Assessment Of Chemotherapy-induced Peripheral Neuropathy Research Articles

Incidence of chemotherapy-induced peripheral neuropathy within 12weeks of starting neurotoxic chemotherapy for multiple myeloma or lymphoma: a prospective, single-center, observational study.

Chemotherapy-induced peripheral neuropathy (CIPN) may necessitate chemotherapy dose reduction, delay, or discontinuation. This pilot study tested feasibility of patient enrollment, CIPN screening, and data collection in cancer patients for a future clinical study that will assess the safety and efficacy of an intervention that may prevent CIPN. This prospective, observational, single-center, pilot study included adults with newly diagnosed lymphoma or multiple myeloma receiving neurotoxic chemotherapy. Patients were enrolled between September 2016 and February 2017. The Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire was completed by patients at 3 time points: baseline, week 6, and week 12. The primary outcome was change in the neurotoxicity score between these time points. Of 33 patients approached for consent, 28 (85%) provided consent and were enrolled. The FACT/GOG-Ntx questionnaire was completed by 28 (100%) at baseline, 25 (89%) at week 6, and 24 (86%) at week 12. Average (standard deviation) neurotoxicity scores were 36.5 (6.6) at baseline, 34.0 (8.3) at week 6, and 30.6 (7.6) at week 12. Neurotoxicity scores changed from baseline by - 2.7 points (95% CI - 5.5 to 0.1; p = 0.061) at week 6 and - 6.0 points (95% CI - 5.6 to - 0.8; p = 0.012) at week 12. Clinically meaningful declines (decrease of > 10% from baseline) in neurotoxicity score were detected in 36% (9 of 25) at week 6 and in 67% (16 of 24) at week 12. Sixty-seven percent of patients experienced clinically significant CIPN within 12weeks of starting chemotherapy. Feasibility metrics for enrollment, consent, CIPN assessment, and follow-up were met.

Mobility in survivors with chemotherapy-induced peripheral neuropathy and utility of the 6-min walk test.

Chemotherapy-induced peripheral neuropathy (CIPN) is a significant and often lasting side effect of cancer treatment, with increasing CIPN severity associated with increasing deficits in balance, gait, and mobility. The 6-min walk test (6MWT) is a widely validated and utilized measure of general physical functioning and mobility, although its utility in a CIPN context is unclear. This study aimed to determine the utility of the 6MWT as an assessment of mobility deficits in a CIPN cohort and utilize the 6MWT to compare mobility data from CIPN patients to those of healthy and clinical populations. Cancer survivors exposed to neurotoxic chemotherapies (N = 100; mean 17 ± 13months post-treatment; mean age 59 ± 13years) completed a single cross-sectional assessment of patient-reported and objective CIPN, mobility (6MWT), and disability. CIPN symptoms were reported in the majority of the cohort (87%). Increasing age, patient-reported and objective CIPN symptoms, and disability were associated with decreasing 6MWT distance (.48 ≤ R ≤ .63; p < .001) in bivariate models. Multiple regression models of 6MWT distance included age, sex, and patient-reported or objective CIPN severity as significant independent correlates (.62 ≤ R ≤ .64; p < .03). 6MWT distances in patients with CIPN symptom severity above the cohort mean were consistent with mean values reported in diabetic neuropathy and clinical populations. Increased CIPN symptoms are associated with increased mobility deficits. The 6MWT demonstrates promising utility as a mobility assessment in a CIPN cohort. The impact of the progression of CIPN on mobility deficits in survivors emphasizes the need for effective interventions to treat and prevent CIPN.

Non-invasive assessment of chemotherapy-induced peripheral neuropathy using neuromuscular ultrasound in breast cancer patients.

e23152 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity for breast cancer patients that leads to early treatment discontinuation and worse outcomes. Neuromuscular ultrasound (NMUS) is a non-invasive assessment of peripheral nerves that has not been studied in taxane CIPN. Methods: This cross-sectional study enrolled breast cancer patients with subjective complaints of CIPN symptoms during or after taxane chemotherapy and compared nerve cross-sectional area (CSA) by NMUS with historical values in 120 healthy adults. Findings were correlated with self-reported symptom scale (EORTC-QLQ CIPN20, range 0-72, higher more severe); nerve conduction studies; and skin biopsies for intraepidermal nerve fiber density (IENF). Results: We evaluated 20 participants (mean 55.4 ± 10.5 yrs) with NMUS at 74 nerve sites after median 3.7 months (IQR 1.0-6.1) since last taxane (paclitaxel 10, docetaxel 8, nab-paclitaxel 2). Participants reported moderate-to-severe CIPN symptoms which were predominantly sensory (19.1 ±4.9, max 32) as opposed to motor (15.6 ±5.8, max 32) or autonomic (3.3 ±1.6, max 8). Sural sensory nerve CSA was 1.2 mm2 smaller than in historical controls (4.1 vs. 5.3 mm2, 2-sample t-test p = 0.005) and decreased with more days from last taxane (Spearman’s r -0.46, p = 0.04). Tibial motor nerve was not significantly different from controls (p = 0.35). Median nerve CSA was enlarged at the distal wrist crease entrapment site (12.5 vs 10.1, p = 0.03). Older age was associated with smaller sural CSA (r = -0.72, p &lt; 0.001). When controlling for age and days from last taxane, for each 1mm2 decrease in sural CSA, distal IENF reduced by 2.1 nerve/mm2 (p = 0.04, R2 = 0.30). Conclusions: NMUS showed expected sensory predominant distal axonopathy in taxane CIPN. Evaluation of nerve CSA by non-invasive NMUS may serve as an objective point-of-care assessment to risk-stratify women with taxane CIPN prior to the development of debilitating symptoms. Clinical trial information: NCT03139435. [Table: see text]

Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy.

To describe the known predictors and pathophysiological mechanisms of chronic painful chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors and the challenges in assessing and managing it. PubMed/Medline, CINAHL, Scopus, and PsycINFO. The research on chronic painful CIPN is limited. Additional research is needed to identify the predictors and pathophysiological mechanisms of chronic painful CIPN to inform the development of assessment tools and management options for this painful and possibly debilitating condition. Recognition of the predictors of chronic painful CIPN and proactive CIPN assessment and palliative management are important steps in reducing its impact on physical function and quality of life.

Characterizing patient-clinician chemotherapy-induced peripheral neuropathy assessment and management communication approaches

ObjectiveTo describe the frequency and characteristics of chemotherapy-induced peripheral neuropathy (CIPN) assessment and management communication approaches between patients receiving neurotoxic chemotherapy and clinicians. MethodsThe data used in this analysis originated from a randomized controlled trial in which adults with cancer self-reported treatment-related symptoms using web-based symptom assessment technology. Three-to-six weeks after study initiation, each participant’s outpatient visit was audio-recorded. Audio recordings and associated clinician notes for 159 participants who received platinum and/or taxane-based chemotherapy were coded for the presence of several CIPN assessment and management communication characteristics. ResultsParticipants received low cumulative neurotoxic chemotherapy doses (75%) at the time of audio recording. CIPN was discussed and documented in 44% and 46% of participant-clinician encounters. In symptomatic participants, clinicians asked an average of 0.7 open-ended questions, appropriately managed 70% of cases, and asked upper and lower extremity CIPN questions in 25% of cases. ConclusionsClinicians infrequently discussed and documented CIPN in participants with low CIPN severity, however appropriately managed mild CIPN. Development of interventions to translate existing recommended CIPN communication approaches into practice are required. Practice ImplicationsEffective participant-clinician communication is required at each clinic visit during chemotherapy treatment to identify initial signs of CIPN and offer appropriate treatment.

A Randomized Controlled Trial to Assess the Effectiveness of Muscle Strengthening and Balancing Exercises on Chemotherapy-Induced Peripheral Neuropathic Pain and Quality of Life Among Cancer Patients.

Chemotherapy-induced peripheral neuropathy (CIPN) is the presence of tingling, burning, itching, and unpleasant sensations in hands and feet due to nerve damage by chemotherapy. Exercise rehabilitation has potential to prevent or alleviate CIPN. The aim of this study was to assess the effectiveness of muscle strengthening and balancing exercises on CIPN pain and quality of life (QOL) among cancer patients. The randomized controlled trial included 45 cancer patients from a tertiary care hospital in India receiving chemotherapeutic drugs paclitaxel and carboplatin and found to have CIPN. Subjects were randomly allocated to exercise (n1 = 22) and usual care (n2 = 23) groups. The exercise group received home-based muscle strengthening and balancing exercise for 10 weeks. Data regarding demographic, clinical characteristics, CIPN, neuropathic pain, and QOL were collected by structured questionnaires Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, nerve conduction velocity, Leeds Assessment of Neuropathic Symptoms and Signs pain scale, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. The 2 groups were homogenous regarding demographic variables. In clinical characteristics, the exercise group had larger body surface area and received a higher dose of paclitaxel. Significant reduction in neuropathic pain scores (P < .0001) and improvement in Functional QOL (P = .0002), Symptom QOL (P = .0003), Global Health Status QOL (P = .004) scores were observed after intervention in the exercise group than the usual-care group. Muscle strengthening and balancing exercises are effective in reducing CIPN pain and improving QOL among cancer patients. Muscle strengthening and balancing exercises can be used as a complementary therapy for effective management of CIPN.

Are we mis-estimating chemotherapy-induced peripheral neuropathy? Analysis of assessment methodologies from a prospective, multinational, longitudinal cohort study of patients receiving neurotoxic chemotherapy

BackgroundThere are inconsistencies in the literature regarding the prevalence and assessment of chemotherapy-induced peripheral neuropathy (CIPN). This study explored CIPN natural history and its characteristics in patients receiving taxane- and platinum-based chemotherapy.Patients and methodsMulti-country multisite prospective longitudinal observational study. Patients were assessed before commencing and three weekly during chemotherapy for up to six cycles, and at 6,9, and 12 months using clinician-based scales (NCI-CTCAE; WHO-CIPN criterion), objective assessments (cotton wool test;10 g monofilament); patient-reported outcome measures (FACT/GOG-Ntx; EORTC-CIPN20), and Nerve Conduction Studies.ResultsIn total, 343 patients were recruited in the cohort, providing 2399 observations. There was wide variation in CIPN prevalence rates using different assessments (14.2–53.4%). Prevalence of sensory neuropathy (and associated symptom profile) was also different in each type of chemotherapy, with paclitaxel (up to 63%) and oxaliplatin (up to 71.4%) showing the highest CIPN rates in most assessments and a more complex symptom profile. Peak prevalence was around the 6-month assessment (up to 71.4%). Motor neurotoxicity was common, particularly in the docetaxel subgroup (up to 22.1%; detected by NCI-CTCAE). There were relatively moderately-to-low correlations between scales (rs = 0.15,p < 0.05-rs = 0.48 p < 0.001), suggesting that they measure different neurotoxicity aspects from each other. Cumulative chemotherapy dose was not associated with onset and course of CIPN.ConclusionThe historical variation reported in CIPN incidence and prevalence is possibly confounded by disagreement between assessment modalities. Clinical practice should consider assessment of motor neuropathy for neurotoxic chemotherapy. Current scales may not be all appropriate to measure CIPN in a valid way, and a combination of scales are needed.

Oncology nurses’ knowledge, practice, and confidence toward chemotherapy-induced peripheral neuropathy in Jordan

Objectives:To assess the knowledge, practice, and confidence of oncology nurses toward chemotherapy-induced peripheral neuropathy (CIPN) among patients with cancer in Jordan.Methods:Descriptive, and cross sectional study was conducted on a convenience sample of 148 Jordanian registered oncology nurses recruited from a Specialized Oncology Center in Jordan. Data collection took place in June, 2015. As a data collection tool, the assessment of oncology nurses’ knowledge and practice-revised questionnaire was used.Results:The mean CIPN knowledge score of 8.98/16 (SD=1.9) indicated that there were knowledge deficits regarding CIPN among Jordanian oncology nurses. Only 58.8% of the subjects indicated that CIPN assessment is necessary for their oncology practices, but the majority rated their CIPN assessment skills as inadequate. Neurologic physical assessment usually is not included in practices assessment. In addition, 57.1% believed that CIPN was a significant problem for patients and their families.Conclusion:There is a significant requirement to enhance the neurological assessment skills of oncology nurses and an efficient approach to CIPN assessment is demanded. Creating guidelines to manage and assess CIPN, and further investigations in different health institutions to generalize the results across Jordan are highly needed.

Chemotherapy-Induced Peripheral Neuropathy: Use of an Electronic Care Planning System to Improve Adherence to Recommended Assessment and Management Practices.

Chemotherapy-induced peripheral neuropathy (CIPN) is often inadequately assessed and managed by advanced practice providers. The aim is to explore the impact of CIPN assessment training and electronic care planning system (CPS) use on CIPN assessment documentation and guidelines adherence. The authors used a pre-/post-test, prospective design with two retrospective chart reviews. Six providers received CIPN assessment training and used the CPS to manage CIPN for 75 women receiving neurotoxic chemotherapy. CPS use significantly improved documentation of numbness and nonpainful CIPN management strategies but had no effect on documentation of additional assessment variables or painful CIPN management.

Reliability and Validity of the Turkish Version of Chemotherapy-induced Peripheral Neuropathy Assessment Tool for Breast Cancer Patients Receiving Taxane Chemotherapy

Objective:The aim was to evaluate the reliability and the validity of the Turkish version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) in cancer patients using taxane.Methods:This methodological study was carried out to evaluate the validity and the reliability of the CIPNAT. The sample cohort comprised 430 breast cancer patients who were administered taxane, a chemotherapeutic agent, between April and December 2017. Data were collected by the CIPNAT and by a demographic data form. The CIPNAT content reliability was checked after completing it in Turkish. Validity was tested after the translation as well. Cronbach's alpha and test–retest reliability were utilized for reliability analyses.Results:Cronbach's alpha value was 0.87 in this study. The test–retest reliability ranged between 0.90 and 0.96 for all items. No difference existed between the means of test and retest scores of the CIPNAT. A statistically significant positive relationship materialized between the item's test and retest scores. There were statistically significant positive relationships among all levels of the CIPNAT. Factor analysis resulted in a size value higher than 1 and explained 66% of total variation. These results show that the Turkish version of the CIPNAT is a valid and reliable scale in Turkish society.Conclusions:This study showed that the CIPNAT in Turkey is a reliable and valid tool to evaluate taxane chemotherapy in breast cancer patients.

The psychometric properties of the Turkish version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT).

Chemotherapy-induced peripheral neuropathy is a common treatment-related adverse effect. It adversely affects the quality of life. Therefore, it is important to evaluate symptoms. The purpose of this study was to evaluate the validity and reliability of Chemotherapy-Induced Peripheral Neuropathy Assessment Tool in Turkish patients. A convenience sample of 327 patients, being treated with peripheral neurotoxic chemotherapeutic agents were asked to fill in the questionnaire. The data was evaluated using SPSS 21 (SPSS Inc., Chicago IL, USA) statistical software. The verification of the structure obtained with CFA was provided by AMOS 21.0. Psychometric testing included internal consistency reliability (Cronbach's alpha coefficient and item-total correlations), test-retest reliability, validity (exploratory factor analysis, confirmatory factor analysis and concurrent validity). The Cronbach alpha value of the scale was 0.97. The test-retest reliability results were significantly high. The CIPNAT significantly correlated with the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy. The model was validated by confirmatory factor analysis (χ2/sd=2.74, GFI=0.95, AGFI=0.92, CFI=0.98, RMSEA=0.07, and RMR=0.009). The Turkish version of the CINAT was found to be reliable and valid with Turkish patients receiving chemotherapy. Use of the CIPNAT may lead to a better understanding of symptom. The CIPNAT can be used in future nursing research and practice as an assessment tool for peripheral neuropathy in patients with cancer who undergo chemotherapy.

Optimal clinical assessment strategies for chemotherapy-induced peripheral neuropathy (CIPN): a systematic review and Delphi survey.

Chemotherapy-induced peripheral neuropathy (CIPN) is a prominent side effect of the treatment of cancer. Despite this frequent complication, there has been no comprehensive review and quality appraisal of CIPN assessments. The purpose of this study is to provide a definitive quality appraisal of CIPN assessment strategies for clinical use. Relevant studies were identified through database searches of Medline, Embase, CINAHL, and Cochrane. CIPN assessment strategies from included articles were extracted and initially rated by an oncologist and neurophysiologist according to criteria related to assessment depth, comprehensiveness, appropriateness, and reliability. The six highest scoring assessment strategies were the focus of a two-round Delphi survey of a working party of 32 physicians, nurses, and consumers to achieve consensus on the highest rated assessments for each criterion. The database search yielded 117 distinct CIPN assessments that were extracted from 2373 articles. Three patient-reported outcome surveys and three clinician-based assessments were included in the Delphi survey. No consensus was generated regarding the best overall CIPN assessment, although good (≥70%) consensus was achieved regarding the best assessment within each criterion. The Participant Neurotoxicity Questionnaire (PNQ) was rated the highest overall and patient-reported outcome (PRO) assessment, while the Total Neuropathy Score clinical version (TNSc) was the highest rated clinician-based assessment. A diverse range of CIPN assessments currently exists. While several assessments assess CIPN symptoms with adequate comprehensiveness, depth, language, and feasibility, the consensus 'gold standard' clinical assessment remains to be established.

Chemotherapy-Induced Peripheral Neuropathy Assessment Tools: A Systematic Review

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting chemotherapy toxicity, which has a long-lasting effect and decreases quality of life. Although several tools have been developed to detect CIPN, the study quality, psychometric properties, and practicality of CIPN assessment tools have not been systematically reviewed. . Electronic searches using keywords were conducted in Medline, PubMed, CINAHL®, and Cochrane Library for articles published from 1980-2015. Eligible studies were included if they involved patients with cancer receiving chemotherapy, provided CIPN assessment tools with psychometric properties, and were published in English. . Data were extracted, and study quality was assessed. CIPN tools were evaluated in terms of psychometric properties and practicality. . A total of 19 studies describing 20 tools were reviewed. The quality of studies varied from strong to weak. The validity ranged from low to high, and the reliability with internal consistency ranged from 0.56-0.96. Poor inter-rater agreement was found. Not all of the tools were deemed practical. . Considering the psychometric properties and practicality, two tools (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity [FACT/GOG-Ntx] and Total Neuropathy Score [TNS]) are recommended for assessing CIPN. . Routine assessment of CIPN and choosing appropriate assessment tools are imperative. The FACT/GOG-Ntx and TNS are recommended for clinical use.

Neurophysiological and clinical outcomes in chemotherapy-induced neuropathy in cancer.

Chemotherapy induced peripheral neuropathy (CIPN) is a significant toxicity of cancer treatment, with the potential to affect long-term function and quality of life in cancer survivors. There remains a lack of consensus around optimal assessment techniques. While current approaches to CIPN assessment are focused on clinical grading scales, it is becoming increasingly evident that a more comprehensive multimodal assessment package is necessary to accurately characterise the impact of CIPN as well as gauge the utility of neuroprotective mechanisms. Neurophysiological techniques provide objective biomarkers and may enable early detection of toxicity while patient reported outcomes are necessary to determine the significance of symptoms to individual patients. In addition to providing an objective assessment, clinical neurophysiological techniques provide important insights into the contributory pathophysiological mechanisms of CIPN with different chemotherapy agents. There is a paucity of implementation of these techniques in the clinical trial setting. The present Review aims to facilitate the use of neurophysiological studies as part of comprehensive assessment packages for the monitoring of CIPN by summarising current understanding of neurophysiological changes that underlie the development of neuropathy, clinical presentations and patient reported outcomes as well as advantages and limitations of current techniques for the neurophysiological assessment of CIPN.

Examining the Impact of a Web-Based Intervention to Promote Patient Activation in Chemotherapy-Induced Peripheral Neuropathy Assessment and Management.

Lack of activation in self-care can compromise a patient's ability to monitor and manage cancer treatment-related side effects, such as chemotherapy-induced peripheral neuropathy (CIPN). The web-based Carevive® Care Planning System (CPS) was developed to promote evidence-based symptom assessment and treatment by enhancing patients' involvement in their own care. The purpose of this single-arm, pre-test/post-test, prospective study was to examine whether the CPS can promote patient activation in CIPN symptom assessment and management. Seventy-five women with breast cancer receiving neurotoxic chemotherapy were recruited from a Comprehensive Cancer Center. Using standardized neuropathy measures embedded within the CPS, patients reported their CIPN symptoms over three consecutive clinical visits and completed the Patient Activation Measure (PAM) at the first and third visits. Mean changes in PAM scores between visits were compared using repeated measure analysis of covariance, adjusting for age. At baseline, patients were diagnosed with cancer within the past year (94.7%), highly activated (85% Level III/IV), and had a mean age of 51.3. PAM scores improved significantly from 67.15 (SD=13.5; range=47-100) at visit one to 69.29 (SD=16.18; range=47-100) (p=0.02) (n=62) at visit three. However, patients perceived the CPS to be of minimal value because it solely focused on CIPN and, for many, CIPN was not severe enough to motivate them to seek out symptom management information. Further research is needed to assess the utility of the CPS in promoting activation in the assessment and management of varying cancer treatment-related symptoms.

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

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 &lt; 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).

Characteristics of chemotherapy-induced peripheral neuropathy in patients with breast cancer.

85 Background: In Brazil, breast cancer has the second highest incidence of neoplasms, the most common among women. It is expected there will be 57,120 new cases and a risk 56.09 cases per 100 thousand women. For its treatment, neurotoxic chemotherapeutics that can cause chemotherapy-induced peripheral neuropathy (CIPN) are used. Methods: This is an exploratory descriptive study developed in a cancer treatment reference hospital in the city of Sao Paulo, Brazil. Aim: To search the patients with breast cancer during treatment with neurotoxic agents and evaluate the presence of CIPN with application of Chemotherapy-Induced Peripheral Neuropathy Assessment Tool questionnaire (CIPNAT). Results: The sample was 44 women with a mean age of 52 years (SD = 10.54), 47.7% had local disease, 72.7% were treating with taxanes neurotoxic agents. The main neuropathic symptoms measured at CIPNAT: 75% had motor symptom weakness with an average score for severity of 6.45 causing an average of distress 5.36; 65.9% muscle and joint pain average severity of 6.31 causing an average of 5.59 distress; and 56.8% sensitive symptom numbness in the hands average severity of 4.76 causing an average of 3.52 distress. These symptoms had a negative impact in the activities of daily living (ADL) such as physical exercise (mean score = 5.32), enjoyment of life (mean score = 4.77) and leisure activities (mean score = 4, 03). Although few (13.6%) reported that suffered some injury or accident due to CIPN. Discussion: The results are consistent with those presented in the scientific literature, but measured with other assessment tools such as the NCI CTCAE, WHO and EORTC QLQ-C30 and CIPN20, which also showed that motor disorders (weakness, muscle cramps and loss of strength in the hands) and sensory (numbness and tingling in the hands and feet). Conclusions: The study explores the relationship between CIPN and ADL affected during treatment for breast cancer. Through the motor and sensory symptoms reported by CIPNAT, nursing will have grant to develop educational strategies to prevent and minimize negative impacts on the quality of life of women with breast cancer undergoing treatment with neurotoxic agents.

Assessment and Treatment of Chemotherapy-induced Peripheral Neuropathy- a Physical Therapy Perspective

Chemotherapy is recognized as a mainline treatment for all types of cancer, and its most debilitating and dose-limiting complication is Chemotherapy-induced peripheral neuropathy (CIPN), the mechanisms of nerve damage of which depends upon the specific chemotherapeutic agent used. Use of non-invasive treatment methods such as physical therapy may provide a valuable therapeutic adjunctive option in patients with CIPN. Physical therapy treatment methods had been shown to produce effective symptom control and enhance quality of life in palliative care. A detailed evidence-based update of literature is provided under evaluation and management of CIPN with a special perspective of physical therapy management using a proposed clinical reasoning-based treatment decision making algorithm so that an ‘out of the box’ self-reflective evidence-informed critical thinking process is applied along a collaborative multidisciplinary biopsychosocial approach. Keywords: Chemotherapy-induced neurotoxicity; Chemotherapy-induced neuropathy; Physical therapy; Palliative rehabilitation

Oncology Section Task Force on Breast Cancer Outcomes: Clinical Measures of Chemotherapy-induced Peripheral Neuropathy—A Systematic Review

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of breast cancer treatment that can limit cancer intervention options, and also impact balance, mobility, and quality of life long after chemotherapy ends. The purpose of this systematic review was to provide physical therapists (PT) with evidence-based recommendations on tools for clinical assessment of CIPN in adult breast cancer survivors. Methods: A team of reviewers identified all published measures of CIPN meeting the criteria of: clinically feasible, addressing the CIPN experience (signs/symptoms/or both), and with published psychometric properties established in survivors of breast cancer, or a cancer for which the same chemotherapy agents are used. Identified measures were then systematically reviewed and scored according to the Breast Cancer EDGE Task Force Rating Scale from 1 (Do Not Recommend) to 4 (Highly Recommend). Results: Of 11 measures meeting the review criteria, only one, the Functional Assessment of Cancer Therapy/ Gynecologic Oncology Group-Neurotoxicity Scale (FACT/GOG-Ntx) received the highest rating of 4 (highly recommend). The FACT-GOG-Ntx has high clinical utility for PT, well-established psychometric properties, and published validation with chemotherapies used in breast cancer survivors. The 10 remaining measures received ratings of 2 (unable to recommend at this time). Conclusions: The Oncology Section Breast Cancer EDGE Task Force on Clinical Measures of CIPN recommends the FACT/GOG-Ntx during physical therapy screening or assessment of CIPN in breast cancer survivors who have received neurotoxic chemotherapy; however, it is not recommended for use in isolation. Therapists are encouraged to supplement with further tests and measures to capture sensory, motor, and autonomic deficits specific to each survivor, along with related activity and participation restrictions.

Properties of the Measures to Assess Oxaliplatin-induced Peripheral Neuropathy: A Literature Review

The purpose of this study is to provide a comprehensive overview of the various measures available for assessment of oxaliplatin-induced peripheral neuropathy (OXLIPN) and to evaluate the measurement properties of each assessment tool. A systematic review was conducted to identify existing measures for OXLIPN found in the databases of PubMed, Cochrane Library, Embase, RISS and KoreaMed. The quality of the 24 identified tools was evaluated based on their properties of measurement including content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor-ceiling effects and interpretability. Ten (41.7%) of the 24 tools were identified as specific measures for assessing OXLIPN and the most popular type of measures were clinical grading systems by clinicians (58.3%) and only 29.2% of measures were identified as patient reported outcomes. The most frequently used tool was National Cancer Institute-Common Toxicity Criteria (NCI-CTC), but the validity of NCI-CTC has not been reported appropriately. Overall, the Neuropathic Pain Symptom Inventory (NPSI) received the best psychometric scores, and the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-neurotoxicity-12 (FACT/GOG-Ntx-12) followed NPSI. To select appropriate measure, evidences should be accumulated through the clinical use of tools. Therefore, practitioner and researchers are urged to report relevant statistics required for the validation of the currently used measures for assessment of OXLIPN.