p.1
Chemotherapy-Induced Neuropathy
What is the main focus of the scoping review by Sempere-Bigorra et al.?
The effects of chemotherapy on the onset or progression of neuropathy in diabetic patients.
p.3
Chemotherapy Drugs and Neurotoxicity
What is a common neurotoxic effect of oxaliplatin in cancer treatment?
Peripheral sensory neuropathy, which can become persistent.
p.4
Literature Review Methodology
What were the inclusion criteria for the articles reviewed?
Original articles based on observational and experimental studies, published in English or Spanish, evaluating neuropathy specifically, and analyzing chemotherapy-induced neuropathy in diabetic patients compared to non-diabetic patients.
p.3
Quality of Life in Cancer Patients with Diabetes
How does diabetic neuropathy affect quality of life?
It leads to a lower quality of life and an increased risk of falls and ulcerations.
p.2
Chemotherapy-Induced Neuropathy
What was the focus of the trial E1199?
It analyzed patients with axillary node-positive or high-risk, node-negative breast cancer receiving adjuvant taxanes containing therapy.
p.12
Impact of Diabetes on Chemotherapy Outcomes
Why is it important to assess neuropathy symptoms before chemotherapy treatment in diabetic patients?
Because cancer itself can induce neuropathy signs.
p.1
Diabetes and Cancer Comorbidity
What correlation exists between diabetes mellitus and cancer outcomes?
Outcomes are often worse in cancer patients who also have diabetes.
p.6
Chemotherapy-Induced Neuropathy
What was the main finding regarding peripheral neuropathy (PN) induced by FOLFOX chemotherapy in diabetic vs non-diabetic patients according to Bano and Ikram 2019?
It cannot be confirmed that PN induced by FOLFOX has a higher incidence in diabetics than in non-diabetics, but dizziness is more common in diabetic cancer patients.
p.6
Chemotherapy-Induced Neuropathy
What was the conclusion regarding diabetes and the risk of developing PSN in colorectal cancer patients treated with FOLFOX according to Ramanathan et al. 2009?
The presence of diabetes was not associated with an increased risk of developing PSN in any of the patients.
p.9
Chemotherapy-Induced Neuropathy
What neuropathy symptoms are more likely reported by diabetic patients undergoing chemotherapy?
Tingling in fingers or hands, tingling in toes or feet, numbness in toes or feet, and erection problems among men.
p.3
Literature Review Methodology
What was the focus of the literature review conducted in this study?
The effects of chemotherapy on the onset or progression of neuropathy in diabetic patients.
p.10
Long-term Effects of Chemotherapy on Diabetic Patients
What percentage of diabetic patients experienced persistent peripheral neuropathy two years after treatment?
68.7% of diabetic patients compared to 29.2% of non-diabetic patients.
p.11
Chemotherapy-Induced Neuropathy
How long can symptoms of chemotherapy-induced neuropathy last after diagnosis?
Between two to eleven years in more than half of the patients.
p.10
Factors Influencing Neuropathy Severity
How does diabetes influence the onset of oxaliplatin-induced paresthesia?
Diabetic patients develop paresthesia in a shorter time during infusion.
p.12
Chemotherapy-Induced Neuropathy
How does obesity relate to chemotherapy-induced neuropathy in breast cancer patients?
Obesity has been associated with an increased risk of neuropathy in breast cancer patients who received taxane-based chemotherapy.
p.2
Chemotherapy-Induced Neuropathy
What factors were associated with an increased risk of neuropathy in the E1199 trial?
Glycemic instability and obesity.
p.12
Chemotherapy Drugs and Neurotoxicity
What are the principal pathophysiological mechanisms leading to neuropathy development in diabetic patients?
Oxidative stress, inflammation, and microangiopathy.
p.1
Chemotherapy-Induced Neuropathy
What is known about high blood glucose levels in relation to peripheral nerves?
High blood glucose can damage peripheral nerves, increasing the risk of chemotherapy-related peripheral neuropathy in diabetic patients.
p.9
Factors Influencing Neuropathy Severity
What relationship was found between diabetes mellitus and the cumulative dose at the onset of neuropathy?
There was a significant relationship, but no differences were reported.
p.7
Chemotherapy-Induced Neuropathy
What did Vissers et al. (2015) conclude about neuropathic symptoms in diabetic versus non-diabetic colorectal cancer patients?
Diabetic patients showed neuropathic symptoms more frequently than non-diabetic patients, suggesting that diabetes mellitus is the main factor responsible for these symptoms.
p.12
Factors Influencing Neuropathy Severity
What factors may influence the occurrence of neuropathy in diabetic patients after chemotherapy?
Glycemic control and modifiable cardiovascular risk factors such as raised triglyceride levels, body-mass index, smoking, and hypertension.
p.3
Chemotherapy Drugs and Neurotoxicity
What type of neuropathy is commonly induced by Paclitaxel?
Peripheral neuropathy, starting with paresthesia and numbness.
p.12
Chemotherapy-Induced Neuropathy
Do hypertension and hypercholesterolemia significantly affect chemotherapy-induced neuropathy?
No, they do not seem to play a major role in chemotherapy-induced neuropathy.
p.1
Factors Influencing Neuropathy Severity
What factors should future studies consider regarding peripheral neuropathy in cancer patients with diabetes?
Duration of diabetes, cancer-induced neuropathic effects, and previous cancer management strategies like radiotherapy and surgery.
p.9
Chemotherapy-Induced Neuropathy
At what cycle of chemotherapy are diabetic patients more likely to develop neuropathy?
From the fifth cycle of chemotherapy.
p.3
Literature Review Methodology
What terms were included in the search equation for the literature review?
Peripheral neuropathy, antineoplastic agents, and diabetes mellitus.
p.8
Chemotherapy-Induced Neuropathy
What was the outcome of studies regarding the association between diabetes and paclitaxel-induced neuropathy?
Some studies found no significant differences in neuropathy incidence between diabetic and non-diabetic patients.
p.2
Chemotherapy-Induced Neuropathy
Why are patients with diabetes often excluded from studies on chemotherapy-induced peripheral neuropathy?
Because peripheral neuropathy is commonly observed in patients with diabetes.
p.10
Chemotherapy-Induced Neuropathy
What was observed about neuropathic symptoms in diabetic patients undergoing chemotherapy?
Most neuropathic symptoms occur at an early stage or at lower doses compared to non-diabetic patients.
p.1
Chemotherapy-Induced Neuropathy
What is a significant source of morbidity in cancer patients undergoing chemotherapy?
Chemotherapy-induced neuropathy.
p.9
Impact of Diabetes on Chemotherapy Outcomes
What effect does dexamethasone have on glucose levels in diabetic cancer patients?
It has a hyperglycemic effect.
p.9
Chemotherapy-Induced Neuropathy
What was the reported incidence of peripheral neuropathy in the MOSAIC study for patients with diabetes?
Grade 1 was reported in 93% of patients.
p.10
Chemotherapy Drugs and Neurotoxicity
What type of neuropathy does oxaliplatin commonly cause?
Acute and transient neurotoxicity.
p.11
Chemotherapy Drugs and Neurotoxicity
Why are corticosteroids generally avoided in diabetic patients?
They can result in deterioration of glycaemic control and worsen neuropathy symptoms.
p.11
Impact of Diabetes on Chemotherapy Outcomes
What was observed regarding chemotherapy delays in diabetic patients with breast cancer treated with paclitaxel?
They experienced more chemotherapy delays (20.9% vs. 7.1%) and dose reductions (32.6% vs. 11.9%) compared to patients without diabetes.
p.5
Literature Review Methodology
What were the four headings under which results were summarized?
1) Characteristics of the studies; 2) Prevalence and severity of neuropathy in diabetic vs non-diabetic patients; 3) Severity of neuropathy and type of chemotherapeutic drugs; 4) Variables affecting the relationship between occurrence and severity of neuropathy.
p.4
Literature Review Methodology
What methods were used to evaluate neuropathy in the articles?
Clinical anamnesis, physiological methods, and/or specific questionnaires.
p.2
Chemotherapy Drugs and Neurotoxicity
What is the incidence of neuropathy for Doxorubicin (Adriamycin)?
75%, with cognitive impairment known as 'chemobrain.'
p.12
Chemotherapy Drugs and Neurotoxicity
What future studies are warranted regarding chemotherapy and diabetes?
Studies to identify mechanisms by which chemotherapy drugs synergize with diabetes-induced nerve damage.
p.7
Chemotherapy-Induced Neuropathy
Did diabetes affect the overall survival of colorectal cancer patients treated with FOLFOX according to Abdel-Rahman (2018)?
No, diabetes did not affect the overall survival, but diabetic patients were more predisposed to developing oxaliplatin-induced peripheral neuropathy in a shorter time.
p.11
Impact of Diabetes on Chemotherapy Outcomes
What are common sensitive symptoms reported by diabetic patients undergoing chemotherapy?
Tingling in fingers, hands, toes, numbness, aching or burning pain in toes or feet.
p.10
Diabetes and Cancer Comorbidity
What did earlier studies conclude about the relationship between diabetes and neurotoxicity from chemotherapy?
The presence of diabetes did not increase the incidence of neurotoxicity.
p.8
Chemotherapy-Induced Neuropathy
What was the incidence of peripheral neuropathy in diabetic patients treated with paclitaxel compared to non-diabetic patients?
74.4% in diabetic patients vs. 58.4% in non-diabetic patients.
p.10
Impact of Diabetes on Chemotherapy Outcomes
What treatment options were compared in patients with advanced colorectal cancer?
Insulin, oral agents, and diet.
p.12
Literature Review Methodology
What is a limitation in studying the influence of diabetes on neuropathy?
The lack of standardized instruments to grade peripheral neuropathy valid for all chemotherapy drugs.
p.5
Chemotherapy Drugs and Neurotoxicity
Which chemotherapeutic drugs were evaluated for neuropathy-induced effects?
Paclitaxel, docetaxel, platinum agents, oxaliplatin, and cisplatin-based regimens.
p.8
Quality of Life in Cancer Patients with Diabetes
What was the impact of diabetes on chemotherapy delays and dose reductions in women?
Diabetic women experienced more delays in chemotherapy (20.9% vs. 7.1%) and dose reductions (32.6% vs. 11.9%).
p.3
Literature Review Methodology
What types of articles were excluded from the literature search?
Reviews, meta-analyses, and systematic reviews.
p.7
Chemotherapy Drugs and Neurotoxicity
What is the recommendation for administering paclitaxel and cisplatin in diabetic patients according to Gogas et al. (1996)?
The treatment can be administered safely using a standard dose with simultaneous monitoring of blood glucose and creatinine, along with a history of the patient’s neurological symptoms and a physical examination.
p.10
Chemotherapy Drugs and Neurotoxicity
What is the reported incidence of neuropathy in patients treated with paclitaxel?
57–83% for any degree of neuropathy, and 2–33% for severe neuropathies.
p.6
Factors Influencing Neuropathy Severity
How does the duration of diabetes affect the incidence of peripheral sensory neuropathy (PSN) in cancer patients treated with taxanes according to Kus et al. 2016?
Patients with diabetes for more than 5 years had higher neuropathy rates compared to those with less than 5 years of diabetes.
p.12
Chemotherapy-Induced Neuropathy
What are some symptoms associated with chemotherapy-induced neuropathy?
Orthostatic hypotension, generalized weakness, or paralytic ileus.
p.1
Literature Review Methodology
How many articles were ultimately included in the review?
Eight articles, with four additional articles retrieved from references.
p.12
Diabetes and Cancer Comorbidity
What is the relationship between diabetes complications and neuropathy?
Patients with complications from diabetes had more than twice the odds of having neuropathy compared to patients without diabetes.
p.1
Long-term Effects of Chemotherapy on Diabetic Patients
How long do the deleterious effects of chemotherapy on diabetic patients last compared to non-diabetic patients?
Peripheral neuropathy persists in a higher proportion of diabetic patients for up to two years after treatment.
p.5
Factors Influencing Neuropathy Severity
What effect did comorbid diabetes have on neuropathy according to the studies?
It ranged from clear and robust to subtle effects.
p.8
Factors Influencing Neuropathy Severity
How did the duration of diabetes affect the incidence of chemotherapy-induced neuropathy?
Diabetic patients with more than five years of diabetes had a neuropathy rate of 75%, significantly higher than non-diabetic patients.
p.2
Chemotherapy Drugs and Neurotoxicity
What is the reported incidence of neuropathy for Paclitaxel?
60% for all grades, with 11% for Grade 3–4 motor and 33% for Grade 3–4 sensory.
p.2
Impact of Diabetes on Chemotherapy Outcomes
What is the relationship between diabetic patients and chemotherapy-induced peripheral neuropathy?
Diabetic patients may have a higher risk of developing neuropathy due to loss of axonal integrity.
p.4
Literature Review Methodology
What was the search equation used in PubMed?
(((“diabetes mellitus”[All Fields]) AND (“chemotherapy”[All Fields])) AND (“neuropathy”[All Fields])) NOT (review).
p.1
Impact of Diabetes on Chemotherapy Outcomes
What is the relationship between diabetes and chemotherapy-induced peripheral neuropathy?
Diabetes may predispose patients to greater neuropathic signs, especially at higher dosages of chemotherapy.
p.4
Literature Review Methodology
What data was extracted from each selected article?
Number of participants, age and sex of participants, type of tumor, type of chemotherapy received, and tools used for neuropathy.
p.10
Chemotherapy Drugs and Neurotoxicity
Which chemotherapy drugs are known to have a high potential to induce neuropathy?
Platinum compounds and taxanes.
p.11
Chemotherapy Drugs and Neurotoxicity
What is a common side effect of dexamethasone in women with advanced ovarian cancers?
Hyperglycemia, with glucose levels over 19.2 mmol/liter reported in many patients.
p.6
Chemotherapy-Induced Neuropathy
What was observed in diabetic women with breast cancer treated with paclitaxel according to De la Morena Barrio et al. 2015?
An increased incidence of peripheral neurotoxicity and a substantial delay in recovery were observed in diabetic patients compared to non-diabetic patients.
p.1
Chemotherapy Drugs and Neurotoxicity
What types of chemotherapy drugs are highlighted for their potential to induce neuropathy?
Platinum derivatives and taxanes.
p.8
Chemotherapy-Induced Neuropathy
What percentage of diabetic patients experienced Grade 2–3 peripheral neuropathy during paclitaxel treatment?
51.2% of diabetic patients experienced Grade 2–3 neuropathy.
p.3
Impact of Diabetes on Chemotherapy Outcomes
What can improve neuropathic symptoms in diabetic patients?
Appropriate glycemic control.
p.10
Factors Influencing Neuropathy Severity
How does the duration of diabetes affect neuropathy rates in diabetic patients receiving chemotherapy?
Neuropathy rates are higher in patients with a longer duration of diabetes.
p.11
Quality of Life in Cancer Patients with Diabetes
What is the impact of chemotherapy-induced neuropathy on quality of life?
It interferes with quality of life and is often accompanied by depressive symptoms and apathy.
p.7
Chemotherapy-Induced Neuropathy
What was the finding regarding diabetes mellitus and oxaliplatin-induced peripheral neuropathy in the study by Uwah et al. (2012)?
No influence of diabetes mellitus on the severity of oxaliplatin-induced peripheral neuropathy was found, but diabetic patients developed neuropathy with a lower cumulative dose of oxaliplatin than non-diabetic patients.
p.2
Chemotherapy Drugs and Neurotoxicity
Which classes of chemotherapy agents are most studied for inducing peripheral neuropathy?
Taxanes and platinum derivatives.
p.10
Factors Influencing Neuropathy Severity
What did subsequent studies find regarding diabetes as a risk factor for peripheral neuropathy in chemotherapy patients?
Diabetes acts as a risk factor for the incidence and severity of peripheral neuropathy.
p.8
Chemotherapy-Induced Neuropathy
Did the development of clinically significant neuropathy appear to be affected by age or sex?
No, it did not appear to be affected by age or sex.
p.11
Impact of Diabetes on Chemotherapy Outcomes
How does diabetes affect the quality of life in colorectal cancer patients with neuropathic symptoms?
Diabetic patients reported a decreased quality of life associated with higher impairment in sensitive symptoms.
p.9
Impact of Diabetes on Chemotherapy Outcomes
What was the association between diabetes and chemotherapy or radiotherapy in multivariate logistic regression models?
No association was found.
p.11
Chemotherapy-Induced Neuropathy
What is the consequence of severe chemotherapy-induced peripheral neuropathy for cancer treatment?
It often leads to dose reduction or treatment cessation, limiting the efficacy of cancer treatment.
