A pooled analysis of all available evidence has suggested that worldwide, cancer chemotherapy is linked to persistent severe peripheral nerve pain (neuropathy) for around four in every 10 patients treated with these drugs.
The researchers said that notwithstanding wide regional variations, platinum-based drugs, taxanes, and lung cancer seem to be associated with the highest rates of persistent painful neuropathy, lasting at least three months – and prompting them to call for tailored approaches to pain relief.
The drugs used to treat cancer damage healthy cells and tissues, including the nervous system, and the effects can manifest in movement disturbances such as loss of balance or co-ordination, and sensory disturbances, such as loss of sensation, numbness, tingling, “pins and needles”, or a burning sensation on the skin.
The research team, led by the Mayo Clinic in Rochester, New York, said several factors influence the frequency and severity of chronic peripheral neuropathic pain, including type and dose of chemotherapy, pre-existing neuropathy, and the use of other drugs that can damage the nervous system.
The condition is thought to be caused by direct peripheral nerve cell damage which disrupts or rewires normal nerve signalling pathways, resulting in persistent pain, they add.
News-Medical.net reports that prompted by the growing number of cancer survivors and increasingly aggressive treatment of the disease, the researchers wanted to gauge the global prevalence of chronic painful peripheral neuropathy linked to chemotherapy.
They scoured databases for relevant studies published between 2000 and 2024, focusing on potentially influential socio-demographic, clinical, and methodological (study design, funding source, for example) factors.
In all, they pooled the results of 77 eligible studies, involving 10 962 participants from 28 countries, all of whom had peripheral neuropathy that was associated with cancer drug treatment. In 4 545 of these participants, this was painful and persistent, lasting for at least three months.
The highest number of studies were carried out in the US (13) and Japan (10), and almost half were prospective observational studies.
The cancers that featured most often were those of the bowel (25; 33%) and breast (17; 22%), while the largest proportion of studies focused on patients treated with either platinum based agents (13; 17%), or taxanes (11; just more than 14%), or both (6; 8%), or the FOLFOX combination of folinic acid plus 5-fluorouracil plus oxalplatin (5; 6.5%).
Pooled data analysis of the study results showed that the overall prevalence of persistent painful peripheral neuropathy was just more than 41%.
When stratified further, the analysis indicated that the highest prevalence was among patients treated with platinum based agents (40.5%) and taxanes (just more than 38%). Prevalence was lowest among those treated with the FOLFOX combination (16.5%).
Prevalence was also highest among those with primary lung cancer (just over 62%), possibly because of the complexities of treatment for this disease, suggest the researchers. Prevalence was lowest among those with primary ovarian cancer (31.5%) and lymphoma (36%).
When stratified by continent, studies of patients in Asia reported the highest prevalence of persistent painful neuropathy (46.5%), while studies of patients in Europe reported the lowest (36%). Prevalence rates were similar in both men and women.
The researchers emphasise that the design and methodology of the included studies differed substantially. And the overall certainty of evidence was considered to be low.
But they write in the journal Anaesthesia & Pain Medicine: “Understanding the prevalence and predictors of chronic painful (chemotherapy induced peripheral neuropathy) is critical for promoting early diagnosis and developing personalised treatment strategies.
“Our findings emphasise that chronic painful (chemotherapy induced peripheral neuropathy) represents a substantial global health challenge, affecting more than 40% of those diagnosed with (it).”
They added that the wide variability in prevalence rates across countries, continents, chemotherapy regimens, and primary cancer history underscored the need for tailored strategies “to address this debilitating condition”.
“Future studies should focus on elucidating the mechanisms underlying these disparities and developing interventions that can reduce the burden of chronic painful [chemotherapy induced peripheral neuropathy] globally.”
Study details
Global estimates of prevalence of chronic painful neuropathy among patients with chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis of data from 28 countries
Ryan D’Souza, Chandan Saini, Nasir Hussain, et al.
Published in Anaesthesia & Pain Medicine on 29 January 2025
Abstract
Introduction
Although the prevalence of chemotherapy-induced peripheral neuropathy (CIPN) has been reported, the proportion of patients with CIPN who report chronic painful neuropathy remains poorly understood, despite its significant impact on patients’ quality of life and treatment outcomes.
Methods
A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the pooled prevalence of chronic (≥3 months) painful CIPN among patients diagnosed with CIPN. Estimates from each study were transformed using double arcsine transformation and pooled in a meta-analysis using an inverse variance heterogeneity model. Subgroup analysis was conducted based on geographical region, sex, chemotherapy regimen, primary cancer type, and funding source; meta-regression analysis was conducted based on study design, human development index (HDI), and publication year.
Results
A total of 77 studies from 28 countries, encompassing 10 962 patients with CIPN, were included. Among patients diagnosed with CIPN, the pooled prevalence of those reporting chronic painful CIPN was estimated at 41.22% (95% CI 32.40 to 50.19; 95% prediction interval 23.71 to 61.28). Substantial heterogeneity was observed across studies (I²=95.27%; 95% CI for I2 94.58 to 95.86). Subgroup analysis revealed that patients treated with platinum based agents and taxanes had the highest prevalence of chronic painful CIPN (40.44% and 38.35%, respectively), and among primary cancers, those with lung cancer reported the highest prevalence of chronic painful CIPN (60.26%). Study design, HDI, and publication year were non-significant moderators of prevalence estimates. Based on our GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessment, the certainty of evidence was considered very low.
Conclusion
This study provides the first comprehensive global estimate of the prevalence of chronic painful CIPN, highlighting its significant burden on patients worldwide. The variation in prevalence across geographical regions, chemotherapy regimens, and primary cancers underscores the need for tailored pain management strategies and further research to address potential disparities.
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