Factors associated with chemotherapy-induced peripheral neuropathy-related reduced taxane dose or premature discontinuation in women with early-stage breast cancer

Abstract

ABSTRACTPurposeIn the absence of treatments for chemotherapy-induced peripheral neuropathy (CIPN), dose reductions (DR) and premature discontinuation (PD) are primary management strategies. However, decision-making guidance is insufficient and knowledge of factors associated with DR/PD is limited. We examined biopsychosocial factors associated with CIPN-related DR/PD in women undergoing taxane-based chemotherapy for early-stage breast cancer.Patients and methodsAs part of a longitudinal study of CIPN measurement, women completed assessments before the first taxane infusion and at the final infusion or within the originally expected timeframe for the final infusion. Participants completed self-report measures of CIPN, pain, and physical and psychosocial wellbeing, and underwent physical testing of lower limb disability and Quantitative Sensory Testing for sensation and pain threshold to thermal, vibration, and touch stimuli in the feet and hands. Sociodemographic and clinical data were collected. Logistic regression was used to identify factors associated with neuropathy-related DR/PD.ResultsAmong 121 participants, 66 (54.5%) received taxane-as-prescribed, 46 (38.0%) had neuropathy-related DR/PD, and 9 (7.4%) had DR/PD for other reasons. Factors associated with neuropathy-related DR/PD were receipt of paclitaxel (Odds Ratio [OR]=75.05, 95% Confidence Interval [CI] 2.56-2197.96]), lower pre-treatment pain catastrophizing (OR=0.72, 95% CI: 0.54 – 0.95), and higher post-treatment neuropathic pain (OR=10.77, 95% CI: 1.99 – 58.15) and sensitivity to cold pain in the hand (OR=1.64, 95% CI: 1.05 – 2.56).ConclusionCIPN-related DR/PD is associated with paclitaxel treatment and post-treatment neuropathic pain and cold pain sensitivity in the hands. CIPN communication to healthcare providers may be influenced by pain catastrophizing, suggesting symptom appraisal may be an important factor in communication. Findings could contribute to clinical practice recommendations to facilitate treatment decision-making.Lay summaryWe studied pre- and post-treatment factors associated with reduced taxane dose or early cessation due to chemotherapy-induced peripheral neuropathy in women undergoing chemotherapy for early-stage breast cancer. Reduced taxane dose or early cessation is associated with paclitaxel treatment, and high post-treatment neuropathic pain and sensitivity to cold pain stimuli in the hands. Communication of these experiences to healthcare providers may be influenced by pre-treatment thoughts and feelings about symptoms.Precis for use in the Table of Contentstwo concise sentences that state the significant conclusion(s) or message of the manuscript; Chemotherapy-induced peripheral neuropathy-related reduced taxane dose or premature discontinuation is associated with paclitaxel treatment and high post-treatment neuropathic pain and cold pain sensitivity in the upper limbs. Reporting of these experiences may be influenced by pre-treatment symptom appraisal and communication style.