Noah Kolb

The Association of Chemotherapy-Induced Peripheral Neuropathy Symptoms and the Risk of Falling.

IMPORTANCE Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of neurotoxic chemotherapy resulting in pain, sensory loss, and decreased quality of life. Few studies have prospectively examined the relationship between sensory neuropathy symptoms, falls, and fall-related injuries for patients receiving neurotoxic chemotherapy. OBJECTIVE To determine the association between the symptoms of CIPN and the risk of falls for patients receiving neurotoxic chemotherapy. DESIGN, SETTING, AND PARTICIPANTS In this secondary analysis of a prospective study, 116 patients with breast, ovarian, or lung cancer who were beginning neurotoxic chemotherapy with a taxane or platinum agent were recruited from oncology clinics. These patients would call a novel automated telephone system daily for 1 full course of chemotherapy. The telephone system (SymptomCare@Home) used a series of relevant CIPN questions to track symptoms on a 0 to 10 ordinal scale and contained a questionnaire about falls. Those reporting a numbness and tingling severity score of 3 or greater for at least 10 days were considered to have significant CIPN symptoms and were compared with those patients who did not. Data analysis was performed in November 2015. EXPOSURE Chemotherapy with a neurotoxic taxane or platinum agent. MAIN OUTCOMES AND MEASURES Patient-reported falls or near falls and fall-related injuries. The hypothesis was generated after data collection but prior to data analysis. RESULTS Of the 116 patients who started neurotoxic chemotherapy (mean [SD] age was 55.5 [11.9] years, and 109 [94.0%] were female), 32 met the predetermined criteria for CIPN symptoms. The mean duration of follow-up was 62 days, with 51 telephone calls completed per participant. Seventy-four falls or near falls were reported. The participants with CIPN symptoms were nearly 3 times more likely to report a fall or near fall than the participants without CIPN symptoms (hazard ratio, 2.67 [95% CI, 1.62-4.41]; P < .001). The participants with CIPN symptoms were more likely than the participants without CIPN symptoms to obtain medical care for falls (8 of 32 participants with CIPN symptoms [25.0%] vs 6 of 84 participants without CIPN symptoms [7.1%]; P = .01). CONCLUSIONS AND RELEVANCE These findings suggest that the sensory symptoms of CIPN are an indicator of an increased risk of falling and an increased use of health care resources. This study demonstrates the utility of a novel telephone-based system to track neuropathy symptoms. Careful monitoring and coaching of patients receiving neurotoxic chemotherapy for new sensory symptoms may facilitate more effective fall prevention strategies.

MTHFR C677T polymorphism is associated with methotrexate-induced myelopathy risk

Myelopathy is a rare complication of methotrexate (MTX) therapy.1 A polymorphism (C677T) in the folate enzyme methylenetetrahydrofolate reductase (MTHFR) gene is associated with MTX hematologic and hepatic toxicity.2 We describe 3 cases of severe MTX myelopathy associated with the MTHFR C677T polymorphism.

Validation of a simple disease-specific, quality-of-life measure for diabetic polyneuropathy: CAPPRI

Objective We studied the performance of a 15-item, health-related quality-of-life polyneuropathy scale in the clinic setting in patients with diabetic distal sensorimotor polyneuropathy (DSPN). Methods Patients with DSPN from 11 academic sites completed a total of 231 Chronic Acquired Polyneuropathy Patient-Reported Index (CAPPRI) scales during their clinic visits. Conventional and modern psychometric analyses were performed on the completed forms. Results Conventional and modern analyses generally indicated excellent psychometric properties of the CAPPRI in patients with DSPN. For example, the CAPPRI demonstrated unidimensionality and performed like an interval-level scale. Conclusion Attributes of the CAPPRI for DSPN include ease of use and interpretation; unidimensionality, allowing scores to be summed; adequate coverage of disease severity; and the scales ability to address relevant life domains. Furthermore, the CAPPRI is free and in the public domain. The CAPPRI may assist the clinician and patient with DSPN in estimating disease-specific quality of life, especially in terms of pain, sleep, psychological well-being, and everyday function. The CAPPRI may be most useful in the everyday clinical setting but merits further study in this setting, as well as the clinical trial setting.

Clinical research in chemotherapy-induced peripheral neuropathy: How, what, and when

Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common and disabling side effects of lifesaving neurotoxic chemotherapy.1,2 The taxanes, platins, and vinka alkaloid-derived chemotherapeutic agents are the most common offenders. During treatment, 30%–80% of individuals develop CIPN and many patients have chronic symptoms.3 The spectrum of CIPN severity varies from mild to severe, and its risk factors remain poorly understood. What is known, to some extent, is the effect of CIPN on patients: the sensory loss, reduction in dexterity, pain, and imbalance from CIPN increase morbidity and reduce the quality of life in many cancer survivors.4–6 Despite dozens of prior treatment trials, CIPN prevention remains elusive, with treatment limited to neuropathic pain medications, supportive care, and sometimes adjustments in chemotherapy dosing.7