title: Oxaliplatin added to fluoropyrimidine for adjuvant treatment of colorectal cancer is associated with long-term impairment of peripheral nerve sensory function and quality of life.
abstract: BACKGROUND
  Oxaliplatin-induced peripheral neuropathy (OIPN) of acute and chronic type is well known, but long-term chronic type OIPN and its impact on quality of life (QoL) has not been extensively studied. Clinical experience indicates that oxaliplatin tolerance might vary with climate.
  
  
  METHODS
  Patient-reported chronic type OIPN and QoL among patients treated with oxaliplatin added to a fluoropyrimidine (Folfox or Capox) in the adjuvant setting of colorectal cancer (CRC) were assessed in a single center cross-sectional study by using the EORTC QLQ-CIPN20 and QLQ-C30 questionnaires. Comparison was made to patients treated with a fluoropyrimidine (5-FU or capecitabine) alone during the same time period.
  
  
  RESULTS
  Of 161 patients being disease-free 1-8 years after stop of treatment and invited, 84% participated; 65 treated with oxaliplatin and 71 with a fluoropyrimidine alone. Mean cumulative oxaliplatin dose was 567 mg/m2(55% of planned dose). Oxaliplatin-treated patients reported statistically and clinically significant worse sensory as well as motor scale scores, dominated by symptoms from the feet. Severe tingling and numbness in toes/feet was reported by 38% and 37%, respectively, by oxaliplatin-treated patients compared with 8% for both by fluoropyrimidine alone patients (p < 0.001). Subgroup analyses indicated no impact of gender, age, regimen, time since stop of treatment or cumulated oxaliplatin dose for severity of the chronic type OIPN. The oxaliplatin compared with the fluoropyrimidine group reported worse QoL scores throughout all domains, with statistically and clinically significant differences for role and social function, nausea/loss of appetite and financial problems.
  
  
  CONCLUSIONS
  Oxaliplatin added to a fluoropyrimidine for adjuvant treatment of CRC in a country with subarctic climate is associated with long-term, seemingly chronic, sensory neuropathy and impairment of QoL. This should be taken into account in clinical decision making on oxaliplatin treatment in the adjuvant setting.
authors.affiliation: a Department of Oncology , Mälarsjukhuset , Eskilstuna , Sweden.
authors.forename: Måns
authors.initials: M
authors.lastname: Stefansson
authors.affiliation: b Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology , Uppsala University , Uppsala , Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Nygren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D002908:Chronic Disease; D002980:Climate; D000066491:Clinical Decision-Making; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D000069451:Long Term Adverse Effects / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D000073222:Patient Health Questionnaire; D000071066:Patient Reported Outcome Measures; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced*; D011788:Quality of Life
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D002955:Leucovorin; D005472:Fluorouracil