Quality of Life Research

, Volume 26, Issue 10, pp 2763–2772 | Cite as

The prevalence and pattern of chemotherapy-induced peripheral neuropathy among women with breast cancer receiving care in a large community oncology practice

  • Natalie B. SimonEmail author
  • Michael A. Danso
  • Thomas A. Alberico
  • Ethan Basch
  • Antonia V. Bennett



To describe the prevalence, severity, and risk factors of chemotherapy-induced peripheral neuropathy (CIPN) and its impact on function and quality of life (QOL) among women treated for breast cancer in a large U.S. Community Oncology practice.


Women previously treated with taxane-based chemotherapy for early-stage breast cancer completed the EORTC QLQ–C30, QLQ–BR23, and QLQ–CIPN20. Subscales are scored 0–100; higher scores indicate greater symptom severity. Pre-specified hypotheses were tested.


126 women with mean age 56.7 years (SD 11.8) were stage I–II (79.4%) or stage III (20.6%) at the time of the survey; 65.1% were White and 27.8% were Black or African American. The mean time since last taxane chemotherapy cycle was 144.9 weeks (SD 112.9). 73.0% reported having CIPN. QLQ–CIPN20 mean scores for the sensory, motor, and autonomic subscales were 18.9 (SD 23.1), 18.6 (SD 18.7), and 17.1 (SD 21.8), respectively. CIPN symptom severity was negatively correlated with global health status/QOL and physical and role functioning (range of r = −0.46 to −0.72). It was not associated with age, body mass index, diabetes, or cumulative taxane dosage, but was greater for Black or African American women (e.g., sensory, p < 0.002). CIPN sensory impairment was marginally greater for patients treated with paclitaxel compared to docetaxel (p < 0.064).


CIPN was prevalent in this community oncology practice and significantly impacts function and QOL. These data highlight the importance of developing methods to mitigate CIPN, and for screening for CIPN particularly among Black or African American women.


Breast cancer Chemotherapy-induced peripheral neuropathy Community practice Disparities Quality of life EORTC QLQ–C30 Treatment toxicity 



This study was not funded.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

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


  1. 1.
    American Cancer Society. (2014). What are the key statistics about breast cancer? Learn about cancer. Retrieved October 12, 2014 from
  2. 2.
    Park, S. B., Goldstein, D., Krishnan, A. V., Lin, C., Friedlander, M. L., Cassidy, J., et al. (2013). Chemotherapy-induced peripheral neurotoxicity: A critical analysis. CA: A Cancer Journal for Clinicians, 63(6), 419–436.Google Scholar
  3. 3.
    Bakitas, M. A. (2007). Background noise: The experience of chemotherapy-induced peripheral neuropathy. Nursing Research, 56(5), 323–331.CrossRefPubMedGoogle Scholar
  4. 4.
    Forsyth, P., Balmaceda, C., Peterson, K., Seidman, A. D., Brasher, P., & DeAngelis, L. M. (1997). Prospective study of paclitaxel-induced peripheral neuropathy with quantitative sensory testing. Journal of Neuro-oncology, 35, 47–53.CrossRefPubMedGoogle Scholar
  5. 5.
    Hilkens, P. H., & van den Bent, M. J. (1997). Chemotherapy-induced peripheral neuropathy. Journal of the Peripheral Nervous System, 2, 350–361.PubMedGoogle Scholar
  6. 6.
    Rowinsky, E. K., Chaudry, V., Cornblath, D. R., & Donehower, R. C. (1993). Neurotoxicity of taxol. Journal of the National Cancer Institute, 15, 107–115.Google Scholar
  7. 7.
    Lipton, R. B., Apfel, S. C., Dutcher, J. P., Rosenberg, R., Kaplan, J., Berger, A., et al. (1989). Taxol produces a predominantly sensory neuropathy. Neurology, 39, 368–373.CrossRefPubMedGoogle Scholar
  8. 8.
    Paice, J. A. (2009). Clinical challenges: Chemotherapy-induced peripheral neuropathy. Seminars in Oncology Nursing, 25, S8–S19.CrossRefPubMedGoogle Scholar
  9. 9.
    Hausheer, F. H., Schilsky, R. L., Bain, S., Berghorn, E. J., & Lieberman, F. (2006). Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Seminars in Oncology, 33(1), 15–49.CrossRefPubMedGoogle Scholar
  10. 10.
    Argyriou, A. A., Kyritsis, A. P., Makatsoris, T., & Kalofonos, H. P. (2014). Chemotherapy-induced peripheral neuropathy in adults: A comprehensive update of the literature. Cancer Management and Research, 6, 135–147.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Mols, F., Beijers, T., Vreugdenhil, G., & van de Poll-Franse, L. (2014). Chemotherapy-induced peripheral neuropathy and its association with quality of life: A systematic review. Supportive Care in Cancer, 22(8), 2261–2269.CrossRefPubMedGoogle Scholar
  12. 12.
    Hilkins, P. H., Verweij, J., Stoter, G., Vecht, C. J., van Putten, W. L., & van den Bent, M. J. (1996). Peripheral neurotoxicity induced by docetaxel. Neurology, 46, 104–108.CrossRefGoogle Scholar
  13. 13.
    Taxol [package insert]. (2003). Princeton, NJ: Bristol-Myers Squibb.Google Scholar
  14. 14.
    Wampler, M. A., Miaskowski, C., Hamel, K., Byl, N., Rugo, H., & Topp, K. S. (2006). The modified total neuropathy score: A clinically feasible and valid measure of taxane-induced peripheral neuropathy in women with breast cancer. The Journal of Supportive Oncology, 4(8), W9–W16.Google Scholar
  15. 15.
    Postma, T. J., Heimans, J. J., Muller, M. J., Ossenkoppele, G. J., Vermorken, J. B., & Aaronson, N. K. (1998). Pitfalls in grading severity of chemotherapy-induced peripheral neuropathy. Annals of Oncology, 9, 739–744.CrossRefPubMedGoogle Scholar
  16. 16.
    Cavaletti, G., Frigeni, B., Lanzani, F., Mattavelli, L., Susani, E., Alberti, P., et al. (2010). Chemotherapy-induced peripheral neurotoxicity assessment: A critical revision of the currently available tools. European Journal of Cancer, 46, 479–494.CrossRefPubMedGoogle Scholar
  17. 17.
    Shimozuma, K., Ohashi, Y., Takeuchi, A., Aranishi, T., Morita, S., Kuroi, K., 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. Supportive Care in Cancer, 17, 1483–1491.CrossRefPubMedGoogle Scholar
  18. 18.
    Kuroi, K., Shimozuma, K., Ohashi, Y., Takeuchi, A., Aranishi, T., Morita, S., et al. (2008). A questionnaire survey of physicians’ perspectives regarding the assessment of chemotherapy-induced peripheral neuropathy in patients with breast cancer. Japanese Journal of Clinical Oncology, 38, 748–754.CrossRefPubMedGoogle Scholar
  19. 19.
    Basch, E., Iasonos, A., McDonough, T., Barz, A., Culkin, A., & Kris, M. G. (2006). Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: Results of a questionnaire-based study. The Lancet Oncology, 7(11), 903–909.CrossRefPubMedGoogle Scholar
  20. 20.
    Speck, R. M., Sammel, M. D., Farrar, J. T., Hennessy, S., Mao, J. J., Stineman, M. G., et al. (2013). Impact of chemotherapy-induced peripheral neuropathy on treatment delivery in nonmetastatic breast cancer. Journal of Oncology Practice, 9(5), e234–e240.CrossRefPubMedGoogle Scholar
  21. 21.
    Mols, F., Beijers, T., Lemmens, V., van den Hurk, C. J., Vreugdenhil, G., & van de Poll-Franse, L. V. (2013). Chemotherapy-induced neuropathy and its association with quality of like among 2- to 11-year colorectal cancer survivors: Results from the population-based PROFILES registry. Journal of Clinical Oncology, 31(21), 2699–2707.CrossRefPubMedGoogle Scholar
  22. 22.
    Stubblefield, M. D., Burstein, H. J., Burton, A. W., Custodio, C. M., Deng, G. E., Ho, M., et al. (2009). NCCN task force report: Management of neuropathy in cancer. Journal of the National Comprehensive Cancer Network, 7(suppl 5), S-1–S-26.CrossRefGoogle Scholar
  23. 23.
    Kim, H. Y., Kang, J. H., Song, C. E., & Youn, H. J. (2013). Chemotherapy-induced peripheral neuropathy and quality of life in breast cancer patients. Asian Oncology Nursing, 13(4), 222–230.CrossRefGoogle Scholar
  24. 24.
    Schneider, B. P., Li, L., Radovich, M., Shen, F., Miller, K. D., Flockhart, D. A., et al. (2015). Genome-wide association studies for taxane-induced peripheral neuropathy in ECOG-5103 and ECOG-1199. Clinical Cancer Research, 21(22), 5082–5091.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Candelario, N., Wongrakpanich, S., & Morginstin, M. S. (2015). Predictors of chemotherapy-induced peripheral neuropathy among breast cancer patients treated with taxanes. Journal of Clinical Oncology, 33(suppl 28S), 90.CrossRefGoogle Scholar
  26. 26.
    Aaronson, N. K., Ahmadzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365–376.CrossRefPubMedGoogle Scholar
  27. 27.
    Sprangers, M. A., Groenvold, M., Arraras, J. I., Franklin, J., te Velde, A., Muller, M., et al. (1996). The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field study. Journal of Clinical Oncology, 14(10), 2756–2768.CrossRefPubMedGoogle Scholar
  28. 28.
    Fayers, P. M., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., & Bottomley, A. (2001). The EORTC QLQ-C30 Scoring Manual (3rd ed.). Brussles: European Organisation for Research and Treatment of Cancer.Google Scholar
  29. 29.
    Postma, T. J., Aaronson, N. K., Heimans, J. J., Muller, M. J., Hildebrand, J. G., Delattre, J. Y., et al. (2005). The development of an EORTC quality of life questionnaire to assess chemotherapy-induced peripheral neuropathy: The QLQ-CIPN20. European Journal of Cancer, 41(8), 1135–1139.CrossRefPubMedGoogle Scholar
  30. 30.
    Lumley, T., Diehr, P., Emerson, S., & Chen, L. (2002). The importance of the normality assumption in large public health data sets. Annual Review of Public Health, 23, 151–169.CrossRefPubMedGoogle Scholar
  31. 31.
    Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592.PubMedGoogle Scholar
  32. 32.
    Bell, D. S. (2010). Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. Southern Medical Journal, 103(3), 265–267.CrossRefPubMedGoogle Scholar
  33. 33.
    Eckhoff, L., Knoop, A. S., Jensen, M. B., Ejlertsen, B., & Ewertz, M. (2013). Risk of docetaxel-induced peripheral neuropathy among 1,725 Danish patients with early stage breast cancer. Breast Cancer Research and Treatment, 142(1), 109–118.CrossRefPubMedGoogle Scholar
  34. 34.
    Alberti, P., Rossi, E., Cornblath, D. R., Merkies, I. S., Postma, T. J., Frigeni, B., et al. (2014). Physician-assessed and patient-reported outcome measures in chemotherapy-induced sensory peripheral neurotoxicity: Two sides of the same coin. Annals of Oncology, 25(1), 257–264.CrossRefPubMedGoogle Scholar
  35. 35.
    Jones, S. E., Erban, J., Overmoyer, B., Budd, G. T., Hutchins, L., Lower, E., et al. (2005). Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. Journal of Clinical Oncology, 22, 5542–5551.CrossRefGoogle Scholar
  36. 36.
    Argyriou, A. A., Polychronopoulos, P., Iconomou, G., Koutras, A., Kalofonos, H. P., & Chroni, E. (2005). Paclitaxel plus carboplatin-induced peripheral neuropathy. A prospective clinical and electrophysiological study in patients suffering from solid malignancies. Journal of Neurology, 252(12), 1459–1464.CrossRefPubMedGoogle Scholar
  37. 37.
    Hershman, D. L., Weimer, L. H., Wang, A., Kranwinkel, G., Brafman, L., Fuentes, D., et al. (2011). Association between patient reported outcomes and quantitative sensory tests for measuring long-term neurotoxicity in breast cancer survivors treated with adjuvant paclitaxel chemotherapy. Breast Cancer Research and Treatment, 125(3), 767–774.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Natalie B. Simon
    • 1
    Email author
  • Michael A. Danso
    • 2
  • Thomas A. Alberico
    • 3
  • Ethan Basch
    • 4
  • Antonia V. Bennett
    • 5
  1. 1.College of Arts and SciencesUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of Medical Oncology and HematologyVirginia Oncology AssociatesNorfolkUSA
  3. 3.Department of Stem Cell Transplant, Medical Oncology, and HematologyVirginia Oncology AssociatesNorfolkUSA
  4. 4.Department of MedicineUniversity of North CarolinaChapel HillUSA
  5. 5.Department of Health Policy and ManagementUniversity of North CarolinaChapel HillUSA

Personalised recommendations