BMI, Lifestyle Factors and Taxane-Induced Neuropathy in Breast Cancer Patients: The Pathways Study

Abstract

Background: Lifestyle factors may be associated with chemotherapy-induced peripheral neuropathy (CIPN). We examined associations between body mass index (BMI) and lifestyle factors with CIPN in the Pathways Study, a prospective cohort of women with invasive breast cancer.

Methods: Analyses included 1237 women who received taxane treatment and provided data on neurotoxicity symptoms. Baseline interviews assessed BMI (normal: <25 kg/m²; overweight: 25-29.9 kg/m²; obese: ≥30 kg/m²), moderate-to-vigorous physical activity (MVPA) (low: <2.5; medium: 2.5-5; high: >5 hours/week) and fruit/vegetable intake (low: <35 servings/week; high: ≥35 servings/week). Baseline and six-month interviews assessed antioxidant supplement use (nonuser, discontinued, continued user, initiator). CIPN was assessed at baseline, six months, and 24 months using the Functional Assessment of Cancer Therapy-Taxane Neurotoxicity (FACT-NTX); a 10% decrease was considered clinically meaningful.

Results: At baseline, 65.6% of patients in the sample were overweight or obese, 29.9% had low MVPA, 57.5% had low fruit/vegetable intake, and 9.5% reported antioxidant supplement use during treatment. In multivariable analyses, increased CIPN was more likely to occur in overweight (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.19 to 4.88) and obese patients (OR = 3.21, 95% CI = 1.52 to 7.02) compared with normal weight patients at 24 months and less likely to occur in patients with high MVPA compared with those with low MVPA at six (OR = 0.56, 95% CI = 0.34 to 0.94) and 24 months (OR = 0.43, 95% CI = 0.21 to 0.87). Compared with nonusers, patients who initiated antioxidant use during treatment were more likely to report increased CIPN at six months (OR = 3.81, 95% CI = 1.82 to 8.04).

Conclusions: Obesity and low MVPA were associated with CIPN in breast cancer patients who received taxane treatment.

Figure 1.

Multivariable-adjusted differences in changes in Functional Assessment of Cancer Therapy–Taxane Neurotoxicity (FACT-NTX) scores from baseline to six and 24 months by baseline body mass index, moderate-to-vigorous physical activity, fruit/vegetable intake, and antioxidant use. A) Results are shown for the 11-item FACT-NTX scale (0–44) and for B) the four-item sensory neuropathy subscale (0–16). A larger decrease in FACT-NTX means a greater increase in chemotherapy-induced peripheral neuropathy symptoms. We tested the differences in changes in FACT-NTX using linear regression models adjusted for baseline score, age, race, smoking status, tumor stage, number of positive nodes, estrogen receptor/progesterone receptor, human epidermal growth factor receptor 2, taxane drug, taxane schedule, and prior taxane use. All P values were two-sided. BMI = body mass index; FACT-NTX = Functional Assessment of Cancer Therapy–Taxane Neurotoxicity.