Cancer drugs linked to severe chronic peripheral nerve pain for 4 in every 10 patients in new research

Worldwide, cancer chemotherapy is linked to persistent severe peripheral nerve pain (neuropathy) for around 4 in every 10 patients treated with these drugs, suggests a pooled data analysis of the available evidence, published in the open access journal Regional Anesthesia & Pain Medicine.

Notwithstanding wide regional variations, platinum based drugs, taxanes, and lung cancer seem to be associated with the highest rates of persistent painful neuropathy, lasting at least 3 months, the findings suggest, prompting the researchers to call for tailored approaches to pain relief.

The drugs used to treat cancer damage healthy cells and tissues, including the nervous system. The effects can manifest in movement disturbances, such as loss of balance or coordination, and sensory disturbances, such as loss of sensation; numbness, tingling, “pins and needles”; or a burning sensation on the skin.

Several factors influence the frequency and severity of chronic peripheral neuropathic pain, including type and dose of chemotherapy, pre-existing neuropathy, and the use of other drugs that can damage the nervous system, explain the researchers.

The condition is thought to be caused by direct peripheral nerve cell damage which disrupts or rewires normal nerve signalling pathways, resulting in persistent pain, they add.

Prompted by the growing number of cancer survivors and increasingly aggressive treatment of the disease, the researchers wanted to gauge the global prevalence of chronic painful peripheral neuropathy linked to chemotherapy.

They scoured research databases for relevant studies published between 2000 and 2024, focusing on potentially influential sociodemographic, clinical, and methodological (study design, funding source, for example) factors.

In all, they pooled the results of 77 eligible studies, involving 10,962 participants from 28 countries, all of whom had peripheral neuropathy that was associated with cancer drug treatment. In 4545 of these participants, this was painful and persistent, lasting for at least 3 months.

The highest number of studies were carried out in the US (13) and Japan (10), and almost half were prospective observational studies.

The cancers that featured most often were those of the bowel (25; 33%) and breast (17; 22%), while the largest proportion of studies focused on patients treated with either platinum based agents (13;17%), or taxanes (11; just over 14%), or both (6 ;8%), or the FOLFOX combination of folinic acid plus 5-fluorouracil plus oxalplatin (5; 6.5%).

Pooled data analysis of the study results showed that the overall prevalence of persistent painful peripheral neuropathy was just over 41%.

When stratified further, the analysis indicated that the highest prevalence was among patients treated with platinum based agents (40.5%) and taxanes (just over 38%). Prevalence was lowest among those treated with the FOLFOX combination (16.5%).

Prevalence was also highest among those with primary lung cancer (just over 62%), possibly because of the complexities of treatment for this disease, suggest the researchers. Prevalence was lowest among those with primary ovarian cancer (31.5%) and lymphoma (36%).

When stratified by continent, studies of patients in Asia reported the highest prevalence of persistent painful neuropathy (46.5%), while studies of patients in Europe reported the lowest (36%). Prevalence rates were similar in both men and women.

The researchers emphasise that the design and methodology of the included studies differed substantially. And the overall certainty of evidence was considered to be low.

But they write: “Understanding the prevalence and predictors of chronic painful [chemotherapy induced peripheral neuropathy] is critical for promoting early diagnosis and developing personalized treatment strategies.

“Our findings emphasize that chronic painful [chemotherapy induced peripheral neuropathy] represents a substantial global health challenge, affecting more than 40% of those diagnosed with [it].”

And they conclude: “The wide variability in prevalence rates across different countries, continents, chemotherapy regimens, and primary cancer history underscores the need for tailored strategies to address this debilitating condition.

“Future studies should focus on elucidating the mechanisms underlying these disparities and developing interventions that can reduce the burden of chronic painful [chemotherapy induced peripheral neuropathy] globally.”

Reference:

Global estimates of prevalence of chronic painful neuropathy among patients with chemotherapy induced peripheral neuropathy: systematic review and meta-analysis of data from 28 countries, 2000–24, Regional Anesthesia & Pain Medicine, DOI:10.1136/rapm-2024-106229