The standard of care for ovarian cancer in elderly is using paclitaxel and carboplatin, an effective and efficient combination, but has serious toxicities. Peripheral neurotoxicity is one of the commonest toxicities which are seen occurring in 60% to 90% of patients. It is debilitating and vexing. Unfortunately, there is very little or no data regarding autonomic neuropathy in this setting. This study is an attempt to highlight this problem.
Single center cohort study of patients for the period 2013-2015. All patients were above the age of 65 years. 88 patients were tested for. All patients were screened for neuropathy using standard forms and methods including positional sense and stereognostic sense for neuropathy. NCI scales of grading peripheral neuropathy were followed. Autonomic neuropathy assessments were done by cardio vascular autonomic reflex test and gastro-intestinal autonomic neuropathy by using gastric phase emptying test. Genito-urinary autonomic neuropathy was tested for erectile dysfunction and bladder dysfunction. The tests were administered at baseline after 2nd, 4th and 6th cycle or if the patient complained of suggestive symptoms.
37% of patients developed grade 3/4 peripheral neuropathy. 59% of patients developed symptomatic autonomic neuropathy. Cardio vascular autonomic neuropathy occurred in 30% while gastric neuropathy was seen in 19%. Combined was seen in 10%. Constipation, diarrhoea and reeling of head were the most common complaints. Autonomic neuropathy was more common in diabetics 60% vs 48% (p > 0.05). Attempts to intervene using pharmacotherapy methods and non-pharmacotherapy methods were attempted.
Autonomic neuropathy seems to be common in geriatric population treated by this drug combination although there is not much mention either in real life or in clinical trials or if available as data attributed to other causes. Caution must be exerted in patients in diabetics and proper screening should be done in this patient population for autonomic neuropathy and peripheral neuropathy.
Clinical trial identification
Legal entity responsible for the study
G S Bhattacharyya
All authors have declared no conflicts of interest.