seconds; grating orientation task, 4.8 versus 3.9 mm; 2-point discrimination, 45% vs 28%. No other impairments that were outside of normative ranges were associated with CIPN. In a multivariable model, factors associated with worse CIPN included: lower hemoglobin (beta = −0.47), higher body mass index (beta = 0.08), and older age (beta = 0.08). Drs. Goldstein and Park said, "The findings...could lead to future interventions investigating the impact of correcting low hemoglobin levels to potentially reduce neuropathy risk. Prospective studies are now indicated to monitor hemoglobin levels over time and their association with neuropathy severity." CIPN biomarker researcher Dr. Daniel Hertz, an assistant professor at the University of Michigan College of Pharmacy and member of the U-M Rogel Cancer Center in Ann Arbor, commented in an email to Reuters Health. "Most patients with cancer will carry at least one of these risk factors. The important next step is to understand how we can combine risk factors to identify patients who are at highest risk, in whom enhanced CIPN monitoring may be beneficial." "Although there are approaches used by our rehabilitation colleagues to reduce the severity and interference caused by CIPN, there is a lack of highly effective treatments once CIPN has occurred," he said. "The best way to prevent long-term, life-altering CIPN is to prevent severe CIPN from occurring during treatment. We are developing and testing a smartphone app, NeuroDetect, to monitor for CIPN during treatment" —Marilynn Larkin Source
