The Use of Current Perception Threshold for the Assessment of Oxaliplatin-Induced Peripheral Neuropathy

Abstract

Background: Colorectal cancer (CRC) is a common malignancy, and up to 80% of patients diagnosed receive chemotherapy. Oxaliplatin is the principal chemotherapy agent for the treatment of CRC, and yet the associated oxaliplatin-induced peripheral neuropathy (OIPN) affects sensory fibers and is a treatment-limiting factor. OIPN reduces quality of life (QoL) and is associated with neuropathic pain (NP). As no effective treatment is available, improved early assessment of OIPN is needed. Current perception threshold (CPT) is a promising approach that uses sine-wave current electrical stimulus delivered at specific frequencies to elicit responses from peripheral nerves and may aid in OIPN identification. Purpose: The purpose of this study was threefold: 1) to compare CPT with validated quantitative sensory testing (QST) clinical tests in assessing sensory fiber function; 2) to compare CPT with provider administered National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTC-AE) for identification of OIPN; and 3) to describe the relationship between NP measured by Neuropathic Pain Scale (NPS) and QST and their differential impact on QoL (FACT-G). Methods: A correlational descriptive design was used and a secondary analysis conducted using data from the Genetic Correlates of OIPN study. A total of 19 participants were enrolled and assessed at baseline, following 500mg/m2 of oxaliplatin, and upon oxaliplatin completion. Bivariate linear mixed models were used to account for repeated assessments clustered within patients. Results: An association between certain QST measures and CPT 2000Hz was identified (Vibration: =-44.55, p=0.045; mechanical detection: =269.59, p=0.008). CPT 2000 Hz and 250 Hz were associated with warm detection threshold (=9.0, p=0.030 and =4.24, p=0.027, respectively). There was also a positive association between neuropathic pain severity (NPS) and QoL [FACT-G (=0.276, p<0.016)]. Conclusion: The association between CPT and currently documented methods of OIPN assessment was limited. Furthermore, the positive association between NP and QoL requires additional exploration as it contradicts published data. Larger studies are needed to explore further if CPT is useful for assessment of OIPN.