Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients
Gait, balance, and patient-reported outcomes during taxane-based chemotherapy in early-stage breast cancer patients
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DOI：
10.1007/s10549-017-4230-8
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发表时间：
2017-07-01
影响因子：
3.8
通讯作者：
Lustberg, Maryam B.
中科院分区：
文献类型：
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作者：
Monfort, Scott M.;Pan, Xueliang;Lustberg, Maryam B.
背景化疗引起的周围神经病变（CIPN）是几种常用化疗药物（包括紫杉烷类、长春花生物碱和铂化合物）的剂量限制性毒性。 CIPN 的发展在自我报告的症状和功能后果方面都有很大差异，并且可能严重到足以改变剂量强度。目的 描述接受紫杉烷类化疗的乳腺癌患者报告的 CIPN 症状和功能障碍的自然史。方法对 33 名乳腺癌患者（32 名女性/1 名男性；47.8 +/- 11.2 岁；n = 17 例 II 期/n = 16 例 III 期）进行了研究已注册。患者在肿瘤门诊的五个时间点完成了症状和功能的自我报告（例如 EORTC QLQ-CIPN20）和身体功能的客观测量（即平衡和步态测试）：(1) 开始化疗之前的基线，(2-4) 开始后续化疗周期之前，以及 (5) 接受最后一次紫杉烷输注后 1-3 个月。 结果 两种患者报告的结果均出现显着的负面变化并观察到客观的功能测量。第一个化疗周期后观察到平衡能力下降（压力中心的内侧-外侧偏移增加 28%，p = 0.016），并且随着累积暴露的增加而进展（增加 43%，p < 0.001）。随着治疗的进展，患者的步行速度也变慢（降低 5%，p = 0.003）。这些功能缺陷与患者报告的所有 EORTC QLQ-CIPN20 子量表症状严重程度的增加相对应（所有 p < 0.05）。 结论 本研究对接受紫杉烷治疗的患者进行平衡和步态测试的同时纵向评估患者报告的结果。紫杉烷治疗与 CIPN 症状和患者功能方面的临床相关问题的发生有关。
Background Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several commonly used chemotherapy drugs including taxanes, vinca alkaloids, and platinum compounds. Development of CIPN is highly variable, both in self-reported symptoms and functional consequences, and can be severe enough to alter dose intensity.Purpose To describe the natural histories of both patient-reported symptoms of CIPN and functional impairments in breast cancer patients undergoing taxane-based chemotherapy.Methods Thirty-three breast cancer patients (32 female/1 male; 47.8 +/- 11.2 years; n = 17 stage II/n = 16 stage III) were enrolled. Patients completed self-reports of symptoms and function (e.g., EORTC QLQ-CIPN20) and objective measures of physical function (i.e., balance and gait testing) in an outpatient oncology clinic at five timepoints: (1) baseline-prior to starting chemotherapy, (2-4) before starting subsequent chemotherapy cycles, and (5) 1-3 months after receiving their last taxane infusion.Results Significant negative changes in both patient-reported outcomes and objective functional measures were observed. Decreased balance was observed after the first chemotherapy cycle (28% increase in medial-lateral excursion of the center of pressure, p = 0.016) and progressed with cumulative exposure (43% increase, p < 0.001). Patients also demonstrated slower walking speeds (5% decrease, p = 0.003) as they progressed through treatment. These functional deficits were mirrored with increased patient-reported symptom severity for all EORTC QLQ-CIPN20 subscales (all p < 0.05).Conclusion This study longitudinally assessed patient-reported outcomes concurrently with balance and gait testing in patients undergoing taxane therapy. Taxane treatment was associated with the development of clinically relevant problems in both CIPN symptoms and patient function.