Wayne State University School of Medicine, Department of Oncology, Detroit, Michigan, USA.
Karmanos Cancer Institute, Detroit, Michigan, USA.
Cancer Med. 2021 Nov;10(22):8151-8161. doi: 10.1002/cam4.4328. Epub 2021 Oct 23.
Epidemiological studies of chemotherapy-induced peripheral neuropathy (CIPN) have predominantly focused on non-Hispanic White patients, despite the observation that African Americans are more likely to experience CIPN. To address this health disparities gap, we sought to identify non-genetic risk factors and comorbidities associated with CIPN in African American cancer survivors using the Detroit Research on Cancer Survivors study.
Logistic regression was used to evaluate relationships between presence of self-reported CIPN and relevant clinical characteristics in 1045 chemotherapy-treated African American cancer survivors. Linear regression was used to evaluate risk factors for CIPN and quality of life outcomes that reflect physical, social, emotional, and functional domains of health.
Patients with CIPN were more likely to report hypertension (OR = 1.28, 95% CI: 0.98-1.67, p = 0.07), hypercholesterolemia (OR = 1.32, 95% CI: 1.001-1.73, p = 0.05), history of depression (OR = 1.62, 95% CI: 1.18-2.25, p = 0.003), and diabetes (OR = 1.33, 95% CI: 0.98-1.82, p = 0.06) after adjustment for age at diagnosis, sex, and cancer site. BMI (OR = 1.02 kg/m , 95% CI: 1.006-1.04 kg/m , p = 0.008) was also positively associated with CIPN. In addition, CIPN status was significantly associated with quality of life (FACT-G total: β = -8.60, 95% CI: -10.88, -6.32) p < 0.0001) and mood (PROMIS Anxiety: β = 4.18, 95% CI: 2.92-5.45, p < 0.0001; PROMIS Depression: β = 2.69, 95% CI: 1.53-3.84, p < 0.0001) after adjustment for age at diagnosis, sex, cancer site, and comorbidities. Neither alcohol consumption (OR = 0.88, 95% CI: 0.68-1.14, p = 0.32) nor tobacco use (ever smoked: OR = 1.04, 95% CI: 0.80-1.35, p = 0.76; currently smoke: OR = 1.28, 95% CI: 0.90-1.82, p = 0.18) was associated with increased CIPN risk.
Risk factor profiles in African Americans are not entirely consistent with those previously reported for non-Hispanic White patients. Neglecting to understand the correlates of common chemotherapy-induced toxicities for this patient population may further contribute to the health disparities these individuals face in receiving adequate healthcare.
化疗引起的周围神经病（CIPN）的流行病学研究主要集中在非西班牙裔白人患者上，尽管观察到非裔美国人更有可能经历 CIPN。为了解决这一健康差异问题，我们利用底特律癌症幸存者研究，旨在确定与非裔美国癌症幸存者 CIPN 相关的非遗传风险因素和合并症。
采用 logistic 回归分析了 1045 例接受化疗的非裔美国癌症幸存者中自我报告的 CIPN 与相关临床特征之间的关系。采用线性回归评估了 CIPN 与反映健康的生理、社会、情感和功能领域的生活质量结果的相关风险因素。
患有 CIPN 的患者更有可能报告患有高血压（OR = 1.28，95%CI：0.98-1.67，p = 0.07）、高胆固醇血症（OR = 1.32，95%CI：1.001-1.73，p = 0.05）、抑郁症病史（OR = 1.62，95%CI：1.18-2.25，p = 0.003）和糖尿病（OR = 1.33，95%CI：0.98-1.82，p = 0.06），这些因素在调整了诊断时的年龄、性别和癌症部位后仍然存在。BMI（OR = 1.02kg/m ，95%CI：1.006-1.04kg/m ，p = 0.008）也与 CIPN 呈正相关。此外，CIPN 状况与生活质量（FACT-G 总分：β = -8.60，95%CI：-10.88，-6.32，p < 0.0001）和情绪（PROMIS 焦虑：β = 4.18，95%CI：2.92-5.45，p < 0.0001；PROMIS 抑郁：β = 2.69，95%CI：1.53-3.84，p < 0.0001）显著相关，在调整了诊断时的年龄、性别、癌症部位和合并症后仍然存在。饮酒（OR = 0.88，95%CI：0.68-1.14，p = 0.32）或吸烟（曾吸烟：OR = 1.04，95%CI：0.80-1.35，p = 0.76；现吸烟：OR = 1.28，95%CI：0.90-1.82，p = 0.18）均与增加 CIPN 风险无关。
非裔美国人的风险因素特征与先前报道的非西班牙裔白人患者的特征不完全一致。如果不了解非裔美国人常见化疗引起的毒性的相关因素，可能会进一步加剧这些患者在获得充分医疗保健方面面临的健康差异问题。
