title: Chemotherapy-related neuropathic symptoms and functional impairment in adult survivors of extracranial solid tumors of childhood: results from the St. Jude Lifetime Cohort Study.
abstract: OBJECTIVE
  To ascertain prevalence of peripheral sensory and motor neuropathy, and to evaluate impairments in relation to function.
  
  
  METHODS
  St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse late effects in adult survivors of childhood cancer.
  
  
  METHODS
  A children's research hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA. kiri.ness@stjude.org
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Kendra E
authors.initials: KE
authors.lastname: Jones
authors.forename: Webb A
authors.initials: WA
authors.lastname: Smith
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Spunt
authors.forename: Carmen L
authors.initials: CL
authors.lastname: Wilson
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Deo Kumar
authors.initials: DK
authors.lastname: Srivastava
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016190:Carboplatin / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D012678:Sensation Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D014747:Vinblastine / Q000009:adverse effects; D014750:Vincristine / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D014750:Vincristine; D014747:Vinblastine; D016190:Carboplatin; D002945:Cisplatin
keywords: CI; Cisplatin; Modified Total Neuropathy Score; Neoplasms; OR; Peripheral nervous system diseases; Rehabilitation; SJLIFE; SOT; Sensory Organization Test; St. Jude Lifetime Cohort Study; TNS; Total Neuropathy Score; Vincristine; confidence interval; mTNS; odds ratio
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