Peripheral Neuropathy After Chemotherapy: An Underappreciated Risk?

A research team from UC Davis, UCLA and other institutions concludes that early-stage breast cancer patients who have been treated with chemotherapy are at elevated risk for development of painful peripheral neuropathy, which can persist for years after completion of treatment. Their work was prompted by the outcome of a systematic review of existing literature that found a significant lack of information on the association. Worse still, the available study data varied widely in the reported incidence of peripheral neuropathy among cancer patients. Coauthor Joy Melnikow, MD, director of the Center for Healthcare Policy and Research at UC Davis, commented, “Until recently, the really strong focus has been to identify treatments to reduce breast cancer recurrence and mortality. I think we’ve reached the point now where we need to ask questions about the adverse effects that come along after curative treatments. We need to balance what are sometimes small therapeutic benefits with the risk of long-term adverse events.” 

In view of the scarcity of available information, the team conducted its own study of 1,512 early-stage breast cancer patients from a large clinical trial investigating different chemotherapy combinations, including doxorubicin, cyclophosphamide, and docetaxel. 42% of patients overall reported symptoms of neuropathy, with 10% experiencing severe pain and impaired quality of life. Some chemotherapy regimens, such as low-dose docetaxel combinations were associated with lower incidence of neuropathy, and the authors recommend that chemotherapy decisions should include consideration of long-term adverse effects. Patricia Gantz, MD, senior author of the paper, noted, “There is very little treatment for neuropathy, and there’s nothing that’s actually proven to work. Since we don’t have an effective treatment, ideally it would be best to prevent it from happening by not administering chemotherapy if it is likely to have minimal additional benefit.” The findings were published in the Journal of the National Cancer Institute.

Read a news story about the research and recommendations.

The journal abstract may be read here.