Balance Deficits and Functional Disability in Cancer Survivors Exposed to Neurotoxic Cancer Treatments

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J. Matt McCrary Prince of Wales Clinical School, University of New South Wales, Kensington;

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David Goldstein Prince of Wales Clinical School, University of New South Wales, Kensington;
Prince of Wales Hospital, Randwick;

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Terry Trinh Prince of Wales Clinical School, University of New South Wales, Kensington;

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Hannah C. Timmins Brain and Mind Centre, The University of Sydney, Camperdown;

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Tiffany Li Brain and Mind Centre, The University of Sydney, Camperdown;

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Jasmine Menant Neuroscience Research Australia, Randwick;

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Michael Friedlander Prince of Wales Clinical School, University of New South Wales, Kensington;
Prince of Wales Hospital, Randwick;

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Craig R. Lewis Prince of Wales Clinical School, University of New South Wales, Kensington;
Prince of Wales Hospital, Randwick;

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Mark Hertzberg Prince of Wales Clinical School, University of New South Wales, Kensington;
Prince of Wales Hospital, Randwick;

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Siobhan O’Neill Prince of Wales Hospital, Randwick;

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Tracy King Royal Prince Alfred Hospital, Camperdown;
Sydney Nursing School, The University of Sydney, Camperdown;

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Annmarie Bosco Prince of Wales Hospital, Randwick;
School of Medical Sciences, University of New South Wales, Kensington; and

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Michelle Harrison School of Medical Sciences, University of New South Wales, Kensington; and
School of Medical Sciences, University of New South Wales, Kensington; and

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Susanna B. Park Prince of Wales Clinical School, University of New South Wales, Kensington;
Brain and Mind Centre, The University of Sydney, Camperdown;

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Background: Chemotherapy-induced peripheral neuropathy (CIPN) persists after treatment in up to 40% of cancer survivors and has been linked with increased balance deficits, disabilities, and fall occurrences. This study aimed to comprehensively assess the links between CIPN, balance deficits, and functional disability and to inform the development of clinical screening tools for patients at risk of these events. Patients and Methods: A total of 190 cancer survivors exposed to neurotoxic chemotherapies (age, 57 ± 13 years; average time from completion of neurotoxic therapy, 12 ± 11 months) attended a neurology research clinic for a single cross-sectional assessment of patient-reported and objective CIPN, standing balance in 4 conditions of increasing difficulty, and functional disability. Results: Most patients (68%) reported CIPN symptoms at assessment. Symptomatic patients displayed increased functional disability (F=39.4; P<.001) and balance deficits (F=34.5; P<.001), with degree of balance impairments consistent with a healthy elderly population (age ≥65 years) reporting multiple falls over the subsequent year. Increasing CIPN severity correlated with increasing functional disability (clinically assessed R2=0.46; patient-reported R2=0.49; P<.001) and balance deficits (clinically assessed R2=0.41; patient-reported R2=0.30; P<.001). A 5-factor model of key independent correlates—patient-reported numbness/tingling, weakness, and balance deficit; age; and vibration perception—was strongly linked to balance deficits (R2=0.46; P<.001) and functional disability (R2=0.56; P<.001). Conclusions: This study confirms links between increasing CIPN severity and increasing balance deficits and functional disability using comprehensive CIPN assessment methodology. The extent of balance deficits in patients with CIPN underscores the functional consequences of neurotoxicity. A 5-factor model provides a foundation for clinical screening tools to assess balance deficits and functional disability in patients exposed to neurotoxic chemotherapies.

Submitted December 4, 2018; accepted for publication February 25, 2019.

Author contributions: Study concept and design: McCrary, Goldstein, Park. Data acquisition: McCrary, Trinh, Timmins, Li. Quality control of data and algorithms: McCrary, Menant. Data analysis and interpretation: McCrary, Goldstein, Menant, Park. Statistical analysis: McCrary. Manuscript preparation: McCrary. Manuscript editing and review: All authors.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This study was supported by a Cancer Institute NSW Program Grant (14/TPG/1-05; Goldstein) and a National Health and Medical Research Council of Australia (NHMRC) Project Grant (1080521; Park). Dr. Park is supported by a NHMRC Career Development Fellowship (1148595).

Correspondence: Susanna B. Park, PhD, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia. Email: susanna.park@sydney.edu.au

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