Patterns and Factors Associated with Podiatry Service Use Among Colorectal Cancer Patients Following Chemotherapy in South Australia: Focus on Chemotherapy-Induced Peripheral Neuropathy (CIPN)

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Objective: To investigate patterns and factors associated with podiatry service use following chemotherapy for colorectal cancer (CRC) in South Australia (SA), with a focus on addressing needs related to Chemotherapy Induced Peripheral Neuropathy (CIPN), a common and detrimental complication of neurotoxic chemotherapy. Methods: This retrospective cohort study included adult CRC cases in SA (2011 to 2013). Patient characteristics, chemotherapy and podiatry service use were determined using linked health and administrative datasets. Crude and adjusted Poisson regression analyses compared annual rates of podiatry service use between chemotherapy recipients and non-recipients, and whether chemotherapy was neurotoxic from four years before to five years after diagnosis. Multivariable Poisson regression identified factors associated with podiatry service use post-diagnosis. Results: This is the first population-level study to examine the use of Medicare funded podiatry services by people with CRC within South Australia. Of 3,292 patients, 1,535 (47%) received chemotherapy. Despite a high prevalence of CIPN reported in the literature (up to 24% at 3 years post-chemotherapy), the crude rate of podiatry service use among chemotherapy recipients in this study did not exceed 20% across the five years post-diagnosis. Adjusted analyses showed similar podiatry service use among chemotherapy recipients and non-recipients, except for higher rates during the second-year post-diagnosis in chemotherapy recipients (Incidence Rate Ratios (IRR) 1.22, 95% CI: 1.01-1.48). No differences were observed at any timepoint between neurotoxic or non-neurotoxic chemotherapy recipients. Podiatry service use post-diagnosis was positively associated with prior podiatry service use (IRR 4.08, 95% CI: 3.48-4.79), having diabetes (IRR 1.26, 95% CI: 1.01-1.57), receiving chemotherapy (IRR 1.18, 95% CI: 1.01-1.37) and older age (IRR 1.28, 95% CI: 1.07-1.53, 80+ vs <80years). Conclusion: Despite a known higher prevalence of CIPN of up to 24% at 3 years post-chemotherapy, the podiatry service use by chemotherapy recipients in this study appears low, and independent of neurotoxic risk. This may indicate suboptimal follow up care for CIPN in CRC patients receiving chemotherapy who are at an inferred higher risk of CIPN. Given the known risks of CIPN to lower limb health (eg, proprioception loss, falls, ulcers), improved integration of podiatry services into cancer survivorship care is critical to address unmet needs in CIPN management.

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