Abstract
Objectives
To ascertain prevalence of peripheral sensory and motor neuropathy, and to evaluate
impairments in relation to function.
Design
St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse
late effects in adult survivors of childhood cancer.
Setting
A children's research hospital.
Participants
Eligibility required treatment for an extracranial solid malignancy between 1962 and
2002, age ≥18 years, ≥10 years postdiagnosis, and no history of cranial radiation.
Survivors (N=531) were included in the evaluation with a median age of 32 years and
a median time from diagnosis of 25 years.
Interventions
Not applicable.
Main Outcome Measures
Primary exposure measures were cumulative doses of vinca-alkaloid and platinum-based
chemotherapies. Survivors with scores ≥1 on the sensory subscale of the Modified Total
Neuropathy Score were classified with prevalent sensory impairment. Those with sex-specific
z scores of ≤−1.3 for dorsiflexion strength were classified with prevalent motor impairment.
Participants completed the 6-minute walk test (endurance), the Timed Up & Go test
(mobility), and the Sensory Organization Test (balance).
Results
The prevalence of sensory and motor impairment was 20% and 17.5%, respectively. Vinca-alkaloid
exposure was associated with an increased risk of motor impairment (adjusted odds
ratio [OR]=1.66; 95% confidence interval [CI], 1.04–2.64) without evidence for a dose
response. Platinum exposure was associated with increased risk of sensory impairment
(adjusted OR=1.62; 95% CI, .97–2.72) without evidence of a dose response. Sensory
impairment was associated with poor endurance (OR=1.99; 95% CI, .99–4.0) and mobility
(OR=1.65; 95% CI, .96–2.83).
Conclusions
Vincristine and cisplatin exposure may increase risk for long-term motor and sensory
impairment, respectively. Survivors with sensory impairment are at increased risk
for functional performance limitations.
Keywords
List of abbreviations:
CI (confidence interval), mTNS (Modified Total Neuropathy Score), OR (odds ratio), SJLIFE (St. Jude Lifetime Cohort Study), SOT (Sensory Organization Test), TNS (Total Neuropathy Score)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 27, 2013
Footnotes
Supported by Cancer Center Support (grant no. CA 21765) from the National Cancer Institute, and by the American Lebanese Syrian Associated Charities.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
