Patterns and predictors of symptoms, falls, and functioning across treatment and recovery in patients treated with neurotoxic chemotherapy for cancer

最近的报告表明，癌症患者跌倒会增加25%-50%，这与治疗有关 副作用，如化疗引起的周围神经病变(CIPN)，改变行动能力(步态和平衡)。 癌症患者的跌倒和功能障碍在很大程度上仍然没有得到认识和治疗，部分原因是 由于目前尚不清楚影响移动性的症状级别，因此增加的具体移动性缺陷 跌倒和残疾风险，或哪些患者风险最大。我们的长期目标是预防跌倒和残疾 与癌症治疗相关，告知临床医生哪些患者以及何时出现癌症风险增加 跌倒和功能衰退，并告知康复提供者针对哪些行动不便。一位批评者 迈向这一目标的第一步是描述症状、功能和跌倒的自然轨迹 癌症护理的治疗中和康复阶段。为了实现这一目标，我们将使用详细的症状跟踪， 简单的临床测试，被动持续监测日常活动和体力活动，以及自我报告跌倒 在200名服用神经毒素的患者中收集治疗前、治疗中和治疗后一年的残疾情况 癌症的化疗。这项研究的具体目的是：1)描述神经病变的轨迹 症状和功能(客观活动能力、体力活动、自我报告功能和残疾) 接受神经毒性化疗的癌症患者的治疗和一年康复2) 确定症状和功能轨迹的最简单预测因子，以确定不同的患者 应考虑治疗方案和/或谁将从早期和有针对性的康复中受益 干预措施。这项研究具有创新性，因为它将是第一个揭示癌症治疗如何 导致摔倒风险和生存残疾的增加，2)测量症状、活动能力和跌倒的变化 在化疗和康复过程中，3)使用持续的被动监测技术，如 对日常生活中活动和活动变化的敏感和具体测量；以及，4)应用一种新的分析方法 方法-生长混合建模(GMM)-识别症状变化的不同轨迹， 与神经毒性化疗相关的功能和跌倒。总而言之，从这项研究中获得的知识 可以用来确定哪些患者可以通过改变治疗计划从早期干预中受益 和/或转诊至康复中心。这项研究的发现可能为肿瘤学团队提供新的信息 为接受神经毒性化疗的患者改善患者安全并加强生存护理计划。 目前，临床实践指南侧重于CIPN相关疼痛的药物治疗， 仍然是次优的，很少注意预防跌倒和功能衰退。这项研究可能会有 通过定义与CIPN相关的功能衰退的自然轨迹产生重大影响，以便及早发现 可以将努力整合到接受神经毒性治疗和靶向护理的患者的临床路径中 为高危患者提供服务。

Recent reports suggest that falls increase by 25%-50% in cancer patients and are linked to treatment-related side effects, such as chemotherapy-induced peripheral neuropathy (CIPN), that alter mobility (gait and balance). Falls and functional impairments in cancer patients remain largely unrecognized and under-treated, in part because it is not yet known what level of symptoms impact mobility, the specific mobility deficits that increase fall and disability risk, or which patients are most at risk. Our long-term objective is to prevent falls and disability associated with cancer treatment by informing clinicians about which and when patients show increased risk for falls and functional decline and informing rehabilitation providers about which mobility deficits to target. A critical first step toward this objective is to characterize the natural trajectories of symptoms, functioning, and falls across the in-treatment and recovery phases of cancer care. To achieve this goal, we will use detailed symptom tracking, simple clinical tests, passive continuous monitoring of daily mobility and physical activity, and self-report falls and disability collected before, during, and one year after treatment in 200 patients prescribed neurotoxic chemotherapy for cancer. The Specific Aims of this study are: 1) to characterize trajectories of neuropathy symptoms and functioning (objective mobility, physical activity, self-report functioning and disability) across treatment and one year of recovery among persons receiving neurotoxic chemotherapy for cancer and 2) Determine the simplest predictors of symptom and functioning trajectories to identify patients in whom different treatment options should be considered and/or who would benefit from early and targeted rehabilitation interventions. This study is innovative because it will be the first study to 1) reveal how cancer treatment could lead to increased risk of falls and disability in survivorship, 2) measure changes in symptoms, mobility and falls across a course of chemotherapy and into recovery, 3) employ continuous passive monitoring technologies as sensitive and specific measures of mobility and activity changes during daily life; and, 4) apply a novel analytic approach - growth mixture modeling (GMM) - to identify the distinct trajectories of changes in symptoms, functioning and falls associated with neurotoxic chemotherapy. Collectively the knowledge gained from this study can be used to identify which patients might benefit from early intervention via alterations in treatment plans and/or referral to rehabilitation. Findings from this study could provide new information for oncology teams to improve patient safety and enhance survivorship care plans for those receiving neurotoxic chemotherapies. Currently, clinical practice guidelines focus on pharmacologic management of pain associated with CIPN, which remains suboptimal, with little attention to prevention of falls and functional decline. This study could have a significant impact by defining the natural trajectories of functional declines related to CIPN so that early detection efforts can be integrated into the clinical pathway of patients receiving neurotoxic treatment and targeted care provided for at-risk patients.