1Concord Cancer Centre, Concord Repatriation General Hospital, Sydney; and.
2Clinical Research Centre, Sydney Local Health District, Camperdown, NSW, Australia.
J Natl Compr Canc Netw. 2022 Dec;20(12):1308-1315. doi: 10.6004/jnccn.2022.7050.
Chemotherapy-induced peripheral neuropathy (CIPN) can be a debilitating toxicity of oxaliplatin used for treatment of colorectal cancer (CRC). We aimed to assess CIPN symptoms and associations in our colorectal survivorship population and review the impact of neurotoxicity on dose delivery of oxaliplatin.
Patients attending their first visit to the Sydney Cancer Survivorship Centre following completion of adjuvant treatment for CRC completed comprehensive patient-reported outcome measures, including symptoms, quality of life (QoL), alcohol intake, and exercise habits. Participants scored symptoms of "numbness or pins and needles" in hands or feet from 0 (no trouble at all) to 10 (worst I can imagine). Diagnosis, treatment, and comorbidity details were obtained from medical records. A subset of patients completed serial assessments of PN symptoms at follow-up visits.
Data were analyzed from 233 patients (52% male; mean age, 63 years) with CRC attending their first visit at the Sydney Cancer Survivorship Centre. A subset of 104 patients were included in the longitudinal analysis. The odds of patient-reported numbness were significantly higher in patients receiving oxaliplatin (odds ratio, 5.6; 95% CI, 3.2-9.8), with 72.4% of oxaliplatin-treated CRC survivors reporting numbness an average of 5.9 months after chemotherapy. Mean patient-reported numbness was significantly higher in those who received oxaliplatin-containing chemotherapy (mean, 3.31) compared with fluoropyrimidines alone (mean, 1.37) and no chemotherapy (mean, 0.66). Of the patients receiving oxaliplatin, 80% required dose reduction or early cessation, with PN the most common reason reported. QoL in physical, emotional, and functional well-being domains was lower in patients with numbness. We found a weak negative association between numbness score and age, and between (1) numbness and cardiovascular disease and (2) numbers and pain score.
CIPN symptoms are common in CRC survivors who have received oxaliplatin and are associated with lower QoL. Neurotoxicity is underreported in clinical trials compared with real-world populations and is a major barrier to oxaliplatin treatment delivery.
奥沙利铂治疗结直肠癌（CRC）引起的周围神经毒性（CIPN）可能是一种使人虚弱的毒性。我们旨在评估结直肠癌生存者人群中的 CIPN 症状及其相关性，并回顾神经毒性对奥沙利铂剂量的影响。
接受 CRC 辅助治疗后首次就诊悉尼癌症生存者中心的患者完成了全面的患者报告结局测量，包括症状、生活质量（QoL）、饮酒习惯和运动习惯。参与者对“手脚麻木或刺痛”症状进行评分，从 0（完全无困扰）到 10（我能想象到的最糟糕）。从病历中获取诊断、治疗和合并症的详细信息。一部分患者在随访时完成了 PN 症状的系列评估。
对 233 名（52%为男性；平均年龄 63 岁）CRC 患者的数据进行了分析，这些患者首次在悉尼癌症生存者中心就诊。104 名患者被纳入纵向分析。与未接受奥沙利铂治疗的患者相比，接受奥沙利铂治疗的患者报告麻木的可能性显著更高（比值比，5.6；95%置信区间，3.2-9.8），奥沙利铂治疗的 CRC 幸存者中有 72.4%在化疗后平均 5.9 个月报告麻木。接受含奥沙利铂化疗的患者报告的平均麻木程度明显高于接受氟嘧啶单药治疗的患者（平均 3.31 分）和未接受化疗的患者（平均 0.66 分）。接受奥沙利铂治疗的患者中有 80%需要减少剂量或提前停药，最常见的原因是神经毒性。有麻木感的患者在身体、情绪和功能健康方面的生活质量较低。我们发现麻木评分与年龄之间呈弱负相关，与（1）麻木与心血管疾病之间，（2）麻木与疼痛评分之间呈负相关。
接受奥沙利铂治疗的 CRC 幸存者中常见 CIPN 症状，与较低的 QoL 相关。与真实世界人群相比，临床试验中神经毒性的报告不足，是奥沙利铂治疗剂量的主要障碍。
