1. Susman, Ed

Article Content

PALM SPRINGS, Calif.-Cancer patients who have chemotherapy-induced neuropathy often say that the pain in their feet hurts more than neuropathy in their hands, and now those observations have been documented.

Figure. T1-weighted ... - Click to enlarge in new windowFigure. T1-weighted fat-saturated postgadolinium coronal MRI at the level of the metatarsal diaphyses in a patient with extensive intrinsic muscle wasting due to peripheral neuropathy.
Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

In a poster study reported here at the American Pain Society Annual Scientific Meeting, Melissa Mazor, RN, MS, a clinical nurse at the University of California, San Francisco, found that on the pain interference scale, patients reported that pain in their lower extremities significantly made their balance and routine activities more difficult than pain in their upper extremities.


In addition, on the pain interference scale, pain in the legs and feet significantly interfered with patients' enjoyment of life, in their ability to walk, in general activities, in their mood, and in their relationships.


The study also determined numerical differences that trended toward more difficulty with pain in the lower extremities in normal work, in sleep, and in sexual activity.


"Further research needs to evaluate both subjective and objective characteristics of chemotherapy-induced neuropathy that can be used to guide the development of future intervention studies," the researchers concluded.


To perform the study, they enrolled 184 patients from the San Francisco Bay area who had completed treatment with a taxane and/or platinum-based chemotherapy regimen and reported persistent chemotherapy-induced neuropathy in their hands and feet.


Persistent pain was defined as pain that had continued for at least three months.


The researchers administered standard questionnaires such as the brief pain inventory, the pain quality assessment scale, and the pain interference scale. "Cancer chemotherapy-induced peripheral neuropathy is the most prevalent neurologic complication of cancer treatment," the researchers noted. "Because no effective preventative or treatment strategies are available for chemotherapy-induced neuropathy it can cause treatment delay, cessation of chemotherapy, painful neurologic symptoms, decreased functional status, and poorer quality of life."


More Debilitating

Asked for her perspective for this article, Stephanie Bernik, MD, Chief of Surgical Oncology at Lenox Hill Hospital in New York City, said that patients often find neuropathy in the feet to be more debilitating than in the hands because it affects the ability to be independent. Pain potentially is also felt with every step and can take away one's mobility.


"Of course, neuropathy in the hands is also debilitating, especially in those who use their hands for work or recreation, but in that situation, patients are often able to take a leave from work, lessening the impact of the problem," she said. "Although both forms of neuropathy are difficult to deal with, it appears that neuropathy in the feet has more of an impact both at work and at home."


The mean age of the patients in the study was about 61, and their mean education level was 16.45 years. About 86 percent of the patients were women. About 75 percent of the cohort in the study identified themselves as Caucasian, about 41 percent of the group was employed. About 34 percent were smokers, and about 62 percent had a history of smoking.