Patient-reported and clinician-reported chemotherapy-induced peripheral neuropathy in patients with early breast cancer: Current clinical practice

Kirsten A. Nyrop*, Allison M. Deal, Kathryn E. Reeder-Hayes, Shlomit S. Shachar, Bryce B. Reeve, Ethan Basch, Seul Ki Choi, Jordan T. Lee, William A. Wood, Carey K. Anders, Lisa A. Carey, Elizabeth C. Dees, Trevor A. Jolly, Gretchen G. Kimmick, Meghan S. Karuturi, Raquel E. Reinbolt, Jo Ellen C. Speca, Hyman B. Muss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In the current study, the authors investigated the incidence of moderate to severe chemotherapy-induced peripheral neuropathy (CIPN) for chemotherapy regimens commonly used in current clinical practice for the treatment of patients with early breast cancer. Patient-reported and clinician-assessed CIPN severity scores were compared, and risk factors for CIPN severity were identified. Methods: Patients completed a Patient-Reported Symptom Monitoring form and oncologists completed a Common Terminology Criteria for Adverse Events form. CIPN reports were collected prospectively during regularly scheduled infusion visits throughout the duration of chemotherapy. Results: The sample included 184 women with a mean age of 55 years; approximately 73% were white. The 4 chemotherapy regimens used were doxorubicin and cyclophosphamide plus paclitaxel (60 patients); docetaxel and cyclophosphamide (50 patients); docetaxel, carboplatin, and anti–human epidermal growth factor receptor 2 (HER2) (24 patients); and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin (18 patients). All patients treated with doxorubicin and cyclophosphamide plus paclitaxel and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin received paclitaxel; all patients treated with docetaxel and cyclophosphamide and docetaxel, carboplatin, and anti-HER2 received docetaxel. The chemotherapy dose was reduced in 52 patients (28%); in 15 patients (29%), this reduction was due to CIPN. Chemotherapy was discontinued in 26 patients (14%), 8 because of CIPN. Agreement between patient-reported and clinician-assessed CIPN severity scores was minimal (weighted Cohen kappa, P =.34). Patient-reported moderate to severe CIPN was higher for paclitaxel (50%) compared with docetaxel (17.7%) (P <.001). Pretreatment arthritis and/or rheumatism (relative risk [RR], 1.58; 95% CI, 1.06-2.35 [P =.023]) and regimens containing paclitaxel (RR, 2.88; 95% CI, 1.72-4.83 [P <.0001]) were associated with higher CIPN severity. Being married (RR, 0.57; 95% CI, 0.37-0.887 [P =.01]) was found to be associated with lower CIPN severity. Conclusions: The discrepancy between patient-reported and clinician-assessed CIPN underscores the need for both patient and clinician perspectives regarding this common, dose-limiting, and potentially disabling side effect of chemotherapy.

Original languageEnglish
Pages (from-to)2945-2954
Number of pages10
JournalCancer
Volume125
Issue number17
DOIs
StatePublished - Sep 2019
Externally publishedYes

Keywords

  • breast
  • cancer
  • chemotherapy
  • neuropathy
  • peripheral

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