Pain descriptors of taxane acute pain syndrome (TAPS) in breast cancer patients—a prospective clinical study
Taxane acute pain syndrome (TAPS) is a clinically significant side-effect of taxane chemotherapy, often described as arthralgia and myalgia that occurs 2–3 days after infusion. The aim of this study was to assess pain descriptors used by patients during their experience of TAPS.
A clinical prospective cohort study was conducted on breast cancer patients who had not received prior chemotherapy and were asked to complete diaries on three consecutive docetaxel treatment cycles on days 1–7, 14, and 21 (acute phase). Questionnaires to assess pain severity, descriptors of pain, and the interference in activities due to pain were adapted from the Brief Pain Inventory and the McGill Pain Questionnaire. Telephone questionnaire follow-up was done at 1, 3, 6, 9, and 12 months following docetaxel (delayed phase).
The most commonly used descriptor for acute and chronic pain was “aching” (90–96%). However, in the delayed phase of the study, “burning” (32–50%), “radiating” (39–48%), and “sharp” (40–69%) were used more often. In both acute and chronic pain phases, most patients experienced moderate/severe pain regardless of the location. Pain in cycle 1 was predictive of pain in subsequent taxane cycles (p < 0.0001). Pain in cycle 3 was predictive of chronic pain (p < 0.002).
The descriptors used by patients experiencing chemotherapy-induced pain (ChIP) may be reflective of the underlying mechanisms. It is suspected that TAPS initiates as an acute inflammatory pain, which over time develops into neuropathic pain, known as chemotherapy-induced peripheral neuropathy (CIPN). However, the subjective pain experience varies from patient to patient.
KeywordsBreast cancer Taxane Pain descriptors Taxane acute pain syndrome (TAPS) Chemotherapy-induced pain (ChIP)
Conception and design: Carlo De Angelis, Edward Chow, Daniela Gallo-Hershberg, Angie Giotis, Jenna van Draanen.
Data management: Daniela Gallo-Hershberg, Angie Giotis, Jenna van Draanen, Shannon Goodall.
Analysis and interpretation: Carlo De Angelis, Rashi Asthana, Liying Zhang.
Drafting of the article: Rashi Asthana, Bo Angela Wan, Patrick Diaz.
Revision of the article: all authors.
Final approval of the version: all authors.
Agreement to be accountable for all aspects of the work: all authors.
We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund. The funding sources were not involved in the study design, data collection, analyses and interpretation of the data, manuscript writing, and the decision to submit the article for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Fernandes R, Mazzarello S, Hutton B, Shorr R, Majeed H, Ibrahim MFK, Jacobs C, Ong M, Clemons M (2016) Taxane acute pain syndrome (TAPS) in patients receiving taxane-based chemotherapy for breast cancer—a systematic review. Support Care Cancer 24(8):3633–3650. https://doi.org/10.1007/s00520-016-3256-5 CrossRefGoogle Scholar
- 4.Chiu N, Zhang L, Dent R, Giotis A, van Draanen J, Gallo-Hershberg D, Chiu L, Chow R, Wan BA, Pasetka M, Stinson J, Stacey E, Verma S, Lam H, Chow E, DeAngelis C (2018) A prospective study of docetaxel-associated pain syndrome. Support Care Cancer 26(1):203–211. https://doi.org/10.1007/s00520-017-3836-z CrossRefGoogle Scholar
- 5.Fernandes R, Mazzarello S, Hutton B, Shorr R, Ibrahim MFK, Jacobs C et al (2016) A systematic review of the incidence and risk factors for taxane acute pain syndrome in patients receiving taxane-based chemotherapy for prostate cancer. Clin Genitourin Cancer 15(1):1–6. https://doi.org/10.1016/j.clgc.2016.07.018 CrossRefGoogle Scholar
- 10.Persohn E, Canta A, Schoepfer S, Traebert M, Mueller L, Gilardini A, Galbiati S, Nicolini G, Scuteri A, Lanzani F, Giussani G, Cavaletti G (2005) Morphological and morphometric analysis of paclitaxel and docetaxel-induced peripheral neuropathy in rats. Eur J Cancer 41(10):1460–1466. https://doi.org/10.1016/j.ejca.2005.04.006 CrossRefGoogle Scholar
- 13.Cleeland CS, Ryan KM (1994) Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap 23(2):129–138Google Scholar
- 22.Loprinzi CL, Reeves BN, Dakhil SR, Sloan JA, Wolf SL, Burger KN, Kamal A, le-Lindqwister NA, Soori GS, Jaslowski AJ, Novotny PJ, Lachance DH (2011) Natural history of paclitaxel-associated acute pain syndrome: prospective cohort study NCCTG N08C1. J Clin Oncol 29(11):1472–1478. https://doi.org/10.1200/JCO.2010.33.0308 CrossRefGoogle Scholar
- 26.Wilkie DJ, Molokie R, Boyd-Seal D, Suarez ML, Kim YO, Zong S, Wittert H, Zhao Z, Saunthararajah Y, Wang ZJ (2010) Patient-reported outcomes: descriptors of nociceptive and neuropathic pain and barriers to effective pain management in adult outpatients with sickle cell disease. J Natl Med Assoc 102(1):18–27. https://doi.org/10.1016/S0027-9684(15)30471-5 CrossRefGoogle Scholar
- 29.Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E (2005) Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 114(1–2):29–36. https://doi.org/10.1016/j.pain.2004.12.010 CrossRefGoogle Scholar
- 36.Makker PGS, Duffy SS, Lees JG, Perera CJ, Tonkin RS, Butovsky O, Park SB, Goldstein D, Moalem-Taylor G (2017) Characterisation of immune and neuroinflammatory changes associated with chemotherapy-induced peripheral neuropathy. PLoS One 12(1):1–24. https://doi.org/10.1371/journal.pone.0170814 CrossRefGoogle Scholar
- 37.Chiu N, Zhang L, Gallo-Hershberg D, Dent R, Chiu L, Pasetka M, van Draanen J, Chow R, Lam H, Verma S, Stinson J, Stacey E, Chow E, DeAngelis C (2016) Which pain intensity scale from the brief pain inventory correlates most highly with functional interference scores in patients experiencing taxane-induced arthralgia and myalgia? Support Care Cancer 24(7):2979–2988. https://doi.org/10.1007/s00520-016-3106-5 Google Scholar
- 38.Zheng FY, Xiao WH, Bennett GJ (2011) The response of spinal microglia to chemotherapy-evoked painful peripheral neuropathies is distinct from that evoked by traumatic nerve injuries. Neuroscience 176:447–454. https://doi.org/10.1016/j.neuroscience.2010.12.052 CrossRefGoogle Scholar