Nearly half of all women treated with chemotherapy for cancer report symptoms of peripheral neuropathy long after their treatment has ended, and those with the condition have a significantly higher risk of falls, altered walking patterns and other difficulties in physical functioning, a new study has found.
Chemotherapy-induced peripheral neuropathy (CIPN) is damage to nerves that are far from the brain and spinal cord. It can interfere with sensation and movement in the arms, legs, bladder and bowel.
“Women with peripheral neuropathy reported significantly lower physical functioning, significantly more difficulty with tasks of daily living, and nearly twice as many of the women with neuropathy experienced a fall in the last year,” says the study’s lead author, Kerri Winters-Stone.
The study was presented in a presscast held in advance of the 2016 Cancer Survivorship Symposium, a meeting sponsored by the American Society of Clinical Oncology (ASCO), the American Academy of Family Physicians, and the American College of Physicians in San Francisco from January 15-16, 2016.
Winters-Stone, a research professor at Oregon Health and Science University, noted that although CIPN is a common side effect during cancer treatment, fewer data exist on the extent of the condition after treatment or its impact on physical functioning. She attributed this to the fact that studies of CIPN in survivors are infrequent and typically draw on self-reports using small samples.
To address this limitation, researchers designed a study employing not only self-reports from 462 survivors on their physical functioning and number of falls in the past year, but also objective measures of their physical fitness based on such indicators as maximal leg press strength, timed chair stand (the amount of time it takes a woman to rise and sit in a chair five times), a physical performance battery which included assessment of balance and gait patterns as observed on a 4-meter electronic walkway (i.e., speed, number of steps and stride length).
The cohort for this comparative analysis was drawn from survivors enrolled in exercise clinical trials: 210 women reported symptoms of CIPN an average of six years after diagnosis (45 percent), and 252 did not. The average age of the participants was 62 years, and the majority (71 percent) had a diagnosis of breast cancer; the remaining diagnoses were lung, colorectal, ovarian or blood cancers.
Although the two groups were similar on objective measures of leg strength, “in nearly all other objective measures of physical functioning, we saw significant differences between the two,” Winters-Stone explained.
“Women who had peripheral neuropathy took longer to rise five times from a chair, they scored worse on the physical performance battery, their gait speed was slower, they took fewer steps, they had shorter strides and they spent more time in their gait cycle with two feet on the ground.”
In addition, 31 percent of the women with CIPN experienced a fall in the previous year versus 19 percent of those without CIPN. The researchers found that women with CIPN have specific underlying impairments that put them at risk for falls, limitations that may differ from those that occur with old age, for example. CIPN does not cause muscle weakness but, rather, can have a specific effect on movement and gait patterns. In this study, women with CIPN had difficulty rising from a chair, possibly because their brain does not get enough information from their feet about how quickly or forcefully to stand up.
“This study is important because it highlights that the neuropathy our patients are experiencing is not just a bothersome symptom — it’s much more than that,” stressed Merry-Jennifer Markham, ASCO spokesperson and moderator of the press cast.
“Neuropathy from chemotherapy not only impacts our survivors’ physical function for years after treatment has ended, it puts them at much higher risk for falls and the morbidity associated with those falls.”
Based on these findings, study authors suggest that commonly recommended exercise, such as walking, may be safer for women with CIPN when done on a treadmill with handrails instead of outdoors, because their altered gait puts them at increased risk of falling. Machine-based resistance training may also not be as beneficial, because neuropathy does not decrease leg strength. Instead, rehabilitation efforts should focus on improving balance during upright movement and specific gait training.
Winters-Stone added that, although the findings from this analysis are based only on women, men with cancer are as likely to experience CIPN as women. She and her research team are currently developing a portable, smartphone-driven device that patients can use to detect and quantify symptoms of neuropathy, such as gait and balance impairments.
Markham added that while CIPN is a common side effect of chemotherapy drugs used to treat a wide range of cancers, it is both under-reported and under-recognized in practice.
“As both physicians and researchers, we owe it to our cancer survivors to take chemotherapy-induced peripheral neuropathy very seriously,” she says. “Strategies to reduce the likelihood of developing the symptom and to improve rehabilitation for those who get the symptom are sorely needed.”
As a man with CIPN I can attest to its deleterious effects like increased risk for falls, changed gait, etc. It can even affect driving because the sensory feedback from the foot on a gas or brake pedal is impaired.
I read this article with great interest -- because I am a man with CIPN. CIPN has caused me misery almost every day since my chemo regimens in 2007 and 2008. I was treated for follicular lymphoma, a blood cancer, with the standard chemotherapy drugs of the day. The nerve damage initially was so bad that I lost all feeling below the waist, and turned me into an invalid. After considerable physical therapy, I gained the ability to walk again. Today, seven years after the last chemo, I still have damage to nerves in my feet that cause me considerable pain that is controlled only by extended release narcotic medicines. My walking gait is a joke: I simply cannot walk a straight line without veering to the right or left. I have the most mixed of feelings in my feet, ranging from stabbing pain to numbness to burning to tingling to any combination thereof. My neurologist says the damage appears to be permanent. So, even though I am thankful my cancer has been in remission for these last seven years, the trade-off has been to have to learn to live with CIPN.
CIPN is a significant annoyance. I too can't seem to walk in a straight line. I do an hour of yoga every week, and after a year and a half, balancing on one foot is just about impossible. My oncologist has the nurse ask me questions when I go in for my check ups, but no remedies are suggested. It's been three and a half years since I completed by chemo for breast cancer, but the CIPN lingers on.
Everyday for 7 years I have struggled with peripheral neuropathy in my feet and lower legs. The sensations include stinging, burning, freezing, aching, and numbness, often all at the same time. Treatment: Cymbalta, Lyrica, several supplements, yoga, exercise, rest, talk therapy for pain related depression. I am grateful for research that suggest doctors should take this affliction seriously, but where is effective treatment, treatments that doesn't leave the patient foggy, tired, and still hurting?
I cried when I read this. At last, someone gets it. It's been 2 years since the completion of my treatment and when I tell my oncologist that my CIPN continues to worsen, she looks at me like I'm nuts. My neurologist pats my shoulder and tells me it will get better. Someday. My family and friends are loving and supportive and remind me that "it beats the alternative." At last, a ray of hope. Someone is paying attention to this debilitating side effect. Thank you!
After treatments in 2001 I did notice some loss of feeling in my feet and fingers. But I was able to handle it. But 5 years ago I had Bi-Lateral Knee replacement and then complications with one leg requiring a total of 5 Surgeries. Even now I can't walk as well as I would like and have blamed it on the Knee surgery. But in the past few months I realized it's not the knees that are giving me a problem. The problem seems to be in not know where my feet are or what they are touching. I do better barefooted but shoes drive me crazy. I feel like I am waling on hard wood platforms, no matter the shoe type. It seems to be harder to walk down steps because your not sure where they are, or stepping down from curbs, same thing. I have also noticed my balance is off and it usually comes from the way I place my feet. I agree with RF, when you mention it they just look at you and smile, and I know it's because they don't understand. Finally someone maybe will take this seriously. I have worried I am ready for a wheel chair.
I'm going on 11 years survivor of breast cancer. I was 44 when diagnosed and I was a very active, motivated person. I wouldn't even know where to start with everything that my body has done to me since my treatments. With my cancer being aggressive my doctor took the aggressive approach. I had 4 rounds of chemo every other week then my radiation. I barley missed any work and kept on trucking through it all.
It gradually started with my hands, then wrists, elbows, shoulders then spread everywhere. I ended up in the ER one time because I thought I was having a severe gallstone attack. It has traveled through out my body going from the top of my head to bottom of my feet. I use to sit at my desk at work and the pain would hit me so suddenly and sharply I'd come out of my chair, or just stay perfectly still until it passed. It now effects every part of my body. My (GP) doctor tried different pain management but nothing seemed to help. We tried Cymbolta but for me it made it worse. I could hardly get out of bed each day.
I've now been on Lyrica for the past 6 years and that has helped me deal with it better. I still have bad days especially with the weather. I have no strength in my hands and arms, balance problems, can't go barefoot, have cysts on my hands and on and on.
My life is nothing as it once was and it most likely won't be. I don't know if I'll ever get use to how limited I am now, it isn't easy and it's very frustrating to not be able to do all the things I once was able to do so well before my cancer.
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