Patient-reported peripheral neuropathy in cervix cancer patients: a trajectory analysis
Anders Tobias Frederiksen,
Denmark
OC-0605
Abstract
Patient-reported peripheral neuropathy in cervix cancer patients: a trajectory analysis
Authors: Anders Tobias Frederiksen1, Marta Pelizzola2, Kathrinl Kirchheiner3, Ina M. Jürgenliemk-Schulz4, Remi A. Nout5, Maximilian P. Schmid3, Kari Tanderup2, Li Tee Tan6, Sofia Spampinato1
1Aarhus University Hospital, Danish Center for Particle Therapy , Aarhus, Denmark; 2Aarhus University Hospital, Danish Center for Particle Therapy, Aarhus, Denmark; 3Medical University of Vienna, Department of Radiation Oncology- Comprehensive Cancer Center, Vienna, Austria; 4University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands; 5Erasmus MC, Department of Radiation Oncology , Rotterdam, The Netherlands; 6Cambridge University Hospitals NHS Foundation Trust, Oncology Centre, Cambridge, United Kingdom
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Purpose or Objective
Peripheral neuropathy (PN) is a common side-effect after chemoradiation. Previous studies found that persistent patient-reported PN has major impact on long-term quality of life (QoL) among patients treated for locally advanced cervical cancer (LACC).
This analysis evaluates persistency and identifies time development patterns of patient-reported PN among LACC patients.
Material and Methods
The analysis was conducted within the prospective, multi-institutional and international EMBRACE-II study which enrolled LACC patients (2016-2021) treated with external beam radiotherapy, concomitant weekly cisplatin, and image-guided adaptive brachytherapy.
Symptoms of PN were prospectively scored with the EORTC CX24 questionnaire by patients at baseline and regular follow-ups. The question analyzed was “Have you had tingling or numbness in your hands or feet?” and score options were: “not at all”, “a little”, “quite a bit” and “very much”. This longitudinal analysis included patients reporting these symptoms at least at baseline and at 3 late follow-ups (FUPs). Late follow up was defined as at 3 months after end of treatment and up till 24 months.
Late persistency (LAPERS) of PN was calculated based on the median score of PN across all late FUPs (3 months to 24 months). Late persistency of PN was defined if patients scored “a little or worse” and “quite a bit or worse” in at least of half of FUPs, respectively (Figure1). Trajectory analysis (TJA) was used to group patients based on their longitudinal time patterns of PN development over the observation period and identify relevant clusters.
Results
Of the EMBRACE II patients included, 768 patients fulfilled the criteria at the time of longitudinal analysis. “A little or worse” late persistent PN was experienced by 40.2% (n=309) and “quite a bit or worse” by 9.5% (n=75) of patients in at least half of FUPs. Among patients with late persistent “a little or worse” and “quite a bit and worse” PN 8.5% and 1%, respectively, did not experience any worsening compared to the baseline condition.
Figure2.a shows different clusters of patients identified by TJA among the 768 patients. Figure2.b shows the clusters identified only in patients with “a little or worse” late persistent PN (n=309). In both scenarios, TJA found three major clusters of patients with similar time development patterns: progressing to “a little”, progressing to “very much”, and transient PN. A small group of patients did not show worsening compared to the baseline condition.
Conclusion
Patient-reported tingling and numbness in hands and feet was experienced frequently after treatment by LACC patients in EMBRACE II. TJA allowed to identify major clusters of patients with clear worsening of PN over time, most of them reporting “a little”. Because of the impact of PN on long-term QoL and activities of daily life of cancer survivors, further efforts should be directed at understanding this symptom, identifying risk factors and potential strategies for reduction.