Peripheral Neuropathy and Falling Risk in 65 Patients Years Old and Older Receiving Chemotherapy: A Prospective Study

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1 Intenational Jounal of Caing Sciences Januay-Ail 2018 Volume 11 Issue 1 Page 450 Oiginal Aticle Peiheal Neuoathy and Falling Risk in 65 Patients Yeas Old and Olde Receiving Chemotheay: A Posective Study Ayse Ozkaaman, RN, PhD Assistant ofesso, Eskisehi Osmangazi Univesity Faculty of Health, Nusing Deatment, Eskisehi, Tukey Nihal Olu, RN Eskisehi Osmangazi Univesity Hosital, Medical Oncology Chemotheay Unıt. Eskisehi, Tukey Oznu Usta Yesilbalkan, RN, PhD Associate ofesso, Ege Univesity Faculty of Nusing, Ayfe Kaadakovan, RN, PhD Pofesso, Ege Univesity Faculty of Nusing, Bonova, Izmi, Tukey Coesondence: Ayse Ozkaaman RN, PhD, Eskisehi Osmangazi Univecity Faculty of Health Sciences, Deatment of Nusing, Meselik Camus, Odunazaı, Eskisehi, Tukey. aozaydin26@hotmail.com. Abstact Objectives: Chemotheay-elated eiheal neuoathy is known to incease the isk of falls in the eldely. This study aims to assess the develomental state of eiheal neuoathy and the isk of falls in 65 yeas and olde eciients of chemotheay. Methods: The study oulation comised atients ove 65 yeas who wee fist teated with chemotheay fo solid and haematological cance between Febuay 1, 2016, and Octobe 31, 2017, in a day teatment unit of a hosital in Eskisehi, Tukey. We collected data evey month fo 6 months using the Individual Identification Fom, the National Cance Institute Common Sense of Toxicity Citeia Sensoy and Moto Neuoathy Scale and the Hendich-II Falling Risks Scale. The quantitative data wee exessed as medians. Futhemoe, we evaluated the comaison of measuements at diffeent time oints with a nomal distibution, analysis of vaiance at eeated measues and nomal non-disesive scoe vaiables by the Fiedman test. Results: The numbe of neuoathic atients inceased in the sixth month than the fist month in the 6-month follow-u eiod. In addition, it was detemined that the Hendich-II Falling Risks Scale scoe inceased in the fifth and sixth months than the fist and second months. Conclusion: This study evealed that the degee of neuoathy and the isk of falling inceased in the sixth month than the fist month fo individuals ove 65 yeas who eceived chemotheay. Hence, no statistically significant coelation existed between age and neuoathy gade and age and isk of falls in this study. Keywods: Aged, chemotheay, eiheal neuoathy, isk of falls Intoduction With inceasing advancements in the field of health sevices aound the wold, including Tukey, a global usuge is witnessed in the ageing oulation (Tukey Statistical Institute, 2016; Intenational Agency fo Reseach on Cance, 2015). The Tukey Statistical Institute eveals that, at esent, 8.3% of the Tukish oulation is olde than 65 yeas (Tukey Statistical Institute, 2016). Aaently, cance is a chonic disease that inceases with age (Intenational Agency fo Reseach on Cance, 2015). Recent yeas have acknowledged temendous technological develoments in the diagnostics and teatment of cance; howeve, atients extensively exeience hysical and

2 Intenational Jounal of Caing Sciences Januay-Ail 2018 Volume 11 Issue 1 Page 451 sychological changes, both fom the disease couse and advese effects of teatments. In geiatic atients with cance, both falling and falling-elated oblems ae common eecussions of cance teatment, along with the hysiological decline that accomanies ageing (Eyigo, 2012; CDC, 2015). Reotedly, chemotheay-elated eiheal neuoathy is the leading cause of an incease in the isk of falls and balance and walking oblems in eldely individuals (Wad et al., 2014; Kolb et al., 2016). Nugalieva et al. (2010) demonstated that atients (aged yeas) teated with a latinum taxane combination theay fo beast, ovay and lung cances had a lowe isk of develoing eiheal neuoathy than did atients olde than 80 yeas. Wad et al. (2014) established that 73% of falls in atients diagnosed with cance esulted in factues, most commonly femoal neck factues. Howeve, a majoity of atients teated with chemotheay and biological teatment ae not even awae that they ae at the isk of falling; in fact, atients aly otective measues against falling afte they have exeienced a fall. To date, no investigation has been conducted on the develoment of eiheal neuoathy and the isk of falling in eldely atients who eceive chemotheay in Tukey. Hence, this study aims to evaluate the coelation between the develomental state of eiheal neuoathy and the isk of falls in atients ove 65 yeas who eceived chemotheay. Hyotheses of study H 0 = Thee is no elationshi between age, develomental state of eiheal neuoathy and the isk of falls H 1 =Thee is elationshi between age, develomental state of eiheal neuoathy and the isk of falls Methods The aim and tye of the eseach: This osective sectional study was conducted to assess the develomental state of eiheal neuoathy and the isk of falls in atients ove 65 yeas who eceived chemotheay. The oulation and samle of the eseach: The study cohot comised atients ove 65 yeas who wee fist teated with chemotheay fo solid and haematological cance between Febuay 1, 2016, and Octobe 31, 2017, in an outatient teatment unit of a hosital in Eskisehi, Tukey. We enolled only those atients in this study who fulfilled the following secified selection citeia: (a) undegoing the same chemotheay otocol fo 6 months; eceiving 24 oints o highe fom the Standadized Mini-Mental Test (SMMT); (c) being able to walk at least 15 metes; (d) no nevous system, musculoskeletal system, skinsecific diseases, o any othe disease that affects these egions; (e) nonalcoholic; (e) and ageeing to aticiate in the study. Data collection: This study was aoved by the Ethical Committee, and we obtained witten consent fom the hosital management and atients befoe commencing the study. Befoe stating the study, five atients who wee not included in the scoe of this study wee eadministeed the test to evaluate the comehensibility of the questions. All enolled atients wee assessed monthly fo 6 months using the Individual Identification Fom, the National Cance Institute Common Toxicity Citeia Sense and Moto Neuoathy Scale (NCI-CTCAE v4.03) and the Hendich-II Falling Risks Scale (HFRS-II). The SMMT was fist oosed by Folstein et al., standadised by Molloy and Standish and validated by Gungen et al. (2002) egading validity and eliability. The test comises 11 items collected unde five main headings (i.e. oientation, ecod memoy, attention and calculation, ecall and language) and is evaluated ove a 30-oint ange. While the sensitivity of the scale is 91% (23 of 24), its secificity is 95%. The SMMT is a actical test that finds alication in a olyclinical envionment o at bedside within a shot eiod of 10 min by a biefly tained hysician, nuse o a sychologist (Gungen et al., 2002). The NCI-CTCAE v4.03 assesses sensoy and moto eiheal neuoathy, including objective and subjective measuements, and is used to detemine chemotheay-elated eiheal neuoathy (National Cance Institute, 2009).Futhemoe, the HFRS-II was develoed by Hendich et al. in 1995, e-examined in 2003 to ceate a second vesion and imoved in tems of validity and eliability by Atay et al. in The highest

3 Intenational Jounal of Caing Sciences Januay-Ail 2018 Volume 11 Issue 1 Page 452 scoe obtained fom HFRS-II was 20 (scoes 5 indicate a high isk) (Dedeli, Kaagozoglu, & Kuukız, 2012). Data Analysis: We analysed data using the IBM SPSS 21 ackage ogam. Quantitative data wee exessed as mean ± standad eo o median (Q1 Q3). The nomal distibution of data was veified using the Shaio Wilk test. While we used the vaiance analysis fo eeated measues, the Fiedman test was used to evaluate non-nomally distibuted scoe vaiables. The coelation between quantitative vaiables was examined by the Seaman coelation analysis. Futhemoe, the elationshi between the categoical vaiables was evaluated by the χ 2 analysis. We consideed P 0.05 as statistically significant. Results In this study, we examined 39 atients. We excluded five atients fom the study because of a change in thei chemotheay otocol, and fou atients died. Hence, we comleted the study with 30 atients. While 50% of the eseach cohot had solid tumous, the emaining wee teated fo haematological cance. The aveage age of aticiants was ± 5.88 yeas; 63.3% wee males, 33.3% undewent latinum-based chemotheaies, and 60% had a histoy of sugey and adiotheay. Of all atients, 83.3% wee awae of the occuence of chemotheay-induced neuoathic comlaints, such as numbness and tingling sensation in the hands and feet, wheeas 56.7% cited ignoance of the fact that these medicines inceased the isk of falls (Table 1). We obseved a statistically significant diffeence in the 6-month follow-u of atients based on the NCI-CTCAE v4.03 atios evaluated evey month ( 0.001). In addition, the degee of neuoathy inceased in the sixth month as comaed to the fist month (fist-month NCI-CTCAE v4.03 degee: 1; sixth-month NCI-CTCAE v4.03 degee: 2; = 0.016; Table 2). We detemined that when the falling status of atients and the isk of falls wee evaluated, 16.7% of atients had fallen. Futhemoe, the isk of falling in the fifth and sixth months inceased statistically significantly (fist-month HFRS-II mean scoe: 2, fifth-month HFRS-II mean scoe: 4, =0.023; fist-month HFRS-II mean scoe: 2, sixth-month HFRS-II mean scoe: 4, =0.032; second-month HFRS-II mean scoe: 2, fifth-month HFRS-II mean scoe: 4, =0.016; second-month HFRS-II mean scoe: 2, sixthmonth HFRS-II mean scoe: 4, =0.032; Table 2). An investigation of the coelation between age and neuoathy develoment status and age and isk of falls evealed no statistically significant diffeences (Table 3). Discussion Peiheal neuoathy is the leading advese effect of taxane- and latinum-based chemotheay (Heshman et al., 2014; Hong, Tian, & Wu, 2014; Bao et al., 2016). In this study, atients wee teated with chemotheay fo the fist time ove a eiod of 6 months, and the numbe of neuoathies inceased in the sixth month comaed with the fist month of the study. In a study, 50% of 50 atients (mean age: 48 yeas) with beast cance undegoing taxanebased chemotheay had gade 1 neuoathy and these comlaints gadually deceased afte the temination of chemotheay (Heshman et al., 2014). Anothe study eoted that chemotheay inceased the incidence of neuoathy in ogessive teatments (Kautıo et al., 2011). Leonad et al. (2005) eoted that atients eceiving oxalilatin-based chemotheay demonstated a diectly ootionate incease of dysesthesia and aaesthesia with a cumulative dose of oxalilatin. In a meta-analysis, 68.1% of atients in the fist month following chemotheay and 30% in the second month wee elated to chemotheay-elated eiheal neuoathy (Seetny et al., 2014). The esults of this study ae aallel to those in the liteatue. In addition to dugs, obesity, inactivity, diabetes mellitus and ageing have been oven to affect the develoment of eiheal neuoathy (Nugalieva et al., 2010; Bao et al., 2016; Ylitalo, 2012). In this study, atients with no nevous system, musculoskeletal system, skin diseases o any diseases that could affect these aeas, and who could walk, at least, 15 metes wee included; thus, we attemted to contol these factos. The seveity of eiheal neuoathy inceased with chemotheay, and a modeately significant

4 Intenational Jounal of Caing Sciences Januay-Ail 2018 Volume 11 Issue 1 Page 453 ositive coelation was obseved between age and eiheal neuoathy in the fist month following chemotheay administation. Based on these esults, nuses should evaluate hamacological and non-hamacological methods egading neuoathic findings befoe and afte chemotheay, and coodinate with health ofessionals fo atient management by consideing these esults. Reotedly, eiheal neuoathy is a citical isk facto fo falls (Richadson, & Huvitz, 1995), and an inceased isk of falling is elated to eiheal neuoathy (Bao et al., 2016; Tofthagen, Ovecash, & Ki, 2012; Mashall, 2016). Patients eot difficulties when doing housewok, being in a wok envionment and efoming activities of daily living (Beijes et al., 2016; Gewandte et al., 2013) while undegoing chemotheay. Table 1. Distibution of socio-demogahic chaacteistics Chaacteistics x ±sd Old(yea) 68.46±5.88 Gende n % Female Male Chemotheay dugs Platinum based Taxan based Azacitidine 6 20 Decitabine Peviously alied theay Non Sugical teatment Radiotheay Radiotheay and sugical teatment Chonic disease Non Chonic obstuctive ulmonay disease 3 10 Cadiovascula disease Hyetension Use of auxiliay devices Non Walking stick Wheelchai 3 10 Fequency of getting hel Eve Occasionaly Always Knowing the state of neuoathy I know I do not know Knowing the state of isk of fall I know I do not know Fall state Yes No Total

5 Intenational Jounal of Caing Sciences Januay-Ail 2018 Volume 11 Issue 1 Page 454 Table 2. Distibution of NCI-CTCAE v4.03 gade ve HFRS-II scoe accoding to months Evaluation time NCI-CTCAE v4.03 HFRS-II Median(Q1-Q3) Median(Q1-Q3) 1. month 1(0-1) a 0.001* 2(1-4.25) g 0.001* 2. month 1(0-2) b 2(1-4.25) h 3. month 1(0-2) c 2(1.75-5) ı 4. month 1(1-2) d 3(1.75-5) j 5. month 2(1-2) e 4(2-6.25) k 6. month 2(1-2) f 4(2-6.25) l *Two Way Anova; **Fiedman test Significant diffeences between a and f gous (=0.016) ** Significant diffeences between g and l gous (=0.032); g and k gous(=0.023); H and l gous (=0.032);h and k gous (=0.016)** Table 3. Coelation between age, NCI-CTCAE v4.03 gade and HFRS-II scoe 1.month NCI-CTCAE v4.03 gade 2. month NCI-CTCAE v4.03 gade 3. month NCI-CTCAE v4.03 gade 4. month NCI-CTCAE v4.03 gade 5. month NCI-CTCAE v4.03 gade 6. month NCI-CTCAE v4.03 gade Age month HFRS-II 2. month HFRS-II 3. month HFRS-II 4. month HFRS-II 5. month HFRS-II 6. month HFRS-II Age This study detemined that in the following months of chemotheay, atients had a highe isk of falling elated to the degee of neuoathy and that age alone did not affect the isk of falling. A etosective evaluation of atients who undewent chemotheay between 1994 and 2007 evealed that the atio of injuies associated with falls e 1000 esons/month was 9.15 fo double neuotoxic chemotheay atients, 7.76 fo single neuotoxic chemotheay atients and 5.19 fo atients who eceived no neuotoxic chemotheay (Wad et al., 2014). Oka et al. (2005) significantly established a coelation between axonal neuoathy and falls. In addition,

6 Intenational Jounal of Caing Sciences Januay-Ail 2018 Volume 11 Issue 1 Page 455 Gewandte et al. (2013) established a significant coelation between moto neuoathy and falls. Anothe two studies eoted that atients who develoed chemotheay-elated neuoathy exeienced moe falls than atients who did not develo neuoathy (Kolb et al., 2016; Tofthagen, Ovecash, & Ki, 2012). While Kolb et al. detemined that the isk of an indeendent fall in atients with neuoathy inceased with age (Kolb et al., 2016), Tofthagen, Ovecash, & Ki (2012) eoted that ageing did not affect the isk of falls. Toaman and Un Yıldıım demonstated (2010) that individuals ove the age of 65 yeas who eoted a diect association with falls had weake muscles and did not maintain balance comaed with healthy subjects in the same age gou. Anothe study emhasised that fall ates augmented the motality ate by thee-fold in geiatic atients eceiving chemotheay (Wildes et al., 2013). Hence, it is ecommended that chemotheay atients who have a high isk of neuoathy should be infomed about the evention of falls by taking safety ecautions egadless of age, hosital egulations, home envionment and the use of assistive devices. Conclusion This study established that the degee of neuoathy and the isk of falling inceased in the sixth month comaed with the fist month. In addition, no statistically significant coelation existed between age and neuoathy gade, and age and isk of falls in the study. As the study oulation comised a small samle gou, including atients aged 65 yeas o olde fom a single hosital, addictive factos (e.g. chemotheaeutic dug, gende and the esence of chonic illness) that could affect neuoathy and fall isk could not be assessed. Hence, futhe extensive studies with a lage samle gou ae waanted to evaluate the deendent factos. Acknowledgements The authos declae no conflict of inteest. Refeence Bao, T., Basal, C., Seluzicki, C., Li, SQ., Seidman, AD., Mao, JJ. (2016). Long tem chemotheayinduced eiheal neuoathy among beast cance suvivos: evelance, isk factos, and fall isk. Beast Cance Res Teat,159, Beijes, AJ., Veugdenhi,l G., Oelemans, S., Euelings, M., Minnema, MC., Eeltink, CM., Van de Poll-Fanse, LV., Mols, F. (2016). Chemotheay-induced neuoathy in multıl myeloma: influence on quality of life and develoment of a questionnaie to comose common toxicity citeia gading fo use in daily clinical actice. Suot Cae Cance, 24(6), Centes fo Disease Contol and Pevention, National Cente fo Injuy Pevention and Contol. Available fom: htt://webaa.cdc.gov/cgibin/boke.exe. Accessed; Eyigo, S. (2012). Aoach to falls. Ege Jounal of Medicine, 51: Dedeli, O., Kaagozoglu, S., Kuukiz, S. (2012). Detemination of fall isk accoding to Hendich II and Mose Fall Scale: A ilot study. Jounal of Anatolia Nusing and Health Sciences, 15,1-9. Gewandte, JS., Fan, L., Magnuson, A., Mustian, K., Peone, L., Heckle, C., Hokins, J., Tejani, M., Moow, GR., Mohile, SG. (2013). Falls and functional imaiments in cance suvivos with chemotheay-induced eiheal neuoathy (CIPN): A univesity of Rocheste CCOP study. Suot Cae Cance, 21, Gungen, C., Etan, T., Eke, E., Yasa, R. (2002). Reliability and validity of the Standadized mini mental state examination in the diagnosis of mild dementia in Tukish oulation. Tukish Psychiatic Jounal, 13(4), Heshman, DL., Lacchetti, C., Dwokin, RH., Lavoie Smith, EM., Bleeke, J., Cavaletti, G., Chauhan, C., Gavin, P., Lavino, A., Lustbeg, MB., Paice, J., Schneide, B., Smith, ML., Smith, T., Testie, S., Wagne-Johnston, N., Bak, K., Loinzi, CL. (2014). Pevention and management of chemotheay-induced eiheal neuoathy in suvivos of adult cances: Ameican Society of Clinical Oncology Clinical Pactice Guideline. Jounal of Clinical Oncology, 32(18), Hong, JS., Tian, J., Wu, LH. (2014). The influence of chemotheay-induced neuotoxicity on sychological distess and slee distubance in cance atients. Cu Oncol, 21: Intenational Agency fo Reseach on Cance (2015) to 2015: IARC, A unique institution fo a changing wold. Available fom: htts:// ARC_Ch3_web.df.Accessed: Kautıo, AL., Haanaa, M., Kautıainen, H., Leminen, A., Kalso, E., Saato, T. (2011). Oxalilatin scale and National Cance Institute-Common toxicity citeia in the assesment of chemotheay-induced eiheal neuoathy. Anticance Reseach, 31,

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