Poster Presentation Cancer Survivorship 2017

LONG TERM OUTCOMES AND RISK FACTORS FOR CHEMOTHERAPY INDUCED PERIPHERAL NEUROPATHY IN CHILDHOOD CANCER SURVIVORS (#58)

Tejaswi Kandula 1 2 , Michelle A Farrar 1 2 , Matthew C Kiernan 3 , David Mizrahi 4 , Kate Carey 2 , Arun V Krishnan 5 , Susanna B Park 3 5 , Richard J Cohn 4
  1. Sydney Children's Hospital, Randwick, Sydney, NSW, Australia
  2. School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
  3. Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
  4. Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
  5. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia

      Background: Chemotherapy induced peripheral neuropathy (CIPN) may be an important cause of morbidity in childhood cancer survivors (CCS), contributing to reduced physical function and restricted participation in day-to-day activities. This study aimed to evaluate the prevalence and impact of CIPN in long term CCS.

      Methods:  Comprehensive neurotoxicity assessments were undertaken in CCS who completed platinum or vinca alkaloid based chemotherapy >5 years ago, comprising of clinical, functional, quality of life and neurophysiological parameters including conventional nerve conduction studies and novel nerve excitability studies.

      Results: Neurotoxicity assessments were performed on 110 participants aged 7-47 years, who received chemotherapy at a mean age of 5.8±0.4yrs and completed treatment 11.2±0.7yrs ago. 33% of patients demonstrated clinical and/or neurophysiological evidence of peripheral neuropathy. Overall, CCS demonstrated reduction in sensory amplitudes compared to age-matched controls (Mean difference -6.3μV; 95%CI -9.6, -3.0µV; p=0.0003), suggesting an impact on axonal reserve. Participants treated with platinum agents (p=0.008) or dual neurotoxic chemotherapy were most affected (p=0.01). There were persistent abnormalities in functional excitability properties of sensory nerves in participants with prior cisplatin treatment (p<0.05). Clinical functional parameters of manual dexterity (44.5th percentile, 95%CI 36.1, 52.9%), balance (49th percentile, 95%CI 38.9, 59%) and co-ordination (55.9th percentile, 95%CI 46.9,65%) were relatively preserved compared to the normal population.

      Conclusion: CIPN produces significant long term morbidity in CCS. Clinical and neurophysiological abnormalities in CCS are consistent with global axonal loss, which may predispose to further age-related degenerative change. Exposure to platinum or dual neurotoxic chemotherapy are risk factors for long term neuropathy. Relative preservation of clinical function suggests a window of opportunity for physical therapy which may preserve long term function.