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Published in: Supportive Care in Cancer 3/2012

01-03-2012 | Original Article

Falls in persons with chemotherapy-induced peripheral neuropathy

Authors: Cindy Tofthagen, Janine Overcash, Kevin Kip

Published in: Supportive Care in Cancer | Issue 3/2012

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Abstract

Purpose

The purpose of this study was to evaluate possible risk factors for falls in a group of patients with chemotherapy-induced peripheral neuropathy (CIPN).

Methods

This prospective, descriptive study included persons receiving paclitaxel, docetaxel, oxaliplatin, or cispatin who reported at least one symptom of CIPN. Each patient was invited to complete the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and a demographic data questionnaire. Data were analyzed using descriptive statistics and logistic regression.

Results

In this sample (n = 109), fallers (n = 21) had higher doses of chemotherapy(p = 0.045), more neuropathic symptoms (p = 0.016), higher scores on the symptom experience (p = 0.005) and interference items (=0.001) on the CIPNAT, more severe muscle weakness (p < 0.001) and loss of balance (p < 0.001), and higher interference with walking(p < 0.001) and driving (p = 0.022). Patients who received taxanes were more likely to have fallen than patients who received platinum-based chemotherapy (p = 0.022). No significant differences in age or disease stage between fallers and non-fallers were present. Severity of loss of balance and cycle number was independently associated with falling.

Conclusions

This study demonstrates that the risk of falls increases with each cycle of chemotherapy and that patients receiving taxanes may be at greater risk of falls than patients receiving neurotoxic platinum-based drugs. Patients who report muscle weakness and loss of balance or say that their symptoms interfere with walking or driving may be at a higher risk of falls.
Literature
2.
go back to reference Overcash J (2007) Prediction of falls in older adults with cancer: a preliminary study. Oncol Nurs Forum 34(2):341–346PubMedCrossRef Overcash J (2007) Prediction of falls in older adults with cancer: a preliminary study. Oncol Nurs Forum 34(2):341–346PubMedCrossRef
3.
go back to reference Holley S (2002) A look at the problem of falls among people with cancer. Clin J Oncol Nurs 6(4):193–197PubMedCrossRef Holley S (2002) A look at the problem of falls among people with cancer. Clin J Oncol Nurs 6(4):193–197PubMedCrossRef
4.
go back to reference Joseph EK, Levine JD (2009) Comparison of oxaliplatin- and cisplatin-induced painful peripheral neuropathy in the rat. J Pain 10(5):534–541PubMedCrossRef Joseph EK, Levine JD (2009) Comparison of oxaliplatin- and cisplatin-induced painful peripheral neuropathy in the rat. J Pain 10(5):534–541PubMedCrossRef
5.
go back to reference Lee JJ, Swain SM (2006) Peripheral neuropathy induced by microtubule-stabilizing agents. J Clin Oncol 24(10):1633–1642PubMedCrossRef Lee JJ, Swain SM (2006) Peripheral neuropathy induced by microtubule-stabilizing agents. J Clin Oncol 24(10):1633–1642PubMedCrossRef
6.
go back to reference Lipton RB, Apfel SC, Dutcher JP, Rosenberg R, Kaplan J, Berger A, Einzig AI, Wiernik P, Schaumburg HH (1989) Taxol produces a predominantly sensory neuropathy. Neurology 39(3):368–373PubMed Lipton RB, Apfel SC, Dutcher JP, Rosenberg R, Kaplan J, Berger A, Einzig AI, Wiernik P, Schaumburg HH (1989) Taxol produces a predominantly sensory neuropathy. Neurology 39(3):368–373PubMed
7.
go back to reference Flatters SJ, Bennett GJ (2006) Studies of peripheral sensory nerves in paclitaxel-induced painful peripheral neuropathy: evidence for mitochondrial dysfunction. Pain 122(3):245–257PubMedCrossRef Flatters SJ, Bennett GJ (2006) Studies of peripheral sensory nerves in paclitaxel-induced painful peripheral neuropathy: evidence for mitochondrial dysfunction. Pain 122(3):245–257PubMedCrossRef
8.
go back to reference Joseph EK, Chen X, Bogen O, Levine JD (2008) Oxaliplatin acts on IB4-positive nociceptors to induce an oxidative stress-dependent acute painful peripheral neuropathy. J Pain 9(5):463–472PubMedCrossRef Joseph EK, Chen X, Bogen O, Levine JD (2008) Oxaliplatin acts on IB4-positive nociceptors to induce an oxidative stress-dependent acute painful peripheral neuropathy. J Pain 9(5):463–472PubMedCrossRef
9.
go back to reference Bove L, Picardo M, Maresca V, Jandolo B, Pace A (2001) A pilot study on the relation between cisplatin neuropathy and vitamin E. J Exp Clin Canc Res 20(2):277–280 Bove L, Picardo M, Maresca V, Jandolo B, Pace A (2001) A pilot study on the relation between cisplatin neuropathy and vitamin E. J Exp Clin Canc Res 20(2):277–280
10.
go back to reference Kruse RL, Lemaster JW, Madsen RW (2010) Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: “feet first” randomized controlled trial. Phys Ther 90:1568–1579PubMedCrossRef Kruse RL, Lemaster JW, Madsen RW (2010) Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: “feet first” randomized controlled trial. Phys Ther 90:1568–1579PubMedCrossRef
11.
go back to reference Son J, Ashton-Miller JA, Richardson JK (2009) Frontal plane ankle proprioceptive thresholds and unipedal balance. Muscle Nerve 39(2):150–157PubMedCrossRef Son J, Ashton-Miller JA, Richardson JK (2009) Frontal plane ankle proprioceptive thresholds and unipedal balance. Muscle Nerve 39(2):150–157PubMedCrossRef
12.
go back to reference Richardson JK, Ashton-Miller JA (1996) Peripheral neuropathy: an often-overlooked cause of falls in the elderly. Postgrad Med 99(6):161–172PubMed Richardson JK, Ashton-Miller JA (1996) Peripheral neuropathy: an often-overlooked cause of falls in the elderly. Postgrad Med 99(6):161–172PubMed
13.
go back to reference Tilling LM, Darawil K, Britton M (2006) Falls as a complication of diabetes mellitus in older people. J Diab Complications 20(3):158–162CrossRef Tilling LM, Darawil K, Britton M (2006) Falls as a complication of diabetes mellitus in older people. J Diab Complications 20(3):158–162CrossRef
14.
go back to reference Herndon JG, Helmick CG, Sattin RW, Stevens JA, DeVito C, Wingo PA (1997) Chronic medical conditions and risk of fall injury events at home in older adults. J Am Geriatr Soc 45(6):739–743PubMed Herndon JG, Helmick CG, Sattin RW, Stevens JA, DeVito C, Wingo PA (1997) Chronic medical conditions and risk of fall injury events at home in older adults. J Am Geriatr Soc 45(6):739–743PubMed
15.
go back to reference Pandya N, Bookhart B, Mody SH, Funk Orsini PA, Reardon G (2008) Study of anemia in long-term care (SALT): prevalence of anemia and its relationship with the risk of falls in nursing home residents. Curr Med Res Opin 24(8):2139–2149PubMedCrossRef Pandya N, Bookhart B, Mody SH, Funk Orsini PA, Reardon G (2008) Study of anemia in long-term care (SALT): prevalence of anemia and its relationship with the risk of falls in nursing home residents. Curr Med Res Opin 24(8):2139–2149PubMedCrossRef
16.
go back to reference Donald IP, Bulpitt CJ (1999) The prognosis of falls in elderly people living at home. Age Ageing 28(2):121–125PubMedCrossRef Donald IP, Bulpitt CJ (1999) The prognosis of falls in elderly people living at home. Age Ageing 28(2):121–125PubMedCrossRef
17.
go back to reference Helbostad JL, Leirfall S, Moe-Nilssen R, Sletvold O (2007) Physical fatigue affects gait characteristics in older persons. J Gerontol A Biol Sci Med Sci 62(9):1010–1015PubMedCrossRef Helbostad JL, Leirfall S, Moe-Nilssen R, Sletvold O (2007) Physical fatigue affects gait characteristics in older persons. J Gerontol A Biol Sci Med Sci 62(9):1010–1015PubMedCrossRef
19.
go back to reference Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10(1):20–30PubMedCrossRef Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10(1):20–30PubMedCrossRef
20.
go back to reference Feldblum I, German L, Bilenko N, Shahar A, Enten R, Greenberg D, Harman I, Castel H, Shahar DR (2009) Nutritional risk and health care use before and after an acute hospitalization among the elderly. Nutrition 25:415–420PubMedCrossRef Feldblum I, German L, Bilenko N, Shahar A, Enten R, Greenberg D, Harman I, Castel H, Shahar DR (2009) Nutritional risk and health care use before and after an acute hospitalization among the elderly. Nutrition 25:415–420PubMedCrossRef
21.
go back to reference Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC (2008) Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 56(1):68–75PubMedCrossRef Carey EC, Covinsky KE, Lui LY, Eng C, Sands LP, Walter LC (2008) Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 56(1):68–75PubMedCrossRef
22.
go back to reference Balducci L (2007) Aging, frailty, and chemotherapy. Cancer Control 14(1):7–12PubMed Balducci L (2007) Aging, frailty, and chemotherapy. Cancer Control 14(1):7–12PubMed
23.
go back to reference Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148PubMed Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39(2):142–148PubMed
24.
go back to reference Gale CR, Martyn CN, Cooper C, Sayer AA (2007) Grip strength, body composition, and mortality. Int J Epidemiol 36(1):228–235PubMedCrossRef Gale CR, Martyn CN, Cooper C, Sayer AA (2007) Grip strength, body composition, and mortality. Int J Epidemiol 36(1):228–235PubMedCrossRef
25.
go back to reference Wrobel JS, Crews RT, Connolly JE (2009) Clinical factors associated with a conservative gait pattern in older male veterans with diabetes. J Foot Ankle Res 2:11PubMedCrossRef Wrobel JS, Crews RT, Connolly JE (2009) Clinical factors associated with a conservative gait pattern in older male veterans with diabetes. J Foot Ankle Res 2:11PubMedCrossRef
26.
go back to reference Paul L, Ellis BM, Leese GP, McFadyen AK, McMurray B (2009) The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy. Diabet Med 26(3):234–239PubMedCrossRef Paul L, Ellis BM, Leese GP, McFadyen AK, McMurray B (2009) The effect of a cognitive or motor task on gait parameters of diabetic patients, with and without neuropathy. Diabet Med 26(3):234–239PubMedCrossRef
27.
go back to reference Macgilchrist C, Paul L, Ellis BM, Howe TE, Kennon B, Godwin J (2010) Lower-limb risk factors for falls in people with diabetes mellitus. Diabet Med 27(2):162–168PubMedCrossRef Macgilchrist C, Paul L, Ellis BM, Howe TE, Kennon B, Godwin J (2010) Lower-limb risk factors for falls in people with diabetes mellitus. Diabet Med 27(2):162–168PubMedCrossRef
28.
go back to reference Hile ES, Fitzgerald GK, Studenski SA (2010) Persistent mobility disability after neurotoxic chemotherapy. Phys Ther 90:1649–1657PubMedCrossRef Hile ES, Fitzgerald GK, Studenski SA (2010) Persistent mobility disability after neurotoxic chemotherapy. Phys Ther 90:1649–1657PubMedCrossRef
29.
go back to reference Richardson JK, Sandman D, Vela S (2001) A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil 82(2):205–209PubMedCrossRef Richardson JK, Sandman D, Vela S (2001) A focused exercise regimen improves clinical measures of balance in patients with peripheral neuropathy. Arch Phys Med Rehabil 82(2):205–209PubMedCrossRef
30.
go back to reference Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, Fallucca F (2006) Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diab Complications 20(4):216–223CrossRef Balducci S, Iacobellis G, Parisi L, Di Biase N, Calandriello E, Leonetti F, Fallucca F (2006) Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diab Complications 20(4):216–223CrossRef
31.
go back to reference Ruhland JL, Shields RK (1997) The effects of a home exercise program on impairment and health-related quality of life in persons with chronic peripheral neuropathies. Phys Ther 77(10):1026–1039PubMed Ruhland JL, Shields RK (1997) The effects of a home exercise program on impairment and health-related quality of life in persons with chronic peripheral neuropathies. Phys Ther 77(10):1026–1039PubMed
32.
go back to reference Bulat T, Hart-Hughes S, Ahmed S, Quigley P, Palacios P, Werner DC, Foulis P (2007) Effect of a group-based exercise program on balance in elderly. Clin Interv Aging 2(4):655–660PubMed Bulat T, Hart-Hughes S, Ahmed S, Quigley P, Palacios P, Werner DC, Foulis P (2007) Effect of a group-based exercise program on balance in elderly. Clin Interv Aging 2(4):655–660PubMed
33.
go back to reference de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947PubMed de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, Boni C, Cortes-Funes H, Cervantes A, Freyer G, Papamichael D, Le Bail N, Louvet C, Hendler D, de Braud F, Wilson C, Morvan F, Bonetti A (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16):2938–2947PubMed
34.
go back to reference Hilpert F, Stahle A, Tome O, Burges A, Rossner D, Spathe K, Heilmann V, Richter B, du Bois A (2005) Neuroprotection with amifostine in the first-line treatment of advanced ovarian cancer with carboplatin/paclitaxel-based chemotherapy—a double-blind, placebo-controlled, randomized phase II study from the Arbeitsgemeinschaft Gynakologische Onkologoie (AGO) Ovarian Cancer Study Group. Support Care Cancer 13(10):797–805PubMedCrossRef Hilpert F, Stahle A, Tome O, Burges A, Rossner D, Spathe K, Heilmann V, Richter B, du Bois A (2005) Neuroprotection with amifostine in the first-line treatment of advanced ovarian cancer with carboplatin/paclitaxel-based chemotherapy—a double-blind, placebo-controlled, randomized phase II study from the Arbeitsgemeinschaft Gynakologische Onkologoie (AGO) Ovarian Cancer Study Group. Support Care Cancer 13(10):797–805PubMedCrossRef
35.
go back to reference Hochster HS, Grothey A, Childs BH (2007) Use of calcium and magnesium salts to reduce oxaliplatin-related neurotoxicity. J Clin Oncol 25(25):4028–4029PubMedCrossRef Hochster HS, Grothey A, Childs BH (2007) Use of calcium and magnesium salts to reduce oxaliplatin-related neurotoxicity. J Clin Oncol 25(25):4028–4029PubMedCrossRef
36.
go back to reference Bakitas MA (2007) Background noise: the experience of chemotherapy-induced peripheral neuropathy. Nurs Res 56(5):323–331PubMedCrossRef Bakitas MA (2007) Background noise: the experience of chemotherapy-induced peripheral neuropathy. Nurs Res 56(5):323–331PubMedCrossRef
37.
go back to reference Tofthagen C (2010) Patient perceptions associated with chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 14(3):E22–E28PubMedCrossRef Tofthagen C (2010) Patient perceptions associated with chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 14(3):E22–E28PubMedCrossRef
38.
go back to reference Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C (2007) Putting evidence into practice: evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 11(6):901–913PubMedCrossRef Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C (2007) Putting evidence into practice: evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs 11(6):901–913PubMedCrossRef
39.
go back to reference Wampler MA, Hamolsky D, Hamel K, Melisko M, Topp KS (2005) Case report: painful peripheral neuropathy following treatment with docetaxel for breast cancer. Clin J Oncol Nurs 9(2):189–193PubMedCrossRef Wampler MA, Hamolsky D, Hamel K, Melisko M, Topp KS (2005) Case report: painful peripheral neuropathy following treatment with docetaxel for breast cancer. Clin J Oncol Nurs 9(2):189–193PubMedCrossRef
40.
go back to reference Tofthagen C, McMillan SC, Kip K (2011) Development and psychometric evaluation of the chemotherapy-induced peripheral neuropathy assessment tool. Cancer Nurs (in press) Tofthagen C, McMillan SC, Kip K (2011) Development and psychometric evaluation of the chemotherapy-induced peripheral neuropathy assessment tool. Cancer Nurs (in press)
41.
go back to reference Lehky TJ, Leonard GD, Wilson RH, Grem JL, Floeter MK (2004) Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy. Muscle Nerve 29(3):387–392PubMedCrossRef Lehky TJ, Leonard GD, Wilson RH, Grem JL, Floeter MK (2004) Oxaliplatin-induced neurotoxicity: acute hyperexcitability and chronic neuropathy. Muscle Nerve 29(3):387–392PubMedCrossRef
42.
go back to reference Badros A, Goloubeva O, Dalal JS, Can I, Thompson J, Rapoport AP, Heyman M, Akpek G, Fenton RG (2007) Neurotoxicity of bortezomib therapy in multiple myeloma: a single-center experience and review of the literature. Cancer 110:1042–1049PubMedCrossRef Badros A, Goloubeva O, Dalal JS, Can I, Thompson J, Rapoport AP, Heyman M, Akpek G, Fenton RG (2007) Neurotoxicity of bortezomib therapy in multiple myeloma: a single-center experience and review of the literature. Cancer 110:1042–1049PubMedCrossRef
43.
go back to reference Storey DJ, Sakala M, McLean CM, Phillips HA, Dawson LK, Wall LR, Fallon MT, Clive S (2010) Capecitabine combined with oxaliplatin (CapOx) in clinical practice: how significant is peripheral neuropathy? Ann Oncol 21:1657–1661PubMedCrossRef Storey DJ, Sakala M, McLean CM, Phillips HA, Dawson LK, Wall LR, Fallon MT, Clive S (2010) Capecitabine combined with oxaliplatin (CapOx) in clinical practice: how significant is peripheral neuropathy? Ann Oncol 21:1657–1661PubMedCrossRef
44.
go back to reference Argyriou AA, Polychronopoulos P, Koutras A, Iconomou G, Gourzis P, Assimakopoulos K, Kalofonos HP, Chroni E (2006) Is advanced age associated with increased incidence and severity of chemotherapy-induced peripheral neuropathy? Support Care Cancer 14(3):223–229PubMedCrossRef Argyriou AA, Polychronopoulos P, Koutras A, Iconomou G, Gourzis P, Assimakopoulos K, Kalofonos HP, Chroni E (2006) Is advanced age associated with increased incidence and severity of chemotherapy-induced peripheral neuropathy? Support Care Cancer 14(3):223–229PubMedCrossRef
45.
go back to reference Dunlap B, Paice JA (2006) Chemotherapy-induced peripheral neuropathy: a need for standardization in measurement. J Support Oncol 4(8):398–399PubMed Dunlap B, Paice JA (2006) Chemotherapy-induced peripheral neuropathy: a need for standardization in measurement. J Support Oncol 4(8):398–399PubMed
Metadata
Title
Falls in persons with chemotherapy-induced peripheral neuropathy
Authors
Cindy Tofthagen
Janine Overcash
Kevin Kip
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 3/2012
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-011-1127-7

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