Highlights
- •Quantification of chemotherapy-induced peripheral neuropathy remains a challenge
- •Difficulty quantifying small fiber involvement contributes to a lack of understanding
- •Identifying patients with pain will assist in individualizing treatment approaches.
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major, dose-limiting side effect
of treatment with neurotoxic cancer treatments which can result in long-term impairment.
Deficits often reflect a large fiber polyneuropathy, however small fiber involvement
resulting in neuropathic pain and autonomic dysfunction can occur. Quantification
of both CIPN and small fiber neuropathy (SFN) remains a challenge. Accordingly, the
prevalence and pathophysiology of small fiber neuropathy amongst cancer survivors
remains poorly understood. This review will provide an overview of the clinical features
of SFN associated with neurotoxic cancer treatments as well as a summary of current
assessment tools for evaluating small fiber function, and their use in patients treated
with neurotoxic chemotherapies. The continued development and utilization of novel
measures quantifying small fiber involvement will help elucidate the pathophysiology
underlying symptoms of CIPN and assist in informing treatment approaches. Accurately
identifying subgroups of patients with neuropathic symptoms which may respond to existing
pain medication may reduce the impact of CIPN and improve long-term quality of life
as well as provide better categorization of patients for future clinical trials of
neuroprotective and treatment strategies for CIPN.
Perspective
This review provides a critical analysis of SFN associated with neurotoxic cancer
treatments and the assessment tools for evaluating small fiber dysfunction in cancer
patients. Quantification of small fiber involvement in CIPN will assist in identifying
subgroups of patients with neuropathic symptoms which may respond to existing pain
medications.
Key words
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Article info
Publication history
Published online: July 17, 2019
Footnotes
Disclosures: This study was supported by a Cancer Institute NSW Program Grant (14/TPG/1-05) and a National Health and Medical Research Council of Australia (NHMRC) Project Grant (#1080521). SBP is supported by a NHMRC Career Development Fellowship (#1148595). MCK was supported by a NHMRC Practitioner Fellowship (1156093); and by ForeFront, a large collaborative research group dedicated to the study of neurodegenerative diseases and funded by the National Health and Medical Research Council of Australia Program Grant (#1132524).
The authors have no conflict of interest to declare.
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