title: Natural history of postural instability in breast cancer patients treated with taxane-based chemotherapy: A pilot study.
abstract: Over 230,000 new cases of breast cancer are expected to be diagnosed in the United States in 2015. Taxane-based chemotherapy is often an effective treatment, but can also cause adverse symptoms in patients due to neurotoxicity. These side effects can impair postural control in patients; however, this instability has scarcely been quantified. The purpose of this pilot study was to gain insight into the natural history of postural instability in breast cancer patients being treated with taxane-based chemotherapy. Thirty-two breast cancer patients (31 female/1 male; 47.6±11.2 year; 16 stage II/16 stage III) completed eyes open and eyes closed quiet standing trials in the oncology clinic where they were being treated. These trials were collected at five timepoints throughout their chemotherapy treatment: (1) before initiating chemotherapy to provide a baseline, (2-4) before starting subsequent chemotherapy cycles, and (5) 1-3 months after receiving their last taxane infusion. After the first chemotherapy cycle, patients demonstrated increases in 95% confidence ellipse area of center of pressure (CoP) [45.2%, p=0.01] and root mean squared CoP excursion [18%, p=0.006] compared to baseline values for the eyes closed condition. These balance deficiencies progressed with cumulative taxane exposure. Postural instability persisted 1-3 months after completing chemotherapy with increases in 95% CoP ellipse area [86.8%, p=0.002], root mean squared CoP excursion [32.6%, p=0.001], and mean CoP velocity [30.4%, p=0.024]. The balance impairments demonstrated by patients in this study appear to be clinically relevant when compared to balance impairments previously reported in other patient populations.
authors.affiliation: Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, USA. Electronic address: scott.monfort@osumc.edu.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Monfort
authors.affiliation: Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Xueliang
authors.initials: X
authors.lastname: Pan
authors.affiliation: Stefanie Spielman Comprehensive Breast Center, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Patrick
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Janani
authors.initials: J
authors.lastname: Singaravelu
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Loprinzi
authors.affiliation: Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Maryam B
authors.initials: MB
authors.lastname: Lustberg
authors.affiliation: Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, USA; School of Health & Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Ajit M W
authors.initials: AMW
authors.lastname: Chaudhari
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy*; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000009:adverse effects*; D010865:Pilot Projects; D004856:Postural Balance / Q000187:drug effects*; D043823:Taxoids / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D017239:Paclitaxel
keywords: Posturography; balance; cancer; center of pressure; chemotherapy; quiet standing