Pediatric Chemotherapy May Be Associated With Long-Term Peripheral Neuropathy

Childhood cancer survivors are at risk for long-term peripheral neuropathy, particularly when treated with cisplatin.

Childhood cancer survivors are at risk for long-term peripheral neuropathy, particularly when treated with cisplatin, according to a cross-sectional observational study published in JAMA Neurology. 

Investigators recruited 121 consecutive cancer survivors who had undergone chemotherapy treatment for extracranial malignancy before age 17 and age-matched healthy controls.

A comprehensive neurotoxicity assessment was conducted in each participant, which consisted of the pediatric-modified Total Neuropathy Score (clinical measures), the Movement Assessment Battery for Children (functional measures), nerve conduction studies (neurophysiologic measures), and the Pediatric Quality of Life Inventory Generic Core Scales and Pediatric Outcomes Data Collection Instrument (patient-reported outcome measures).

The main neurotoxic agents used in the cohort were vinca alkaloids and platinum compounds. Cisplatin was found to be associated with a greater rate of long-term neurotoxicity compared with vinca alkaloids. Of the 107 patients treated with neurotoxic chemotherapy agents, 54 (50.5%) had clinical abnormalities consistent with peripheral neuropathy (mean Total Neuropathy Score increase, 2.1; 95% CI, 1.4-2.9; P <.001). The clinical abnormalities were associated with lower limb predominant sensory axonal neuropathy (mean amplitude reduction, 5.8 μV; 95% CI, 2.8-8.8; P <.001). 

Observed deficits in functional capacity affected balance, distal sensation, and manual dexterity. In addition, the total Neuropathy Score was associated with reductions in global quality of life and physical functioning. There were no associations between neurophysiologic or patient-reported deficits and age at diagnosis, time since completion of treatment, body mass index, type of malignancy, type of chemotherapy, and bone marrow transplantation.

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The findings from the study may not generalize to patients who were treated with chemotherapy in adulthood.

According to the investigators, “Both the type of neurotoxic agent used and a targeted clinical neurological assessment are important considerations when screening childhood cancer survivors for long-term neuropathy.”

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Kandula T, Farrar MA, Cohn RJ, et al. Chemotherapy-induced peripheral neuropathy in long-term survivors of childhood cancer clinical, neurophysiological, functional, and patient-reported outcomes [published online May 14, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2018.0963