Late Effects of Chemotherapy on Patient-Reported Neuropathy, Balance Problems, and Fall Outcomes Among Older Breast Cancer Survivors

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PURPOSE Late effects of chemotherapy in older breast cancer (BC) survivors remain understudied. We evaluated the long-term impact of taxane chemotherapy on patient-reported neuropathy, balance problems, and falls among older BC survivors. METHODS Using Texas Cancer Registry-Medicare linked data, BC survivors age 65 years or older at diagnosis, with local or regional disease diagnosed between 2012 and 2013 were identified. Survivors completed questionnaires including patient-reported outcomes and clinical characteristics between April 2018 and October 2019. Rao-Scott chi-square tests and multivariable logistic regression models evaluated associations between taxane chemotherapy and neuropathy in the past 7 days, and balance problems and fall outcomes in the past 12 months. RESULTS Among 1,493 BC survivors, the majority were non-Hispanic White (80.8%), had hormone receptor–positive BC (78.1%), and had localized disease (75.6%). 26.5% received chemotherapy, and 89% of those received a taxane. Survivors who received chemotherapy were more likely to report neuropathy (61.8% v 36.0%, P < .01). Those who received paclitaxel had worse neuropathy than survivors treated with docetaxel (73.3% v 55.7%, P < .01). Although taxane use was not significantly associated with falls (adjusted odds ratio [aOR], 1.2 [95% CI, 0.83 to 1.64]), those treated with a taxane were more likely to report balance problems than those who did not receive chemotherapy (aOR, 1.6 [95% CI, 1.13 to 2.24]). Although Black BC survivors were more likely to report neuropathy (aOR, 1.8 [95% CI, 1.10 to 3.07]), Hispanic (aOR, 1.5 [95% CI, 1.01 to 2.31]) survivors were more likely to receive a provider intervention to prevent falls or treat balance problems relative to White survivors. CONCLUSION Older BC survivors who received taxane chemotherapy were more likely to report neuropathy and balance problems but not falls. Future research should evaluate effective fall prevention and balance interventions in this population.

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