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Dongxue G, Ran L, Fangfei Z, Zirui Z, Lizhi Z. Therapeutic effects of compression therapy on taxane-induced peripheral neuropathy incidence, negative emotions, and sleep disorders in patients with breast cancer. Support Care Cancer 2024; 32:260. [PMID: 38561474 DOI: 10.1007/s00520-024-08461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To explore the effects of compression therapy on chemotherapy-induced peripheral neuropathy (CIPN), anxiety, depression, and sleep disorders in breast cancer patients administered taxanes. METHODS Eighty patients with breast cancer undergoing chemotherapy at Tangshan People's Hospital between October 2022 and July 2023 were randomly divided into control (n = 40) and intervention (n = 40) groups. The control group received routine care, while intervention group received compression therapy in addition to routine care (30 min before the infusion of chemotherapy drugs, patients wore surgical gloves on their hands that were one size smaller than the appropriate size and elastic socks on their feet until 30 min after the infusion). The incidence of CIPN, anxiety, depression, and sleep scores, were compared between these groups before and after compression therapy during chemotherapy cycles 2, 4, and 6. RESULTS The general characteristics did not differ significantly between the groups (P > 0.05). The CIPN incidence, anxiety and depression scores, and sleep scores also did not differ significantly between the two groups before and after the intervention period (P > 0.05). After the fourth and sixth cycles of intervention, the incidence of CIPN (≥ 1 and ≥ 2), anxiety and depression scores, and sleep scores were significantly lower in the intervention group than in the control group (P < 0.05). CONCLUSION Compression therapy can effectively reduce the incidence of CIPN, as well as improve the level of anxiety, depression, and sleep disorders in chemotherapy patients. Therefore, medical personnel should closely observe the physical and psychological changes in patients undergoing chemotherapy and provide corresponding preventive measures. REGISTRATION NUMBER RMYY-LLKS-2022-054. DATE OF REGISTRATION September 25, 2022.
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Affiliation(s)
- Guo Dongxue
- North China University of Science and Technology, Tangshan, 063210, China
| | - Li Ran
- North China University of Science and Technology, Tangshan, 063210, China
| | - Zhao Fangfei
- North China University of Science and Technology Affiliated Hospital, Tangshan, 063000, China
| | - Zhang Zirui
- North China University of Science and Technology, Tangshan, 063210, China
| | - Zhou Lizhi
- Tangshan People's Hospital, Tangshan, 063000, China.
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Manuweera T, Wagenknecht A, Kleckner AS, Dorsey SG, Zhu S, Tivarus ME, Kesler SR, Ciner A, Kleckner IR. Preliminary evaluation of novel Bodily Attention Task to assess the role of the brain in chemotherapy-induced peripheral neurotoxicity (CIPN). Behav Brain Res 2024; 460:114803. [PMID: 38070689 PMCID: PMC10860373 DOI: 10.1016/j.bbr.2023.114803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common, sometimes dose-limiting side effect of neurotoxic chemotherapy. Treatment is limited because its pathophysiology is poorly understood. Compared to research on peripheral mechanisms, the role of the brain in CIPN is understudied and it may be important to develop better treatments. We propose a novel task that assesses brain activation associated with attention to bodily sensations (interoception), without the use of painful stimulation, to understand how CIPN symptoms may be processed in the brain. The goals of this preliminary study were to assess, 1) feasibility of the task, 2) sensitivity to changes in brain activity, and 3) suitability for assessing relationships between brain activation and CIPN severity. Eleven participants with varying types of cancer completed a brain fMRI scan and rated CIPN severity (CIPN-20) before and/or 12 weeks after starting neurotoxic chemotherapy. The Bodily Attention Task is a 7.5-min long fMRI task involving attentional focus on the left fingertips, the heart, or a flashing word "target" for visual attention (reference condition). Feasibility was confirmed, as 73% of all data collected were usable and participants reported feeling or focus during 75% of the trials. Regarding brain activity, finger attention increased activation in somatosensory regions (primary sensory cortex, insula) and sensory integration regions (precuneus, dorsolateral prefrontal cortex). Exploratory analyses suggested that brain activation may be associated with CIPN severity. A larger sample size and accounting of confounding factors is needed to test for replication and to identify brain and interoceptive biomarkers to help improve the prediction, prevention, and treatment of CIPN.
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Affiliation(s)
- Thushini Manuweera
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Amelia Wagenknecht
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Amber S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences and Department of Neuroscience University of Rochester Medical Center, Rochester, NY, USA
| | - Shelli R Kesler
- Department of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Aaron Ciner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
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Mahfouz FM, Li T, Joda M, Harrison M, Horvath LG, Grimison P, King T, Marx G, Goldstein D, Park SB. Sleep dysfunction associated with worse chemotherapy-induced peripheral neurotoxicity functional outcomes. Support Care Cancer 2023; 32:46. [PMID: 38117349 PMCID: PMC10733204 DOI: 10.1007/s00520-023-08245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Sleep problems are commonly reported by cancer survivors; however, knowledge of the impact of chemotherapy-induced peripheral neurotoxicity (CIPN) on sleep quality remains limited. In this study, we explored the impact of CIPN on sleep quality, as well as identified clinical characteristics associated with poor sleep quality. METHODS Participants were assessed cross-sectionally post-neurotoxic chemotherapy. CIPN severity was graded using a range of questionnaires that assessed CIPN severity and quality of life, as well as neurological grading scales. Sleep quality was assessed using a self-rated questionnaire (Pittsburgh Sleep Quality Index, PSQI). Participants with poor sleep quality were further grouped according to whether sleep impairment was due to CIPN or other factors. RESULTS Among 77 participants who reported CIPN, 75% (n = 58) reported poor sleep quality. Of those, 41% (n = 24) reported CIPN as contributing to sleep impairment, while 59% (n = 34) reported other causes. Participants with CIPN-induced sleep impairments had higher CIPN severity across all outcome measures, as well as greater neuropathic pain (all p < 0.05). Furthermore, participants with CIPN-induced sleep impairments reported worse impact of neuropathy on physical and social functioning, as well as emotional well-being (all p < 0.05). CONCLUSIONS Participants with CIPN-induced poor sleep quality reported worse scores across all CIPN severity measures. This emphasises the negative impacts of CIPN symptoms on quality of life of chemotherapy-treated patients and highlights the importance of sleep quality assessment in cancer survivors.
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Affiliation(s)
- Fawaz Mayez Mahfouz
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Masarra Joda
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
| | | | - Lisa G Horvath
- Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW, 2050, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Peter Grimison
- Chris O'Brien Lifehouse, Camperdown, NSW, 2050, Australia
- Sydney Medical School, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Tracy King
- Cancer Nursing Research Unit, The University of Sydney, Camperdown, NSW, 2050, Australia
- Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Gavin Marx
- Sydney Adventist Hospital, Wahroonga, NSW, 2076, Australia
| | - David Goldstein
- Prince of Wales Clinical School, Faculty of Medicine & Health, UNSW Sydney, Randwick, NSW, 2031, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Susanna B Park
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
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Kroenke K, Lam V, Ruddy KJ, Pachman DR, Herrin J, Rahman PA, Griffin JM, Cheville AL. Prevalence, Severity, and Co-Occurrence of SPPADE Symptoms in 31,866 Patients With Cancer. J Pain Symptom Manage 2023; 65:367-377. [PMID: 36738867 PMCID: PMC10106386 DOI: 10.1016/j.jpainsymman.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To examine the prevalence, severity, and co-occurrence of SPPADE symptoms as well as their association with cancer type and patient characteristics. BACKGROUND The SPPADE symptoms (sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy /fatigue) are prevalent, co-occurring, and undertreated in oncology and other clinical populations. METHODS Baseline SPPADE symptom data were analyzed from the E2C2 study, a stepped wedge pragmatic, population-level, cluster randomized clinical trial designed to evaluate a guideline-informed symptom management model targeting the six SPPADE symptoms. Symptom prevalence and severity were measured with a 0-10 numeric rating (NRS) scale for each of the six symptoms. Prevalence of severe (NRS ≥ 7) and potential clinically relevant (NRS ≥ 5) symptoms as well as co-occurrence of clinical symptoms were determined. Distribution-based methods were used to estimate the minimally important difference (MID). Associations of cancer type and patient characteristics with a SPPADE composite score were analyzed. RESULTS A total of 31,886 patients were assessed for SPPADE symptoms prior to, during, or soon after an outpatient medical oncology encounter. The proportion of patients with a potential clinically relevant symptom ranged from 17.5% for depression to 33.4% for fatigue. Co-occurrence of symptoms was high, with the proportion of patients with three or more additional clinically relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score demonstrated good internal reliability (Cronbach's alpha of 0.86), with preliminary MID estimates of 4.1-4.3. Symptom burden differed across several types of cancer but was generally similar across most sociodemographic characteristics. CONCLUSION The high prevalence and co-occurrence of SPPADE symptoms in patients with all types of cancer warrants clinical approaches that optimize detection and management.
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Affiliation(s)
- Kurt Kroenke
- Indiana University School of Medicine (K.K.), Indianapolis, Indiana, USA; Regenstrief Institute, Inc. (K.K.), Indianapolis, Indiana, USA.
| | - Veronica Lam
- Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn J Ruddy
- Division of Medical Oncology (K.J.R.), Mayo Clinic, Rochester, Minnesota, USA
| | - Deirdre R Pachman
- Division of Community Internal Medicine, Geriatrics, and Palliative Care (D.R.P.), Mayo Clinic, Rochester, Minnesota, USA
| | - Jeph Herrin
- Yale University School of Medicine (J.H.), New Haven, Connecticut, USA
| | - Parvez A Rahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA; Division of Health Care Delivery Research (J.M.G.), Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea L Cheville
- Department of Physical Medicine and Rehabilitation (V.L., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (P.A.R., J.M.G., A.L.C.), Mayo Clinic, Rochester, Minnesota, USA
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Mapping chemotherapy-induced peripheral neuropathy phenotype and health-related quality of life in patients with cancer through exploratory analysis of multimodal assessment data. Support Care Cancer 2022; 30:4007-4017. [DOI: 10.1007/s00520-022-06821-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
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Yoga for chronic chemotherapy-induced peripheral neuropathy pain: a pilot, randomized controlled trial. J Cancer Surviv 2021; 16:882-891. [PMID: 34524631 PMCID: PMC8442518 DOI: 10.1007/s11764-021-01081-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the feasibility of implementing a yoga intervention for cancer survivors with chronic CIPN pain, as well as the impact of the intervention on patient-reported outcomes. METHODS Cancer survivors with chronic CIPN pain were recruited from the breast, gastrointestinal, and gynecological oncology centers at Dana-Farber Cancer Institute. Participants were randomized (2:1) to receive an 8-week yoga intervention or usual care. After 21/50 of participants were enrolled, the COVID-19 pandemic required the yoga intervention to be delivered virtually (i.e., Zoom). Pre- and post-intervention, participants self-reported CIPN and co-occurring symptom severity. Adherence to the intervention was defined as practicing ≥ 12 yoga sessions over the 8-week intervention period. Changes in patient-reported outcomes between groups were compared using Wilcoxon's rank-sum tests. RESULTS Participants (n = 28 yoga, n = 16 control) were mainly female (96%) and diagnosed with stage III/IV disease (66%). Overall, 19/28 (67.8%) of yoga group participants were adherent to the yoga protocol. Yoga group participants experienced significant within-group improvements in all patient-reported outcomes, including worst CIPN pain (median change = - 1.7, p < 0.0001) and sensory CIPN (median change = - 14.8, p < 0.0001), but only improvements in fatigue (p = 0.05) and depression (p = 0.04) were significant compared to the control. There were no differences (p > 0.05) in changes in patient-reported outcomes between in-person (n = 6) or virtual (n = 15) yoga group participants. CONCLUSIONS Yoga is a feasible non-pharmacological modality for cancer survivors with CIPN, but more information is needed regarding its impact on CIPN and other symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03824860 IMPLICATIONS FOR CANCER SURVIVORS: Oncology clinicians may consider referring cancer survivors to yoga for chronic CIPN pain, but yoga cannot be currently recommended as an efficacious treatment.
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Efficacy of the Motivational Interviewing-Walk Intervention for Chemotherapy-Induced Peripheral Neuropathy and Quality of Life During Oxaliplatin Treatment: A Pilot Randomized Controlled Trial. Cancer Nurs 2021; 45:E531-E544. [PMID: 34483279 DOI: 10.1097/ncc.0000000000001003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oxaliplatin-induced peripheral neuropathy (OIPN) is prevalent among gastrointestinal cancer survivors and often impairs quality of life (QOL). OBJECTIVE This pilot randomized controlled trial aimed to explore the effect of an 8-week home-based brisk walking (the "MI-Walk") intervention on (1) OIPN severity and (2) QOL at 8 weeks, compared with physical activity (PA) education alone in oxaliplatin-receiving adults with gastrointestinal cancer. INTERVENTIONS/METHODS Participants (N = 57) recruited from 5 infusion sites received PA education at their second oxaliplatin visit, followed by phone assessments of adverse events over 8 weeks. Half (n = 29) received additional MI-Walk intervention motivational supports (eg, a Fitbit Charge 2 and motivational enhancement therapy sessions). Self-reported OIPN, QOL, and PA were measured before and after intervention. RESULTS The intervention compared with the control condition had no effect on sensory OIPN (mean difference [X¯[INCREMENT]] = -0.01; P > .99), motor OIPN (X¯[INCREMENT] = 2.39; P = .17), and QOL (X¯[INCREMENT] = -1.43; P > .99). Eight-week sensory (X¯ =11.48 ± 0.38) and motor OIPN severities (X¯ = 7.48 ± 0.36) were mild but higher than baseline (P ≤ .01). Self-reported PA level increased over time in both groups (X¯[INCREMENT] = 44.85; P = .01). Averaging ≥225 moderate to vigorous PA minutes per week led to less sensory OIPN, particularly finger/hand tingling (X¯[INCREMENT] = -26.35; P = .01). CONCLUSIONS This study failed to detect beneficial effects of the MI-Walk intervention; however, the findings suggest that aerobic walking may blunt but not completely prevent OIPN. Further research is necessary. IMPLICATIONS FOR PRACTICE Although the effectiveness of brisk walking in reducing OIPN is unclear, this study supports prior evidence that moderate to vigorous PA is beneficial and safe during chemotherapy treatment.
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Rusin A, Li M, Cocchetto A, Seymour C, Mothersill C. Radiation exposure and mitochondrial insufficiency in chronic fatigue and immune dysfunction syndrome. Med Hypotheses 2021; 154:110647. [PMID: 34358921 DOI: 10.1016/j.mehy.2021.110647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/19/2021] [Accepted: 07/25/2021] [Indexed: 12/13/2022]
Abstract
Chronic fatigue and Immune Dysfunction Syndrome (CFIDS) is a heterogeneous disease that may be promoted by various environmental stressors, including viral infection, toxin uptake, and ionizing radiation exposure. Previous studies have identified mitochondrial dysfunction in CFIDS patients, including modulation of mitochondrial respiratory chain activity, deletions in the mitochondrial genome, and upregulation of reactive oxygen species (ROS). This paper focuses on radiation effects and hypothesizes that CFIDS is primarily caused by stressor-induced mitochondrial metabolic insufficiency, which results in decreased energy production and anabolic metabolites required for normal cellular metabolism. Furthermore, tissues neighbouring or distant from directly perturbed tissues compensate for this dysfunction, which causes symptoms associated with CFIDS. This hypothesis is justified by reviewing the links between radiation exposure and CFIDS, cancer, immune dysfunction, and induction of oxidative stress. Moreover, the relevance of mitochondria in cellular responses to radiation and metabolism are discussed and putative mitochondrial biomarkers for CFIDS are introduced. Implications for diagnosis are then described, including a potential urine assay and PCR test for mitochondrial genome mutations. Finally, future research needs are offered with an emphasis on where rapid progress may be made to assist the afflicted.
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Affiliation(s)
- Andrej Rusin
- Department of Biology, McMaster University, Hamilton, ON Canada.
| | - Megan Li
- Department of Physics and Astronomy, McMaster University, Department of Physics and Astronomy, McMaster University, Hamilton, ON Canada
| | - Alan Cocchetto
- National CFIDS Foundation Inc., 103 Aletha Road, Needham, MA USA
| | - Colin Seymour
- Department of Biology, McMaster University, Hamilton, ON Canada
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Tanaka Y, Shigetoh H, Sato G, Fujii R, Imai R, Osumi M, Morioka S. Classification of circadian pain rhythms and pain characteristics in chronic pain patients: An observational study. Medicine (Baltimore) 2021; 100:e26500. [PMID: 34160466 PMCID: PMC8238338 DOI: 10.1097/md.0000000000026500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
This study aimed to perform cluster analysis in patients with chronic pain to extract groups with similar circadian rhythms and compare neuropathic pain and psychological factors among these groups to identify differences in pain-related outcomes. A total of 63 community-dwellers with pain lasting at least 3 months and Numerical Rating Scale scores of ≥2 were recruited from 3 medical institutions. Their pain circadian rhythms were evaluated over 7 days by measuring pain intensity at 6-time points per day using a 10-cm visual analog scale. Cluster analysis was performed using 6 variables with standardized visual analog scale values at 6-time points for individual participants to extract groups with similar pain circadian rhythms. The results of the Neuropathic Pain Symptom Inventory and psychological evaluations in each group were compared using the Kruskal-Wallis test. The results revealed 3 clusters with different circadian rhythms of pain. The total and evoked pain subscale Neuropathic Pain Symptom Inventory scores differed among the 3 clusters. The results suggest that a thorough understanding of circadian pain rhythms in chronic pain patients may facilitate the performance of activities of daily living and physical exercise from the perspective of pain management.
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Affiliation(s)
- Yoichi Tanaka
- Graduate School of Health Sciences, Kio University
- Department of Rehabilitation, Nara Prefecture General Rehabilitation Center
| | | | - Gosuke Sato
- Neuro Rehabilitation Research Center, Kio University, Nara
| | - Ren Fujii
- Graduate School of Health Sciences, Kio University
| | - Ryota Imai
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan
| | | | - Shu Morioka
- Graduate School of Health Sciences, Kio University
- Neuro Rehabilitation Research Center, Kio University, Nara
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Hertz DL, Childs DS, Park SB, Faithfull S, Ke Y, Ali NT, McGlown SM, Chan A, Grech LB, Loprinzi CL, Ruddy KJ, Lustberg M. Patient-centric decision framework for treatment alterations in patients with Chemotherapy-induced Peripheral Neuropathy (CIPN). Cancer Treat Rev 2021; 99:102241. [PMID: 34174668 DOI: 10.1016/j.ctrv.2021.102241] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 01/20/2023]
Abstract
Recently updated American Society of Clinical Oncology (ASCO) guidelines for Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy (CIPN) in Survivors of Adult Cancers make a single recommendation to alter treatment by delaying, decreasing, or discontinuing dosing in patients who develop CIPN during neurotoxic chemotherapy treatment. Dosing guidelines have inconsistent recommendations for when (i.e., what CIPN severity) and how (i.e., delay, decrease, or discontinue) to alter neurotoxic chemotherapy treatment in patients with CIPN. Clinical decision making requires an understanding the benefits and risks of treatment alteration, in addition to consideration of other disease and patient factors. This review summarizes four areas of literature and culminates in a patient-centric decision framework to guide clinicians in helping patients to make treatment alteration decisions. First, we describe the current practice of altering treatment due to CIPN, including treatment alteration recommendations and published rates. Second, we summarize the potential benefits of treatment alteration including the reduction in CIPN severity and persistence. Third, we evaluate the potential risk of treatment alteration in compromising treatment efficacy by reviewing prospective trials comparing dosing regimens and retrospective analyses of the effect of relative dose intensity on efficacy. Fourth, we summarize disease and patient factors that should be considered when making a treatment alteration decision for a patient. We then propose a patient-centric decision framework that clinicians can use to assess an individual patient's current and anticipated future CIPN severity and compare that to their maximum tolerable severity to determine whether they should continue, delay, decrease, or discontinue neurotoxic chemotherapy.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109-1065, United States.
| | - Daniel S Childs
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Susanna B Park
- Brain and Mind Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Sara Faithfull
- School of Health Sciences, University of Surrey, Guildford, Surrey, United Kingdom.
| | - Yu Ke
- Department of Pharmacy, National University of Singapore, Singapore.
| | - Nadeen T Ali
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan.
| | | | - Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California Irvine School of Pharmacy & Pharmaceutical Sciences, Irvine 92697-3958, United States.
| | - Lisa B Grech
- Medicine Monash Health, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Australia.
| | - Charles L Loprinzi
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, United States.
| | - Maryam Lustberg
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University, Columbus, OH, USA.
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Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It manifests with numbness, tingling, and possibly neuropathic pain and motor and autonomic symptoms. This review aims to provide an evidence synthesis that prepares nurses to comprehensively assess, provide supportive care for, and critically evaluate the literature on CIPN. The prevalence, significance, characteristics, mechanisms, and risk factors of CIPN will be discussed, as well as nursing-relevant evidence on the assessment, prevention, and management of CIPN. The importance of critical literature evaluation before clinical implementation to reduce physical and financial harms to patients will also be highlighted.
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12
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Tofthagen CS, Cheville AL, Loprinzi CL. The Physical Consequences of Chemotherapy-Induced Peripheral Neuropathy. Curr Oncol Rep 2020; 22:50. [DOI: 10.1007/s11912-020-00903-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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13
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Knoerl R, Gilchrist L, Kanzawa-Lee GA, Donohoe C, Bridges C, Lavoie Smith EM. Proactive Rehabilitation for Chemotherapy-Induced Peripheral Neuropathy. Semin Oncol Nurs 2020; 36:150983. [DOI: 10.1016/j.soncn.2019.150983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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14
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Smith EML. Pharmacologic Treatments for Chronic Cancer-Related Pain: Does Anything Work? J Clin Oncol 2019; 37:1686-1689. [PMID: 31084543 DOI: 10.1200/jco.19.00936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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15
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Kanzawa-Lee GA, Knoerl R, Donohoe C, Bridges CM, Smith EML. Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy. Semin Oncol Nurs 2019; 35:253-260. [PMID: 31053396 DOI: 10.1016/j.soncn.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE 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. DATA SOURCES PubMed/Medline, CINAHL, Scopus, and PsycINFO. CONCLUSION 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. IMPLICATIONS FOR NURSING PRACTICE 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.
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Affiliation(s)
| | - Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Clare Donohoe
- School of Nursing, University of Michigan, Ann Arbor, MI
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Tofthagen C, Visovsky C, Dominic S, McMillan S. Neuropathic symptoms, physical and emotional well-being, and quality of life at the end of life. Support Care Cancer 2019; 27:3357-3364. [PMID: 30623244 DOI: 10.1007/s00520-018-4627-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/27/2018] [Indexed: 01/09/2023]
Abstract
The purpose of this cross-sectional, descriptive study was to assess differences in neuropathic symptoms, physical and emotional well-being, and quality of life in cancer patients at the end of life compared to those without neuropathic symptoms. Neuropathic symptoms were defined as numbness and tingling in the hands and/or feet. A secondary analysis of data from two hospices in Central Florida was performed. Adults (n = 717) with a cancer diagnosis, an identified family caregiver, and who were receiving hospice services, were eligible. The prevalence of numbness/tingling in the hands or feet was 40% in this sample of hospice patients with cancer. Participants with neuropathic symptoms of numbness/tingling had a significantly higher prevalence of pain (76.7% vs. 67.0%; p = .006), difficulty with urination (29.4% vs. 20.3%; p = .007), shortness of breath (64.9% vs. 54.1%; p = .005), dizziness/lightheadedness (46.0% vs. 28.2%; p < .001), sweats (35.5% vs. 20.3%; p < .001), worrying (50.7% vs. 37.3%; p = .001), feeling irritable (38.5% vs. 28.7%; p = .008), feeling sad (48.2% vs. 37.8%; p = .008), and difficulty concentrating (46.2% vs. 32.5%; p < .001). They also reported significantly higher overall symptom intensity and symptom distress scores (p = < .001), higher pain severity (p = .001) and pain distress (p = .002), and decreased quality of life (p = .002) compared to those without numbness/tingling. Neuropathic symptoms are emotionally distressing at the end of life and associated with higher symptom burden and diminished quality of life.
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Affiliation(s)
- Cindy Tofthagen
- Mayo Clinic Florida, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA.
| | - Constance Visovsky
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612, USA
| | - Sara Dominic
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612, USA
| | - Susan McMillan
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd., MDC22, Tampa, FL, 33612, USA
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