Chemotherapy-Induced Peripheral Neuropathy: Nursing Implications

CORRECTION OF PATHOLOGICAL CHANGES IN SALIVARY GLANDS OF ANIMALS WITH PACLITAXEL-INDUCED NEUROPATHY

BACKGROUND

Paclitaxel is a highly effective chemotherapeutic agent used to treat breast, ovarian, and other cancers. At the same time, paclitaxel causes peripheral neuropathy as a side effect in 45%-70% of patients.

AIM

The aim of the study was to investigate the effect of paclitaxel-induced peripheral neuropathy on the development of pathological changes in the salivary glands of animals and to explore the possibility of correction of the identified changes with vitamin B/ATP complex.

MATERIALS AND METHODS

To simulate toxic neuropathy, animals were injected i/p with paclitaxel 2 mg/kg for 4 days. In order to correct the identified changes, rats were injected i/m with vitamin B/ATP complex (1 mg/ kg) for 9 days. In the homogenate of the submandibular salivary glands, α-amylase activity, total proteolytic activity, total antitryptic activity, the content of medium mass molecules, thiobarbituric acid reactive substances (TBARS), oxidatively modified proteins, and catalase activity were determined.

RESULTS

A significant increase in the content of oxidatively modified proteins, medium mass molecules, and the content of TBARS and significant decrease in the activity of catalase and amylase were determined in the salivary glands of animals with toxic neuropathy compared to these parameters in intact animals. Administration of vitamin B/ATP complex for 9 days against the background of paclitaxel-induced neuropathy led to normalization of antitryptic activity and amylase activity, a significant decrease in the content of oxidatively modified proteins, medium mass molecules, and TBARS along with a significant increase in catalase activity in the salivary glands of animals compared to the untreated rats with neuropathy.

CONCLUSION

Paclitaxel-induced neuropathy caused the development of pathological changes in the salivary glands of rats, which was evidenced by a carbonyl- oxidative stress and impaired protein synthetic function. The correction with vitamin B/ATP complex restored the protein-synthetic function and the proteinase-inhibitor balance, suppressed the oxidative stress and normalized free radical processes in the salivary glands of rats.

Real-Life Experiences of Chemotherapy-Induced Peripheral Neuropathy in Patients with Cancer: A Qualitative Meta-Synthesis Study

PURPOSE

Chemotherapy-induced peripheral neuropathy is an unpleasant symptom experienced by most cancer survivors who receive neurotoxic chemotherapy. It is not life threatening; however, it impairs sensorimotor skills, thereby interfering with daily activities and reducing the quality of life. Healthcare providers are becoming increasingly aware of the significance of its management. Nonetheless, a lack of understanding remains. This study aimed to understand the experience of cancer survivors with chemotherapy-induced peripheral neuropathy.

DATA SOURCES

The selection and search for relevant literature conformed to the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines. Four databases were searched for literature exploring the experiences of cancer survivors with chemotherapy-induced peripheral neuropathy. Moreover, articles from reference lists were retrieved. Of 969 collected articles, 13 qualitative studies were included. The seven-step meta-ethnography developed by Noblits and Hare was used to analyze and synthesize selected studies. This study complied with the enhancing transparency in reporting the synthesis of qualitative research guidelines.

CONCLUSION

Three themes ("Tough and challenging life with chemotherapy-induced peripheral neuropathy," "Being patient in a chaotic life," and "Transition to a new way of life") and six subthemes were derived after reviewing, analyzing, and synthesizing selected study findings. They faced difficult daily challenges and endured psychologically chaotic moments; however, they gradually learned to live with the symptoms and adapted their way of life.

IMPLICATIONS FOR NURSING PRACTICE

This review emphasizes the importance of the need for personalized nursing interventions promoting self-management and new adaptation strategies for gaining better understanding of chemotherapy-induced peripheral neuropathy.

Nursing Dilemmas in Chemotherapy-Induced Peripheral Neuropathy: A Qualitative Study of a Tertiary Hospital in China

Purpose

This study investigated the experience of oncology nurses caring for chemotherapy-induced peripheral neuritis patients.

Patients and Methods

Through phenomenological research method, 11 nurses in a tertiary hospital in Shanghai were interviewed using face-to-face semi-structured interviews. Data analysis was conducted with the thematic analysis approach.

Results

This analysis revealed the experiences of oncology nurses in caring for patients with CIPN and identified three themes: 1) stress in the nursing of CIPN (inadequate knowledge of CIPN among oncology nurses, oncology nurses' CIPN nursing skills need to be improved, negative emotions of oncology nurses at work); 2) environmental dilemmas in nursing of CIPN (lack of effective care norms, busy schedules, doctors pay little attention to CIPN); 3) oncology nurses' desire to improve their knowledge of CIPN to meet care needs.

Conclusion

Based on the perspective of oncology nurses, the care dilemma of CIPN is mainly influenced by individual and environmental factors. It is recommended to enhance the attention of oncology nurses to CIPN, set specific and feasible training courses, explore CIPN assessment tools that meet our clinical practice, and construct CIPN care programs to improve CIPN clinical care ability and reduce patient suffering.

Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis

PURPOSE

Summarize and critically evaluate the existing studies to determine the effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients.

METHODS

We searched PubMed, Scopus, Web of Science, and Cochrane Library databases for randomized controlled trials reporting exercise intervention in cancer patients with chemotherapy-induced peripheral neuropathy. The outcomes of interest included chemotherapy-induced peripheral neuropathy symptoms, physical function (balance control, muscle strength, and functional status), and quality of life. The Cochrane Collaboration's tool was employed to assess the risk of bias.

RESULTS

The search identified 1309 studies, 16 of which eligible. Our meta-analysis revealed that exercise intervention significantly improved the quality of life (SMD = 0.83, 95% CI = 0.58 to 1.08, I² = 0%, P < 0.00001) and relieved neuropathic pain (MD =  - 4.93, 95% CI =  - 5.60 to - 4.26, I² = 0%, P < 0.00001). The muscular strength of the upper (SMD = 1.10, 95% CI = 0.68 to 1.51, I² = 25%, P < 0.00001) and the lower limbs (SMD = 0.84, 95% CI = 0.42 to 1.26, I² = 36%, P < 0.00001) increased and balance performance (SMD = 1.05, 95% CI = 0.62 to1.48, I² = 0%, P < 0.00001) was better in the exercise group than in the group with usual care. However, no evidence was found that exercise intervention could improve CIPN symptoms.

CONCLUSIONS

The results of this study showed that combined exercise could be an effective option for improving quality of life, physical function (balance control and muscle strength), and neuropathic pain in cancer patients with chemotherapy-induced peripheral neuropathy. Further exploration of appropriate exercise prescriptions is needed to improve other outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Specific and appropriate exercise intervention for cancer patients with chemotherapy-induced peripheral neuropathy should be recommended because these interventions can improve their quality of life and physical function.

Examination of the psychometric properties of pediatric-modified total neuropathy score in Turkish children with cancer

BACKGROUND

Evaluation of chemotherapy-induced peripheral neuropathy has gained importance in symptom management of pediatric patients with cancer. This study aimed to perform the Turkish validity and reliability study of the Pediatric-Modified Total Neuropathy Score (Ped-mTNS).

METHODS

A methodological, descriptive, and cross-sectional design was used in the study. Forty children aged between 5 and 18 and were treated for cancer and 40 age- and gender-matched healthy children (control group) were included in the study. The mean scores of the items on the Ped-mTNS were compared, and item-total score correlations were evaluated. Cronbach's alpha coefficient of the Ped-mTNS was calculated for internal consistency.

FINDINGS

Cronbach's alpha value of the scale was found as 0.709. The item-total correlations of the scale items ranged from 0.260 to 0.658. The mean score of cancer patients on the Ped-mTNS was found as 4.4 ± 3.8.

DISCUSSION

Ped-mTNS scores of children with cancer indicated more deficits than those of the control group. In the evaluation of children in the patient and control groups, a difference was found in terms of light touch sensation, which is one of the sensory symptoms in the items of the Ped-mTNS, and pin sensibility and strength, which are among the clinical symptoms.

APPLICATION TO PRACTICE

The Ped-mTNS was determined to be a valid and reliable measurement tool for children with cancer aged between 5 and 18 in the Turkish population.

Construction and validation of a nomogram for predicting the risk of secondary peripheral neuropathy in patients with advanced lung cancer

OBJECTIVE

To construct and validate a nomogram for predicting the risk of secondary peripheral neuropathy in patients with advanced lung cancer.

METHODS

The sociodemographic and clinical data of 335 patients with advanced lung cancer admitted to Department of Respiratory, the First Affiliated Hospital of Zhejiang University School of Medicine from May 2020 to May 2021 were retrospectively collected. Pearson correlation analysis, univariate and multivariate logistic regression analyses were used to identify the risk factors of secondary peripheral neuropathy in patients with advanced lung cancer. A nomogram was constructed according to the contribution of each risk factor to secondary peripheral neuropathy, and the receiver operating characteristic (ROC) curve, Calibration curve and clinical decision curve were used to evaluate differentiation, calibration, and the clinical utility of the model. The nomogram was further validated with data from 64 patients with advanced lung cancer admitted between June 2021 and August 2021.

RESULTS

The incidences of secondary peripheral neuropathy in two series of patients were 34.93% (117/335) and 40.63% (26/64), respectively. The results showed that drinking history ( OR=3.650, 95% CI: 1.523-8.746), comorbid diabetes ( OR=3.753, 95% CI: 1.396-10.086), chemotherapy ( OR=2.887, 95% CI: 1.046-7.970), targeted therapy ( OR=8.671, 95% CI: 4.107-18.306), immunotherapy ( OR=2.603, 95% CI: 1.337-5.065) and abnormal liver and kidney function ( OR=12.409, 95% CI: 4.739-32.489) were independent risk factors for secondary peripheral neuropathy (all P<0.05). A nomogram was constructed based on the above risk factors. The area under the ROC curve (AUC) of the nomogram for predicting the secondary peripheral neuropathy was 0.913 (95% CI: 0.882-0.944); and sensitivity, specificity, positive and negative predictive values were 85.47%, 81.65%, 71.43% and 91.28%, respectively. The Calibration curve and clinical decision curve showed good calibration and clinical utility. External validation results showed that the AUC was 0.764 (95% CI: 0.638-0.869); and sensitivity, specificity, positive and negative predictive values were 79.28%, 85.79%, 73.25% and 85.82%, respectively.

CONCLUSIONS

Advanced lung cancer patients have a high risk of secondary peripheral neuropathy after anticancer therapy. Drinking history, comorbid diabetes, chemotherapy, targeted therapy, immunotherapy, abnormal liver and kidney function are independent risk factors. The nomogram prediction model constructed in the study is effective and may be used for the risk assessment of secondary peripheral neuropathy in patients with advanced lung cancer.

Self-Reported Severity, Characteristics, and Functional Limitations of Chemotherapy-Induced Peripheral Neuropathy

BACKGROUND

The early identification of chemotherapy-induced peripheral neuropathy (CIPN) (e.g., numbness or tingling in the fingers or toes) is important due to its frequency and the few effective treatment options available. The identification of common patient-reported CIPN characteristics and associated functional limitations may help to facilitate patient-clinician discussions of CIPN in practice.

AIMS

To quantify the severity, duration, location, characteristics, and associated functional limitations of chemotherapy-induced peripheral neuropathy (CIPN) in patients receiving neurotoxic chemotherapy.

DESIGN

Exploratory secondary analysis of a prospective, two-phase study SETTING: Breast, gastrointestinal, and multiple myeloma clinics at Dana-Farber Cancer Institute.

PARTICIPANTS

142 individuals who planned to receive at least three more cycles of neurotoxic chemotherapy after consent.

METHODS

Participants self-reported CIPN using standardized measures (i.e., PRO-CTCAE™ Numbness and Tingling Items or 0-10 numerical rating scale of worst CIPN pain intensity) and/or study team generated follow up questions about CIPN location, duration, characteristics, and functional limitations prior to three consecutive clinic visits (T1, T2, T3). Participants' responses to the CIPN self-report questionnaires were described by chemotherapy type and age.

RESULTS

Over approximately 36.5 days (T1-T3), the percentage of participants reporting at least mild CIPN increased from 59.3% to 71%. At T3, patients with non-painful (n = 98) or painful neuropathy (n = 34) frequently reported symptoms in the fingers (non-painful = 83.5%, painful = 76.5%) or toes (non-painful = 49.5%, painful = 41.2%) and characterized symptoms as numbness (non-painful = 54.1%, painful = 50%) or tingling (non-painful = 68.4%, painful = 82.4%). Self-reported CIPN functional limitations (n = 55) included difficulties with buttoning a shirt (38.2%) or walking (25.5%). Paclitaxel-related CIPN (n = 33) was frequently characterized as "continuous" (30.3%), whereas oxaliplatin-related CIPN (n = 51) was frequently characterized as "intermittent" (41.2%). Young adults (15-39 years old, n = 15) frequently reported moderate-severe non-painful CIPN (46.7%), painful CIPN (40%), and CIPN interference (33.3%).

CONCLUSIONS

Consistent with qualitative research, participants frequently described CIPN as numbness and/or tingling in the fingers and/or toes.

Brentuximab-Induced Peripheral Neurotoxicity: A Multidisciplinary Approach to Manage an Emerging Challenge in Hodgkin Lymphoma Therapy

Brentuximab vedotin (BV) is an anti-CD30 antibody-drug conjugate approved to treat classical Hodgkin lymphoma (HL). BV-induced peripheral neurotoxicity (BVIN) is one of the greatest concerns for haematologists treating HL for several reasons. First, BVIN is highly frequent. Most patients receiving BV will experience some degree of BVIN, resulting in the primary reason for dose modification or discontinuation of HL therapy. Second, BV produces sensory, motor, and/or autonomic peripheral nerve dysfunction, which can present as severe, disabling forms of BVIN-predominantly motor-in some patients. Third, although largely reversible, BVIN may persist months or years after treatment and thereby become a major issue in HL survivorship. BVIN may, therefore, negatively affect the quality of life and work-life of often young patients with HL, in whom long-term survival is expected. Currently, the only strategy for BVIN includes dose adjustments and treatment discontinuation; however, this could interfere with LH therapy efficacy. In this setting, early recognition and adequate management of BVIN are critical in improving clinical outcomes. Careful neurologic monitoring may allow accurate diagnoses and gradation of ongoing forms of BVIN presentation. This review analysed current, available data on epidemiology, pathophysiology, patient- and treatment-related risk factors, clinical and neurophysiologic phenotypes, and management in patients with HL. Furthermore, this review specifically addresses limitations posed by BVIN assessments in clinical practice and provides skills and tools to improve neurologic assessments in these patients. Integrating this neurotoxic drug in clinical practice requires a multidisciplinary approach to avoid or minimise neurotoxicity burden in survivors of HL.

CE: Chemotherapy-Induced Peripheral Neuropathy

ABSTRACT

Chemotherapy-induced peripheral neuropathy (CIPN) occurs in more than 68% of patients receiving the neurotoxic chemotherapy agents commonly used to treat breast, gastrointestinal, gynecologic, and hematologic malignancies. CIPN, often experienced initially as numbness, tingling, or pain in the upper or lower extremities, may progress to the point where the resultant decline in physical function requires a reduction in the chemotherapy dose. This article provides nurses with strategies to use in assessing, managing, and educating patients who are at risk for or who are already experiencing CIPN. Currently, the American Society of Clinical Oncology endorses only one treatment for CIPN: duloxetine 60 mg/day. Discussing CIPN with patients before chemotherapy is initiated and throughout the course of treatment promotes its early identification and management, which may minimize its impact on physical function and chemotherapy dosing, reducing the patient's risk of experiencing chronic symptoms after chemotherapy ends.