Persistent Neuropathy After Chemotherapy Leads to Falls, Disability in Women

Following completion of their chemotherapy regimen, many women who have survived cancer experience lingering symptoms of chemotherapy-induced peripheral neuropathy (CIPN), according to a new study. These symptoms were associated with worsened functioning and higher fall risk.

CIPN is an adverse effect of neurotoxic chemotherapies that can persist well after treatment ends, according to the study published in the Journal of Clinical Oncology, putting patients at risk of falls and often causing functional disabilities. Researchers examined self-reported and objectively measured symptoms among 512 women who had survived cancer.

Nearly half of the women (238, or 47%) reported persistent symptoms of neuropathy, even though the mean follow-up was 6 years after treatment. These women reported worse functioning and more disability, which was confirmed in clinical assessments, such as a timed chair stand, a physical function battery, and gait measurements.

For instance, women with CIPN demonstrated an altered gait pattern with slower and shorter steps than those without. Their risk of falls was also 1.8-fold higher than the risk for survivors not experiencing CIPN. As symptom severity increased, researchers observed a significant association with worsening function, increasing disability, and higher fall risk.

“CIPN must be assessed earlier in the clinical pathway, and strategies to limit symptom progression and to improve function must be included in clinical and survivorship care plans,” the study authors wrote.

An accompanying editorial published in the same issue explained that the study’s findings contradicted the commonly held perception that CIPN symptoms disappear over time. According to author Nicole L. Stout, DPT, the study also demonstrated the importance of early intervention to increase mobility and function, instead of waiting until after a patient has a fall.

Stout recommended that providers measure a patient’s balance and mobility at baseline prior to chemotherapy, during the treatment regimen, and throughout survivorship so they may identify any signs of deterioration and recommend participation in a fall prevention program. Such programs often include targeted exercises that focus on improving mobility, posture, and balance.

Research has shown these programs to be effective in neuropathic patients, but have not yet been incorporated into CIPN management guidelines. By emphasizing proactive monitoring and exercise-based interventions, guidelines could shift away from the current reliance on pharmaceutical agents to manage CIPN, Stout wrote.

She also called for research that incorporates the known fall risk factors present in cancer survivors, other than just the chemotherapy regimens that can damage the nervous system.

“Until such time, the current evidence suggests the need for a broader perspective and altered clinical pathways to facilitate improved CIPN symptom management that addresses balance and functional mobility deficits both during active cancer treatment and through survivorship,” Stout concluded.