Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients

Abstract

Background

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several commonly used chemotherapy drugs including taxanes, vinca alkaloids, and platinum compounds. Development of CIPN is highly variable, both in self-reported symptoms and functional consequences, and can be severe enough to alter dose intensity.

Purpose

To describe the natural histories of both patient-reported symptoms of CIPN and functional impairments in breast cancer patients undergoing taxane-based chemotherapy.

Methods

Thirty-three breast cancer patients (32 female/1 male; 47.8 ± 11.2 years; n = 17 stage II/n = 16 stage III) were enrolled. Patients completed self-reports of symptoms and function (e.g., EORTC QLQ-CIPN20) and objective measures of physical function (i.e., balance and gait testing) in an outpatient oncology clinic at five timepoints: (1) baseline—prior to starting chemotherapy, (2–4) before starting subsequent chemotherapy cycles, and (5) 1–3 months after receiving their last taxane infusion.

Results

Significant negative changes in both patient-reported outcomes and objective functional measures were observed. Decreased balance was observed after the first chemotherapy cycle (28% increase in medial–lateral excursion of the center of pressure, p = 0.016) and progressed with cumulative exposure (43% increase, p < 0.001). Patients also demonstrated slower walking speeds (5% decrease, p = 0.003) as they progressed through treatment. These functional deficits were mirrored with increased patient-reported symptom severity for all EORTC QLQ-CIPN20 subscales (all p < 0.05).

Conclusion

This study longitudinally assessed patient-reported outcomes concurrently with balance and gait testing in patients undergoing taxane therapy. Taxane treatment was associated with the development of clinically relevant problems in both CIPN symptoms and patient function.

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Acknowledgements

This research was supported by the National Cancer Institute (Grant No. R03 CA182165-01) and the National Science Foundation Graduate Research Fellowship Program (Grant No. DGE-1343012). The authors would also like to thank Tatiana Sedlak and Samuel Seelbach for their assistance with analyzing gait videos.

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Correspondence to Scott M. Monfort.

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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 and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all participants that were included in this study.

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Ajit M. W. Chaudhari and Maryam B. Lustberg are the senior authors with equal contribution.

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Monfort, S.M., Pan, X., Patrick, R. et al. Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients. Breast Cancer Res Treat 164, 69–77 (2017). https://doi.org/10.1007/s10549-017-4230-8

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Keywords

  • Gait
  • Balance
  • Breast cancer
  • CIPN
  • Neuropathies
  • Taxane