Category: Cancer Rehabilitation; Pediatric Rehabilitation
Chemotherapy-induced peripheral neuropathy (CIPN) is a common treatment side-effect with potential long-term consequences. Our purpose was to describe the recovery of vincristine-related CIPN in childhood cancer survivors and investigate the impact of residual neuropathy.
Design : Longitudinal, cohort study
Setting : Hospital and Outpatient Clinics
Participants (or Animals, Specimens, Cadavers) : Children treated for non-CNS cancers (n=56)
Interventions : Not applicable
Main Outcome Measure(s) : Pediatric modified Total Neuropathy Score (ped-mTNS) for CIPN, BOT-2 test of motor performance, PedsQL for quality of life (QOL). The ped-mTNS was administered during treatment and 2 years post-treatment. At 2 years post-treatment, standardized measures of balance, manual dexterity, and QOL were administered. Measures were compared between diagnostic groups (acute lymphoblastic leukemia (n=21), lymphoma (n=21) and other solid tumors (n=14)) and treatment groups (based on neurotoxic agent exposure) with ANOVA. Associations between CIPN and other measures were investigated.
Results : As a group, ped-mTNS scores improved from 9.3±4.5 on treatment to 3.9±2.9 2 years post-treatment, with no significant difference between diagnostic groups. On-treatment and 2 years post-treatment, patients who received a combination of vincristine and etoposide (V+E) had worse ped-mTNS scores (12.4±5.1, 6.1±3.2), as compared to vincristine (V) (9.2±4.7, 2.4±2.2) or vincristine and IT methotrexate (V+ITM) (7.2± 2.6, 3.0± 2.1) (p=0.002, p=0.001 respectively). Residual CIPN at 2 years (ped-mTNS>4) was found in 58.8% of those receiving V+E, as compared to 27% receiving V and 20% receiving V+ITM. Neuropathy was associated with self-reported QOL (rs=0.374, p=0.006) and specifically physical function (rs=0.527, p'0.001), but not balance or manual dexterity.
Conclusions : Children and adolescents who received a combination of vincristine and etoposide had worse CIPN on-treatment and were more likely to have persistent CIPN. Neuropathy post-treatment was associated with worse physical function-related QOL.