MesotheliomaHelp has written numerous times about the pain and lifestyle issues caused by chemotherapy-induced peripheral neuropathy (CIPN) in mesothelioma patients. According to statistics, nearly one-third of all cancer patients who receive chemotherapy will be affected by CIPN. Now, one research team is asking, “What if CIPN could be prevented instead of treated?”
Chemotherapy has been shown to cause nerve damage, leading to shooting pain, burning, tingling, numbness, problems with balance and grasping things, as well as cold or heat sensitivity. Various reports show that CIPN can be severe or minor, long-lasting, reversible, or only partially reversible, and that treatments are usually ineffective. But when researchers set out to understand exactly how neuropathy affects cancer patients one or more years after treatment, they found the data sorely lacking.
So a team of researchers from UC Davis and UCLA conducted their own study of 1,512 breast cancer patients, from the National Surgical Adjuvant Breast and Bowel Project Protocol B-30 (NSABP B-30), a clinical trial that investigated the effectiveness of combinations of chemotherapy, who were treated with varying doses of chemotherapy. The findings showed that two years after the start of treatment, 42 percent of patients experienced neuropathy symptoms with 10 percent reporting severe discomfort. Not surprisingly, those reporting severe symptoms also reported a “much worse quality of life.”
Furthermore, the team uncovered that low-dose chemotherapy combinations were less likely to affect patients, and that patients who had pre-existing neuropathy, were older or were obese, were impacted more with neuropathy symptoms.
For most cancer patients, including mesothelioma and breast cancer patients, chemotherapy is the most prescribed treatment. Most people who are diagnosed with the disease in its later stages are not eligible for “curative” surgeries, so chemotherapy becomes their best chance at extending life. For patients who are diagnosed in an earlier stage or are otherwise candidates for surgery, chemotherapy is likely to be used along with other options such as surgery and radiation therapy for a multimodal treatment protocol.
“Since we don’t have an effective treatment [for neuropathy], ideally it would be best to prevent it from happening by not administering chemotherapy if it is likely to have minimal additional benefit,” said Patricia Ganz, director of the Center for Cancer Prevention & Control Research at UCLA’s Jonsson Comprehensive Cancer Center and senior author of the study.
“I think we’ve reached the point now where we need to ask questions about the adverse effects that come along after curative treatments,” said Joy Melnikow, co-author of the study who directs the Center for Healthcare Policy and Research at UC Davis. “We need to balance what are sometimes small therapeutic benefits with the risk of long-term adverse events.”
Although this study focused on breast cancer patients, the findings relate to nearly all cancer patients who undergo chemotherapy. The researchers suggest chemotherapy be avoided in “patients who are at higher risk for persistent neuropathy” like those found in the study. If it is administered, “at the minimum, patients need to be informed about the likelihood of persistent symptoms,” say the researchers.
Calling their study a “call to action,” the researchers believe these findings will give oncologists information needed to adjust treatments, or look at other treatments, to reduce the risk of “long-term neuropathy.”
Close to 3,000 Americans are diagnosed with mesothelioma each year. The cancer is highly aggressive and is resistant to many cancer treatments making it a difficult disease to treat effectively. There is no known cure for the disease.