Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Clinical Risk Factors Associated with Development of Significant Nerve Damage During Chemotherapy (#538)

Tiffany Li 1 , Hannah C Timmins 2 , Lisa G Horvath 3 , Michelle Harrison 3 , Peter Grimison 3 , Michael Friedlander 4 , Gavin Marx 5 , Frances Boyle 6 , David Wyld 7 , Robert Henderson 7 , Sally Baron-Hay 8 , Matthew C Kiernan 2 , Elizabeth H Barnes 1 , David Goldstein 9 , Susanna B Park 1
  1. Faculty of Medicine and Health, University of Sydney, Sydney
  2. Neuroscience Research Australia, Randwick
  3. Chris O’Brien Lifehouse, Camperdown
  4. Prince of Wales Hospital, Randwick
  5. Sydney Adventist Hospital, Wahroonga
  6. Mater Hospital, North Sydney
  7. The University of Queensland, Brisbane
  8. Royal North Shore Hospital, St Leonards
  9. Prince of Wales Clinical School, UNSW, Kensington

Background and Objective

Chemotherapy-induced peripheral neuropathy (CIPN) is a complex and dose-limiting toxicity of anticancer treatments with chronic symptoms leading to increased disability and reduced quality of life. While majority of patients treated with neurotoxic treatments will develop CIPN, subgroup of patients will me more significantly impacted by these symptoms. This study evaluated clinical risk factors associated with development of chronic, severe and dose-limiting CIPN, utilising a comprehensive multi-modal battery of neuropathy assessment.

Methods

Baseline clinical risk factors were investigated in patients who had completed neurotoxic chemotherapy (taxanes, platinums and haematological cancer therapies). CIPN was assessed using patient reported outcome measure (EORTC QLQ-CIPN20), neurological and neurophysiological evaluation (Total Neuropathy Score, nerve conduction studies), and clinically graded neuropathy (NCI-CTCAE). Multivariate models of risk factors associated with development of chronic, severe and dose-limiting CIPN were evaluated using backwards stepwise regression model building.

Results

The study recruited 903 patients (age 61 (IQR 50-69) years) who were assessed 12 (IQR 6-24) months post neurotoxic treatment. 73% of patients presented with CIPN at time of assessment, with 37% having moderate to severe symptoms. 32% of patients had their neurotoxic treatment dose modified due to CIPN. Risk factors of CIPN differed depending on method of CIPN assessment. Common risk factors for chronic CIPN across all assessment approaches included older age, diabetes diagnosis, higher BMI and prior exposure to neurotoxic treatment (all P<0.05). Risk factors for severe CIPN included older age, higher BMI, prior neurotoxic treatment and female gender (all P<0.05), whereas risk factors for dose-limiting CIPN included older age and female gender (all P<0.05).

Discussion

This study identified baseline clinical risk factors associated chronic, severe and dose-limiting CIPN. Closer monitoring of these vulnerable cohorts will allow for timely CIPN management, including referral pathways to intervention and rehabilitation therapies which will ultimately lead to improved CIPN morbidity.