Impact of persistent peripheral neuropathy on health-related quality of life among early-stage breast cancer survivors: a population-based cross-sectional study

Abstract

Background: We explored the impact of persistent sensory and motor taxane-induced peripheral neuropathy (TIPN) symptoms on health-related quality of life (HRQL) among early-stage breast cancer survivors (ESBCS).

Methods: A population-based cohort of 884 residual-free ESBCS received a postal questionnaire, including the EORTC chemotherapy-induced PN (CIPN20) and the EORTC QLQ-C30 instruments. Mean scores of QLQ-C30 scales among ESBCS with and without TIPN were calculated and adjusted for confounding factors (age, lifestyle factors, co-morbidities; linear regression analyses). Interpretation of QLQ-C30 results were based on guidelines.

Results: Response rate was 79%, and 646 survivors were included in the analysis. In median, 3.6 (1.5-7.3) years had elapsed post-taxane treatment. All TIPN symptoms had a significant impact on global QoL, which worsened with increased severity of TIPN. Between 29.5% and 93.3% of ESBCS with moderate-severe TIPN reported a clinical important impairment of functioning and personal finances, 64.3-85.7% reporting "difficulty walking because of foot drop," and 53.1-81.3% reporting "problems standing/walking because of difficulty feeling ground under feet" had impaired functioning/finances. The difference in mean scores between affected and non-affected survivors was highest for "numbness in toes/feet" and "difficulty walking because of foot drop." Moderate-severe "difficulty climbing stairs or getting out of chair because of weakness of legs" and "problems standing/walking because of difficulty feeling ground under feet" were associated with the largest clinically important differences on all scales.

Conclusion: Persistent sensory and motor TIPN is associated with clinically relevant impairment of global QoL, functioning, and personal finances among ESBCS, which increased with level of TIPN severity.

Keywords: Adjuvant therapy; Breast cancer survivorship; CIPN20; Chemotherapy; Chemotherapy-Induced Peripheral Neuropathy CIPN; Financial toxicity; Functional health; Health-related quality of life; QLQ-C30; Quality of life; Survivorship; Taxane; Taxane-induced peripheral neuropathy.

Fig. 1

Flowchart of the study population showing eligible criteria, reasons for non-participation, and participation rate

Fig. 2

The impact of different levels of peripheral neuropathy symptoms among early-stage breast cancer survivors, illustrating worse GHS/QoL with increased severity of the symptom. The box expresses 25th, 50th (median), and 75th percentiles. The bar represents minimum and maximum values, and the dots represent observations considered to be outliers. The test for trend was done with quantile (median) regression and adjusted for age, BMI at survey, and treatment for diabetes mellitus

Fig. 2

The impact of different levels of peripheral neuropathy symptoms among early-stage breast cancer survivors, illustrating worse GHS/QoL with increased severity of the symptom. The box expresses 25th, 50th (median), and 75th percentiles. The bar represents minimum and maximum values, and the dots represent observations considered to be outliers. The test for trend was done with quantile (median) regression and adjusted for age, BMI at survey, and treatment for diabetes mellitus

Fig. 3

Prevalence rate of survivors with functional health and financial difficulties of clinical importance (threshold of clinical importance), classified by reported level of 13 peripheral neuropathy symptoms from the EORTC-CIPN20. The bars represent “Not at all,” “A little,” “Quite a bit,” or “Very much” of the symptoms

Fig. 4

One or several actions taken by 239 survivors with persistent peripheral neuropathy in hands/feet to relieve their discomfort