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Epidemiology

Persistent neuropathy among early-stage breast cancer survivors in a population-based cohort

British Journal of Cancer volume 125, pages 445–457 (2021)Cite this article

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Abstract

Background

The prevalence of persistent peripheral neuropathy (PN) in early-stage breast cancer (ESBC) survivors is largely unknown. We explored the occurrence and risk factors of PN among long-term ESBC survivors treated with taxane chemotherapy.

Methods

A population-based cohort of 884 recurrence-free ESBC survivors diagnosed 2010–2015 in the South East Health Care region, Sweden and 1768 control women without prior cancer received a postal questionnaire that included the European Organisation for Research and Treatment of Cancer chemotherapy-induced peripheral neuropathy (CIPN20) items. Prevalence, relative risks (RRs) (Poisson regression) and risk factors (binomial regression) were calculated. Adjustments were made for confounding factors (e.g. age, body mass index, comorbidities).

Results

The response rate was 79% for survivors and 59% for controls. The median time post taxane was 3.6 years (1.5–7.3 years). The adjusted RR was highest (RR 1.8) for “tingling/numbness of toes/feet”. Individual sensory symptoms occurred in 8.9–48.4% and motor symptoms in 7.2–61.3% of survivors; the most prevalent symptoms were “difficulty opening jar” and “cramps in feet”. Paclitaxel, older age, overweight, diabetes mellitus, vibrating hand tools, autoimmune disease and smoking were independent risk factors.

Conclusions

PN was more common among ESBC survivors than control women and many symptoms persisted over time. Risk factors should be considered when treatment decisions are made.

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Fig. 1
Fig. 2: Self-reported symptoms of peripheral neuropathy (EORTC QLQ-CIPN20) among early-stage breast cancer survivors and control women.

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Acknowledgements

We wish to thank all the study participants, Marika Wenemark for assistance in developing the questionnaire and Rasmus Mikiver for cancer register assistance.

Author information

Authors and Affiliations

  1. Department of Oncology, Jönköping, Region Jönköping County, Sweden

    Kristina Engvall

  2. Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

    Kristina Engvall

  3. Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

    Henrik Gréen

  4. Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden

    Henrik Gréen

  5. Department of Biomedical and Clinical Sciences and Forum Östergötland, Linköping University, Linköping, Sweden

    Mats Fredriksson

  6. Department of Oncology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden

    Elisabeth Åvall-Lundqvist

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  1. Kristina Engvall
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Contributions

Conceptualisation; data curation; formal analysis; methodology; resources; software; supervision; validation; visualisation; roles/writing—original draft: K.E., M.F., H.G. and E.Å.-L. Funding acquisition; investigation; project administration; writing—review and editing: K.E., H.G. and E.Å.L.

Corresponding author

Correspondence to Kristina Engvall.

Ethics declarations

Ethics approval and consent to participate

The Regional Ethics Committee in Linköping approved the study (Ref. no. 2016/548-31). All women who participated in the study gave informed consent by returning the questionnaire. The study was performed in accordance with the Declaration of Helsinki.

Consent to publish

This study contained no individual person’s data.

Data availability

The dataset analysed during the current study is available from the corresponding author on reasonable request.

Competing interests

The funding sources played no role in the study. The authors declare no competing interests.

Funding information

This work was supported by the Swedish Cancer Society (190224); the Medical Research Council of Southeast Sweden (FORSS-932359); Futurum—The Academy for Health and Care, Jönköping County Council (575361); Forsknings-ALF (LIO-901261).

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Engvall, K., Gréen, H., Fredriksson, M. et al. Persistent neuropathy among early-stage breast cancer survivors in a population-based cohort. Br J Cancer 125, 445–457 (2021). https://doi.org/10.1038/s41416-021-01429-3

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