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Original Article

Relationship between Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Patients with Hematologic Malignancies

Chi Eun Song1, Hye Young Kim2, Eun Sook Lee3
Korean Journal of Adult Nursing 2015;27(3):358-366.
Published online: June 30, 2015

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Corresponding author: Kim, Hye Young College of Nursing, Chonbuk National University, 20 GunJi-ro, Deokjin-gu, Jeonju 561-712, Korea. Tel: +82-63-270-4618, Fax: +82-63-270-3127, E-mail: tcellkim@chonbuk.ac.kr
• Received: January 26, 2015   • Accepted: May 24, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was aimed to identify the incidence and severity of chemotherapy-induced peripheral neuropathy (CIPN) among patients with hematologic malignancies and to examine the relationship between the quality of life (QOL) and CIPN.
  • Methods
    A total of 66 patients with CIPN-related symptoms participated in this study. Data were collected through self-reported questionnaires consisted of the European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0 and the 16-item QLQ-CIPN20. Data were analyzed with SPSS/ WIN20 for descriptive statistics using the Mann-Whitney and Kruskal-Wallis tests, and Spearman's rho.
  • Results
    The mean lower and upper extremity scale scores were 31.95 and 23.16 respectively for the 16-item QLQ-CIPN20. The mean QLQ-C30 subcategory scores were 46.84 for global health status, 58.72 for functional scales, and 34.85 for symptom scales. The CIPN-related lower extremity scale symptoms correlated negatively with the QOL subscales. There was no correlation between CIPN-related upper extremity symptoms and health-related QOL.
  • Conclusion
    Patients with hematologic malignancies treated with neurotoxic chemotherapeutic agents had CIPN-related symptoms in the lower extremities mainly, and their QOL functional subscale scores were relatively lower than those of other cancer patients. Interventions need to be developed for patients with hematologic malignancies to alleviate CIPN and enhance their QOL.
  • Key Words: Quality of life; Chemotherapy; Peripheral neuropathies; Hematologic malignancy
Figure 1.
Percentage of patients who reported "quite a bit" or "very much"tingling, numbness, and/or shooting/burning pain on the 16-item QLQ-CIPN20 sensory scales.
kjan-27-358f1.jpg
Table 1.
Mean Rank Differences in CIPN and QOL, according to the General and Clinical Characteristics (N=66)
Characteristics Categories n (%) CIPN QOL
Lower extremity scales Upper extremity scales Global health status scales Functional scales Symptom scales
Mean rank p Mean rank p Mean rank p Mean rank p Mean rank p
Gender Male 43 (65.2) 34.94 .403 34.37 .612 34.53 .544 31.88 .349 34.44 .585
Female 23 (34.8) 30.80   31.87   31.57   36.52   31.74  
Age (year) ≤49 15 (22.7) 19.67 .004 30.07 .759 44.33 .038 47.20 .014 21.87 .060
50–59 20 (30.3) 35.55   36.78   34.98   31.60   38.60  
60–69 15 (22.7) 33.03   34.07   28.27   30.10   35.30  
≥70 16 (24.2) 44.34   32.09   26.41   26.22   36.34  
Education ≤Middle school 24 (36.3) 41.69 .009 30.19 .287 27.71 .060 25.92 .015 38.81 .089
≥High school 42 (63.7) 28.82   35.39   36.81   37.83   30.46  
Employment Yes 22 (33.3) 32.16 .688 31.41 .529 32.07 .664 33.64 .967 30.64 .391
No 44 (66.7) 34.17   34.55   34.22   33.43   34.93  
ECOG PS ≤1 55 (83.3) 31.05 .020 33.05 .665 36.25 .008 35.99 .018 31.92 .134
≥2 11 (16.7) 45.73   35.77   19.73   21.05   41.41  
Diagnosis ALL 7 (10.6) 24.86 ＜.001 38.21 .778 25.86 .309 30.50 .097 35.79 .303
NHL 28 (42.4) 24.21   33.36   37.09   39.41   29.27  
MM 31 (47.0) 43.84   32.56   31.98   28.84   36.81  
Duration of diagnosis (months) ≤4 18 (27.3) 24.36 .025 33.58 .837 29.11 .063 33.86 .027 35.86 .093
5–12 18 (27.3) 30.33   30.83   43.75   43.53   23.83  
13–24 9 (13.6) 37.94   32.11   29.06   32.83   37.39  
≥25 21 (31.8) 42.14   36.31   30.38   24.88   38.10  
Current chemotherapy Yes 46 (69.7) 33.72 .889 34.29 .609 32.71 .606 31.17 .135 37.80 .006
No 20 (30.3) 33.00   31.68   35.33   38.85   23.60  
Duration of CIPN (month) ≤4 26 (39.4) 21.02 ＜.001 33.87 .833 32.15 .173 36.42 .008 31.83 .071
5–12 17 (25.8) 36.72   29.25   41.16   41.63   25.34  
13–24 6 (9.0) 38.00   35.00   32.42   31.17   31.67  
≥25 17 (25.8) 46.06   34.50   26.82   20.29   42.47  
Exposure to neurotoxic agents Single 45 (68.2) 26.83 ＜.001 32.83 .678 35.16 .298 37.42 .015 30.02 .031
Multiple 21 (31.8) 47.79   34.93   29.95   25.10   40.95  
                       

CIPN=chemotherapy-induced peripheral neuropathy; QOL=quality of life; ECOG PS=Eastern Cooperative Oncology Group performance status; ALL=Acute lymphocytic leukemia; NHL=non-Hodgkin lymphoma; MM=multiple myeloma.

Table 2.
Scores from the 16-item QLQ-CIPN20 Subscales and EORTC QLQ-C30 Subscales (N=66)
Variables   M±SD
16-item QLQ-CIPN20 Lower extremity scales 31.95±23.30
Upper extremity scales 23.16±19.01
EORTC QLQ-C30 　 Global health status scales 46.84±21.62
Functional scales 58.72±20.61
Physical scales 56.24±21.71
Role scales 51.01±36.97
Emotional scales 71.46±25.61
Cognitive scales 62.12±28.58
Social scales 41.16±36.19
Symptom scales 34.85±16.79
Fatigue 55.22±27.90
Nausea & vomiting 11.11±16.10
Pain 30.56±30.74
Dyspnea 41.41±35.60
Insomnia 37.88±38.73
Appetite loss 37.88±36.46
Constipation 22.22±36.20
Diarrhea 12.12±21.59
Financial problem 52.53±40.95

16-item QLQ-CIPN20=16-item quality of life questionnaire-chemotherapy-induced peripheral neuropathy; EORTC QLQ-C30= European Organization for the Research and Treatment of Cancer quality of life questionnaire core 30 items.

Table 3.
Correlation between Health-related QOL and Peripheral Neuropathy Status (N=66)
Subscales in EORTC QLQ-C30 Subscales in 16-item QLQ-CIPN
Lower extremity Upper extremity
rho (p) rho (p)
Global health status -.243 (.050) -.075 (.550)
Functional -.469 (.002) -.236 (.057)
Symptom .463 (.002) .126 (.314)

QOL=quality of life; 16-item; QLQ-CIPN20=16-item quality of life questionnaire-chemotherapy-induced peripheral neuropathy; EORTC QLQ-C30=European Organization for the Research and Treatment of Cancer quality of life questionnaire core 30 items.

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    Relationship between Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Patients with Hematologic Malignancies
    Korean J Adult Nurs. 2015;27(3):358-366.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.358
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    Relationship between Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Patients with Hematologic Malignancies
    Korean J Adult Nurs. 2015;27(3):358-366.   Published online June 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.3.358
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    Relationship between Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Patients with Hematologic Malignancies
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    Figure 1. Percentage of patients who reported "quite a bit" or "very much"tingling, numbness, and/or shooting/burning pain on the 16-item QLQ-CIPN20 sensory scales.

    Figure 1.

    Relationship between Chemotherapy-induced Peripheral Neuropathy and Quality of Life in Patients with Hematologic Malignancies

    Mean Rank Differences in CIPN and QOL, according to the General and Clinical Characteristics (N=66)

    Characteristics Categories n (%) CIPN QOL
    Lower extremity scales Upper extremity scales Global health status scales Functional scales Symptom scales
    Mean rank p Mean rank p Mean rank p Mean rank p Mean rank p
    Gender Male 43 (65.2) 34.94 .403 34.37 .612 34.53 .544 31.88 .349 34.44 .585
    Female 23 (34.8) 30.80   31.87   31.57   36.52   31.74  
    Age (year) ≤49 15 (22.7) 19.67 .004 30.07 .759 44.33 .038 47.20 .014 21.87 .060
    50–59 20 (30.3) 35.55   36.78   34.98   31.60   38.60  
    60–69 15 (22.7) 33.03   34.07   28.27   30.10   35.30  
    ≥70 16 (24.2) 44.34   32.09   26.41   26.22   36.34  
    Education ≤Middle school 24 (36.3) 41.69 .009 30.19 .287 27.71 .060 25.92 .015 38.81 .089
    ≥High school 42 (63.7) 28.82   35.39   36.81   37.83   30.46  
    Employment Yes 22 (33.3) 32.16 .688 31.41 .529 32.07 .664 33.64 .967 30.64 .391
    No 44 (66.7) 34.17   34.55   34.22   33.43   34.93  
    ECOG PS ≤1 55 (83.3) 31.05 .020 33.05 .665 36.25 .008 35.99 .018 31.92 .134
    ≥2 11 (16.7) 45.73   35.77   19.73   21.05   41.41  
    Diagnosis ALL 7 (10.6) 24.86 ＜.001 38.21 .778 25.86 .309 30.50 .097 35.79 .303
    NHL 28 (42.4) 24.21   33.36   37.09   39.41   29.27  
    MM 31 (47.0) 43.84   32.56   31.98   28.84   36.81  
    Duration of diagnosis (months) ≤4 18 (27.3) 24.36 .025 33.58 .837 29.11 .063 33.86 .027 35.86 .093
    5–12 18 (27.3) 30.33   30.83   43.75   43.53   23.83  
    13–24 9 (13.6) 37.94   32.11   29.06   32.83   37.39  
    ≥25 21 (31.8) 42.14   36.31   30.38   24.88   38.10  
    Current chemotherapy Yes 46 (69.7) 33.72 .889 34.29 .609 32.71 .606 31.17 .135 37.80 .006
    No 20 (30.3) 33.00   31.68   35.33   38.85   23.60  
    Duration of CIPN (month) ≤4 26 (39.4) 21.02 ＜.001 33.87 .833 32.15 .173 36.42 .008 31.83 .071
    5–12 17 (25.8) 36.72   29.25   41.16   41.63   25.34  
    13–24 6 (9.0) 38.00   35.00   32.42   31.17   31.67  
    ≥25 17 (25.8) 46.06   34.50   26.82   20.29   42.47  
    Exposure to neurotoxic agents Single 45 (68.2) 26.83 ＜.001 32.83 .678 35.16 .298 37.42 .015 30.02 .031
    Multiple 21 (31.8) 47.79   34.93   29.95   25.10   40.95  
                           

    CIPN=chemotherapy-induced peripheral neuropathy; QOL=quality of life; ECOG PS=Eastern Cooperative Oncology Group performance status; ALL=Acute lymphocytic leukemia; NHL=non-Hodgkin lymphoma; MM=multiple myeloma.

    Scores from the 16-item QLQ-CIPN20 Subscales and EORTC QLQ-C30 Subscales (N=66)

    Variables   M±SD
    16-item QLQ-CIPN20 Lower extremity scales 31.95±23.30
    Upper extremity scales 23.16±19.01
    EORTC QLQ-C30 　 Global health status scales 46.84±21.62
    Functional scales 58.72±20.61
    Physical scales 56.24±21.71
    Role scales 51.01±36.97
    Emotional scales 71.46±25.61
    Cognitive scales 62.12±28.58
    Social scales 41.16±36.19
    Symptom scales 34.85±16.79
    Fatigue 55.22±27.90
    Nausea & vomiting 11.11±16.10
    Pain 30.56±30.74
    Dyspnea 41.41±35.60
    Insomnia 37.88±38.73
    Appetite loss 37.88±36.46
    Constipation 22.22±36.20
    Diarrhea 12.12±21.59
    Financial problem 52.53±40.95

    16-item QLQ-CIPN20=16-item quality of life questionnaire-chemotherapy-induced peripheral neuropathy; EORTC QLQ-C30= European Organization for the Research and Treatment of Cancer quality of life questionnaire core 30 items.

    Correlation between Health-related QOL and Peripheral Neuropathy Status (N=66)

    Subscales in EORTC QLQ-C30 Subscales in 16-item QLQ-CIPN
    Lower extremity Upper extremity
    rho (p) rho (p)
    Global health status -.243 (.050) -.075 (.550)
    Functional -.469 (.002) -.236 (.057)
    Symptom .463 (.002) .126 (.314)

    QOL=quality of life; 16-item; QLQ-CIPN20=16-item quality of life questionnaire-chemotherapy-induced peripheral neuropathy; EORTC QLQ-C30=European Organization for the Research and Treatment of Cancer quality of life questionnaire core 30 items.
    Table 1. Mean Rank Differences in CIPN and QOL, according to the General and Clinical Characteristics (N=66)

    CIPN=chemotherapy-induced peripheral neuropathy; QOL=quality of life; ECOG PS=Eastern Cooperative Oncology Group performance status; ALL=Acute lymphocytic leukemia; NHL=non-Hodgkin lymphoma; MM=multiple myeloma.

    Table 2. Scores from the 16-item QLQ-CIPN20 Subscales and EORTC QLQ-C30 Subscales (N=66)

    16-item QLQ-CIPN20=16-item quality of life questionnaire-chemotherapy-induced peripheral neuropathy; EORTC QLQ-C30= European Organization for the Research and Treatment of Cancer quality of life questionnaire core 30 items.

    Table 3. Correlation between Health-related QOL and Peripheral Neuropathy Status (N=66)

    QOL=quality of life; 16-item; QLQ-CIPN20=16-item quality of life questionnaire-chemotherapy-induced peripheral neuropathy; EORTC QLQ-C30=European Organization for the Research and Treatment of Cancer quality of life questionnaire core 30 items.

    Table 1.

    Table 2.

    Table 3.

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