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Neuropathy secondary to Chemotherapy

Discussion in 'General Issues and Discussion Forum' started by Natalie, Feb 4, 2011.

  1. Natalie

    Natalie Welcome New Poster

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    Dear Colleagues,
    I am a Podiatrist with a special interest in Diabetes and High Risk Feet.
    I have also a personal connection with my local branch of the Leukaemia foundation.
    They have asked me to do a presentation as part of an upcoming patient education day on 'Neuropathy secondary to Chemotherapy'
    Neuropathy is one of the side effects of the treatment for many cancers, but in particular Multiple Myeloma.

    I am seeking any information from Podiatrists, Neurologists, Haematologists or any interested professionals on their knowledge and experience in this area.

    As a Podiatrist I'm interested in the following,
    - does our current practice in regard to Diabetic Neuropathy inform the pathological process in other Neuropathies ?
    - what are the clinical manifestations of this type of Neuropathy ?
    - are the current Podiatric Neurological examination tools useful in this type of Neuropathy ?

    or any other information / anedoctal experience would be gratefully received.

  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    Peripheral neuropathy is peripheral neuropathy, IMHO.

    The distinction between, mono/poly/motor/sensory/autonomic etc is just the effect of individial variations between the aetiologies.

    I like to start my neuropathy presentations by addressing the 'DANG THERAPIST' mnemonic and working my way through to the various aetiologies to get to the topic the target audience is interested in.

    For example, a couple of years ago I did a talk to a HIV support group. In this situation there are two possible aetiologies at play, the infection itself, and the toxic neuropathy caused by the older generation HIV drugs.

    I make a big deal out of compound problems (eg tarsal tunnel sydrome underlying a spinal stenosis in the presence of diabetes). Everyone looks at the diabetes, but the spinal stenosis or tarsal tunnel could be the issue.

    As you know, in the case of toxic neuropathies secondary to adverse drug reaction, the is supportive rather than curative. Much time can be spent on weighing the risks/benefits of gabapentin, amitriptylline and other drugs to palliate the situation, and praying for slow resolution of the pain.

  3. NewsBot

    NewsBot The Admin that posts the news.

    Persistent pain, sensory disturbances and functional impairment after adjuvant chemotherapy for breast cancer: cyclophosphamide, epirubicin and fluorouracil compared with docetaxel + epirubicin and cyclophosphamide.
    Andersen KG, Jensen MB, Kehlet H, Gärtner R, Eckhoff L, Kroman N.
    Acta Oncol. 2012 Nov;51(8):1036-44.
  4. NewsBot

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    Central pain processing in chronic chemotherapy-induced peripheral neuropathy: a functional magnetic resonance imaging study.
    Boland EG1, Selvarajah D2, Hunter M3, Ezaydi Y4, Tesfaye S2, Ahmedzai SH5, Snowden JA4, Wilkinson ID6.
    PLoS One. 2014 May 12;9(5):e96474.
  5. NewsBot

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    Comparison of Foot Bathing and Foot Massage in Chemotherapy-Induced Peripheral Neuropathy.
    Park, Ranhee PhD, RN; Park, Chaisoon PhD
    Cancer Nursing: October 1, 2014
  6. NewsBot

    NewsBot The Admin that posts the news.

    Chemotherapy-induced peripheral neuropathic pain
    R Gupta, A Bhaskar
    BJA Education
  7. NewsBot

    NewsBot The Admin that posts the news.

    Chemotherapy-induced Peripheral Neuropathy and Depression in Cancer Patients
    Kyung Yeon Kim et al
    Asian Oncol Nurs. 2015 Sep;15(3):149-155. Korean.
  8. NewsBot

    NewsBot The Admin that posts the news.

    Neurofeedback reduces pain, increases quality of life for cancer patients suffering from chemotherapy-induced neuropathy
  9. NewsBot

    NewsBot The Admin that posts the news.

    Gait Characteristics of Children and Youth With Chemotherapy Induced Peripheral Neuropathy Following Treatment for Acute Lymphoblastic Leukemia
    Marilyn J. Wright et al
    Gait and Posture; Article in Press
  10. NewsBot

    NewsBot The Admin that posts the news.

    Press Release:
    Preliminary Results from Clinical Study Evaluating Use of Quell in Chemotherapy-Induced Peripheral Neuropathy to be presented at the American Pain Society Annual Meeting
    May 15, 2017 10:30 AM Eastern Daylight Time
    WALTHAM, Mass.--(BUSINESS WIRE)--NeuroMetrix, Inc. (Nasdaq: NURO) today reported that researchers from the University of Rochester School of Medicine and Dentistry will present a scientific poster titled “Wearable TENs band for chemotherapy-induced peripheral neuropathy (CIPN): A feasibility study” at the upcoming annual meeting of the American Pain Society to be held in Pittsburgh, PA, May 17-20.

    Chemotherapy-induced peripheral neuropathy (CIPN) is a common cause of chronic neuropathic pain. It is characterized by symptoms that include burning pain, a distorted sense of touch, numbness, tingling, and cramps. CIPN is a common dose limiting side effect of chemotherapy and significantly impacts the quality of life of many cancer survivors. About one-third of patients will develop chronic CIPN 6 months or more after the end of chemotherapy,

    The Quell® study was led by Dr. Jennifer Gewandter, Assistant Professor, Department of Anesthesiology. The objective of the study was to test the feasibility of evaluating Quell technology in cancer survivors with CIPN and to obtain preliminary clinical efficacy data.

    “We are pleased to have supported this study, and hope it lays the groundwork for a large scale randomized clinical study that further evaluates the efficacy of Quell in CIPN,” said Shai N. Gozani, M.D., Ph.D., President and CEO of NeuroMetrix. “Many Quell users have neuropathic pain, including from CIPN. We therefore hope that this and future studies help us optimize Quell for treatment of chronic neuropathic pain.”

    About Quell
    Quell is designed for millions of people suffering from chronic pain. The advanced wearable device is lightweight and can be worn during the day while active, and at night while sleeping. It has been cleared by the FDA for treatment of chronic pain without a prescription. In a recent study, 81% of Quell users reported an improvement in their chronic pain. Quell users can personalize and manage therapy discreetly via the Quell Relief app. Quell also offers advanced health tracking relevant to chronic pain sufferers including pain, sleep, activity, and gait. Quell was the winner of the 2016 SXSW (South by Southwest) Innovation Award for Best Wearable Technology. Quell is available at select healthcare professionals and retailers. Visit QuellRelief.com for more information.

    About NeuroMetrix
    NeuroMetrix is a commercial stage, innovation driven healthcare company combining bioelectrical and digital medicine to address chronic health conditions including chronic pain, sleep disorders, and diabetes. The company's lead product is Quell, an over-the-counter wearable therapeutic device for chronic pain. Quell is integrated into a digital health platform that helps patients optimize their therapy and decrease the impact of chronic pain on their quality of life. The company also markets DPNCheck®, a rapid point-of-care test for diabetic neuropathy, which is the most common long-term complication of Type 2 diabetes. The company maintains an active research effort and has several pipeline programs. The company is located in Waltham, Massachusetts and was founded as a spinoff from the Harvard-MIT Division of Health Sciences and Technology in 1996. For more information, please visit NeuroMetrix.com.
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    Falls, Functioning, and Disability Among Women With Persistent Symptoms of Chemotherapy-Induced Peripheral Neuropathy
    Kerri M. Winters-Stone, Fay Horak, Peter G. Jacobs, Phoebe Trubowitz, Nathan F. Dieckmann, Sydnee Stoyles, et al
    Journal of Clinical Oncology - June 6, 2017
  12. NewsBot

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    Balance, gait negatively impacted after chemotherapy treatment
    Researchers say objective measures of physical function should be integrated into oncology follow-up care to reduce fall risk, improve treatment compliance

    COLUMBUS - A single chemotherapy treatment can result in a significant negative impact on walking gait and balance, putting patients at an increasing risk for falls, according to a new study involving breast cancer patients conducted by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James).

    Up to 60 percent of patients experience chemotherapy-induced peripheral neuropathy (CIPN), nerve damage that impacts feeling in the hands or feet; however, when and to what extent this damage impacts functional abilities has been largely unknown.

    This new study is the first to objectively measure the functional abilities of cancer patients during and after taxane-based chemotherapy. Researchers followed 33 patients with stage I-III breast cancer, assessing functional performance (standing balance and gait) and patient-reported outcomes at five timepoints spanning before treatment began up to three months post-treatment completion.

    Researchers observed a 28 percent increase in side-to-side sway (medial-lateral) after just one chemotherapy treatment. That increased to 48 percent with cumulative chemotherapy exposure. Patients also demonstrated a 5 percent reduction in walking speed after three cycles of chemotherapy.

    "This is not simply a quality of life concern -- CIPN can impact a patient's ability to receive treatment at all, limiting the potential for a cure. For patients who have great difficulty with neuropathy, we often have to modify their treatment regimen to make it tolerable -- sometimes the therapy has to be ceased entirely," says Maryam Lustberg, MD, MPH, senior author of the study and director of breast cancer survivorship services at the OSUCCC - James. "We need to make these treatments more tolerable to patients so they can get the full benefit of the treatments."

    Lustberg and her colleagues report that taxane exposure is also associated with worsened sensory symptoms and poorer postural control. There was also an association between patients' balance and self-reported sensory symptoms.

    The study was published online ahead of print in the medical journal Breast Cancer Research and Treatment April 3, 2017.

    Significant Clinical Problem

    CIPN leads to pain, falls and difficulty walking as well as performing activities of daily living. Although symptoms can improve with time, up to 30 percent of patients have persistent symptoms that last at least six months.

    Researchers say the study provides initial support for the feasibility and potential utility of implementing objective measures of physical function into the oncology clinic.

    "Cancer survivors are at a significant increased risk for falls, and the incidence rate of falling after chemotherapy is a serious concern for survivors' long-term quality of life," adds Lustberg. "Our study provides new insights on how taxane-based chemotherapy can impact fundamental aspects of patient function. These new insights can help us develop better strategies to help patients combat these challenges and, in some cases, choose a different therapy to treat the disease but with reduced side effects."

    The OSUCCC - James is expanding this research to assess CIPN in colorectal cancer patients receiving taxane-based chemotherapy.

    Integrating Gait, Balance Testing Into Clinical Practice

    Study co-author Ajit Chaudhari, PhD, associate professor of physical therapy, orthopedics, mechanical engineering and biomedical engineering at The Ohio State University Wexner Medical Center says the study was an important first step in achieving better long-term outcomes after cancer and provides a new tool for integrating gait and balance screening into clinical care.

    "We have created an easy-to-use clinical tool that has strong potential to quickly help clinicians identify patients -- very early on -- who are developing a chemotherapy reaction that impacts gait and balance," says Chaudhari. "It's no longer good enough for someone to just 'survive' cancer because many patients have decades of life ahead of them. It is critical to do everything we can to make the rest of their lives as productive and enjoyable as they want it to be."
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    Diagnosing, treating neuropathy symptoms in cancer patients not exact science

    ANN ARBOR--Most of the roughly 15.5 million cancer survivors in the U.S. receive chemotherapy, and roughly 65 percent develop some degree of the chemotherapy-induced nerve damage known as peripheral neuropathy.

    Peripheral neuropathy simply means nerves outside of the brain and spinal cord are affected, and symptoms include numbness and tingling in extremities, and in about 30 percent of patients, pain. Neuropathy can drastically diminish quality of life--and in extreme cases, may necessitate chemotherapy dose reductions.

    Unfortunately, neuropathy often goes underreported and untreated, said Ellen Lavoie Smith, associate professor at the University of Michigan School of Nursing. This happens because clinicians and researchers don't have a valid, standardized way to measure symptoms or the effectiveness of neuropathy treatments. Right now, the drug Cymbalta (duloxetine) is the only drug FDA-approved to treat painful neuropathy symptoms.

    Some doctors and nurses ask patients about neuropathy, or whether they have symptoms of numbness and tingling, and others don't.

    "If we don't have a reliable measurement tool, we can't know if the interventions are effective or not," Smith said. "Historically, it's possible that we've discounted treatments and said they are ineffective based on poor measurements."

    Smith's lab wanted to find a better way to quantify neuropathy symptoms and treatment efficacy.

    "The ultimate goal is to use a measurement tool in research and clinical settings that has been thoroughly tested and found to be reliable and valid. We believe we have that now," she said.

    The neuropathy measurement tool Smith examined in her research is a questionnaire developed in Europe and owned by an international research network. It's a patient-reported outcome measure called the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy Scale (QLQ-CIPN20).37.

    Findings suggest that with minor revisions, it could be universally adopted in both labs and doctors' offices to help researchers and clinicians quantify and treat this painful condition.

    Six previous publications provide evidence supporting the tool's effectiveness. However, two studies provide conflicting evidence about the instrument's validity, and another study suggests that minor revisions could improve that.

    Some researchers use the questionnaire now, but for a variety of reasons it's not used in the clinic with cancer patients, Smith said.

    "The next step is for researchers worldwide to consider using the same tool, because then the results from one researcher can be compared directly with results from the next," she said.

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