Kandula T, et al. - Researchers performed a comprehensive assessment of chemotherapy-induced peripheral neuropathy in childhood cancer survivors to define disease burden and functional effect and to inform screening recommendations. Childhood cancer survivors demonstrated clinical abnormalities attributable to peripheral neuropathy commonly. These abnormalities persisted long term, with concurrent deficits in patient-reported outcomes. Findings highlight the significance of considering both the type of neurotoxic agent and a targeted clinical neurological assessment when screening survivors for long-term neuropathy.

Methods

• A cross-sectional observational study was performed of cancer survivors who were treated with chemotherapy for extracranial malignancy before age 17 years.
• These participants were recruited consecutively between April 2015 and December 2016 from a single tertiary hospital-based comprehensive cancer survivorship clinic and compared with healthy age-matched controls.
• In this study, investigators were blinded to the type of chemotherapy.
• Inclusion criteria was fulfilled by 169 patients; 48 (28.4%) of 169 were unable to be contacted or declined participation.
• Exposures included chemotherapy agents known to be toxic to peripheral nerves.
• Comparison of the clinical peripheral neurological assessment using the Total Neuropathy Score was performed between recipients of different neurotoxic chemotherapy agents and control participants.
• Outcomes were correlated with neurophysiological, functional, and patient-reported outcome measures.

Results

• This study included 121 childhood cancer survivors; 65 (53.7%) were male, and the cohort underwent neurotoxicity assessments at a median (range) age of 16 (7-47) years, a median (range) 8.5 (1.5-29) years after treatment completion.
• The main neurotoxic agents identified were Vinca alkaloids and platinum compounds.
• Common occurrence of clinical abnormalities consistent with peripheral neuropathy was observed; these abnormalities were seen in 54 of 107 participants (50.5%) treated with neurotoxic chemotherapy (mean Total Neuropathy Score increase, 2.1; 95% CI, 1.4-2.9; P < .001), and were associated with lower limb predominant sensory axonal neuropathy (mean amplitude reduction, 5.8 μV; 95% CI, 2.8-8.8; P < .001).
• In manual dexterity, distal sensation, and balance, functional deficits were observed.
• Patient-reported outcomes showing reduction in global quality of life and physical functioning were noted to be have correlation with the Total Neuropathy Score.
• Cisplatin was observed producing long-term neurotoxicity more frequently than vinca alkaloids.