Correlates of Taxane-Induced Neuropathy, an Electronic Health Record Based Observational Study

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common therapeutic complication affecting cancer patients’ quality-of-life. We evaluated clinical characteristics, demographics, and lifestyle factors in association with CIPN following taxane treatment. Methods: Data were extracted from the electronic health record of 3387 patients diagnosed with a primary cancer and receiving taxane (i.e., paclitaxel or docetaxel) at Vanderbilt University Medical Center. Neuropathy was assessed via a validated computer algorithm. Univariate and multivariate regression models were applied to evaluate odds ratios (ORs) and 95% confidence intervals (CIs) of CIPN-associated factors. Results: Female sex (OR = 1.28, 95% CI = 1.01–1.62), high body-mass index (BMI) (OR = 1.31, 95% CI = 1.06–1.61 for overweight, and OR = 1.49, 95% CI = 1.21–1.83 for obesity), diabetes (OR = 1.66, 95% CI = 1.34–2.06), high mean taxane dose (OR = 1.05, 95% CI = 1.03–1.08 per 10 mg/m2), and more treatment cycles (1.12, 95% CI = 1.10–1.14) were positively associated with CIPN. Concurrent chemotherapy (OR = 0.74, 95% CI = 0.58–0.94) and concurrent radiotherapy (OR = 0.77, 95% CI = 0.59–1.00) were inversely associated with CIPN. Obesity and diabetes both had a stronger association with docetaxel CIPN compared to paclitaxel, although interaction was only significant for diabetes and taxane (p = 0.019). Increased BMI was associated with CIPN only among non-diabetic patients (OR:1.34 for overweight and 1.68 for obesity), while diabetes increased CIPN risk across all BMI strata (ORs were 2.65, 2.41, and 2.15 for normal weight, overweight, and obese, respectively) compared to normal-weight non-diabetic patients (p for interaction = 0.039). Conclusions: Female sex, obesity, and diabetes are significantly associated with taxine-induced CIPN. Further research is needed to identify clinical and pharmacologic strategies to prevent and mitigate CIPN in at-risk patient populations.