Impact of Pain on Symptom Burden in Chemotherapy-Induced Peripheral Neurotoxicity

Authors:
Fawaz Mayez Mahfouz Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia

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 BAdvSc
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Tiffany Li Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia

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 MBiostat
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Hannah C. Timmins Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia

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 PhD
,
Lisa G. Horvath Chris O’Brien Lifehouse, Camperdown, Australia
Sydney Medical School, The University of Sydney, Camperdown, Australia
Royal Prince Alfred Hospital, Camperdown, Australia

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 MBBS, PhD
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Michelle Harrison Chris O’Brien Lifehouse, Camperdown, Australia

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Peter Grimison Chris O’Brien Lifehouse, Camperdown, Australia
Sydney Medical School, The University of Sydney, Camperdown, Australia

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Gavin Marx Sydney Adventist Hospital, Wahroonga, Australia

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David Goldstein Prince of Wales Clinical School, Faculty of Medicine & Health, UNSW Sydney, Randwick, Australia
Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia

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Susanna B. Park Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia

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 PhD
Volume/Issue:
Volume 22: Issue 2
Online Publication Date:
15 Feb 2024
DOI:
https://doi.org/10.6004/jnccn.2023.7083
Restricted access

Background: Chemotherapy-induced peripheral neurotoxicity (CIPN) affects the quality of life of cancer survivors. However, the impact of pain on symptom burden remains undefined. This study aimed to define differences in the clinical symptom profile of patients with painful and nonpainful CIPN. Patients and Methods: A total of 579 participants (median age, 59 years [IQR, 19 years]; F=66%) were assessed cross-sectionally 6 months posttreatment. CIPN severity was graded using multiple methods, including patient-reported outcome measures, a clinically graded scale (NCI-CTCAE), and a neurologic examination score. Participants were classified into subgroups based on patient symptom report, with painful CIPN characterized by the presence of shooting/burning pain, and nonpainful CIPN characterized by the presence of numbness or tingling without shooting/burning pain. Behavioral changes were assessed via structured patient interview regarding symptom impact on sleep, exercise, and treatment-seeking. Results: Among 579 participants, 24% (n=140) reported painful CIPN, 48% (n=280) reported nonpainful CIPN, and 28% (n=159) had no CIPN. Participants with painful CIPN demonstrated higher CIPN severity than those with nonpainful CIPN across multiple measures, including NCI-CTCAE, neurologic grading, and patient report (all P<.05). Participants with painful CIPN were more likely to report that their symptoms affected their ability to exercise (P=.007), produced sleep impairment, and increased treatment-seeking behavior due to their symptoms (both P<.001) compared with participants with nonpainful CIPN. Conclusions: Overall, participants with painful CIPN reported higher scores across all CIPN severity measures, including behavioral changes. This study underlines the need for accurate identification of different CIPN subgroups in hopes of informing better treatment and rehabilitation options for cancer survivors with painful CIPN.

Submitted July 6, 2023; final revision received September 4, 2023; accepted for publication September 5, 2023. Published online February 15, 2024.

Author contributions: Study concept and design: All authors. Data collection: Mahfouz, Li, Timmins, Park. Data analysis and interpretation: Mahfouz, Park. Provision of study participants: Horvath, Harrison, Grimison, Marx, Goldstein. Writing—original draft: Mahfouz. Writing—review and editing: All authors. Final approval of manuscript: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration 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) and a National Health and Medical Research Council of Australia (NHMRC) Project Grant (#1080521). T. Li received a PhD Scholarship from Sydney Cancer Partners through funding from the Cancer Institute NSW (2021/CBG0002). S.B. Park is supported by an NHMRC Career Development Fellowship (#1148595).

Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2023.7083. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.

Correspondence: Susanna B. Park, PhD, IN FOCUS Research Team, Level 4, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, NSW, Australia. Email: susanna.park@sydney.edu.au

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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2024 by the National Comprehensive Cancer Network 2024
Page Numbers:
9
Article Category:
Research Article
Received:
06 Jul 2023
Accepted:
05 Sep 2023
Print Publication Date:
01 Mar 2024
Online Publication Date:
15 Feb 2024

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