| Description |
Taxanes are commonly used chemotherapeutics in women with breast and ovarian cancer. As microtubule stabilizing agents they can be neurotoxic, leading to numbness, tingling, and pain in hands and feet. The symptoms usually start in the fingers and toes and can slowly progress along the extremities. In addition to their sensory effects, taxanes can also lead to muscle weakness, increasing the risks of falls, and effecting fine motor skills (Jaggi & Singh, 2012). Taxane induced peripheral neuropathy (TIPN) can persist for a long time after cessation of chemotherapy and increases the risk of developing chronic neuropathic pain by threefold (Reyes-Gibby, Morrow, Buzdar & Shete, 2009; Nurgalieva et al., 2010). More women are becoming long-time survivors of breast cancer, and often have to deal with side effects and squeals of multiple chemotherapy regimens. The lack of effective preventive or therapeutic measures for TIPN warrants a thorough clinical assessment in order to minimize long-lasting effects on the quality of life of these cancer survivors (Park et al., 2013). The incidence of TIPN varies widely (between 1-83%), supporting the notion that better diagnostic tools are needed to improve the accuracy of diagnosis. TIPN is frequently graded with the Common Terminology Criteria for Adverse Events of the National Cancer Institute (NCI CTCAE). Griffith, Merkier, Hill & Cornblath (2010) demonstrated low inter-rater reliability and sensitivity of the NCI CTCAE for TIPN, suggesting that more reliable and standardized testing is needed. Implementing a standardized assessment of TIPN with scoring of subjective and objective measures could help quantify TIPN during and after taxane containing chemotherapy. The shortened and revised Total Neuropathy Score (TNSrs) is a reliable and validated tool for measuring TIPN (Calavetti et al., 2010). It measures the distribution of tingling, numbness and pain along the extremities and tests for vibration sensitivity and reflex status. The FACT/GOG-Ntx (Functional Assessment of Cancer Treatment from the Gynecological Oncology Group Neurotoxicity subscale) is one example of a validated and reliable patient self-reported questionnaire, and adds critical information about the effects of TIPN on the quality of life (Huang, Brady, Cella & Fleming, 2007). The overall goal of this pilot project is improvement in the diagnosis of TIPN in women receiving taxane containing chemotherapy at the Huntsman Cancer Institute (HCI). The project will determine satisfaction with and effectiveness of two validated and reliable tools for TIPN assessment, and test their feasibility in a clinical setting at the HCI infusion center. The objectives for this study are as follows: Increase awareness of TIPN in patients, nurses and providers Assess satisfaction with the current grading system among providers Implement two validated and reliable tools for the assessment of TIPN that will score subjective and objective measures (vibration threshold, reflexes) Evaluate reactions of patients, nurses and providers on the effectiveness, applicability and satisfaction of aforementioned tools. Patients, nurses and providers were surveyed about their satisfaction with the new TIPN assessment tools. Patients were mostly in favor of continuing the FACT/GOG-Ntx and the TNSrs either with each visit or on a monthly base. Nurses had difficulties in scoring vibration sensitivity and reflex status and the majority of nurses would not like to continue this assessment. Providers were mostly undecided about the value and the continuation of the TIPN testing. In conclusion improving TIPN assessment through the TNSrs and the FACT/GOG-Ntx can only be achieved through increased training of nurses in performing the TNSrs. In addition TIPN testing might be better placed at the clinical visit with the provider, allowing direct feed-back from providers in case of difficulties in scoring. Visualizing the test results during the clinical visit might persuade the physician to score neuropathy more consistently in their charting. |
