Although certain types of chemotherapy are known to cause peripheral neuropathy, understanding and monitoring for specific risk factors may help mitigate the adverse effect in patients, suggests recent study findings published in JAMA Network Open.

To investigate the prevalence of chemotherapy-induced peripheral neuropathy (CIPN) in patients who had received paclitaxel (Taxol) or oxaliplatin (Eloxatin), a team of researchers in Australia evaluated the association of pretreatment blood-based and clinical factors, as well as demographic characteristics.

The study included 333 participants who were treated with either of the 2 chemotherapy drugs at different cancer clinics and institutions in Sydney and Brisbane between September 2015 and February 2020. Eligible participants had stage I to IV cancer (breast, colorectal, ovarian, endometrial, gastrointestinal, pancreatic, or cervical cancer or  lymphoma) and were 3 to 12 months posttreatment. Nearly 80% were women and the median age was 58 years. Most participants (71.5%) had grade 1 CIPN or higher; 228 were treated with paclitaxel and 105 with oxaliplatin.

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The researchers used composite neurological grading scales and nerve conduction studies, as well as assessments of fine motor skills (grooved pegboard test), sensory function (grating orientation test and 2-point discrimination), and patient-reported outcomes using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity questionnaire to measure CIPN.

CIPN was compared between patients according to blood-based factor normative ranges using independent samples t tests and Mann-Whitney U tests with post hoc Bonferroni correction. Linear regression helped identify blood-based and clinical associations with CIPN development.

Study findings showed that patients with low hemoglobin prior to treatment had worse CIPN after treatment. In addition to lower hemoglobin, higher body mass index (BMI), older age, and female sex were all factors associated with worse CIPN.

Subgroup analyses were conducted to determine if the risk factors were the same in both groups. Neuropathy symptoms were reported by 66% of the paclitaxel group and 88% of the oxaliplatin group. In the paclitaxel-treated group, older age, BMI, and lower hemoglobin were associated with a higher Total Neuropathy Score-clinical (TNSc). And in the oxaliplatin-treated group, higher TNSc was associated with older age, lower hemoglobin, and higher albumin.

No individual marker stood out as a strong prognostic factor for CIPN, so multiple markers are likely to contribute as prognostic factors for CIPN risk, the researchers noted.

Also of note, analyzing CIPN with only 2 chemotherapy drugs and a sample population of predominantly women limit this study to making a more broad generalization.

Before prescribing chemotherapy regimens, age, BMI, and anemia should be taken into consideration, explained the researchers, as CIPN can create long-term morbidity and adverse outcomes in cancer survivors.


Mizrahi D, Park SB, Li T, et al. Hemoglobin, body mass index, and age as risk factors for paclitaxel- and oxaliplatin-induced peripheral neuropathy. JAMA Network Open. 2021;4(2):e2036695. doi:10.1001/jamanetworkopen.2020.36695