Survivorship and Patients Perspective
L. Smardova1, E. Vlckova2, A. Rajdova2, J. Raputova2, J. Bednarik2, Z. Kral1
1 Department of Hematology and Oncology, Masaryk University and University Hospital Brno, Czech Republic, 2 Department of Neurology, Masaryk University and University Hospital Brno, Czech Republic
Background: Chemotherapy-induced peripheral neuropathy (CIPN) represents one of the most worrisome and common long-term adverse effects of chemotherapy treatment of cancer. In patients treated with vinca-alkaloids (V-A), the clinical manifestation is mainly sensory and may affect predominantly small sensory fibers. The aim was to assess the incidence of CIPN in patients treated with V-A and compare treatment regimens and the diagnostic validity of several tests and methods.
Methods: A group of 26 patients (18 men, 8 women, median age 36) with Hodgkin lymphoma (HL) underwent detailed clinical neurological examination, pain status, routine electromyography/nerve conduction studies (EMG/NCS) and comprehensive quantitative sensory testing protocole (QST) before and 6 months after the end of the administration of anti-cancer V-A chemotherapy (BEACOPP, “”2+2”” regimens).
Results: At the follow-up examination, fourteen patients (54%) reported some sensory symptoms and/or neuropathic pain in lower (11 cases) and/or upper (8 cases) extremities. There was an unsignificant trend to higher incidence of clinical symptoms in patients treated with vincristine (60%) comparing to those treated with the combination of vinblastine and vincristine (33%) (p = 0.25, not significant probably due to low numbers of patients in both the subgroups). The symptoms were usually of mild to moderate intensity. In upper extremities, the symptoms -mostly corresponded with clinically symptomatic carpal tunnel syndrome. The EMG/NCS examination confirmed polyneuropathy in 13 patients (50%) (8 symptomatic, 5 asymptomatic), while clinical examination displayed only minor abnormities in two of the symptomatic individuals. Twenty-two patients (84%) displayed at least one new QST abnormity in feet (and 9 in hands), most frequently in thermal sensation and thermal pain modalities. Some abnormities relevant to peripheral nerve dysfunction in any of the methods used in this study were found in 88% of HL patients treated with V-A.
Conclusions: Symptoms of CIPN persist at least 6 months after the end of V-A chemotherapy in about 54% of HL patients. Clinical neurological examination is the least sensitive method used for confirmation of peripheral neuropathy in these patients, while both the EMG/NCS and QST reveal neuropathy more frequently. Some abnormities of peripheral nerve function can be found even in asymptomatic individuals.