Nearly half of female cancer survivors suffer from chemotherapy-induced peripheral neuropathy (CIPN) even years after completing treatment, a new study shows. The women experience pain, loss of sensation and gait changes that make walking difficult and falls more frequent. The risk of falls increases 1.5 times with each unit of increase of symptom severity, the study reports.
Falls can be life threatening for cancer patients whose blood counts are low due to the side effects of treatment, said Cathie Limbaugh, MSN, of the Siteman Cancer Center/ Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri in an interview with MedPage Today. And even many years later, a fall can add thousands of dollars to the overall cost of care. According to study authors Kerri M. Winters-Stone, Ph.D., of the Oregon Health & Science University in Portland and colleagues, a single fall can add up to $17,000 to a cancer survivor’s healthcare costs.
Poor physical functioning in cancer survivors also correlates with an almost 20 percent greater risk of death, the authors point out.
Treatment-Related Disability High
The OHSU researchers studied 518 women who were enrolled in four different fall-prevention studies who had completed cancer treatment between three and 33 years before. The women were asked to complete a self-assessment that documented physical functioning, disability and the number of falls within the last year. The subjects also completed objective testing for leg strength and gait characteristics such as step speed, step rate and stride length.
In all, 47 percent of the women experienced chemotherapy-induced neuropathy an average of six years after completing chemotherapy. Symptoms were more common in the women who were closest to their diagnosis. Other factors that increased the likelihood of neuropathy symptoms were:
- Stage II or III cancer (other than breast cancer)
- Less physical activity
- More coexisting conditions
The rate of falls was 1.8 times higher for women with neuropathy symptoms than for those without symptoms. Additionally, younger cancer survivors with neuropathy symptoms were nearly 25 percent more likely than older adults in the general population to experience a fall.
Earlier Intervention Needed
The study highlights the need for better assessment of women undergoing cancer treatment, the study authors point out. Patients are often reluctant to self-report neuropathy symptoms because they fear it may disrupt their therapy, Limbaugh adds. Thus, part of the overall screening of women with cancer should include pretreatment assessment for physical mobility. And ongoing, objective measurement of physical function should be part of the overall treatment plan.
“Our data suggest that the etiology of disability and falls associated with CIPN symptoms may be unique; thus, efforts to define, implement, and evaluate the efficacy and cost effectiveness of specific prevention strategies for persons with CIPN are urgently needed,” the study authors wrote.
Treatment of neuropathy symptoms should also be more aggressive, the authors conclude. Current treatment guidelines, which rely on pharmaceutical management and strength training exercises, are not enough. Instead, female cancer survivors need “task-specific functional training” to address specific deficits that contribute to disability and increase the risk of falls.
In an accompanying editorial in the Journal of Clinical Oncology, Nicole L. Stout, DPT, of the National Institutes of Health Clinical Center in Bethesda, Maryland, agreed. “Addressing the issue of CIPN-related falls requires a significant change in oncology clinical practice” she said.