Abstract P3-14-06: The prevention and management of chemotherapy-induced peripheral neuropathy in breast cancer patients: A systematic review
Bibliographic record
Abstract
Abstract Background: Chemotherapy induced peripheral neuropathy (CIPN) remains a common treatment related adverse event for breast cancer (BC) patients. CIPN interferes with the ability to complete chemotherapy & therefore potentially compromises survival outcomes. CIPN can worsen health-related quality of life and also add to the ongoing morbidity experienced by BC survivors. Previously, systematic reviews & ASCO guidelines have examined CIPN across many cancer types & different chemotherapies, which may lead to the introduction of confounding factors not relevant to BC patients. A recent prospective cohort also identified other specific lifestyle factors associated with CIPN in BC patients (1). From our search, a systematic review specifically looking at CIPN in BC patients has not previously been undertaken. Methods: We conducted a systematic search in PubMed, EMBASE, CINAHL and CENTRAL. Clinical trials and observational studies for all potential pharmacological and non-pharmacological interventions were included. Risk of bias for full-text papers was assessed using the Cochrane Risk of Bias Assessment or the modified Newcastle Ottawa score. Results: Of 706 records being identified, 601 unique citations were screened with 21 full text papers retrieved for assessment, and 16 studies included in the qualitative assessment. We identified 10 randomised controlled trials (RCTs), one observational cohort study, and five controlled before-and-after studies (CBA). Pharmacological interventions which were investigated included calcium/magnesium infusion, glutamine, amifostine, goshajinkigan, omega 3 fatty acids, acetyl-L-carnitine, pregabalin, alpha-lipoic acid and minocycline. Non-pharmacological interventions included body mass index & lifestyle factors, electroacupuncture, exercise, limb hypothermia, carbon dioxide limb bathing and limb compression therapy. All trials identified were investigating primary prevention of CIPN in the setting of taxane chemotherapy. Improvements in the incidence of CIPN were reported with omega 3 fatty acids, glutamine and alpha-lipoic acid, but only one of these studies is a published RCT. In two of the studies, the benefit was identified only on physical examination, but no significant benefit with nerve conduction (NCS) testing. On subgroup analysis of trials investigating exercise, there was a benefit in the use of high intensity exercise versus low intensity exercise, particularly in patients <50 years old within a healthy weight range. Mixed results were seen with goshajinkigan. An increase in CIPN was seen with antioxidant use, electroacupuncture and acetyl L carnitine. Majority of the RCTs were associated with a high overall risk of bias. Conclusions: There has been a paucity of research on CIPN in BC patients. There were no interventions identified in this systematic review which show a clear clinical benefit in the prevention of CIPN in BC patients. BC patients may have specific lifestyle and hormonal factors which influence CIPN and this should prompt ongoing specific patient focussed research within this subgroup with large, blinded, randomised controlled trials. Greenlee, et al. Natl Cancer Inst 2017; 109(2). Citation Format: Roberts KE, Feng S, Adsett I, Rickett K, Woodward N. The prevention and management of chemotherapy-induced peripheral neuropathy in breast cancer patients: A systematic review [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-06.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.030 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.007 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.010 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".