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Multicenter Study
. 2017 Nov;54(5):701-706.e1.
doi: 10.1016/j.jpainsymman.2017.07.033. Epub 2017 Jul 23.

Oxaliplatin-Induced Peripheral Neuropathy and Identification of Unique Severity Groups in Colorectal Cancer

Kathleen A Griffith  1 , Shijun Zhu  2 , Meg Johantgen  2 , Michael D Kessler  3 , Cynthia Renn  4 , Andreas S Beutler  5 , Rahul Kanwar  5 , Nicholas Ambulos  6 , Guido Cavaletti  7 , Jordi Bruna  8 , Chiara Briani  9 , Andreas A Argyriou  10 , Haralabos P Kalofonos  10 , Laura M Yerges-Armstrong  3 , Susan G Dorsey  4
Affiliations
Multicenter Study

Oxaliplatin-Induced Peripheral Neuropathy and Identification of Unique Severity Groups in Colorectal Cancer

Kathleen A Griffith et al. J Pain Symptom Manage. 2017 Nov.

Abstract

Context: Oxaliplatin-induced peripheral neuropathy (OIPN) is a dose-limiting toxicity of oxaliplatin and affects most colorectal cancer patients. OIPN is commonly evaluated by patient symptom report, using scales to reflect impairment. They do not discriminate between unique grouping of symptoms and signs, which impedes prompt identification of OIPN.

Objective: The objective of this study was to identify clusters of symptoms and signs that differentiated underlying clinical severity and segregated patients within our population into OIPN subgroups.

Methods: Chemotherapy-naive colorectal cancer patients (N = 148) receiving oxaliplatin were administered the Total Neuropathy Score clinical (TNSc©), which includes symptom report (sensory, motor, autonomic) and sensory examination (pin sense, vibration, reflexes). The TNSc was administered before chemotherapy initiation (T0) and after cumulative doses of oxaliplatin 510-520 mg/m2 (T1) and 1020-1040 mg/m2 of oxaliplatin (T2). Using mean T2 TNSc scores, latent class analysis grouped patients into OIPN severity cohorts.

Results: Latent class analysis categorized patients into four distinct OIPN groups: low symptoms and low signs (n = 54); low symptoms and intermediate signs (n = 44); low symptoms and high signs (n = 21); and high symptoms and high signs (n = 29). No differences were noted among OIPN groups on age, sex, chemotherapy regimen, or cumulative oxaliplatin dose.

Conclusion: We identified OIPN patient groups with distinct symptoms/signs, demonstrating variability of OIPN presentation regardless of cumulative oxaliplatin dose. Over half of the sample had positive findings on OIPN examination despite little or no symptoms. Sensory examination of all patients receiving oxaliplatin is indicated for timely identification of OIPN, which will allow earlier symptom management.

Keywords: Chemotherapy-induced peripheral neuropathy; chronic pain; latent class analysis; measurement; oxaliplatin; pain.

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Figures

Figure 1
Figure 1
Mean TNSc© Mean Scores for Each Item within OIPN Severity Group
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References

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