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Falls in persons with chemotherapy-induced peripheral neuropathy

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Abstract

Purpose

The purpose of this study was to evaluate possible risk factors for falls in a group of patients with chemotherapy-induced peripheral neuropathy (CIPN).

Methods

This prospective, descriptive study included persons receiving paclitaxel, docetaxel, oxaliplatin, or cispatin who reported at least one symptom of CIPN. Each patient was invited to complete the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and a demographic data questionnaire. Data were analyzed using descriptive statistics and logistic regression.

Results

In this sample (n = 109), fallers (n = 21) had higher doses of chemotherapy(p = 0.045), more neuropathic symptoms (p = 0.016), higher scores on the symptom experience (p = 0.005) and interference items (=0.001) on the CIPNAT, more severe muscle weakness (p < 0.001) and loss of balance (p < 0.001), and higher interference with walking(p < 0.001) and driving (p = 0.022). Patients who received taxanes were more likely to have fallen than patients who received platinum-based chemotherapy (p = 0.022). No significant differences in age or disease stage between fallers and non-fallers were present. Severity of loss of balance and cycle number was independently associated with falling.

Conclusions

This study demonstrates that the risk of falls increases with each cycle of chemotherapy and that patients receiving taxanes may be at greater risk of falls than patients receiving neurotoxic platinum-based drugs. Patients who report muscle weakness and loss of balance or say that their symptoms interfere with walking or driving may be at a higher risk of falls.

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References

  1. CDC (2010) Injury prevention & control: home and recreational safety. www.cdc.gov/homeandrecreationalsafety/falls/adults/adultfalls.htlm

  2. Overcash J (2007) Prediction of falls in older adults with cancer: a preliminary study. Oncol Nurs Forum 34(2):341–346

    Article  PubMed  Google Scholar 

  3. Holley S (2002) A look at the problem of falls among people with cancer. Clin J Oncol Nurs 6(4):193–197

    Article  PubMed  Google Scholar 

  4. Joseph EK, Levine JD (2009) Comparison of oxaliplatin- and cisplatin-induced painful peripheral neuropathy in the rat. J Pain 10(5):534–541

    Article  PubMed  CAS  Google Scholar 

  5. Lee JJ, Swain SM (2006) Peripheral neuropathy induced by microtubule-stabilizing agents. J Clin Oncol 24(10):1633–1642

    Article  PubMed  CAS  Google Scholar 

  6. Lipton RB, Apfel SC, Dutcher JP, Rosenberg R, Kaplan J, Berger A, Einzig AI, Wiernik P, Schaumburg HH (1989) Taxol produces a predominantly sensory neuropathy. Neurology 39(3):368–373

    PubMed  CAS  Google Scholar 

  7. Flatters SJ, Bennett GJ (2006) Studies of peripheral sensory nerves in paclitaxel-induced painful peripheral neuropathy: evidence for mitochondrial dysfunction. Pain 122(3):245–257

    Article  PubMed  CAS  Google Scholar 

  8. Joseph EK, Chen X, Bogen O, Levine JD (2008) Oxaliplatin acts on IB4-positive nociceptors to induce an oxidative stress-dependent acute painful peripheral neuropathy. J Pain 9(5):463–472

    Article  PubMed  CAS  Google Scholar 

  9. Bove L, Picardo M, Maresca V, Jandolo B, Pace A (2001) A pilot study on the relation between cisplatin neuropathy and vitamin E. J Exp Clin Canc Res 20(2):277–280

    CAS  Google Scholar 

  10. Kruse RL, Lemaster JW, Madsen RW (2010) Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: “feet first” randomized controlled trial. Phys Ther 90:1568–1579

    Article  PubMed  Google Scholar 

  11. Son J, Ashton-Miller JA, Richardson JK (2009) Frontal plane ankle proprioceptive thresholds and unipedal balance. Muscle Nerve 39(2):150–157

    Article  PubMed  Google Scholar 

  12. Richardson JK, Ashton-Miller JA (1996) Peripheral neuropathy: an often-overlooked cause of falls in the elderly. Postgrad Med 99(6):161–172

    PubMed  CAS  Google Scholar 

  13. Tilling LM, Darawil K, Britton M (2006) Falls as a complication of diabetes mellitus in older people. J Diab Complications 20(3):158–162

    Article  Google Scholar 

  14. Herndon JG, Helmick CG, Sattin RW, Stevens JA, DeVito C, Wingo PA (1997) Chronic medical conditions and risk of fall injury events at home in older adults. J Am Geriatr Soc 45(6):739–743

    PubMed  CAS  Google Scholar 

  15. Pandya N, Bookhart B, Mody SH, Funk Orsini PA, Reardon G (2008) Study of anemia in long-term care (SALT): prevalence of anemia and its relationship with the risk of falls in nursing home residents. Curr Med Res Opin 24(8):2139–2149

    Article  PubMed  Google Scholar 

  16. Donald IP, Bulpitt CJ (1999) The prognosis of falls in elderly people living at home. Age Ageing 28(2):121–125

    Article  PubMed  CAS  Google Scholar 

  17. Helbostad JL, Leirfall S, Moe-Nilssen R, Sletvold O (2007) Physical fatigue affects gait characteristics in older persons. J Gerontol A Biol Sci Med Sci 62(9):1010–1015

    Article  PubMed  Google Scholar 

  18. Luciani A, Jacobsen PB, Extermann M, Foa P, Marussi D, Overcash JA, Balducci L (2008) Fatigue and functional dependence in older cancer patients. Am J Clin Oncol 31(5):424–430. doi:10.1097/COC.0b013e31816d915f

    Article  PubMed  Google Scholar 

  19. Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10(1):20–30

    Article  PubMed  CAS  Google Scholar 

  20. Feldblum I, German L, Bilenko N, Shahar A, Enten R, Greenberg D, Harman I, Castel H, Shahar DR (2009) Nutritional risk and health care use before and after an acute hospitalization among the elderly. Nutrition 25:415–420

    Article  PubMed  Google Scholar 

  21. Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC (2008) Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 56(1):68–75

    Article  PubMed  Google Scholar 

  22. Balducci L (2007) Aging, frailty, and chemotherapy. Cancer Control 14(1):7–12

    PubMed  Google Scholar 

  23. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148

    PubMed  CAS  Google Scholar 

  24. Gale CR, Martyn CN, Cooper C, Sayer AA (2007) Grip strength, body composition, and mortality. Int J Epidemiol 36(1):228–235

    Article  PubMed  Google Scholar 

  25. Wrobel JS, Crews RT, Connolly JE (2009) Clinical factors associated with a conservative gait pattern in older male veterans with diabetes. J Foot Ankle Res 2:11

    Article  PubMed  Google Scholar 

  26. Paul L, Ellis BM, Leese GP, McFadyen AK, McMurray B (2009) The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy. Diabet Med 26(3):234–239

    Article  PubMed  CAS  Google Scholar 

  27. Macgilchrist C, Paul L, Ellis BM, Howe TE, Kennon B, Godwin J (2010) Lower-limb risk factors for falls in people with diabetes mellitus. Diabet Med 27(2):162–168

    Article  PubMed  CAS  Google Scholar 

  28. Hile ES, Fitzgerald GK, Studenski SA (2010) Persistent mobility disability after neurotoxic chemotherapy. Phys Ther 90:1649–1657

    Article  PubMed  Google Scholar 

  29. Richardson JK, Sandman D, Vela S (2001) A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil 82(2):205–209

    Article  PubMed  CAS  Google Scholar 

  30. Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, Fallucca F (2006) Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diab Complications 20(4):216–223

    Article  Google Scholar 

  31. Ruhland JL, Shields RK (1997) The effects of a home exercise program on impairment and health-related quality of life in persons with chronic peripheral neuropathies. Phys Ther 77(10):1026–1039

    PubMed  CAS  Google Scholar 

  32. Bulat T, Hart-Hughes S, Ahmed S, Quigley P, Palacios P, Werner DC, Foulis P (2007) Effect of a group-based exercise program on balance in elderly. Clin Interv Aging 2(4):655–660

    PubMed  Google Scholar 

  33. de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947

    PubMed  Google Scholar 

  34. Hilpert F, Stahle A, Tome O, Burges A, Rossner D, Spathe K, Heilmann V, Richter B, du Bois A (2005) Neuroprotection with amifostine in the first-line treatment of advanced ovarian cancer with carboplatin/paclitaxel-based chemotherapy—a double-blind, placebo-controlled, randomized phase II study from the Arbeitsgemeinschaft Gynakologische Onkologoie (AGO) Ovarian Cancer Study Group. Support Care Cancer 13(10):797–805

    Article  PubMed  CAS  Google Scholar 

  35. Hochster HS, Grothey A, Childs BH (2007) Use of calcium and magnesium salts to reduce oxaliplatin-related neurotoxicity. J Clin Oncol 25(25):4028–4029

    Article  PubMed  Google Scholar 

  36. Bakitas MA (2007) Background noise: the experience of chemotherapy-induced peripheral neuropathy. Nurs Res 56(5):323–331

    Article  PubMed  Google Scholar 

  37. Tofthagen C (2010) Patient perceptions associated with chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 14(3):E22–E28

    Article  PubMed  Google Scholar 

  38. Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C (2007) Putting evidence into practice: evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 11(6):901–913

    Article  PubMed  Google Scholar 

  39. Wampler MA, Hamolsky D, Hamel K, Melisko M, Topp KS (2005) Case report: painful peripheral neuropathy following treatment with docetaxel for breast cancer. Clin J Oncol Nurs 9(2):189–193

    Article  PubMed  Google Scholar 

  40. Tofthagen C, McMillan SC, Kip K (2011) Development and psychometric evaluation of the chemotherapy-induced peripheral neuropathy assessment tool. Cancer Nurs (in press)

  41. Lehky TJ, Leonard GD, Wilson RH, Grem JL, Floeter MK (2004) Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy. Muscle Nerve 29(3):387–392

    Article  PubMed  CAS  Google Scholar 

  42. Badros A, Goloubeva O, Dalal JS, Can I, Thompson J, Rapoport AP, Heyman M, Akpek G, Fenton RG (2007) Neurotoxicity of bortezomib therapy in multiple myeloma: a single-center experience and review of the literature. Cancer 110:1042–1049

    Article  PubMed  CAS  Google Scholar 

  43. Storey DJ, Sakala M, McLean CM, Phillips HA, Dawson LK, Wall LR, Fallon MT, Clive S (2010) Capecitabine combined with oxaliplatin (CapOx) in clinical practice: how significant is peripheral neuropathy? Ann Oncol 21:1657–1661

    Article  PubMed  CAS  Google Scholar 

  44. Argyriou AA, Polychronopoulos P, Koutras A, Iconomou G, Gourzis P, Assimakopoulos K, Kalofonos HP, Chroni E (2006) Is advanced age associated with increased incidence and severity of chemotherapy-induced peripheral neuropathy? Support Care Cancer 14(3):223–229

    Article  PubMed  Google Scholar 

  45. Dunlap B, Paice JA (2006) Chemotherapy-induced peripheral neuropathy: a need for standardization in measurement. J Support Oncol 4(8):398–399

    PubMed  Google Scholar 

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Acknowledgments

This study was funded by an American Cancer Society Doctoral Scholarship in Cancer Nursing (DSCN-08-205-01).

Conflict of interest

Authors have no financial relationship with the organization that sponsored the research and have full control of all primary data. We agree to allow the journal to review our data if requested.

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Authors and Affiliations

  1. College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC22, Tampa, FL, 33612, USA

    Cindy Tofthagen, Janine Overcash & Kevin Kip

Authors
  1. Cindy Tofthagen
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  2. Janine Overcash
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  3. Kevin Kip
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Corresponding author

Correspondence to Cindy Tofthagen.

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Tofthagen, C., Overcash, J. & Kip, K. Falls in persons with chemotherapy-induced peripheral neuropathy. Support Care Cancer 20, 583–589 (2012). https://doi.org/10.1007/s00520-011-1127-7

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  • DOI: https://doi.org/10.1007/s00520-011-1127-7

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