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Purpose <p>Oxaliplatin chemotherapy improves survival in patients with colorectal cancer, but a common dose-limiting toxicity is oxaliplatin-induced peripheral neuropathy (OIPN). The purpose of this study was to assess the association between OIPN and falls with intercycle delays and early discontinuation of oxaliplatin chemotherapy.</p> Methods <p>Colorectal cancer patients in this study were obtained from the Surveillance, Epidemiology, and End Results database combined with Medicare claims data (SEER-Medicare). All patients were ≥ 66&#xa0;years of age at diagnosis. OIPN and falls were considered time-dependent exposures and were identified by diagnosis codes. Intercycle chemotherapy delay was defined as receipt of chemotherapy ≥ 7&#xa0;days after the planned chemotherapy date. Early discontinuation was determined according to the chemotherapeutic regimen (infusional 5-FU &lt; 6 cycles, oral capecitabine &lt; 4 cycles). Poisson regression with generalized estimating equations and 95% confidence intervals was used to obtain adjusted incidence rate ratios (IrR) and rate differences (IrD) for intercycle delays and risk ratios (RR) and risk differences (RD) for early discontinuation.</p> Results <p>A total of 3802 patients were available for analysis. Intercycle oxaliplatin delay occurred in 57.7% of subjects (<i>n</i> = 2194). OIPN (IrR = 1.87: 95% CI, 1.67–2.10; IrD = 2.09 delays/81 person-days: 95% CI, 1.48–2.69) and falls (IrR = 2.62: 95% CI, 2.06–3.34; IrD = 3.30 delays/81 person-days: 95% CI, 1.96–4.64) were associated with increased rates of delay. Early discontinuation of chemotherapy occurred in 22.1% of patients (<i>n</i> = 841). OIPN (RR = 2.51: 95% CI, 1.78–3.55; RD = 7.2%; 95% CI, 3.0–11.4%) and falls (RR = 2.19; 95% CI, 1.24–3.85) were also associated with increased risks of early discontinuation.</p> Conclusion <p>Patients who experience intercycle delays and early discontinuation of scheduled chemotherapy treatment may experience poorer cancer-related outcomes. Therapeutics to prevent and treat OIPN and fall prevention strategies are needed to decrease the likelihood of chemotherapy treatment disruptions in older colorectal cancer patients.</p>

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The association of oxaliplatin-induced peripheral neuropathy and falls with intercycle delays and early discontinuation of chemotherapy in older colorectal cancer patients

  • 期刊论文

  • 发表日期：

    2025年9月26日

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  • Robert B. Hines,
  • Xiang Zhu,
  • Christopher Schoborg,
  • Stephanie Sutton,
  • Eunkyung Lee,
  • Shunpu Zhang

摘要

Purpose

Oxaliplatin chemotherapy improves survival in patients with colorectal cancer, but a common dose-limiting toxicity is oxaliplatin-induced peripheral neuropathy (OIPN). The purpose of this study was to assess the association between OIPN and falls with intercycle delays and early discontinuation of oxaliplatin chemotherapy.

Methods

Colorectal cancer patients in this study were obtained from the Surveillance, Epidemiology, and End Results database combined with Medicare claims data (SEER-Medicare). All patients were ≥ 66 years of age at diagnosis. OIPN and falls were considered time-dependent exposures and were identified by diagnosis codes. Intercycle chemotherapy delay was defined as receipt of chemotherapy ≥ 7 days after the planned chemotherapy date. Early discontinuation was determined according to the chemotherapeutic regimen (infusional 5-FU < 6 cycles, oral capecitabine < 4 cycles). Poisson regression with generalized estimating equations and 95% confidence intervals was used to obtain adjusted incidence rate ratios (IrR) and rate differences (IrD) for intercycle delays and risk ratios (RR) and risk differences (RD) for early discontinuation.

Results

A total of 3802 patients were available for analysis. Intercycle oxaliplatin delay occurred in 57.7% of subjects (n = 2194). OIPN (IrR = 1.87: 95% CI, 1.67–2.10; IrD = 2.09 delays/81 person-days: 95% CI, 1.48–2.69) and falls (IrR = 2.62: 95% CI, 2.06–3.34; IrD = 3.30 delays/81 person-days: 95% CI, 1.96–4.64) were associated with increased rates of delay. Early discontinuation of chemotherapy occurred in 22.1% of patients (n = 841). OIPN (RR = 2.51: 95% CI, 1.78–3.55; RD = 7.2%; 95% CI, 3.0–11.4%) and falls (RR = 2.19; 95% CI, 1.24–3.85) were also associated with increased risks of early discontinuation.

Conclusion

Patients who experience intercycle delays and early discontinuation of scheduled chemotherapy treatment may experience poorer cancer-related outcomes. Therapeutics to prevent and treat OIPN and fall prevention strategies are needed to decrease the likelihood of chemotherapy treatment disruptions in older colorectal cancer patients.