THE OVERLOOKED BURDEN OF PACLITAXEL INDUCED PERIPHERAL NEUROPATHY ON PSYCHOLOGICAL DISTRESS, FATIGUE AND QUALITY OF LIFE: A MINI REVIEW

Background: Paclitaxel is a primary anticancer drug for breast cancer but it mostly results in dose-limiting side effect known as paclitaxel-induced peripheral neuropathy (PIPN), characterized as sensory, and motor neuropathy. Sensory neuropathy may remain for longer periods even after the termination of chemotherapy. Cancer treatment, PIPN and breast cancer itself comes with physical as well as psychological symptoms including anxiety, depression and fatigue. Patients with breast cancer usually feel depressed due to loss in body image, disease burden and PIPN after chemotherapy. While physical and functional outcomes of PIPN are clearly articulated, the psychological symptoms (anxiety, depression, fatigue) that mostly come as a result of breast cancer and cancer treatment are not adequately focused. Aim: To correlate and compile current findings and linking PIPN with anxiety, depression, and fatigue in breast cancer patients, and demonstrate research gaps notably in low- and middle-income countries (LMICs) including Pakistan. Methods: A precisely directed descriptive search of PubMed, Scopus, and Google Scholar was conducted (2000–2025) using keywords such as “paclitaxel”, “peripheral neuropathy”, “chemotherapy-induced peripheral neuropathy”, “anxiety”, “depression”, “fatigue”, and similar combinations. Principal focus was given to systematic reviews, validated measurement studies, clinical cohorts, and cross-sectional studies. Results: Incidence of PIPN among paclitaxel recipients is high (many series report 30–60% with any symptoms; some report persistent symptoms in up to ~50% at follow-up), with major impacts on function and Quality of Life (QoL). Experimental and clinical studies showed convincing and reasonable underlying connections between neurotoxicity as a result of paclitaxel, neural inflammation, altered sleep patterns, and psychological and fatigue related outcomes. Various tools such as HADS, EORTC CIPN20 and FACIT F are commonly used but variable outcomes have resulted in limited comparisons. There is very limited observational clinical data available which is directly evaluating correlation between PIPN severity and anxiety/depression/fatigue as well as longitudinal and LMIC-based evidence is very rare and insufficient. Conclusion: The review emphasized a complementary evidence that PIPN contributes to psychological burden (anxiety and depression), as well as fatigue and quality of life, but thorough comprehensive longitudinal and context-dependent and environment-specific studies are required particularly in Pakistan/LMIC settings. Periodic screening for neuropathic symptoms, fatigue and common psychological symptoms during and after paclitaxel treatment, and multidisciplinary supplementary interventions, are recommended. This research would let the researchers to build strategies to help in reducing and conceivably diminishing such signs and symptoms in breast cancer patients experiencing PIPN as a result of treatment with paclitaxel, hence reducing the negative effect on QoL of patients.