Background: The prevalence of CIPN has been estimated to be 68.1% in the 1st month after administration of platinum (oxaliplatin/ carboplatin) or taxane based antineoplastic agents (paclitaxel/ Docetaxel). These agents have increased the overall survival rate of cancer patients but with development of debilitating side effects like motor and sensory symptoms-numbness, paraesthesia, dysaesthesias, loss of balance, muscle weakness and burning pain which poses a great challenge for oncologists to warrant a reduction in the dosage or stop the chemotherapeutic course to mitigate CIPN symptoms. Therefore, it is of at most importance to develop prophylactic measures to prevent CIPN so that the patients can be cancer free and not suffer from debilitating neuropathy induced by cancer treatment.
Aim: Improvement in chemotherapy induced neuropathic pain symptoms on VAS scale and SLANSS scale through selective nutritional supplementation.
Materials and Methods: A total of 103 patients receiving platinum, taxane and vinca-alkaloids based chemotherapy with clinically diagnosed chemotherapy induced peripheral neuropathy were enrolled in the study. After taking informed consent, a baseline workup of vitamin B12 and vitamin D3 was done. Those with deficiency of either vitamin were given Gabapentin with the deficient nutritional supplement likewise the other group was receiving gabapentin alone. They were subsequently followed up for a period of 3 months and 6 months with SLANSS scale and VAS scale. All the inclusion and exclusion criteria were checked before enrolment of the patient into the study. No patient had lost to follow up or expired during the study period.
Results: Comparative Statistical Analysis Among Intervention Groups was done Visual analogue scale calculated at 6 months in different intervention groups, the mean score of Gabapentin alone treated was found to be 3.73±1.26 (Mean±SD), Gabapentin and Vitamin D3 groups 3.30±0.823 (Mean±SD), Gabapentin and Vitamin B12 3.1 ±1.31 (Mean±SD), Gabapentin Vitamin D3 and Vitamin B12 2.5±1.31 (Mean±SD) respectively, which showed that the VAS score improvement in intervention groups as compared to Gabapentin alone groups. Mean value of two independent groups were compared using the Independent Samples t Test. The difference in mean VAS score at 6 months between the ‘Gabapentin Alone’ and ‘Gabapentin and Vitamin D3’ groups was not statistically significant. The difference in mean VAS score at 6 months between the ‘Gabapentin Alone’ and ‘Gabapentin and Vitamin B12’ groups, ‘Gabapentin Alone’ and ‘Gabapentin, vitamin D3 and Vitamin B12’ groups was statistically significant with p value less than 0.05. SLANSS score calculated at 6 months in different intervention groups, the mean score of Gabapentin alone treated was found to be 8.84±3.9 (Mean±SD), Gabapentin and Vitamin D3 groups 8.60±5.02 (Mean±SD), Gabapentin and Vitamin B12 groups 5.46±3.0 (Mean±SD), Gabapentin, Vitamin D3 and Vitamin B12 was 5.06±.68 (Mean±SD) respectively, which showed that the SLANSS score improvement in Vitamin supplementations groups as compared to Gabapentin alone groups. Mean value of two independent groups were compared using the Independent Samples t Test. The difference in mean SLANSS score at 6 months between the ‘Gabapentin Alone’ and ‘Gabapentin and Vitamin D3’ groups was not statistically significant. The difference in mean VAS score at 6 months between the ‘Gabapentin Alone’ and ‘Gabapentin and Vitamin B12’ groups, ‘Gabapentin Alone’ and ‘Gabapentin, vitamin D3 and Vitamin B12’ groups was statistically significant with p value less than 0.05.
Conclusion: Gabapentin and Vitamin D3 supplementation did not show significant improvement in the neuropathic pain component in CIPN patients as measured by VAS score and SLANSS score from baseline to 6 months follow-up. Gabapentin and Vitamin B12 and Gabapentin + Vitamin B12 + Vitamin D3 supplementation in CIPN shows significant improvement in reduction of neuropathic pain as compared to Gabapentin alone cases at 3 months and 6 months follow-up. Therefore, we can recommend the use of vitamin B12 and vitamin D3 supplementation with Gabapentin to mitigate the CIPN symptoms in cancer patients.