Chemotherapy-Induced Peripheral Neuropathy as a Predictor of Neuropathic Pain in Breast Cancer Patients Previously Treated With Paclitaxel

Neuropathic pain (NP) remains difficult to control for a significant number of patients with cancer. Chemotherapy-induced peripheral neuropathy (CIPN) has been postulated as an initial stage in the development of NP. To assess whether CIPN (defined as National Cancer Institute Common Toxicity Criteria grade 2 or higher) was associated with NP we conducted a survey of breast cancer patients who had participated in clinical trials of paclitaxel. Of the 430 potential respondents, 240 responded to the survey. Results showed that 64% experienced CIPN during paclitaxel treatment. Follow-up survey data revealed that 27% of those with CIPN were subsequently diagnosed with NP. Logistic regression analyses showed that those who had experienced CIPN were 3 times more likely to develop NP (95% confidence interval = 1.2-7.2; P<.001), which persisted in the multivariate logistic model. In addition, NP patients reported twice as many visits to their health care provider (P=.02) and had taken more prescription (50% vs 19%; P=.001) and over-the-counter medications (62.5% versus 45%; P=.08) for pain than those without NP. The results of this study confirm that CIPN is a predictor of NP suggesting that survivors treated with paclitaxel should be regularly monitored for NP beyond treatment. Perspective: The survival rates of breast cancer patients have steadily improved over recent years, thus, research into symptoms that persist after treatment is important. We found CIPN as a predictor of NP Understanding the epidemiology of NP in breast cancer patients has high clinical and public health significance. (C) 2009 by the American Pain Society