Dataset Information

Persistent mobility disability after neurotoxic chemotherapy.

ABSTRACT:

Background and purpose

The impact of cancer and its treatments on balance and functional mobility in older adults remains unknown but is increasingly important, given the evolution of cancer treatments. Subacute and more persistent side effects such as chemotherapy-induced peripheral neuropathy are on the rise, and the effects on mobility and balance, as well as the prognosis for resolution of any functional deficits, must be established before interventions can be trialed. The purpose of this case report is to describe the severity and long-term persistence of mobility decline in an older adult who received neurotoxic chemotherapy. To our knowledge, this is the first case report to describe an older adult with chemotherapy-induced peripheral neuropathy using results of standardized balance and mobility tests and to focus on prognosis by repeating these measures more than 2 years after chemotherapy.

Case description

An 81-year-old woman received a neurotoxic agent (paclitaxel) after curative mastectomy for breast cancer. Baseline testing prior to taxane therapy revealed a socially active woman with no reported functional deficits or neuropathic symptoms, 1.2-m/s gait speed, and performance at the ceiling on balance and gait portions of a standardized mobility measure.

Outcomes

After 3 cycles, paclitaxel therapy was stopped by the oncologist because of neurotoxicity. Declines as large as 50% were seen in performance-based measures at 12 weeks and persisted at 2.5 years, and the patient reported recurrent falls, cane use, and mobility-related disability.

Discussion

This case highlights the extent to which function can decline in an older individual receiving neurotoxic chemotherapy, the potential for these deficits to persist years after treatment is stopped, and the need for physical therapy intervention and further research in this population.

SUBMITTER: Hile ES

PROVIDER: S-EPMC2967709 | biostudies-literature | 2010 Nov

REPOSITORIES: biostudies-literature

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Publications

Persistent mobility disability after neurotoxic chemotherapy.

Hile Elizabeth S ES Fitzgerald G Kelley GK Studenski Stephanie A SA

Physical therapy 20100902 11

<h4>Background and purpose</h4>The impact of cancer and its treatments on balance and functional mobility in older adults remains unknown but is increasingly important, given the evolution of cancer treatments. Subacute and more persistent side effects such as chemotherapy-induced peripheral neuropathy are on the rise, and the effects on mobility and balance, as well as the prognosis for resolution of any functional deficits, must be established before interventions can be trialed. The purpose o ...[more]

PMID: 20813818

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Project description:Background/objectivesTo examine the prevalence of mobility device use in U.S. community-dwelling older adults including older adults with cancer history ("survivors") and to estimate mobility disability noting variation by cancer history, cancer site, and other factors to improve early detection of mobility limitations.DesignCross-sectional analysis from the 2011 National Health and Aging Trends Study.SettingIn-person interviews in the homes of study participants.ParticipantsNationally representative sample of community-dwelling Medicare beneficiaries, aged 65 and older (n = 6,080 including 1,203 survivors).MeasurementsParticipants were asked about cancer history, pain that limited activity, mobility device use (eg, canes, walkers, wheelchairs, and scooters), history of falls, and medical conditions plus they were assessed for approximate mobility disability using a 3-m gait speed test. The results were scored on a scale of 0 to 4 (0 = lowest, 4 = highest) using criteria from the National Institute on Aging.ResultsA total of 19% of older adults and 23% of survivors reported using one or more mobility device, most commonly a single-point cane. Approximately 10% of breast, 6% of prostate, and 3% of colorectal cancer survivors reported using two or more devices in the past month. Survivors had lower mean gait speed scores (2.27) than adults without cancer history (2.39). In regression models, survivors were 18% less likely than adults without cancer history to score high on the gait speed test (odds ratio = .82; P < .05). Prior mobility device use, history of multiple falls, unhealthy weight, Black race, multimorbidity, and pain that limited activity were associated with lower gait speed scores in all participants (all P < .05).ConclusionA greater proportion of older survivors used mobility devices than adults without cancer history. Mobility device use varied by cancer site and was highest in survivors of breast, colorectal, and gynecological cancer. Survivors were also more likely to show signs of mobility disability, based on gait speed, compared with adults without cancer history. These indications, although modest, suggest that older survivors may require special attention to functional changes in survivorship.

Project description:Chemotherapy exposure is a known risk factor for cancer-related cognitive impairments. Anthracycline-based regimens are commonly used chemotherapies that have been shown to be associated with cognitive impairment and brain changes in clinical studies.To directly compare the effects of anthracycline and nonanthracycline regimens on cognitive status and functional brain connectivity.In this observational study, we retrospectively examined cognitive and resting state functional magnetic resonance imaging data acquired from 62 primary breast cancer survivors (mean [SD] age, 54.7 [8.5] years) who were more than 2 years off-therapy, on average. Twenty of these women received anthracycline-based chemotherapy as part of their primary treatment, 19 received nonanthracycline regimens, and 23 did not receive any chemotherapy. Participants were enrolled at a single academic institution (Stanford University) from 2008 to 2014, and the study analyses were performed at this time.Cognitive status was measured using standardized neuropsychological tests, and functional brain connectivity was evaluated using resting state functional magnetic resonance imaging with a focus on the brain's default mode network.The anthracycline group demonstrated significantly lower verbal memory performance including immediate recall (F = 3.73; P =?.03) and delayed recall (F = 11.11; P <?.001) as well as lower left precuneus connectivity (F = 7.48; P =?.001) compared with the other 2 groups. Patient-reported outcomes related to cognitive dysfunction (F = 7.27; P =?.002) and psychological distress (F = 5.64; P =?.006) were similarly elevated in both chemotherapy groups compared with the non-chemotherapy-treated controls.These results suggest that anthracyclines may have greater negative effects than nonanthracycline regimens on particular cognitive domains and brain network connections. Both anthracycline and nonanthracycline regimens may have nonspecific effects on other cognitive domains as well as certain patient reported outcomes. Further research is needed to identify potential methods for protecting the brain against the effects of various chemotherapeutic agents.

Dataset Information

Persistent mobility disability after neurotoxic chemotherapy.

Background and purpose

Case description

Outcomes

Discussion

Publications

Persistent mobility disability after neurotoxic chemotherapy.

Similar Datasets

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