Long-Term Prevalence of Sensory Chemotherapy-Induced Peripheral Neuropathy for 5 Years after Adjuvant FOLFOX Chemotherapy to Treat Colorectal Cancer: A Multicenter Cross-Sectional Study

Abstract

(1) Background: Oxaliplatin is among the most neurotoxic anticancer drugs. Little data are available on the long-term prevalence and consequences of chemotherapy-induced peripheral neuropathy (CIPN), even though the third largest population of cancer survivors is made up of survivors of colorectal cancer. (2) Methods: A multicenter, cross-sectional study was conducted in 16 French centers to assess the prevalence of CIPN, as well as its consequences (neuropathic pain, anxiety, depression, and quality of life) in cancer survivors during the 5 years after the end of adjuvant oxaliplatin chemotherapy. (3) Results: Out of 406 patients, the prevalence of CIPN was 31.3% (95% confidence interval: 26.8-36.0). Little improvement in CIPN was found over the 5 years, and 36.5% of patients with CIPN also had neuropathic pain. CIPN was associated with anxiety, depression, and deterioration of quality of life. None of the patients with CIPN were treated with duloxetine (recommendation from American Society of Clinical Oncology), and only 3.2%, 1.6%, and 1.6% were treated with pregabalin, gabapentin, and amitriptyline, respectively. (4) Conclusions: Five years after the end of chemotherapy, a quarter of patients suffered from CIPN. The present study showed marked psychological distress and uncovered a failure in management in these patients.

Keywords: cancer survivors; colorectal cancer; health-related quality of life; oxaliplatin; peripheral neuropathy.

Figure 1

Flowchart of patient inclusion.

Figure 2

Prevalence of sensory CIPN and QLQ-CIPN20 sensory scores from 1 year until 5 years after chemotherapy end. The prevalence of sensory CIPN (A) is expressed as a percentage (white: no CIPN, black: sensory CIPN). The sensory scores (B) are expressed as mean ± standard deviation. p-values are provided for global comparison over time (from year 1 to year 5). CIPN, chemotherapy-induced peripheral neuropathy.

Figure 3

Severity proportions of the QLQ-CIPN20 items assessing tingling, numbness, and pain in the hands and feet among patients with sensory CIPN. The response categories were recoded to yield a dichotomous outcome per item (white: “not at all” or “a little” vs. black: “quite a bit” or “very much”). Results are expressed by percentage.

Figure 4

Forrest plot of the regression coefficients comparing QLQ-CIPN20 sensory scores with patient characteristics and oxaliplatin treatments. Multivariable analyses were performed, including patient characteristics (sex, age, tobacco, alcohol, and variation of weight) and characteristics of chemotherapy (chemotherapy date, cumulative dose and dose intensity of oxaliplatin, and center). * p < 0.05, ** p < 0.01, and *** p < 0.001.

Figure 5

Proportion of patients with anxiety or depression (Hospital Anxiety and Depression scale) according to sensory CIPN. Results are expressed as percentages.