CHICAGO — As many as 50% of patients undergoing chemotherapy for cancer experience chemotherapy induced peripheral neuropathy. But most cases go undiagnosed, according to results presented at the American Neurological Association 2015 Annual Meeting in Chicago.
Noah A. Kolb, MD, of the University of Utah, and colleagues studied the frequency of chemotherapy-induced peripheral neuropathy and other neuropathy codes in three large databases: the Utah Cancer Registry, Population Database, and Electronic Data Warehouse. Overall, 984 patients exposed to neurotoxic chemotherapy were identified.
Chemo Induced Peripheral Neuropathy
Disorders of peripheral nerves are frequent complications of chemotherapy and certain other drug therapies. As more and more effective therapies for cancer are found and patients are living longer, peripheral neuropathy complications of chemotherapy is increasing in prevalence. Chemotherapy can cause degeneration of peripheral sensory and motor nerves and cause patients to present with sensory disturbances, balance problems or weakness.
Symptoms of Chemotherapy Induced Peripheral Neuropathy
The symptoms of chemotherapy induced peripheral neuropathy depend on the type of chemotherapy and which nerve fibers are affected. In chemotherapies that affect mainly the sensory nerve fibers, the patients experience unusual sensations (paresthesias), numbness, balance problems or pain. In cases where the motor nerves are affected, the patients may experience weakness of the muscles in the feet and hands.
Chemotherapy Induced Peripheral Neuropathy Diagnosis
Diagnosis of chemotherapy induced neuropathies is based on history, clinical examination and supporting laboratory investigations. These include electromyography with nerve conduction studies, skin biopsies to evaluate cutaneous nerve innervation, and nerve and muscle biopsies for histopathological evaluation.
Treatment for Chemotherapy Induced Peripheral Neuropathy
Treatment of chemotherapy induced neuropathies depends on discontinuation or lowering the dose of the anti-cancer drug. Persistent neuropathic pain can be treated with anti-seizure medications, antidepressants, or analgesics including opiate drugs. In severe painful conditions patients may be referred to the Blaustein Chronic Pain Clinic for a multidisciplinary approach to pain management. Patients who have severe balance problems often benefit from balance (vestibular) rehabilitation.
Among the patients, 13.4% with breast cancer, 9.3% with colorectal cancer, 9.2% with urinary/bladder cancer, and 12.1% with uterine cancer had generic neuropathy codes, while 0.8% of those with breast cancer, 1.4% with colorectal cancer, 3.3% with uterine cancer and none with urinary/bladder cancer had chemotherapy-induced peripheral neuropathy-specific codes.
09/30/2015
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