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Taxane-induced peripheral neuropathy: differences in patient report and objective assessment

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Abstract

Purpose

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting side-effect of neurotoxic cancer treatment impacting on long-term quality of life. Symptoms include numbness, tingling, and pain, affecting the distal extremities. However, patients often report symptoms discrepant from the expected symmetrical distribution and the degree of concurrence with objective assessment remains ill-defined. This study aimed to investigate severity and symmetry of neuropathy symptoms to enable comparison of objective measures and patient report.

Methods

Forty-five taxane-treated patients (F = 43, 66 ± 1.5 years, 19 months post-treatment) completed bilateral neuropathy assessments via clinical examination, sensory nerve conduction studies (NCS), and patient questionnaires. The laterality index (LI) was calculated as a ratio of smaller to larger side-to-side differences.

Results

Neuropathy was reported by 89% of the cohort. On clinical examination, 83% had ≥ 2 abnormalities, with 38–35% having upper or lower limb sensory amplitudes below normative range. Thirty-five percent indicated side-to-side symptom asymmetry; however, there was no significant asymmetry evident on clinical examination (LI Asym = .60 ± .10, Sym = .76 ± .05, NS) and no difference in side-to-side NCS (median LI:Asym = .69 ± .06, Sym = .81 ± .04, NS; Sural LI:Asym = .80 ± .04, Sym = .81 ± .04, NS). Accordingly, there was no statistical association between patient-reported and objective assessment of side-to-side asymmetry, suggesting discordance between patient experience and objective assessment. Similarly, discrepancies in symptom severity between hands and feet were reported by 32% of the cohort. However, patients reporting differences in symptom severity between the hands and feet were just as likely to present with comparable assessments as to demonstrate objective discrepancies.

Conclusions

Discrepancies may exist between the patient experience of CIPN and objective assessments. Understanding these discrepancies may help to elucidate underlying mechanisms and better inform treatment strategies.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

This study was supported by a Cancer Institute NSW Program Grant (14/TPG/1-05) and a National Health and Medical Research Council of Australia (NHMRC) Project Grant (#1080521). SBP is supported by a NHMRC Career Development Fellowship (#1148595). MCK was supported by a NHMRC Practitioner Fellowship (1156093); and by ForeFront, a large collaborative research group dedicated to the study of neurodegenerative diseases and funded by the National Health and Medical Research Council of Australia Program Grant (#1132524).

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Authors and Affiliations

  1. Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia

    Hannah C. Timmins, Tiffany Li, Matthew C. Kiernan & Susanna B. Park

  2. Sydney Medical School, The University of Sydney, Sydney, Australia

    Matthew C. Kiernan

  3. Royal Prince Alfred Hospital, Camperdown, Australia

    Matthew C. Kiernan

  4. Department of Oncology, Royal North Shore Hospital, St Leonards, Australia

    Sally Baron-Hay

  5. Sydney Adventist Hospital, SAN Integrated Cancer Centre, University of Sydney, Sydney, Australia

    Gavin Marx

  6. Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, North Sydney, Australia

    Frances Boyle

  7. Prince of Wales Clinical School, UNSW, Kensington, Australia

    David Goldstein

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Correspondence to Susanna B. Park.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (RPAH Zone of the Sydney Local Health District X14-0239) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Timmins, H.C., Li, T., Kiernan, M.C. et al. Taxane-induced peripheral neuropathy: differences in patient report and objective assessment. Support Care Cancer 28, 4459–4466 (2020). https://doi.org/10.1007/s00520-020-05299-y

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