QST testing may detect subclinical neuropathy and hence, treatment may be adjusted in time.

Treatment for subclinical neuropathy

What is CIPN

Chemotherapy induced peripheral neuropathy (CIPN) is a common painful and treatment-limiting side effect of chemotherapy. (Staff et al. 2017)

CIPN and chemotherapy agents

Diverse chemotherapy agents affect the nervous system differently. Among those; platinum agents are known to produce sensory neuropathy, while taxanes have a history of producing a musculoskeletal pain syndrome which may be correlated to CIPN, and vinca-alkaloids are known to cause a mixed sensorimotor peripheral neuropathy. (Staff et al. 2017, Dougherty et al. 2007)

QST before chemotherapy

In another unfortunate twist, recent studies in colorectal cancer and squamous cell carcinoma (a type of skin cancer) have shown through Quantitative Sensory Testing (QST) that peripheral fibers may already be sub-clinically affected prior to the application of chemotherapy, in essence, linking the presence of the cancer itself to nerve damage. (de Cavalho Barbosa et al. 2014,  Boyette-Davis et al. 2011, and Roldan et al. 2018, respectively)

The added value of QST in cancer patients

Given the fact that these patients are vulnerable to neuropathy, Roldan et al. has suggested that they should be monitored using QST prior to commencement and during their chemotherapy treatment to prevent or control the development of CIPN. (Roldan et al. 2018) A new publication by Ramnarine et al. (2018) gives weight to this point by finding that cold detection thresholds significantly increased during chemotherapy treatment in a mixed group of patients with various types of treatment agents. This points to the added value of QST during chemotherapy treatment and in chemotherapy clinical trials.

References:

1. Staff, N. P., Grisold, A., Grisold, W., & Windebank, A. J. (2017). Chemotherapy‐induced peripheral neuropathy: A current review. Annals of neurology, 81(6), 772-781.

2. Dougherty, P. M., Cata, J. P., Burton, A. W., Vu, K., & Weng, H. R. (2007). Dysfunction in multiple primary afferent fiber subtypes revealed by quantitative sensory testing in patients with chronic vincristine-induced pain. Journal of pain and symptom management, 33(2), 166-179.

3. Boyette-Davis, J. A., Eng, C., Wang, X. S., Cleeland, C. S., Wendelschafer-Crabb, G., Kennedy, W. R., … & Dougherty, P. M. (2012). Subclinical peripheral neuropathy is a common finding in colorectal cancer patients prior to chemotherapy. Clinical Cancer Research, clincanres-0205.

4. de Carvalho Barbosa, M., Kosturakis, A. K., Eng, C., Wendelschafer-Crabb, G., Kennedy, W. R., Simone, D. A., … & Dougherty, P. M. (2014). A quantitative sensory analysis of peripheral neuropathy in colorectal cancer and its exacerbation by oxaliplatin chemotherapy. Cancer research.

5. Roldan, C. J., Johnson, C., Lee, S. O., Peng, A., Dougherty, P. M., & Huh, B. (2018). Subclinical Peripheral Neuropathy in Patients with Head and Neck Cancer: A Quantitative Sensory Testing (QST) Study. Pain physician, 21(4), E419-E427.

6. Krøigård, T., Schrøder, H. D., Qvortrup, C., Eckhoff, L., Pfeiffer, P., Gaist, D., & Sindrup, S. H. (2014). Characterization and diagnostic evaluation of chronic polyneuropathies induced by oxaliplatin and docetaxel comparing skin biopsy to quantitative sensory testing and nerve conduction studies. European journal of neurology, 21(4), 623-629.

7. Ramnarine, S., Rolke, R., Colvin, L. A., & Fallon, M. T. (2018). Investigating nerve fibre damage in chemotherapy-induced peripheral neuropathy (CIPN): A prospective study.