Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3101
Peer-review started: May 15, 2021
First decision: June 12, 2021
Revised: July 27, 2021
Accepted: February 22, 2022
Article in press: February 22, 2022
Published online: April 6, 2022
As the number of cancer survivors increases worldwide, long-term side effects of anti-cancer treatments have become more and more important, since they can impact quality of life and the success of social reinsertion. Currently, chemotherapy-induced neuropathy (CIPN), following Oxaliplatin treatment, can have debilitating side-effects with long-term consequences, but its assessment is heterogeneous and there are few to no prophylaxis or treatment methods.
Using real-world data, this study was designed to underline the impact of Oxaliplatin-induced neuropathy on the quality of life in colon and rectal cancer patients. Adding this information to the existing data can contribute to increased awareness for the risks of over-using chemotherapy and its long-term consequences.
To assess the impact of CIPN on the QoL in colon and rectal cancer patients. A significant impact on the QoL is especially relevant for cancer survivors with a long life expectancy. Currently, there are very few treatment options for chronic CIPN. To Assessing treatment discontinuation rates secondary to CIPN and their impact on progression-free survival and relapse-free survival. If a significant percentage of patients cannot complete the recommended chemotherapy regimen due to neurological toxicity, perhaps less aggressive or less intensive chemotherapy regiments should be evaluated by means of novel clinical trials.
We performed a prospective cross-sectional study in two oncology tertiary hospitals. Consecutive colorectal cancer patients undergoing oxaliplatin-based chemotherapy were assessed by means of two questionnaires (EORTC for quality of life and QLQ-CIPN20 for neuropathy) and potential correlations were analyzed by means of a student t test. Additional demographical, social, clinical and treatment data were collected from patient charts and Kaplan-Meyer curves were used for three-year PFS. Statistical analysis was performed by means of SPSS v20.
101 patients agreed to participate in the study. Of these, most had recently discontinued oxaliplatin-based chemotherapy. The reason for not finishing the recommended number of cycles was neuropathy in most cases; even in cases where neuropathy was not the main reason for treatment discontinuation, all patients had some neuropathic symptoms. The presence and severity of neuropathy correlated with the quality of life in all patients. Stage III patients that interrupted chemotherapy had a slightly lower recurrence-free survival (24.33 mo vs 28.27 mo) when compared with patients that underwent 6 mo of chemotherapy, although this difference did not reach statistical significance.
CIPN is significantly more frequent outside clinical trials due to heterogeneous types of assessments being performed world-wide and under-reporting by both physicians and patients. Acute CIPN can have long-term consequences due to its impact on the QoL and its association with treatment discontinuation that can, in turn, affect progression-free survival. Physicians should actively search and assess for signs and symptoms of CIPN in order to prevent chronic complications.
Large, real-world prospective studies are needed to identify the best method for diagnosing and monitoring CIPN. Additionally, there is an urgent need for more data regarding the optimal number of adjuvant chemotherapy cycles and the dose at which Oxaliplatin is still effective, but less neurotoxic in order to minimize this important side-effect of anti-cancer treatment.