Pre-treatment anxiety is associated with persistent chemotherapy-induced peripheral neuropathy in women treated with neoadjuvant chemotherapy for breast cancer
Introduction
Breast cancer is the most common cancer in women worldwide and the second most common cancer after thyroid cancer in Korea [1]. As a result of early detection and improved treatment strategies, survival rates have improved remarkably in most developed countries, with a 92% 5-year relative survival rate in Korea [2]. The increased number of breast cancer survivors highlights the need to focus on the persistent burden of the disease, especially related to cancer treatment, which has an enormous potential to impact quality of life.
Neoadjuvant chemotherapy with taxanes has been commonly recommended for locally advanced breast cancer in order to improve surgical outcomes and to increase the opportunity for breast-conserving intervention [3,4]. Peripheral neuropathy is one of the most frequent adverse reactions induced by chemotherapeutic agents, especially the taxanes [5]. Chemotherapy-induced peripheral neuropathy (CIPN) predominantly involves the sensory peripheral nervous system and leads to symptoms characterised by numbness, tingling, paresthesia and sensory loss [6]. The incidence of CIPN in patients receiving chemotherapy ranges from approximately 30 to 40% [7]. Importantly, CIPN can persist from months to years after completion of chemotherapy, causing significant distress and decreasing the quality of life for cancer survivors [5].
Demographic variables such as health status, obesity, and age are considered predisposing factors for occurrence and duration of CIPN [8,9]. In addition, the chemotherapeutic regimen, cumulative dose and pre-existing neuropathy (related to diabetes or alcohol consumption or idiopathic) were also suggested to increase the risk of developing CIPN [[10], [11], [12]]. However, the identification of which patients will develop CIPN is still rather controversial, and most of these previous studies refer to adjuvant chemotherapy, and not specifically to neoadjuvant chemotherapy [13,14]. Furthermore, we are not aware of other studies that have investigated psychiatric factors including anxiety, depression, and sleep disturbance as risk factors for CIPN. Considering that antidepressant agents, for example, duloxetine and amitriptyline, have been shown to be helpful for CIPN [[15], [16], [17]], it is necessary to explore which psychiatric factors in the pre-treatment period could be potentially associated with the development and persistence of CIPN.
Consequently, a prospective study with a standardised clinical assessment conducted for a 1-year period before, during, and after neoadjuvant chemotherapy may contribute to a better understanding of the pre-treatment factors associated with this neurological complication. The aim of this study was to explore the prevalence of CIPN in women with breast cancer receiving neoadjuvant chemotherapy and to identify these risk factors, including psychiatric factors that contribute to the development and persistence of CIPN.
Section snippets
Study design and setting
Participants were enrolled in this prospective observational study in a tertiary general hospital in Seoul, Korea, between November 2013 and March 2016. Participants were women with breast cancer, aged 18 to 70 years, and were enrolled while they awaited neoadjuvant chemotherapy. The participants' treatment plan consisted of four cycles of anthracyclines and cyclophosphamide, followed by additional four cycles of docetaxel. Patients were excluded if they had a history of another cancer or
Sample characteristics
We approached 328 patients scheduled to receive chemotherapy before surgery. Of these, 63 patients were ineligible (due to metastasis, 24; changed treatment plan, 9; psychiatric treatment, 9; shift work, 10; low literacy, 3; and other medical conditions, 8). Among the remaining 265 eligible participants, 122 patients declined to participate. Accordingly, 143 participants were included at baseline. Of these, 32 participants were excluded during the follow-up (due to loss to follow-up, 23;
Discussion
The objective of this study was to explore the incidence and risk factors associated with CIPN in breast cancer patients receiving neoadjuvant chemotherapy using docetaxel. Among the participants, 45% reported CIPN at the end of treatment. Among them, 42% reported persistent CIPN after discontinuation of treatment. These results seem to be consistent with previous studies that found that the incidence of docetaxel-induced peripheral neuropathy ranged from 11 to 64% in patients treated with
Declaration of interest statement
This work was supported by the National Research Foundation of Korea (NRF; grant number NRF-2013R1A1A2013480). The authors declare that they have no conflict of interest. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or the national research committee, as well as with the 1964 Helsinki Declaration and its later amendments and incorporating comparable ethical standards.
Conflict of interest
The authors have no competing interests to report.
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