Patient‐reported and clinician‐reported chemotherapy‐induced peripheral neuropathy in patients with early breast cancer: Current clinical practice

Abstract

BACKGROUND: In the current study, the authors investigated the incidence of moderate to severe chemotherapy-induced peripheral neuropathy (CIPN) for chemotherapy regimens commonly used in current clinical practice for the treatment of patients with early breast cancer. Patient-reported and clinician-assessed CIPN severity scores were compared, and risk factors for CIPN severity were identified. METHODS: Patients completed a Patient-Reported Symptom Monitoring form and oncologists completed a Common Terminology Criteria for Adverse Events form. CIPN reports were collected prospectively during regularly scheduled infusion visits throughout the duration of chemotherapy. RESULTS: The sample included 184 women with a mean age of 55 years; approximately 73% were white. The 4 chemotherapy regimens used were doxorubicin and cyclophosphamide plus paclitaxel (60 patients); docetaxel and cyclophosphamide (50 patients); docetaxel, carboplatin, and anti-human epidermal growth factor receptor 2 (HER2) (24 patients); and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin (18 patients). All patients treated with doxorubicin and cyclophosphamide plus paclitaxel and doxorubicin and cyclophosphamide plus paclitaxel and carboplatin received paclitaxel; all patients treated with docetaxel and cyclophosphamide and docetaxel, carboplatin, and anti-HER2 received docetaxel. The chemotherapy dose was reduced in 52 patients (28%); in 15 patients (29%), this reduction was due to CIPN. Chemotherapy was discontinued in 26 patients (14%), 8 because of CIPN. Agreement between patient-reported and clinician-assessed CIPN severity scores was minimal (weighted Cohen kappa, P = .34). Patient-reported moderate to severe CIPN was higher for paclitaxel (50%) compared with docetaxel (17.7%) (P < .001). Pretreatment arthritis and/or rheumatism (relative risk [RR], 1.58; 95% CI, 1.06-2.35 [P = .023]) and regimens containing paclitaxel (RR, 2.88; 95% CI, 1.72-4.83 [P < .0001]) were associated with higher CIPN severity. Being married (RR, 0.57; 95% CI, 0.37-0.887 [P = .01]) was found to be associated with lower CIPN severity. CONCLUSIONS: The discrepancy between patient-reported and clinician-assessed CIPN underscores the need for both patient and clinician perspectives regarding this common, dose-limiting, and potentially disabling side effect of chemotherapy. Cancer 2019;125:2945-2954.

Involving patients and nurses in choosing between two validated questionnaires to identify chemotherapy‐induced peripheral neuropathy before implementing in clinical practice—A qualitative study

“…This is in accordance with Mooney, Berry, Whisenant, and Sjoberg (2017) who demonstrated that using a questionnaire may contribute to intensifying symptom care and improve quality of life among the patients (Mooney et al, 2017). However, the outcome may rely on the ability to narrow or close the gap between the patients' and the professionals' estimation and grading of symptoms, a gap which in other studies is articulated as a crucial problem (Molassiotis et al, 2019;Mooney et al, 2017;Nyrop et al, 2019).…”

“…Multiple instruments have been developed to identify CIPN but no gold standard has been established, although it is common for physicians to use the scales of National Cancer Institute-Common Terminology Criteria Adverse Events (NCI-CTCAE) in their assessments of patients' adverse events. However, comparing a clinician-based grading system like the CTCAE scale with patient-reported outcome measures shows that professionals score patients' conditions lower than patient' themselves and thus identify fewer patients with CIPN (Molassiotis et al, 2019;Nyrop et al, 2019).…”

What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence

“…School, University of New South Wales, Sydney, NSW 2217, Australia. 7 Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia. 8 Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia.…”

“…PROMs data may relate to one or multiple health-relevant domains including psychological and physical wellbeing, and be collected using a range of electronic and/or paper-based mediums [5]. Studies have identified differences between patient and clinician assessments of outcomes in oncology with regard to treatment side effects, numerous physical symptoms, as well as psychological issues, whereby oncologists only identified a small proportion of the total patients who were experiencing clinical anxiety and depression [6,7]. This discordance has not improved over the past two decades [6,7], supporting the need for patients' direct reports.…”

“…Studies have identified differences between patient and clinician assessments of outcomes in oncology with regard to treatment side effects, numerous physical symptoms, as well as psychological issues, whereby oncologists only identified a small proportion of the total patients who were experiencing clinical anxiety and depression [6,7]. This discordance has not improved over the past two decades [6,7], supporting the need for patients' direct reports. A systematic review found that PROMs may be useful in cancer care, to longitudinally monitor and respond to the impacts of treatments or symptoms on patients' lives [8].…”