Year: 2012
Type: dissertation
Abstract: The present study aimed to investigate the effect of amitriptyline in prevention and treatment of chemo-therapy-induced peripheral neuropathy (CIPN). The secondary aims were to evaluate the prevalence and discomfort of CIPN in a clinical cohort predisposed to neurotoxic chemotherapy agents, grading of neu-rotoxicity, and the changes in intraepidermal nerve fiber (IENF) density during the neurotoxic chemo-therapy treatment. The study included three cancer patient populations treated with neurotoxic chemotherapy. The first study population was screened from 448 patients aged 20 to 70 years who were treated with neurotoxic chemotherapy, of whom 152 reported neuropathic symptoms and were hence eligible for evaluation of the burden of neuropathic symptoms. Of that cohort 33 patients with sensory neuropathic symptoms (numbness, tingling or pain) of at least moderate severity were randomised to the treatment study. The third study population consists of 104 patients without previous neuropathy who started neurotoxic chemotherapy and were randomized to the prevention study. The fifth study investigating IENF density consisted of 12 patients starting adjuvant chemotherapy with taxanes or platinum derivatives. Fifty-nine percent of the screened patients reported neuropathic symptoms. Tingling (71 %), numbness (58 %), impaired sensory function (46 %) and pain in hands and feet (40 %) were the most common symptoms. Neuropathic symptoms were the third most commonly reported adverse effect symptoms. Every third patient (37 %) with neuropathic symptoms ranked them as the most troublesome symptom. Comparing the NCI-CTC sensory and Oxaliplatin Scales the progression of the toxicity from mild (grade 1 or 2) to moderate or severe (grade 3 or 4) was detected more frequently with the Oxaliplatin Scale. Neither the treatment study nor the prevention study showed significant difference between the amitriptyline and placebo groups in the intensity of the neuropathic symptoms during the follow-up. However, amitriptyline significantly improved quality of life measured with the EORTC QLQ-C30 compared with placebo in treatment study. Reduced IENF density was found in 8/12 patients at base-line. During the follow-up IENF density increased significantly in six of them and remained unchanged in two. No association was found between neuropathic symptoms and IENF count.
Source: Työväentutkimus Vuosikirja
Author: Anna-Liisa Kautio
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1578722514