Chemotherapy-related neuropathic symptoms and functional impairment in adult survivors of extracranial solid tumors of childhood: results from the St. Jude Lifetime Cohort Study

Arch Phys Med Rehabil. 2013 Aug;94(8):1451-7. doi: 10.1016/j.apmr.2013.03.009. Epub 2013 Mar 26.


Objectives: To ascertain prevalence of peripheral sensory and motor neuropathy, and to evaluate impairments in relation to function.

Design: St. Jude Lifetime Cohort Study, a clinical follow-up study designed to evaluate adverse late effects in adult survivors of childhood cancer.

Setting: A children's research hospital.

Participants: Eligibility required treatment for an extracranial solid malignancy between 1962 and 2002, age ≥ 18 years, ≥ 10 years postdiagnosis, and no history of cranial radiation. Survivors (N=531) were included in the evaluation with a median age of 32 years and a median time from diagnosis of 25 years.

Interventions: Not applicable.

Main outcome measures: Primary exposure measures were cumulative doses of vinca-alkaloid and platinum-based chemotherapies. Survivors with scores ≥ 1 on the sensory subscale of the Modified Total Neuropathy Score were classified with prevalent sensory impairment. Those with sex-specific z scores of ≤-1.3 for dorsiflexion strength were classified with prevalent motor impairment. Participants completed the 6-minute walk test (endurance), the Timed Up & Go test (mobility), and the Sensory Organization Test (balance).

Results: The prevalence of sensory and motor impairment was 20% and 17.5%, respectively. Vinca-alkaloid exposure was associated with an increased risk of motor impairment (adjusted odds ratio [OR]=1.66; 95% confidence interval [CI], 1.04-2.64) without evidence for a dose response. Platinum exposure was associated with increased risk of sensory impairment (adjusted OR=1.62; 95% CI, .97-2.72) without evidence of a dose response. Sensory impairment was associated with poor endurance (OR=1.99; 95% CI, .99-4.0) and mobility (OR=1.65; 95% CI, .96-2.83).

Conclusions: Vincristine and cisplatin exposure may increase risk for long-term motor and sensory impairment, respectively. Survivors with sensory impairment are at increased risk for functional performance limitations.

Keywords: CI; Cisplatin; Modified Total Neuropathy Score; Neoplasms; OR; Peripheral nervous system diseases; Rehabilitation; SJLIFE; SOT; Sensory Organization Test; St. Jude Lifetime Cohort Study; TNS; Total Neuropathy Score; Vincristine; confidence interval; mTNS; odds ratio.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Agents / adverse effects*
  • Carboplatin / adverse effects
  • Child
  • Child, Preschool
  • Cisplatin / adverse effects
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Movement Disorders / diagnosis
  • Movement Disorders / epidemiology
  • Movement Disorders / etiology*
  • Neoplasms / drug therapy*
  • Neoplasms / mortality
  • Neoplasms / pathology
  • Peripheral Nervous System Diseases / chemically induced*
  • Peripheral Nervous System Diseases / diagnosis
  • Peripheral Nervous System Diseases / epidemiology
  • Sensation Disorders / chemically induced*
  • Sensation Disorders / diagnosis
  • Sensation Disorders / epidemiology
  • Vinblastine / adverse effects
  • Vincristine / adverse effects
  • Young Adult


  • Antineoplastic Agents
  • Vincristine
  • Vinblastine
  • Carboplatin
  • Cisplatin