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McEvoy L, Cliff J, Carr DF, Jorgensen A, Lord R, Pirmohamed M. CYP3A genetic variation and taxane-induced peripheral neuropathy: a systematic review, meta-analysis, and candidate gene study. Front Pharmacol 2023; 14:1178421. [PMID: 37469869 PMCID: PMC10352989 DOI: 10.3389/fphar.2023.1178421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Taxane-induced peripheral neuropathy (TIPN) is an important cause of premature treatment cessation and dose-limitation in cancer therapy. It also reduces quality of life and survivorship in affected patients. Genetic polymorphisms in the CYP3A family have been investigated but the findings have been inconsistent and contradictory. Methods: A systematic review identified 12 pharmacogenetic studies investigating genetic variation in CYP3A4*22 and CYP3A5*3 and TIPN. In our candidate gene study, 288 eligible participants (211 taxane participants receiving docetaxel or paclitaxel, and 77 control participants receiving oxaliplatin) were successfully genotyped for CYP3A4*22 and CYP3A5*3. Genotyping data was transformed into a combined CYP3A metaboliser phenotype: Poor metabolisers, intermediate metabolisers and extensive metabolisers. Individual genotypes and combined CYP3A metaboliser phenotypes were assessed in relation to neurotoxicity, including by meta-analysis where possible. Results: In the systematic review, no significant association was found between CYP3A5*3 and TIPN in seven studies, with one study reporting a protective association. For CYP3A4*22, one study has reported an association with TIPN, while four other studies failed to show an association. Evaluation of our patient cohort showed that paclitaxel was found to be more neurotoxic than docetaxel (p < 0.001). Diabetes was also significantly associated with the development of TIPN. The candidate gene analysis showed no significant association between either SNP (CYP3A5*3 and CYP3A4*22) and the development of TIPN overall, or severe TIPN. Meta-analysis showed no association between these two variants and TIPN. Transformed into combined CYP3A metaboliser phenotypes, 30 taxane recipients were poor metabolisers, 159 were intermediate metabolisers, and 22 were extensive metabolisers. No significant association was observed between metaboliser status and case-control status. Summary: We have shown that the risk of peripheral neuropathy during taxane chemotherapy is greater in patients who have diabetes. CYP3A genotype or phenotype was not identified as a risk factor in either the candidate gene analysis or the systematic review/meta-analysis, although we cannot exclude the possibility of a minor contribution, which would require a larger sample size.
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Affiliation(s)
- Laurence McEvoy
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Joanne Cliff
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Daniel F Carr
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Andrea Jorgensen
- Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Rosemary Lord
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
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Stewart SL, Thomas S, Höke E, Simpson D, Singleton JR, Höke A. Vitamin B6 levels do not correlate with severity of neuropathy in chronic idiopathic axonal polyneuropathy. J Peripher Nerv Syst 2021; 27:31-37. [PMID: 34931740 DOI: 10.1111/jns.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022]
Abstract
Pyridoxine (vitamin B6) toxicity is known to cause a length-dependent, sensory predominant axonal polyneuropathy. There is debate regarding the threshold at which intake levels can cause neurological symptoms through pyridoxine toxicity. We asked if elevated plasma vitamin B6 levels were related to outcome measures in a well-characterized cohort of patients with chronic idiopathic axonal polyneuropathy (CIAP). We included 261 patients enrolled in the Peripheral Neuropathy Research Registry who had a complete dataset including a plasma vitamin B6 value. Patients with vitamin B6 deficiency (0-4.9 μg/L) were excluded. We performed a chi-square test for independence and analyzed the logistic relation of elevated plasma B6 level to nerve conduction studies (NCS), neurological examination findings, and patient-reported symptoms controlling for age and time elapsed since neuropathy symptom onset. Plasma B6 level was not related to neuropathy severity. There was no logistic relation of elevated plasma B6 level to NCS results, examination features including toe strength, vibration sense, and deep tendon reflexes, or patient-reported numbness or pain intensity. This study suggests that moderately elevated plasma B6 levels, even in the 100 to 200 μg/L range, are not associated with significantly worse neuropathy signs or symptoms. Although standard supplementation of B6 does not appear to have a major negative affect on CIAP, this study does not directly answer whether stopping supplementation will have a beneficial effect. Very few patients in the study had vitamin B6 levels >300 μg/L, suggesting that screening for vitamin B6 toxicity may be left to the discretion of the physician.
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Affiliation(s)
- Sarah L Stewart
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Simone Thomas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erol Höke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Simpson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ahmet Höke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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3
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Knoerl R, Mazzola E, Mitchell SA, Hong F, Salehi E, McCleary N, Ligibel JA, Reyes K, Berry DL. Measurement properties of brief neuropathy screening items in cancer patients receiving taxanes, platinums, or proteasome inhibitors. J Patient Rep Outcomes 2021; 5:101. [PMID: 34568984 PMCID: PMC8473487 DOI: 10.1186/s41687-021-00377-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely detection of chemotherapy-induced peripheral neuropathy (CIPN) is critical to effectively tailor chemotherapy dose levels and offer supportive care. The purpose of this secondary analysis was to determine the reliability and validity of the two Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) numbness and tingling severity and interference items to screen for CIPN in patients receiving taxanes, platinums, or proteasome inhibitors. METHODS Participants (N = 142) completed the two PRO-CTCAE items, a 0-10 numerical rating scale of worst CIPN pain intensity, and the Quality of Life Questionnaire-CIPN20 (QLQ-CIPN20) prior to three clinical visits (T1, T2, T3) during neurotoxic chemotherapy. Participants completed the two PRO-CTCAE items again following the T3 clinical visit (T4). In addition, study staff administered the modified Total Neuropathy Score-Clinical Version (TNSc©) at T3. We examined floor (i.e., no CIPN severity or interference) and ceiling effects, test-retest reliability, concurrent validity, longitudinal validity, construct validity of the response categories, and sensitivity and specificity of the two PRO-CTCAE items. RESULTS At T3, 29% of participants had PRO-CTCAE severity scores at the floor; 60.1% of participants reported interference item scores at the floor. Agreements between scores reported at T3 and T4 for PRO-CTCAE severity (ICC = 0.79) and interference (ICC = 0.73) were moderate to strong. The PRO-CTCAE severity and interference items correlated moderately-strongly with QLQ-CIPN20 sensory (Spearman's ρ-range = 0.53-0.72) and motor (Spearman's ρ-range = 0.50-0.58) subscale scores. The Cohen's d from T1 to T3 for the PRO-CTCAE items were small (severity: d = 0.32, interference: d = 0.40) and comparable to the effect sizes for change observed with the QLQ-CIPN20. The PRO-CTCAE severity (0-3) and interference (0-2) response categories distinguished respondents with significantly different levels of QLQ-CIPN20 sensory and motor subscale scores (p < 0.001 via Jonckheere-Terpstra tests). The sensitivity and specificity of the PRO-CTCAE severity item (cutoff > 0) to detect probable sensory peripheral neuropathy were 95.83% and 65.22%, while the sensitivity and specificity of the PRO-CTCAE™ interference item (cutoff > 0) were 51.39% and 73.91%. CONCLUSION Preliminary evidence supports the reliability and validity of the PRO-CTCAE numbness and tingling items for CIPN screening, although there may be floor effects and limitations in the capacity of the PRO-CTCAE items to identify the full range of CIPN sensory and motor features beyond numbness and tingling. Trial Registration ClinicalTrials.Gov, NCT03514680. Registered 21 April 2018. https://clinicaltrials.gov/ct2/show/NCT03514680.
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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, USA. .,University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Emanuele Mazzola
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Fangxin Hong
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nadine McCleary
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Kaitlen Reyes
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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4
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Bonomo R, Cavaletti G. Clinical and biochemical markers in CIPN: A reappraisal. Rev Neurol (Paris) 2021; 177:890-907. [PMID: 33648782 DOI: 10.1016/j.neurol.2020.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
The increased survival of cancer patients has raised growing public health concern on associated long-term consequences of antineoplastic treatment. Chemotherapy-induced peripheral neuropathy (CIPN) is a primarily sensory polyneuropathy, which may be accompanied by pain, autonomic disturbances, and motor deficit. About 70% of treated cancer patients might develop CIPN during or after the completion of chemotherapy, and in most of them such complication persists after six months from the treatment. The definition of the potential risk of development and resolution of CIPN according to a clinical and biochemical profile would be certainly fundamental to tailor chemotherapy regimen and dosage on individual susceptibility. In recent years, patient-reported and clinician-related tools along with quality of life instruments have been featured as primary outcomes in clinical setting and randomized trials. New studies on metabolomics markers are further pursuing accurate and easily accessible indicators of peripheral nerve damage. The aim of this review is to outline the strengths and pitfalls of current knowledge on CIPN, and to provide a framework for future potential developments of standardized protocols involving clinical and biochemical markers for CIPN assessment and monitoring.
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Affiliation(s)
- R Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
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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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Comparison of chemotherapy effects on mechanical sensitivity and food-maintained operant responding in male and female rats. Behav Pharmacol 2021; 31:477-490. [PMID: 31833969 DOI: 10.1097/fbp.0000000000000527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chemotherapies of varying classes often cause neuropathy and debilitating chemotherapy-induced neuropathic pain sufficient to limit treatment and reduce quality of life for many patients battling cancer. There are currently no effective preventive or alleviative treatments for chemotherapy-induced neuropathic pain. Preclinical models have been developed to test candidate chemotherapy-induced neuropathic pain treatments; however, studies using these models rarely provide direct comparisons of effects of different chemotherapies or assess the degree to which chemotherapies produce clinically relevant signs of pain-depressed behavior. Male and female Sprague-Dawley rats received four injections of vehicle, paclitaxel, oxaliplatin, vincristine, or bortezomib on alternate days. Mechanical hypersensitivity, body weight, and food-maintained operant responding were evaluated before, during, and for up to 42 days after initiation of treatment. Morphine potency and effectiveness to reverse chemotherapy-induced effects were also evaluated. All four chemotherapies produced dose-dependent and sustained mechanical hypersensitivity in all rats. Vincristine and oxaliplatin produced transient weight loss and decreases in food-maintained operant responding in all rats, whereas paclitaxel and bortezomib produced lesser or no effect. At 4 weeks after treatment, operant responding was depressed only in paclitaxel-treated males. Morphine reversed mechanical hypersensitivity in all rats but failed to reverse paclitaxel-induced depression of operant responding in males. We conclude that chemotherapy treatments sufficient to produce sustained mechanical hypersensitivity failed to produce sustained or morphine-reversible behavioral depression in rats. Insofar as pain-related behavioral depression is a cardinal sign of chemotherapy-induced neuropathic pain in humans, these results challenge the presumption that these chemotherapy-dosing regimens are sufficient to model clinically relevant chemotherapy-induced neuropathic pain in rats.
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Ng DQ, Tan CJ, Soh BC, Tan MML, Loh SY, Tan YE, Ong HH, Teng PPC, Chan JJ, Chay WY, Lee J, Lai G, Beh SY, Tan TJY, Yap YS, Lee GE, Wong M, Dent R, Lo YL, Chan A, Loh KWJ. Impact of Cryotherapy on Sensory, Motor, and Autonomic Neuropathy in Breast Cancer Patients Receiving Paclitaxel: A Randomized, Controlled Trial. Front Neurol 2020; 11:604688. [PMID: 33424755 PMCID: PMC7793726 DOI: 10.3389/fneur.2020.604688] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: We conducted a randomized controlled trial evaluating the efficacy and tolerability of cryotherapy in preventing chemotherapy-induced peripheral neuropathy (CIPN) in patients with early breast cancer receiving neo/adjuvant weekly paclitaxel. Methods: Patients were recruited from the National Cancer Centre Singapore and randomized (1:1) to receive either cryotherapy or usual care. Cryotherapy was applied as frozen gloves and socks on all extremities from 15 min before paclitaxel until 15 min post-infusion every cycle. Efficacy was measured by patient-reported outcomes (Patient Neurotoxicity Questionnaire [PNQ] and EORTC QLQ-CIPN20) and electrophysiological assessments. The primary endpoint was PNQ severity at 2 weeks after 12 cycles of weekly paclitaxel. Results: A total of 46 patients were recruited, of which 8 dropped out before paclitaxel treatment, leaving 38 evaluable. There was no significant difference in PNQ severity between cryotherapy and usual care at 2 weeks after paclitaxel treatment (sensory: p = 0.721; motor: p = 1.000). A benefit was observed at 3 months post-paclitaxel based on PNQ (sensory: 14.3 vs. 41.2%, p = 0.078; motor: 0 vs. 29.4%, p = 0.012) and CIPN20 (sensory: β = −3.6, 95%CI = −10.5–3.4, p = 0.308; motor: β = −7.3, 95%CI = −14.6–0, p = 0.051). Additionally, cryotherapy subjects have lower CIPN20 autonomic score (β = −5.84, 95%CI = −11.15 to −0.524, p = 0.031) and higher sympathetic skin response hand amplitudes (β = 0.544, 95%CI = 0.108–0.98, p = 0.014), suggesting possible autonomic benefits from cryotherapy. Temporary interruption with cryotherapy occurred in 80.9% of the subjects due to cold intolerance. Conclusions: There is insufficient evidence that cryotherapy prevents sensory neuropathy which may be due to the high rates of cryotherapy interruption in this study. The autonomic benefits of cryotherapy should be further investigated with appropriate outcome measures. Clinical Trial Registration:ClinicalTrials.gov: NCT03429972.
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Affiliation(s)
- Ding Quan Ng
- Department of Pharmacy, National University of Singapore, Singapore, Singapore.,Department of Clinical Pharmacy Practice, University of California, Irvine, Irvine, CA, United States
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Boon Chua Soh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mabel May Leng Tan
- Division of Nursing, National Cancer Centre Singapore, Singapore, Singapore
| | - Soon Yue Loh
- Division of Nursing, National Cancer Centre Singapore, Singapore, Singapore
| | - Yam Eng Tan
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | - Hui Hui Ong
- Department of Neurology, Singapore General Hospital, Singapore, Singapore
| | | | - Jack Junjie Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joycelyn Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Gillianne Lai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Sok Yuen Beh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Tira Jing Ying Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Yoon Sim Yap
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Guek Eng Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Rebecca Dent
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yew Long Lo
- Department of Neurology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National Neuroscience Institute, Singapore, Singapore
| | - Alexandre Chan
- Department of Clinical Pharmacy Practice, University of California, Irvine, Irvine, CA, United States.,Duke-NUS Medical School, Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Kiley Wei-Jen Loh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Stewart S, Thomas S, Van Doormaal PT, Höke A. Relation of exercise and pain in patients with idiopathic distal axonal polyneuropathies. J Peripher Nerv Syst 2020; 25:388-394. [PMID: 33025680 DOI: 10.1111/jns.12415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 12/24/2022]
Abstract
Although exercise is associated with better outcomes in patients with some peripheral neuropathies, data in idiopathic peripheral neuropathies is lacking. This study was completed to do a comprehensive data analysis about the benefits of regular exercise in a well-characterized cohort of patients with idiopathic distal, symmetrical, axonal polyneuropathy enrolled in the Peripheral Neuropathy Research Registry (PNRR) at Johns Hopkins University School of Medicine. From the patient-reported exercise habits, metabolic equivalents (METs) were calculated and the patient information was grouped into four categories. The PNRR data set, including patient reported pain, numbness, and weakness, was analyzed using the METs categories to evaluate for the benefits of exercise. We controlled for the components of metabolic syndrome including Hemoglobin A1c (HbA1c), systolic and diastolic blood pressure (BP), high density lipids (HDL) and triglyceride level, and body mass index (BMI) as defined by the Adult Treatment Panel III Guidelines. Lower METs were associated with neuropathic pain, but not with other peripheral neuropathy symptoms. Patients with IPN who exercised were less likely to have painful neuropathy independent of the average METs per week (P < .01). No significant differences were seen for patient reported numbness, weakness, or balance issues. The data suggests that patients with idiopathic neuropathy benefit from exercises even if performed on a low intensity level or less frequently, and patients are less likely to have severe pain symptoms when exercising on a regular basis.
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Affiliation(s)
- Sarah Stewart
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Simone Thomas
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Perry Tc Van Doormaal
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ahmet Höke
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tamburin S, Park SB, Alberti P, Demichelis C, Schenone A, Argyriou AA. Taxane and epothilone-induced peripheral neurotoxicity: From pathogenesis to treatment. J Peripher Nerv Syst 2020; 24 Suppl 2:S40-S51. [PMID: 31647157 DOI: 10.1111/jns.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 01/17/2023]
Abstract
Taxane-induced peripheral neurotoxicity (TIPN) is the most common non-hematological side effect of taxane-based chemotherapy, and may result in dose reductions and discontinuations, having as such a detrimental effect on patients' overall survival. Epothilones share similar mechanism of action with taxanes. The typical TIPN clinical presentation is mainly comprised of numbness and paresthesia, in a stocking-and-glove distribution and may progress more proximally over time, with paclitaxel being more neurotoxic than docetaxel. Motor and autonomic involvement is less common, whereas an acute taxane-induced acute pain syndrome is frequent. Patient reported outcomes questionnaires, clinical evaluation, and instrumental tools offer complementary information in TIPN. Its electrodiagnostic features include reduced/abolished sensory action potentials, and less prominent motor involvement, in keeping with a length-dependent, axonal dying back predominately sensory neuropathy. TIPN is dose-dependent and may be reversible within months after the end of chemotherapy. The single and cumulative delivered dose of taxanes is considered the main risk factor of TIPN development. Apart from the cumulative dose, other risk factors for TIPN include demographic, clinical, and pharmacogenetic features with several single-nucleotide polymorphisms potentially linked with increased susceptibility of TIPN. There are currently no neuroprotective strategies to reduce the risk of TIPN, and symptomatic treatments are very limited. This review critically examines the pathogenesis, incidence, risk factors (both clinical and pharmacogenetic), clinical phenotype and management of TIPN.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Paola Alberti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,NeuroMI (Milan Center for Neuroscience), Milan, Italy
| | - Chiara Demichelis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Policlinico San Martino, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, "Saint Andrew's" State General Hospital of Patras, Patras, Greece
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10
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Park SB, Alberti P, Kolb NA, Gewandter JS, Schenone A, Argyriou AA. Overview and critical revision of clinical assessment tools in chemotherapy-induced peripheral neurotoxicity. J Peripher Nerv Syst 2020; 24 Suppl 2:S13-S25. [PMID: 31647154 DOI: 10.1111/jns.12333] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a major toxicity of cancer treatment, leading to dose reduction and premature treatment cessation, potentially affecting patient function, and quality of life. The development of accurate and sensitive assessment tools for CIPN is essential to enable clinical monitoring during treatment, follow-up of long-term outcomes and measurement of toxicity in clinical trials. This review examines CIPN clinical assessment scales incorporating clinician-based, composite, and patient-reported outcomes (PROs), providing a systematic review of their properties and an updated critical analysis of recommendations on current evidence for their use. This systematic review of CIPN assessment tools identified 50 papers containing 41 assessment tools, across 4 categories (common toxicity criteria; composite neurological scale; PROs; pain scale). The majority of these tools were PROs, underscoring the importance of patient-based assessment of symptoms. While there has been considerable work in the field over the past 10 years, this review highlights significant gaps, including a lack of evaluation of responsiveness and problematic neuropathic pain evaluation. There remains a need for consensus on the best available tool and the need to modify existing instruments to improve utility.
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Affiliation(s)
- Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paola Alberti
- Experimental Neurology Unit and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Noah A Kolb
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genova, Genoa, Italy
| | - Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras, Greece
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11
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Psychometric Testing of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20-Item Scale Using Pooled Chemotherapy-Induced Peripheral Neuropathy Outcome Measures Standardization and Alliance for Clinical Trials in Oncology A151408 Study Data. Cancer Nurs 2020; 42:179-189. [PMID: 29649081 DOI: 10.1097/ncc.0000000000000596] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND No criterion-standard patient-reported outcome measure of chemotherapy-induced peripheral neuropathy (CIPN) exists. OBJECTIVES The aims of this study were to reevaluate the sensitivity, reliability, and validity of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-CIPN (QLQ-CIPN20) measure and suggest possible revisions that could strengthen it. METHODS Cross-sectional QLQ-CIPN20 data from 8 European countries (n = 271) were pooled with data from 4 North American multisite CIPN intervention trials (n = 884). The combined sample (N = 1155) included patients with varied cancer diagnoses who had received neurotoxic chemotherapy. Item score ranges, Cronbach's α, and exploratory factor analysis were used to evaluate sensitivity, internal consistency, and structural validity. RESULTS Individual item mean scores ranged from 1.21 to 2.34 (SD range, 0.55-1.17). All item scores encompassed the entire 1 to 4 range. We recommend that 4 items be removed because of low item-item score correlations (r < 0.30). On the basis of the remaining 16 items, 88% of the variance was explained by 2 factors whose Cronbach's α coefficients were .90 and .85. However, items lacked conceptual alignment with previously published factor structures. CONCLUSION Using a large, diverse sample of European and North American participants, the reduced 16-item QLQ-CIPN20 is sensitive and internally consistent. However, factor analysis results revealed an unstable factor structure. IMPLICATIONS FOR PRACTICE The use of a reliable, valid, and sensitive criterion-standard QLQ-CIPN20 variant in clinical practice settings could improve function, quality of life, and CIPN symptom control by facilitating patient reporting and thereby clinician awareness of this underrecognized consequence of cancer therapy.
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12
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Knoerl R, Smith EML, Han A, Doe A, Scott K, Berry DL. Characterizing patient-clinician chemotherapy-induced peripheral neuropathy assessment and management communication approaches. PATIENT EDUCATION AND COUNSELING 2019; 102:1636-1643. [PMID: 31003878 PMCID: PMC6660983 DOI: 10.1016/j.pec.2019.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To describe the frequency and characteristics of chemotherapy-induced peripheral neuropathy (CIPN) assessment and management communication approaches between patients receiving neurotoxic chemotherapy and clinicians. METHODS The 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. RESULTS Participants 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. CONCLUSIONS Clinicians 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 IMPLICATIONS Effective participant-clinician communication is required at each clinic visit during chemotherapy treatment to identify initial signs of CIPN and offer appropriate treatment.
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Affiliation(s)
- Robert Knoerl
- Post-Doctoral Research Fellow, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215, USA.
| | - Ellen M L Smith
- School of Nursing, University of Michigan, 400 N. Ingalls, Ann Arbor, MI 48109, USA.
| | - Amy Han
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, 450 Brookline Avenue, LG 1B, Boston, MA 02215, USA.
| | - Allison Doe
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215, USA
| | - Katelyn Scott
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215, USA.
| | - Donna L Berry
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW 518, Boston, MA 02215, USA.
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Zhi WI, Chen P, Kwon A, Chen C, Harte SE, Piulson L, Li S, Patil S, Mao JJ, Bao T. Chemotherapy-induced peripheral neuropathy (CIPN) in breast cancer survivors: a comparison of patient-reported outcomes and quantitative sensory testing. Breast Cancer Res Treat 2019; 178:587-595. [PMID: 31456070 DOI: 10.1007/s10549-019-05416-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE CIPN is a common, debilitating, and dose-limiting side effect of chemotherapy. Here, we describe characteristics of patients with CIPN using both patient-reported outcomes (PRO) and quantitative sensory testing (QST). METHODS Breast cancer survivors with persistent moderate to severe CIPN defined by a rating of 4 or greater on a 0-10 Numeric Rating Scale (NRS) from two ongoing clinical trials were included. PROs included the Neuropathic Pain Scale (NPS) and Functional Assessment of Cancer Therapy-Gynecologic Oncology Group/Neurotoxicity (FACT/GOG-Ntx). QST included tactile and vibration detection threshold measurements. Data were analyzed using descriptive statistics and Spearman correlation coefficients. RESULTS 49 female patients with a mean age of 61 years were assessed; 63% were Caucasian. Mean NRS scores were 4.2, 5.7, and 4.3 on 0-10 scale for pain, numbness, and tingling, respectively. Mean NPS score was 41.0 on a 0-100 scale, and the mean FACT/GOG-Ntx score was 25.8 on a 0-44 scale. QST showed mild to moderate impairments in tactile and vibration perception. The FACT/GOG-Ntx subscale for numbness was negatively correlated with tactile and vibration thresholds in both hands and feet (both p < 0.05). NPS was positively correlated with tactile thresholds in the hands and feet (p < 0.05). CONCLUSION Patients with moderate to severe CIPN report moderate pain, numbness, and tingling, and exhibit reduced tactile and vibration perception on QST. Weak to moderate correlations were observed between PRO and QST. These data suggest that QST outcomes are associated with CIPN symptoms and may be useful in helping monitor and manage CIPN treatment.
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Affiliation(s)
- W Iris Zhi
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice Kwon
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Connie Chen
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Lauren Piulson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Li
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Timmins HC, Li T, Kiernan MC, Horvath LG, Goldstein D, Park SB. Quantification of Small Fiber Neuropathy in Chemotherapy-Treated Patients. THE JOURNAL OF PAIN 2019; 21:44-58. [PMID: 31325646 DOI: 10.1016/j.jpain.2019.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major, dose-limiting side effect of treatment with neurotoxic cancer treatments which can result in long-term impairment. Deficits often reflect a large fiber polyneuropathy, however small fiber involvement resulting in neuropathic pain and autonomic dysfunction can occur. Quantification of both CIPN and small fiber neuropathy (SFN) remains a challenge. Accordingly, the prevalence and pathophysiology of small fiber neuropathy amongst cancer survivors remains poorly understood. This review will provide an overview of the clinical features of SFN associated with neurotoxic cancer treatments as well as a summary of current assessment tools for evaluating small fiber function, and their use in patients treated with neurotoxic chemotherapies. The continued development and utilization of novel measures quantifying small fiber involvement will help elucidate the pathophysiology underlying symptoms of CIPN and assist in informing treatment approaches. Accurately identifying subgroups of patients with neuropathic symptoms which may respond to existing pain medication may reduce the impact of CIPN and improve long-term quality of life as well as provide better categorization of patients for future clinical trials of neuroprotective and treatment strategies for CIPN. PERSPECTIVE: This review provides a critical analysis of SFN associated with neurotoxic cancer treatments and the assessment tools for evaluating small fiber dysfunction in cancer patients. Quantification of small fiber involvement in CIPN will assist in identifying subgroups of patients with neuropathic symptoms which may respond to existing pain medications.
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Affiliation(s)
- Hannah C Timmins
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Tiffany Li
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, The University of Sydney, Australia
| | - Lisa G Horvath
- The Chris O'Brien Lifehouse, Camperdown, Australia; Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, The University of Sydney, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia; Prince of Wales Hospital, Randwick, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
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Knoerl R, Barton DL, Holden JE, Krauss JC, LaVasseur B, Smith EML. Médiateurs potentiels d’amélioration de la neuropathie périphérique chimio-induite douloureuse par une intervention cognitivocomportementale en ligne. Can Oncol Nurs J 2019; 28:184-190. [PMID: 31148827 DOI: 10.5737/23688076283184190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Robert Knoerl
- Chercheur boursier postdoctoral, Phyllis Cantor, Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215, Courriel : , Téléphone : 617-632-6386
| | - Debra L Barton
- Mary Lou Willard, professeure, française de soins infirmiers; University of Michigan Medical School, Ann Arbor, M.I.; courriel :
| | - Janean E Holden
- Barbara A. Therrien, professeure en soins infirmiers, University of Michigan School of Nursing, Ann Arbor, M.I.; courriel :
| | - John C Krauss
- Professeure adjointe, University of Michigan, Comprehensive Cancer Center, Ann Arbor, M.I.; courriel :
| | - Beth LaVasseur
- Directrice de la recherche et des opérations, St. Joseph Mercy Hospital, Ann Arbor, M.I.; courriel :
| | - Ellen M L Smith
- Professeurs adjointe, University of Michigan School of Nursing, Ann Arbor, M.I.; courriel :
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16
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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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Knoerl R, Bridges C, Smith G, Yang J, Kanzawa-Lee G, Smith E. Chemotherapy-Induced Peripheral Neuropathy: Use of an Electronic Care Planning System to Improve Adherence to Recommended Assessment and Management Practices. Clin J Oncol Nurs 2018; 22:E134-E140. [DOI: 10.1188/18.cjon.e134-e140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Smith EML, Knoerl R, Yang JJ, Kanzawa-Lee G, Lee D, Bridges CM. In Search of a Gold Standard Patient-Reported Outcome Measure for Use in Chemotherapy- Induced Peripheral Neuropathy Clinical Trials. Cancer Control 2018; 25:1073274818756608. [PMID: 29480026 PMCID: PMC5925747 DOI: 10.1177/1073274818756608] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To test a reduced version—CIPN15—of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy scale (QLQ-CIPN20) to establish a possible gold-standard patient-reported outcome measure for chemotherapy-induced peripheral neuropathy (CIPN). Methods: Using a prospective, longitudinal, case–control design, patients (n = 121) receiving neurotoxic chemotherapy completed the CIPN15 at baseline and 12 weeks and underwent objective neurological assessment using the 5-item Total Neuropathy Score-Clinical (TNSc). Healthy controls (n = 30) completed the CIPN15 once. Structural validity was evaluated using factor analysis. Because a stable factor structure was not found, a sum score was used to evaluate measures of the CIPN15’s psychometric properties—reliability, validity, sensitivity, and responsiveness—as follows: internal consistency via Cronbach’s α and item–item correlations; test–retest reliability via correlation between 2 CIPN15 scores from each patient; concurrent validity via correlation between CIPN15 and 5-item TNSc scores; contrasting group validity via comparison of CIPN15 scores from patients and healthy controls; sensitivity via descriptive statistics (means, standard deviation, ranges); and responsiveness via Cohen’s d effect size. Results: Most patients received single agent oxaliplatin (33.7%), paclitaxel (21.2%), or more than 1 neurotoxic drug concurrently (29.8%). Factor analysis revealed no stable factor structure. Cronbach’s α for the CIPN15 sum score was 0.91 (confidence interval [CI] = 0.89-0.93). Test–retest reliability was demonstrated based on strong correlations between the 2 scores obtained at the 12-week time point (r = 0.86; CI = 0.80-0.90). The CIPN15 and 5-item TNSc items reflecting symptoms (not signs) were moderately correlated (r range 0.57-0.72): concurrent validity. Statistically significant differences were found between patient and healthy control CIPN15 mean scores (P < .0001): contrasting group validity. All items encompassed the full score range but the CIPN15 linearly converted sum score did not: sensitivity. The CIPN15 was responsive based on a Cohen’s d of 0.52 (CI = 0.25-0.79). Conclusion: The sum-scored CIPN15 is reliable, valid, sensitive, and responsive when used to assess taxane- and platinum-induced CIPN.
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Affiliation(s)
| | - Robert Knoerl
- 2 Phylllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, MA, USA
| | - James J Yang
- 1 University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - Deborah Lee
- 1 University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Celia M Bridges
- 1 University of Michigan School of Nursing, Ann Arbor, MI, USA
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19
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Knoerl R, Barton DL, Holden JE, Krauss JC, LaVasseur B, Smith EML. Potential mediators of improvement in painful chemotherapy-induced peripheral neuropathy via a web-based cognitive behavioural intervention. Can Oncol Nurs J 2018; 28:178-183. [PMID: 31148833 DOI: 10.5737/23688076283178183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose Preliminary evidence suggests that a self-guided cognitive and behaviourally-based pain management intervention (PROSPECT) is effective for chronic painful chemotherapy-induced peripheral neuropathy (CIPN), but its mechanism of action is unknown. The purpose of this secondary analysis was to explore if changes in anxiety, depression, sleep-related impairment, or fatigue mediated improvements in worst pain following PROSPECT in individuals with chronic painful CIPN. Methods Sixty participants were randomized to receive self-guided cognitive behavioural pain management (access for eight weeks) or treatment as usual. A seven-day worst CIPN pain diary and the PROMIS measures of anxiety, depression, fatigue, and sleep-related impairment were administered pre/posttest (eight-weeks). Causal mediation analysis was used to quantify mediators of worst pain improvement. Results None of the hypothesized mediators had a statistically significant effect on worst pain (n=38). Implications Further research is needed to identify potential mediators of pain intensity that can be targeted by specific cognitive behavioural strategies to improve painful CIPN severity.
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Affiliation(s)
- Robert Knoerl
- Post-Doctoral Research Fellow, Phyllis F. Cantor, Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer, Institute, 450 Brookline Avenue, LW 517, Boston, MA 02215,
| | - Debra L Barton
- Mary Lou Willard French Professor of Nursing, University of Michigan School of Nursing, Ann Arbor, MI,
| | - Janean E Holden
- Barbara A. Therrien Collegiate Professor of Nursing, University of Michigan School of Nursing, Ann Arbor, MI,
| | - John C Krauss
- Assistant Professor, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI,
| | - Beth LaVasseur
- Director of Oncology Research and Operation, St. Joseph Mercy Hospital, Ann Arbor, MI,
| | - Ellen M L Smith
- Associate Professor, University of Michigan School of Nursing, Ann Arbor, MI,
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20
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Skiles JL, Chiang C, Li CH, Martin S, Smith EL, Olbara G, Jones DR, Vik TA, Mostert S, Abbink F, Kaspers GJ, Li L, Njuguna F, Sajdyk TJ, Renbarger JL. CYP3A5 genotype and its impact on vincristine pharmacokinetics and development of neuropathy in Kenyan children with cancer. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26854. [PMID: 29115708 PMCID: PMC5766375 DOI: 10.1002/pbc.26854] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/14/2017] [Accepted: 09/06/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Vincristine (VCR) is a critical part of treatment in pediatric malignancies and is associated with dose-dependent peripheral neuropathy (vincristine-induced peripheral neuropathy [VIPN]). Our previous findings show VCR metabolism is regulated by the CYP3A5 gene. Individuals who are low CYP3A5 expressers metabolize VCR slower and experience more severe VIPN as compared to high expressers. Preliminary observations suggest that Caucasians experience more severe VIPN as compared to nonCaucasians. PROCEDURE Kenyan children with cancer who were undergoing treatment including VCR were recruited for a prospective cohort study. Patients received IV VCR 2 mg/m2 /dose with a maximum dose of 2.5 mg as part of standard treatment protocols. VCR pharmacokinetics (PK) sampling was collected via dried blood spot cards and genotyping was conducted for common functional variants in CYP3A5, multi-drug resistance 1 (MDR1), and microtubule-associated protein tau (MAPT). VIPN was assessed using five neuropathy tools. RESULTS The majority of subjects (91%) were CYP3A5 high-expresser genotype. CYP3A5 low-expresser genotype subjects had a significantly higher dose and body surface area normalized area under the curve than CYP3A5 high-expresser genotype subjects (0.28 ± 0.15 hr·m2 /l vs. 0.15 ± 0.011 hr·m2 /l, P = 0.027). Regardless of which assessment tool was utilized, minimal neuropathy was detected in this cohort. There was no difference in the presence or severity of neuropathy assessed between CYP3A5 high- and low-expresser genotype groups. CONCLUSION Genetic factors are associated with VCR PK. Due to the minimal neuropathy observed in this cohort, there was no demonstrable association between genetic factors or VCR PK with development of VIPN. Further studies are needed to determine the role of genetic factors in optimizing dosing of VCR for maximal benefit.
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Affiliation(s)
- Jodi L. Skiles
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana,School of Medicine, Department of Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - ChienWei Chiang
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Claire H. Li
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Steve Martin
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ellen L. Smith
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Gilbert Olbara
- School of Medicine, Department of Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - David R. Jones
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Terry A. Vik
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Saskia Mostert
- Pediatric Oncology-Hematology and Doctor2Doctor program, VU University Medical Center, Amsterdam, The Netherlands
| | - Floor Abbink
- Pediatric Oncology-Hematology and Doctor2Doctor program, VU University Medical Center, Amsterdam, The Netherlands
| | - Gertjan J. Kaspers
- Pediatric Oncology-Hematology and Doctor2Doctor program, VU University Medical Center, Amsterdam, The Netherlands
| | - Lang Li
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Festus Njuguna
- School of Medicine, Department of Child Health and Paediatrics, Moi University College of Health Sciences, Eldoret, Kenya,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Tammy J. Sajdyk
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jamie L. Renbarger
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Cardoso ACLR, Araújo DDD, Chianca TCM. Risk prediction and impaired tactile sensory perception among cancer patients during chemotherapy. Rev Lat Am Enfermagem 2018; 25:e2957. [PMID: 29319742 PMCID: PMC5768208 DOI: 10.1590/1518-8345.1979.2957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/30/2017] [Indexed: 12/03/2022] Open
Abstract
Objectives: to estimate the prevalence of impaired tactile sensory perception, identify risk
factors, and establish a risk prediction model among adult patients receiving
antineoplastic chemotherapy. Method: historical cohort study based on information obtained from the medical files of
127 patients cared for in the cancer unit of a private hospital in a city in Minas
Gerais, Brazil. Data were analyzed using descriptive and bivariate statistics,
with survival and multivariate analysis by Cox regression. Results: 57% of the 127 patients included in the study developed impaired tactile sensory
perception. The independent variables that caused significant impact, together
with time elapsed from the beginning of treatment up to the onset of the
condition, were: bone, hepatic and regional lymph node metastases; alcoholism;
palliative chemotherapy; and discomfort in lower limbs. Conclusion: impaired tactile sensory perception was common among adult patients during
chemotherapy, indicating the need to implement interventions designed for early
identification and treatment of this condition.
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Simsek NY, Demir A. Reliability and Validity of the Turkish Version of Chemotherapy-induced Peripheral Neuropathy Assessment Tool for Breast Cancer Patients Receiving Taxane Chemotherapy. Asia Pac J Oncol Nurs 2018; 5:435-441. [PMID: 30271828 PMCID: PMC6103197 DOI: 10.4103/apjon.apjon_29_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ayten Demir
- Department of Nursing, Faculty of Health Sciences, Ankara University, Ankara, Turkey
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Brozou V, Vadalouca A, Zis P. Pain in Platin-Induced Neuropathies: A Systematic Review and Meta-Analysis. Pain Ther 2017; 7:105-119. [PMID: 29196945 PMCID: PMC5993684 DOI: 10.1007/s40122-017-0092-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction Platin-induced peripheral neuropathy (PIPN) is a common cause of PN in cancer patients. The aim of this paper is to systematically review the current literature regarding PIPN, with a particular focus on epidemiological and clinical characteristics of painful PIPN, and to discuss relevant management strategies. Methods A systematic computer-based literature search was conducted on the PubMed database. Results This search strategy resulted in the identification of 353 articles. After the eligibility assessment, 282 articles were excluded. An additional 24 papers were identified by scanning the reference lists. In total, 95 papers met the inclusion criteria and were used for this review. The prevalence of neuropathic symptoms due to acute toxicity of oxaliplatin was estimated at 84.6%, whereas PN established after chemotherapy with platins was estimated at 74.9%. Specifically regarding pain, the reported prevalence of pain due to acute toxicity of oxaliplatin was estimated at 55.6%, whereas the reported prevalence of chronic peripheral neuropathic pain in PIPN was estimated at 49.2%. Conclusion Peripheral neuropathy is a common complication in patients receiving platins and can be particularly painful. There is significant heterogeneity among studies regarding the method for diagnosing peripheral neuropathy. Nerve conduction studies are the gold standard and should be performed in patients receiving platins and complaining of neuropathic symptoms post-treatment.
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Affiliation(s)
| | | | - Panagiotis Zis
- Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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The psychometric properties of the Turkish version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT). Eur J Oncol Nurs 2017; 31:84-89. [DOI: 10.1016/j.ejon.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/19/2022]
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Optimal clinical assessment strategies for chemotherapy-induced peripheral neuropathy (CIPN): a systematic review and Delphi survey. Support Care Cancer 2017; 25:3485-3493. [PMID: 28589310 DOI: 10.1007/s00520-017-3772-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Reddy SM, Vergo MT, Paice JA, Kwon N, Helenowski IB, Benson AB, Mulcahy MF, Nimeiri HS, Harden RN. Quantitative Sensory Testing at Baseline and During Cycle 1 Oxaliplatin Infusion Detects Subclinical Peripheral Neuropathy and Predicts Clinically Overt Chronic Neuropathy in Gastrointestinal Malignancies. Clin Colorectal Cancer 2016; 15:37-46. [DOI: 10.1016/j.clcc.2015.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/07/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022]
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Carvalho AB, Garcia JBS, Silva TKM, Ribeiro JVF. Translation and transcultural adaptation of Pain Quality Assessment Scale (PQAS) to Brazilian version. Braz J Anesthesiol 2016; 66:94-104. [PMID: 26768938 DOI: 10.1016/j.bjane.2013.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/30/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Most cancer patients are treated with chemotherapy, and peripheral neuropathy is a serious and common clinical problem affecting patients undergoing cancer treatment. However, the symptoms are subjective and underdiagnosed by health professionals. Thus, it becomes necessary to develop self-report instruments to overcome this limitation and improve the patient's perception about his medical condition or treatment. OBJECTIVE Translate and culturally adapt the Brazilian version of the Pain Quality Assessment Scale, constituting a useful tool for assessing the quality of neuropathic pain in cancer patients. METHOD The procedure followed the steps of translation, back translation, analysis of Portuguese and English versions by a committee of judges, and pretest. Pretest was conducted with 30 cancer patients undergoing chemotherapy following internationally recommended standards, and the final versions were compared and evaluated by a committee of researchers from Brazil and MAPI Research Trust, the scale's creators. RESULTS Versions one and two showed 100% semantic equivalence with the original version. Back-translation showed difference between the linguistic translation and the original version. After evaluation by the committee of judges, a flaw was found in the empirical equivalence and idiomatic equivalence. In pretest, two people did not understand the item 12 of the scale, without interfering in the final elaboration. CONCLUSION The translated and culturally adapted instrument is now presented in this publication, and currently it is in the process of clinical validation in Brazil.
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Affiliation(s)
- Anamada Barros Carvalho
- Outpatient Chronic Pain, Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil; Liga Acadêmica de Dor Maranhão, São Luís, MA, Brazil; Health Sciences, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil.
| | - João Batista Santos Garcia
- Outpatient Chronic Pain, Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil; Liga Acadêmica de Dor Maranhão, São Luís, MA, Brazil; Department of Anesthesiology Pain and Palliative Care, Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
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Carvalho AB, Garcia JBS, Silva TKM, Ribeiro JVF. Tradução e adaptação transcultural da Pain Quality Assessment Scale (PQAS) para a versão brasileira. Braz J Anesthesiol 2016. [DOI: 10.1016/j.bjan.2013.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mendoza TR, Wang XS, Williams LA, Shi Q, Vichaya EG, Dougherty PM, Thomas SK, Yucel E, Bastida CC, Woodruff JF, Cleeland CS. Measuring Therapy-Induced Peripheral Neuropathy: Preliminary Development and Validation of the Treatment-Induced Neuropathy Assessment Scale. THE JOURNAL OF PAIN 2015. [PMID: 26210041 DOI: 10.1016/j.jpain.2015.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED Various sensory and motor effects are associated with cancer treatment-induced peripheral neuropathy. The current method for capturing the multifaceted nature of neuropathy includes a combination of objective tests, clinician evaluation, and subjective patient report, an approach that is often not logistically feasible, especially for multisite trials. We report the performance of a brief yet comprehensive, easily administered measure, the Treatment-Induced Neuropathy Assessment Scale (TNAS), for assessing the severity and course of neuropathy across various cancer treatments. Data were derived from 4 longitudinal or cross-sectional patient cohorts (N = 573). Patients with multiple myeloma treated primarily with bortezomib and patients with colorectal cancer receiving oxaliplatin evaluated candidate items. Cognitive debriefing showed that all items were easy to understand, and this preliminary TNAS demonstrated reliability, validity, and sensitivity. Numbness/tingling was the most severe item, regardless of therapeutic agent. Although numbness and general pain were moderately correlated, patients perceived them as distinct. Most TNAS items were more severe at follow-up, demonstrating the sensitivity of the instrument to accumulating dose. The TNAS will be refined with further patient input, with final psychometric evaluation conducted in a new patient sample receiving treatments known to be associated with peripheral neuropathy. The nonpainful component of neuropathy may be more disabling than the pain component. PERSPECTIVE Our data suggest that the nonpainful components of neuropathy may be more disabling than the pain component during cancer treatment. Here we report data on sensory and motor symptoms reported by patients receiving neurotoxic cancer therapy, and we detail the development of a neuropathy assessment scale that follows regulatory guidance for patient-reported outcomes.
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Affiliation(s)
- Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elisabeth G Vichaya
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheeba K Thomas
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emre Yucel
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christel C Bastida
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeanie F Woodruff
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): what we need and what we know. J Peripher Nerv Syst 2015; 19:66-76. [PMID: 24976572 DOI: 10.1111/jns5.12073] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/19/2014] [Indexed: 12/16/2022]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the most frequent and severe long-term side effects of cancer chemotherapy. Preclinical and clinical studies have extensively investigated CIPN searching for effective strategies to limit its severity or to treat CIPN-related impairment, but the results have been disappointing. Among the reasons for this failure are methodological flaws in both preclinical and clinical investigations. Their successful resolution might provide a brighter perspective for future studies. Among the several neurotoxic chemotherapy drugs, oxaliplatin may offer a clear example of a methodological approach eventually leading to successful clinical trials. However, the same considerations apply to the other neurotoxic agents and, although frequently neglected, also to the new "targeted" agents.
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Affiliation(s)
- Guido Cavaletti
- Experimental Neurology Unit and Milan Center for Neuroscience, Department of Surgery and Translational Medicine, University of Milano-Bicocca, Monza, Italy
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Measuring vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia. Cancer Nurs 2014; 36:E49-60. [PMID: 23842524 DOI: 10.1097/ncc.0b013e318299ad23] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Vincristine-induced peripheral neuropathy (VIPN) is difficult to quantify in children. OBJECTIVE The study objective was to examine the reliability, validity, and clinical feasibility of several VIPN measures for use in children with acute lymphoblastic leukemia. INTERVENTIONS/METHODS Children (n = 65) aged 1 to 18 years receiving vincristine at 4 academic centers participated in the study. Baseline and pre-vincristine administration VIPN assessments were obtained using the Total Neuropathy Score-Pediatric Vincristine (TNS©-PV), the National Cancer Institute Common Terminology Criteria for Adverse Events, the Balis grading scale, and the FACES Pain Scale. The TNS-PV scores (n = 806) were obtained over 15 weeks. Blood was obtained at several time points to quantify pharmacokinetic parameters. RESULTS Cronbach's α for a reduced TNS-PV scale was .84. The TNS-PV scores correlated with cumulative vincristine dosage (r = 0.53, P = 0.01), pharmacokinetic parameters (r = 0.41, P = 0.05), and grading scale scores (r range = 0.46-0.52, P = .01). FACES scores correlated with the TNS-PV neuropathic pain item (r = 0.48; P = .01) and were attainable in all ages. A 2-item V-Rex score (vibration and reflex items) was the most responsive to change (effect size = 0.65, P < 0.001). The TNS-PV scores were attainable in 95% of children 6 years or older. CONCLUSIONS The TNS-PV is reliable and valid for measuring VIPN. It is sensitive to change over time (15 weeks) and feasible for use in children 6 years or older. IMPLICATIONS FOR PRACTICE The TNS-PV may be a useful tool for assessing vincristine toxicity in children with acute lymphoblastic leukemia.
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da Silva Simão DA, Teixeira AL, Souza RS, de Paula Lima EDR. Evaluation of the Semmes-Weinstein filaments and a questionnaire to assess chemotherapy-induced peripheral neuropathy. Support Care Cancer 2014; 22:2767-73. [PMID: 24811218 DOI: 10.1007/s00520-014-2275-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 04/28/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aims to assess the use of Semmes-Weinstein monofilaments (SWMs) and of the Chemotherapy-Induced Neurotoxicity Questionnaire (CINQ) in the detection of chemotherapy-induced peripheral neuropathy (CIPN). METHOD It is a comparative and cross-sectional study performed in a philanthropic general hospital, located in the state of Minas Gerais, Brazil. One hundred seventeen individuals have participated in this study; they were divided into two groups: patients (n = 87) treated with oxaliplatin, paclitaxel, or docetaxel and controls (n = 30) without malignant disease. RESULTS There were statistically significant differences between groups for all symptoms assessed by means of the CINQ. Lower limbs were more severely affected. Patients had increased frequency and severity of changes in all points assessed with SWM compared with controls. In the analyses of concordance between CINQ and SWM, kappa = 0.320 (p < 0.001) was obtained, and there was a moderate and positive correlation (ρ = 0.357; p < 0.001). CONCLUSION CINQ and SWM may be valid tools for diagnosing CIPN in oncology practice. SWM may identify subclinical CIPN.
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Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg MB, Paice J, Schneider B, Smith ML, Smith T, Terstriep S, Wagner-Johnston N, Bak K, Loprinzi CL. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2014; 32:1941-67. [PMID: 24733808 DOI: 10.1200/jco.2013.54.0914] [Citation(s) in RCA: 775] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To provide evidence-based guidance on the optimum prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathies (CIPN) in adult cancer survivors. METHODS A systematic literature search identified relevant, randomized controlled trials (RCTs) for the treatment of CIPN. Primary outcomes included incidence and severity of neuropathy as measured by neurophysiologic changes, patient-reported outcomes, and quality of life. RESULTS A total of 48 RCTs met eligibility criteria and comprise the evidentiary basis for the recommendations. Trials tended to be small and heterogeneous, many with insufficient sample sizes to detect clinically important differences in outcomes. Primary outcomes varied across the trials, and in most cases, studies were not directly comparable because of different outcomes, measurements, and instruments used at different time points. The strength of the recommendations is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. RECOMMENDATIONS On the basis of the paucity of high-quality, consistent evidence, there are no agents recommended for the prevention of CIPN. With regard to the treatment of existing CIPN, the best available data support a moderate recommendation for treatment with duloxetine. Although the CIPN trials are inconclusive regarding tricyclic antidepressants (such as nortriptyline), gabapentin, and a compounded topical gel containing baclofen, amitriptyline HCL, and ketamine, these agents may be offered on the basis of data supporting their utility in other neuropathic pain conditions given the limited other CIPN treatment options. Further research on these agents is warranted.
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Affiliation(s)
- Dawn L Hershman
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Christina Lacchetti
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Robert H Dworkin
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Ellen M Lavoie Smith
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Jonathan Bleeker
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Guido Cavaletti
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Cynthia Chauhan
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Patrick Gavin
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Antoinette Lavino
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Maryam B Lustberg
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Judith Paice
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Bryan Schneider
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Mary Lou Smith
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Tom Smith
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Shelby Terstriep
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Nina Wagner-Johnston
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Kate Bak
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
| | - Charles L Loprinzi
- Dawn Hershman, Columbia University Medical Center, New York; Robert Dworkin, University of Rochester, Rochester, NY; Christina Lacchetti and Kate Bak, American Society of Clinical Oncology, Alexandria, VA; Ellen M. Lavoie Smith, University of Michigan, Ann Arbor; Patrick Gavin, Marne, MI; Jonathan Bleeker, Sanford University of South Dakota Medical Center, Sioux Falls, SD; Guido Cavaletti, University of Milano-Bicocca, Monza, Italy; Cynthia Chauhan, Wichita, KS; Antoinette Lavino, Massachusetts General North Shore Cancer Center, Danvers, MA; Maryam Lustberg, Ohio State University, Columbus, OH; Judith Paice, Northwestern University, Chicago, IL; Bryan Schneider, Indiana University, Indianapolis, IN; Mary Lou Smith, Research Advocacy Network, Plano, TX; Tom Smith, Johns Hopkins, Baltimore, MD; Shelby Terstriep, Sanford Health, Fargo, ND; Nina Wagner-Johnston, Washington University, St Louis, MO; and Charles Loprinzi, Mayo Clinic, Rochester, MN
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Relationship between Quality of Life and Nurse-led Bedside Symptom Evaluations in Patients with Chemotherapy-induced Peripheral Neuropathy. Asian Nurs Res (Korean Soc Nurs Sci) 2014; 8:36-41. [DOI: 10.1016/j.anr.2013.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/23/2013] [Accepted: 10/28/2013] [Indexed: 11/18/2022] Open
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Smith EML. Current methods for the assessment and management of taxane-related neuropathy. Clin J Oncol Nurs 2013; 17 Suppl:22-34. [PMID: 23360700 DOI: 10.1188/13.cjon.s1.22-34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Taxane-induced peripheral neuropathy (TIPN) affects a number of patients with breast cancer. To properly manage these patients, nurses must be able to identify and assess TIPN, as well as educate patients on TIPN as a side effect of taxane therapy. This article provides practical suggestions regarding how nurses can incorporate clinically feasible measurement approaches into practice and includes examples of grading TIPN that illustrate the limitations of the current tools and techniques for assessment. For example, a shortened and revised version of the Total Neuropathy Score and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale should be considered for future use. In addition, neuropathy-related results from numerous phase III trials in breast cancer are discussed, and the latest evidence regarding pharmacologic interventions for TIPN is briefly summarized.
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Comparison of two chemotherapy-induced peripheral neuropathy measurement approaches in children. Support Care Cancer 2013; 22:359-66. [PMID: 24072474 DOI: 10.1007/s00520-013-1981-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of cancer treatment in children; however, measurement of CIPN has been hampered by limitations in available tools, which may impact prevalence estimates. The purpose of this study was to assess the relative ability of the Common Terminology Criteria (CTCAE) rating process to detect sensory and motor neuropathy as compared to administration of the pediatric modified Total Neuropathy Score (peds-mTNS). METHODS The ped-mTNS was administered to 60 children/adolescents ages 5-18 undergoing treatment for acute lymphocytic leukemia, lymphoma, or non-CNS solid tumors. CTCAE v3.0 scores for the same time point were abstracted from the medical record by a separate trained rater. Comparisons were made between scores using descriptive statistics, correlations, and specificity and sensitivity calculations. RESULTS The median ped-mTNS score was 9 (32 possible), while the median sensory and motor CTCAE ratings were 0 and 2, respectively (4 and 5 possible, respectively). There was no correlation between ped-mTNS and combined sensory and motor CTCAE scores. The only ped-mTNS item with significant correlation to CTCAE scoring was strength testing. Medical record abstraction of CTCAE scores failed to identify sensory neuropathy in 40 % and significant motor neuropathy (manual muscle test grade 3 or worse) in 15 % of subjects. CONCLUSIONS Prospective measures of CIPN using the ped-mTNS identified a far greater proportion of subjects with peripheral neurotoxicity as compared to CTCAE v3.0 sensory and motor neuropathy ratings, and thus we recommend the use of a specific measure of CIPN such as the ped-mTNS.
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Smith EML, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Fadul CE, Knox C, Le-Lindqwister N, Gilman PB, Shapiro CL. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA 2013; 309:1359-67. [PMID: 23549581 PMCID: PMC3912515 DOI: 10.1001/jama.2013.2813] [Citation(s) in RCA: 642] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE There are no known effective treatments for painful chemotherapy-induced peripheral neuropathy. OBJECTIVE To determine the effect of duloxetine, 60 mg daily, on average pain severity. DESIGN, SETTING, AND PATIENTS Randomized, double-blind, placebo-controlled crossover trial at 8 National Cancer Institute (NCI)-funded cooperative research networks that enrolled 231 patients who were 25 years or older being treated at community and academic settings between April 2008 and March 2011. Study follow-up was completed July 2012. Stratified by chemotherapeutic drug and comorbid pain risk, patients were randomized to receive either duloxetine followed by placebo or placebo followed by duloxetine. Eligibility required that patients have grade 1 or higher sensory neuropathy according to the NCI Common Terminology Criteria for Adverse Events and at least 4 on a scale of 0 to 10, representing average chemotherapy-induced pain, after paclitaxel, other taxane, or oxaliplatin treatment. INTERVENTIONS The initial treatment consisted of taking 1 capsule daily of either 30 mg of duloxetine or placebo for the first week and 2 capsules of either 30 mg of duloxetine or placebo daily for 4 additional weeks. MAIN OUTCOME MEASURES The primary hypothesis was that duloxetine would be more effective than placebo in decreasing chemotherapy-induced peripheral neuropathic pain. Pain severity was assessed using the Brief Pain Inventory-Short Form "average pain" item with 0 representing no pain and 10 representing as bad as can be imagined. RESULTS Individuals receiving duloxetine as their initial 5-week treatment reported a mean decrease in average pain of 1.06 (95% CI, 0.72-1.40) vs 0.34 (95% CI, 0.01-0.66) among those who received placebo (P = .003; effect size, 0.513). The observed mean difference in the average pain score between duloxetine and placebo was 0.73 (95% CI, 0.26-1.20). Fifty-nine percent of those initially receiving duloxetine vs 38% of those initially receiving placebo reported decreased pain of any amount. CONCLUSION AND RELEVANCE Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00489411.
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Kim JH, Lee KM, Jeon MJ, Seol ME, Lee SH, Park J. Symptom and Interference of Activities of Daily Living of Chemotherapy-Induced Peripheral Neuropathy in Patients Receiving Taxanes and Platinums. ASIAN ONCOLOGY NURSING 2013. [DOI: 10.5388/aon.2013.13.3.145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jeong Hye Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Kyoung Min Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Mi Jin Jeon
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Mi Ee Seol
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Soon Haeng Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
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