Longitudinal assessment of chemotherapy-induced peripheral neuropathy in women undergoing taxane-based treatment for breast cancer: a prospective observational study

Chemotherapy-induced peripheral neuropathy (CIPN) is a common, debilitating side effect of taxane-based chemotherapy. However, its trajectory during and after treatment remains poorly understood. This study aimed to estimate the natural history of CIPN symptoms using patient-reported and objective measures. Women with stage I-III breast cancer scheduled to receive taxane-based chemotherapy underwent CIPN assessments at five timepoints (pre-chemotherapy, post-anthracycline, mid-taxane, post-taxane, and 6-month follow-up) using physical function tests, patient-reported outcomes, quantitative sensory testing, H-reflex assessments, and static balance testing. Data were analysed using linear mixed models. Twelve participants enrolled (48% of eligible patients, 100% retention). Self-reported autonomic (all timepoints), motor (post-anthracycline and post-taxane) and sensory (post-taxane and 6-month follow-up) symptoms were greater than pre-chemotherapy (all p < 0.05). Health-related quality of life was impaired at all timepoints compared to pre-chemotherapy. Maximal H-reflex amplitude normalised to maximal M-wave amplitude (Hmax/Mmax) decreased post-taxane (-0.23, 95% CI -0.36 to -0.10, p = 0.001) and at 6-month follow-up (-0.27, 95% CI -0.39 to -0.16, p < 0.001). Anterior-posterior (mid-taxane: 8 mm, 95% CI 2 to 13 mm, p = 0.007; post-taxane: 9 mm, 95% CI 4 to 15 mm, p = 0.001) and total (mid-taxane, p <0.001; post-taxane, p <0.001) sway increased from pre-chemotherapy, but mediolateral sway did not change (all timepoints p ≥ 0.05). Comprehensive CIPN assessment during and after chemotherapy is feasible and reveals impairments in nerve function and balance. ClinicalTrials.gov Identifier: NCT05441722