TY - JOUR
T1 - Falls, functioning, and disability among women with persistent symptoms of chemotherapy-induced peripheral neuropathy
AU - Winters-Stone, Kerri M.
AU - Horak, Fay
AU - Jacobs, Peter G.
AU - Trubowitz, Phoebe
AU - Dieckmann, Nathan F.
AU - Stoyles, Sydnee
AU - Faithfull, Sara
N1 - Publisher Copyright:
Copyright © 2017 American Society of Clinical Oncology. All rights reserved.
PY - 2017/8/10
Y1 - 2017/8/10
N2 - Purpose Chemotherapy-induced peripheral neuropathy (CIPN) may persist after treatment ends and may lead to functional decline and falls. This study compared objective and self-report measures of physical function, gait patterns, and falls between women cancer survivors with and without symptoms of CIPN to identify targets for functional rehabilitation. Methods A secondary data analysis of 512 women cancer survivors (age, 62 6 6 years; time since diagnosis, 5.8 6 4.1 years) categorized and compared women self-reporting symptoms of CIPN (CIPN+) with asymptomatic women (CIPN2) on the following: maximal leg strength, timed chair stand, physical function battery, gait characteristics (speed; step number, rate, and length; base of support), self-report physical function and disability, and falls in the past year. Results After an average of 6 years after treatment, 47% of women still reported symptoms of CIPN. CIPN+ had significantly worse self-report and objectively measured function than did CIPN2, with the exception of maximal leg strength and base of support during a usual walk. Gait was slower among CIPN+, with those women taking significantly more, but slower and shorter, steps than did CIPN2 (all P, .05). CIPN+ reported significantly more disability and 1.8 times the risk of falls compared with CIPN2 (P, .0001). Increasing symptom severity was linearly associated with worsening function, increasing disability, and higher fall risk (all P, .05). Conclusion This work makes a significant contribution toward understanding the functional impact of CIPN symptoms on cancer survivors. Remarkably, 47% of women in our sample had CIPN symptoms many years after treatment, together with worse function, greater disability, and more falls. CIPN must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to improve function must be included in clinical and survivorship care plans.
AB - Purpose Chemotherapy-induced peripheral neuropathy (CIPN) may persist after treatment ends and may lead to functional decline and falls. This study compared objective and self-report measures of physical function, gait patterns, and falls between women cancer survivors with and without symptoms of CIPN to identify targets for functional rehabilitation. Methods A secondary data analysis of 512 women cancer survivors (age, 62 6 6 years; time since diagnosis, 5.8 6 4.1 years) categorized and compared women self-reporting symptoms of CIPN (CIPN+) with asymptomatic women (CIPN2) on the following: maximal leg strength, timed chair stand, physical function battery, gait characteristics (speed; step number, rate, and length; base of support), self-report physical function and disability, and falls in the past year. Results After an average of 6 years after treatment, 47% of women still reported symptoms of CIPN. CIPN+ had significantly worse self-report and objectively measured function than did CIPN2, with the exception of maximal leg strength and base of support during a usual walk. Gait was slower among CIPN+, with those women taking significantly more, but slower and shorter, steps than did CIPN2 (all P, .05). CIPN+ reported significantly more disability and 1.8 times the risk of falls compared with CIPN2 (P, .0001). Increasing symptom severity was linearly associated with worsening function, increasing disability, and higher fall risk (all P, .05). Conclusion This work makes a significant contribution toward understanding the functional impact of CIPN symptoms on cancer survivors. Remarkably, 47% of women in our sample had CIPN symptoms many years after treatment, together with worse function, greater disability, and more falls. CIPN must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to improve function must be included in clinical and survivorship care plans.
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U2 - 10.1200/JCO.2016.71.3552
DO - 10.1200/JCO.2016.71.3552
M3 - Article
C2 - 28586243
AN - SCOPUS:85028733280
SN - 0732-183X
VL - 35
SP - 2604
EP - 2612
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 23
ER -