Heterogeneous chemotherapy-induced peripheral neuropathy trajectories and their associated factors in patients with gastrointestinal tumors: a cohort study

Abstract Chemotherapy-induced peripheral neuropathy (CIPN) is a common and important nerve-related side effect of chemotherapy. However, researchers still know little about how CIPN changes over time in patients with gastrointestinal tumors. This prospective cohort study aimed to identify different CIPN patterns during chemotherapy and to examine factors related to these patterns. We recruited 233 patients with gastrointestinal tumors from a tertiary cancer center. All patients had a pathological diagnosis and received first-line chemotherapy with drugs known to cause peripheral nerve damage. At baseline, we collected demographic and clinical data. We also measured cancer-related fatigue with the Revised Piper Fatigue Scale, physical performance with the Short Physical Performance Battery, and self-management efficacy with the Strategies Used by People to Promote Health scale. We assessed CIPN symptoms with the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool after the 1st, 3rd, 5th, and 7th chemotherapy cycles. We used latent class growth modeling to identify CIPN trajectory patterns. We used chi-square tests, analysis of variance, and logistic regression analyses to examine factors related to these patterns. We identified four CIPN trajectories: worsening CIPN symptoms (71 patients, 30.5%), mild stable CIPN symptoms (81 patients, 34.8%), improving CIPN symptoms (42 patients, 18.0%), and severe stable CIPN symptoms (39 patients, 16.7%). Age, smoking history, number of chronic diseases, chemotherapy regimen, standardized cumulative dose of neurotoxic agents, cancer-related fatigue, physical performance, and self-management efficacy were related to CIPN trajectory membership. These findings show that CIPN does not follow the same course in all patients with gastrointestinal tumors during chemotherapy. Early identification of high-risk patients and individualized symptom management may help reduce nerve damage, maintain physical function, and improve tolerance to chemotherapy.