A comparison of chemotherapy-induced peripheral neuropathy assessment tools in patients receiving neurotoxic chemotherapy.

Abstract

132 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a challenging toxicity with significant sequelae impacting prognosis and quality of life. Clinical presentation although predominantly sensory can include motor and autonomic dysfunction. As there is no standardised approach to the diagnosis and assessment of CIPN, characterisation of symptoms can be problematic. This study aims to investigate the relationship between various CIPN assessment tools in gynaecological, colorectal and lung cancer patients receiving neurotoxic chemotherapy. Methods: Patients with the above cancers receiving chemotherapy (platinum and/or taxanes) were assessed prospectively every 3 weeks for a cumulative total of 159 cycles. Prior to each cycle the following tools were utilised: European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 questionnaire, MD Anderson Symptom Inventory (MDASI) and associated descriptors of sensory disturbance/pain. Spearman’s correlation coefficients were used to compare these tools with the most commonly measured CIPN diagnostic tool, the National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE). Results: The EORTC sensory, motor subscales and total scores were highly correlated as expected. MDASI, question 13 (severity of numbness or tingling at its worst) was most correlated with the EORTC sensory subscale (ρ = 0.76). The correlation between the descriptors and EORTC sensory improved (ρ = 0.64 to ρ = 0.71) when the analysis focused on only numbness or tingling. CTCAE grade was more highly correlated with EORTC sensory (ρ = 0.61) and descriptors (ρ = 0.76) compared with EORTC motor (ρ = 0.46). All correlations were statistically significant (p < 0.001). Conclusions: In this mixed cohort of patients, comparison of the various CIPN assessment tools during chemotherapy cycles revealed significant correlations. This suggests the tools are useful in capturing the predominance of sensory symptoms and characterising the sensation of numbness and tingling. Further evaluation of this cohort along with additional studies may provide insight regarding the optimum choice of assessment tool(s).