Chronic Severe Neuropathy Affects Over 40% of Cancer Patients With CIPN

Many cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) will develop a chronic form of the disorder, according to findings from a systematic review and meta-analysis.

For more than 10,000 patients with CIPN included in 77 studies, the estimated pooled prevalence of chronic painful CIPN — lasting for as long as 3 months — was 41.2%, reported Ryan S. D’Souza, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues.

Subgroup analyses showed that patients treated with platinum-based agents and taxanes had the highest prevalence of chronic painful CIPN (40.4% and 38.4%, respectively), as did those with lung cancer (60.3%), they wrote in Regional Anesthesia & Pain Medicine.

“This study represents the first meta-analysis to provide comprehensive global prevalence estimates for chronic painful CIPN among patients diagnosed with CIPN, thus addressing a significant gap in the existing literature,” the authors noted.

“However, the GRADE [Grading of Recommendations, Assessment, Development and Evaluation] certainty of evidence was considered ‘very low,'” they pointed out. “The wide variability in prevalence rates across different countries, continents, chemotherapy regimens, and primary cancer history underscores the need for tailored strategies to address this debilitating condition.”

D’Souza and colleagues explained that while a substantial percentage of patients with CIPN experience non-painful neuropathic features, such as numbness or tingling, those with chronic painful neuropathy are likely to have a diminished quality of life with significant functional impairment that can contribute “substantially to the economic burden on healthcare systems, with increased disability costs and a heightened need for pain management interventions.”

“Given the projected increase in cancer survivorship and the rising incidence of CIPN due to more aggressive chemotherapy regimens, understanding the global prevalence of chronic painful neuropathy in CIPN is critical,” they added.

For this systematic review and meta-analysis, D’Souza and colleagues included 77 studies involving 10,962 patients from 28 countries, all of whom had CIPN, and 4,545 of whom had chronic painful CIPN (defined as 3 or more months since CIPN onset).

Studies conducted in the U.S. comprised 16.9% of the cohort, while studies from Japan comprised 13%. Nearly half were prospective observational studies (45.5%), 37.7% were retrospective observational studies, and 16.9% were randomized trials. Of these studies, 32.5% focused on colorectal cancer, 22.1% focused on breast cancer, and 18.2% included patients with different primary cancer types.

Most studies — 81.8% — reported patients with CIPN in the upper and/or lower extremities.

In terms of chemotherapy regimen, 16.9% of studies focused on patients who received platinum-based agents, 14.3% focused on taxanes, 7.8% focused on platinum-based agents plus taxanes, and 6.5% focused on folinic acid, fluorouracil, and oxaliplatin (FOLFOX).

Patients who received FOLFOX had the lowest prevalence of painful CIPN (16.4%), as did those with ovarian cancer (31.4%) and lymphoma (36%). Prevalence rates were similar between men and women.

Studies that took place in Asia reported the highest prevalence of chronic painful CIPN (46.5%), while studies that took place in Europe reported the lowest prevalence (35.9%).

D’Souza and team noted that substantial statistical heterogeneity was observed both in the primary outcome and in subgroup analyses, “a common issue in prevalence meta-analyses that integrate diverse studies across global contexts.”

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