Title : A study to assess the severity, risk factors and quality of life of patients associated with chemotherapy-induced peripheral neuropathy with a view to formulate information booklet for self-management
Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) refers to numbness, tingling and burning sensation caused due to nerve damage by chemotherapeutic agent that can lead to impairment in overall Quality Of Life (QoL) of the patients. Various self-management strategies can be beneficial in terms of prevention and management of CIPN
Aims and Objectives: The aim of the study is to assess the severity, risk factors and quality of life of patients associated with chemotherapy-induced peripheral neuropathy and its association with selected variables.
Materials and methods: A cross sectional descriptive study was conducted at day care ward, BRAIRCH, AIIMS, New Delhi. Total of 98 patients receiving paclitaxel for ≥ 4 months were enrolled by convenient sampling. Data regarding demographic, clinical characteristics, CIPN, Risk factors and QoL were collected by structured questionnaires. Demographic profile and clinical data sheet was used to elicit details of the patients such as age, gender, educational level, marital status and current employment status and clinical variables such as Body Mass Index(BMI), Body Surface Area(BSA), ECOG performance status, cancer type, H/O radiation/surgery, current use of analgesics and information regarding chemotherapeutic agent, Standardized self-reported EORTC QLQ – CIPN20 tool was used for assessing the severity of chemotherapy induced peripheral neuropathy (CIPN), Standardized tool Total Neuropathy Score-Nurse (Modified) was used for the objective assessment of the severity of chemotherapy induced peripheral neuropathy (CIPN), Data sheet to assess the risk factors predisposing CIPN was used to elicit details on comorbid illnesses and lifestyle factors such as history of alcohol consumption, history of smoking, use of antioxidant supplements, current exercise behaviour, frequency and quantity of fruits and vegetables intake. Standardized tool FACT-GOG-Ntx was used for assessing the Quality of life of patients associated with chemotherapy induced peripheral neuropathy.
Results: The mean age (years) of the participants was 51.63±10.68 with majority (80.61%) being female. Majority (54.08%) of the patients had normal BMI, Mean body surface area of patients was found to be 1.61±0.91, Most (75.51%) of the patients belonged to PS-1.Majority (38.8%) of the patients were diagnosed with ovarian cancer. Median score of autonomic symptoms was higher as compared to sensory and motor symptoms. Majority (31.63%) had sensory symptoms limited to toes/fingers. Mean score of FACT/GOG-Ntx sub-domain was 99.05±20.87on a scale of 0-152. ECOG Performance status, current exercise behaviour and fruit and vegetable intake was found to be significantly (at p?0.05) associated with sensory, motor and autonomic symptom score. Sensory, motor and autonomic symptom scores were significantly inversely correlated (p?0.05) with almost all the sub-domains of Quality of Life (QoL) except social-well-being.
Conclusion: Chemotherapy induced peripheral neuropathy (CIPN) was found to be severe enough to cause impairment in quality of life of patients receiving paclitaxel for ≥ 4 months. The healthcare team members should stress upon dietary management, lifestyle modifications and exercises as an alternative to manage CIPN.
Specific learning experience of Audience:
• The study pertains to the oncology nurses and other healthcare personnel involved in caring for the cancer patients.
• Outcome of the study will be helpful for the physicians/medical oncologists in the way that it stresses on the periodical assessment of the patients receiving neurotoxic chemotherapeutic agents for the onset of chemotherapy induced peripheral neuropathy (CIPN) by enquiring about sign and symptoms and carrying out neurological examination at each follow up visit.
• Nurses should also encourage relatives and family members to take care of the patient by helping him in adopting constructive coping mechanism and various self-managing strategies when dealing with chemotherapy induced peripheral neuropathy (CIPN).
• Oncology nurses should use various CIPN assessment tools in their daily practice such as patient-reported questionnaires and neurological examination which will help in early detection of CIPN.
• Oncology nurse has a responsibility to explain about dietary management and lifestyle modifications to the patients at risk for developing CIPN.