Date of Paper/Work

4-2015

Type of Paper/Work

Research Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Laura Gilchrist

Abstract

Background

Chemotherapeutic agents have been the backbone treatment for pediatric cancers. Unfortunately, a number of the chemotherapy medications have potential side effects, including chemotherapy-induced peripheral neuropathy (CIPN). To measure the extent of CIPN, the Pediatric Modified Total Neuropathy Score (Peds-mTNS) has been shown to be a reliable and valid measure of CIPN in school-aged children and is associated with relevant functional limitations. However, future research is needed to describe the recovery of CIPN in children and adolescent cancer patients after treatment has ended.

Purpose

To analyze the trajectory of recovery for CIPN in school-aged children diagnosed with non-CNS cancers and to evaluate if diagnosis and treatment impact CIPN type and recovery.

Methods

Forty-seven subjects ranging in age from 5-18 years undergoing chemotherapy with vincristine or a combination of vincristine and intrathecal methotrexate participated in the study. Peds-mTNS scores as well as standardized balance and hand function measures were taken on treatment (at the anticipated peak of CIPN) and then 3 and 6 months post treatment. Descriptive statistics and one-way repeated measures ANOVA were run to compare subjects over time (on treatment, 3 months, and 6 months post). A 2-way III

repeated measures ANOVA was run to compare mean Peds-mTNS scores for each diagnostic group over time.

Results

18 subjects with Acute Lymphoblastic Leukemia (ALL), 8 with Wilma’ tumor, 14 with non/Hodgkin’s lymphoma and 7 with other non-CNS cancers were evaluated. Across all subjects (n=47), Peds-mTNS scores decreased significantly over time (on treatment 9.5± 4.4, 3 months 5.8 ± 4.7, 6 months 4.3 ± 4.0, p< 0.001), indicating an improvement in CIPN. Overall effect size, with Partial Eta Squared, was found to be large (0.609). Greatest individual measure effect size was shown in deep tendon reflex (.659). Of the diagnostic groups, patients with Hodgkin’s lymphoma were found to have significantly less improvement on the Peds-mTNS than subjects with leukemia (6.4 ± 0.7 vs 2.2 ± 0.6 at 6 months, p<0.05), even though their treatment time was shorter in duration and they received less vincristine.

Conclusion

Overall, the trajectory of recovery for pediatric cancer patients was found to be positive, resulting in significant improvements in CIPN symptoms over time post-treatment, although patients with Hodgkin’s lymphoma were more likely to have residual neuropathy.

Available for download on Friday, November 24, 2017

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