Evaluation of Paclitaxel Induced Neurotoxicity and its Impact on the Quality of Life in Breast Cancer Patients

Abstract

Objective: To determine the incidence as well as the grade of neurotoxicity due to taxanes in breast cancer patients. Further goal was to determine the effect of neurotoxicity with taxanes on quality of life (QOL). Additionally, another one of our aims was to look at the effect of treatment setting on the grade of neuropathy
as well as on the quality of life.
Methods: This is a prospective open-labeled study. Breast cancer patients were enrolled through the outdoorpatient-department. Neurotoxicity was monitored clinically by questioning and physical examination at  baseline and then after 6th cycle of Paclitaxel. Neuropathy was graded using NCI-CTCAE (National Cancer Institute Common Terminology Criteria forAdverse Events) guidelinesinto grade 1 through 4. Patients having pre-existing neuropathy were excluded from the study. Quality of life was measured using FACT-Taxane scale and was classified into two groups. 0-100 score (low QOL) group and 101-172 (high QOL) group). The results of these variables were presented as mean values, frequencies and percentages. Chi-square test was used to assess correlation of these variables with each other and various demographic factors like age, treatment setting and stage of the disease. p<0.05 was considered significant.
Results: Atotal of 92 (n=92) patients took part in the study with ages ranging from 25 to 70. All 100% of the patients were females. Peripheral neuropathy was present in 88 (95.7%) patients. Among these 88 cases, according to NCI-CTCAE guidelines, 29 (33%) had Grade 1 neuropathy, 31 (35.2%) had Grade 2 neuropathy and the remaining 28 (31.8%) had Grade 3 neuropathy. No patient (0%) had Grade 4 neuropathy. According to FACT-TAXANE, quality of life was low (1-100 score) in 47 (51.1%) patients whereas 45 (48.9%) patients
had high (101-172 score) quality of life. The grade of peripheral neuropathy had a significant impact on the quality-of-life scores(p<0.05). There was a significant impact of diabetes, hypertension and high BMI on both the grade of neuropathy and thequality-of-life. No significant impact of other risk factors (age, stage, treatment setting, other comorbid conditions and ER/PR/HER2neu status) on the grade of neuropathy or on the quality of life was seen.
Conclusion: Treatment with Paclitaxel is associated with significantly low quality of life due to its neurotoxic effects. Benefits and risks should be properly evaluated before commencing patients on any neurotoxic drugs.