Chemotherapy-Related Neuropathic Symptoms and Functional Impairment in Adult Survivors of Extracranial Solid Tumors of Childhood: Results From the St. Jude Lifetime Cohort Study

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. (c) 2013 by the American Congress of Rehabilitation Medicine