[Nursing care of chemotherapy-induced peripheral neuropathy].

Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse event occurring in patients who receive neurotoxic chemotherapeutic agents such as taxanes, platinum, and vinca alkaloids. The manifestations of CIPN include intolerable symmetric numbness, burning and tingling in distal limbs, disruption of daily functions, reduced quality of life, and the reduction in dosage or discontinued use of these agents. There is a paucity of articles on nursing care related to CIPN in the literature. This article reviews the pathophysiology, clinical presentation, diagnostic criteria, medical management and nursing care of CIPN. Review findings are intended to help nurses identify high-risk groups in order to implement preventive measures that strengthen the muscles, train the balance, and initiate falling precautions of persons in this population. Timely preventive measures may effectively alleviate CIPN symptoms and assure the safety and overall quality of life of patients.

Exploring Chemotherapy-Induced Peripheral Neuropathy Management Practice Patterns Among Oncology Clinicians.

OBJECTIVES: Approximately 60% of cancer survivors receiving neurotoxic chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN) (eg, hand and foot numbness, tingling, or pain). There is only one recommended pharmacological treatment (duloxetine) and one modestly beneficial nonpharmacological treatment (exercise) for CIPN. However, data suggest national guideline recommendations are not routinely practiced. Further, less is known about nurses' CIPN management practices. The purpose of this convergent mixed methods study was to explore oncology clinicians' self-reported practices and perceptions regarding CIPN prevention and management. METHODS: Oncology clinicians at three cancer centers completed a survey about their recommendations for CIPN prevention and management in practice. A subset of clinicians also participated in a semi-structured interview to explore their perspectives of and motivations for implementing CIPN assessment, prevention, and management in practice. Quantitative data were described (eg, frequency or median) and qualitative data were analyzed using inductive content analysis. RESULTS: This study (N = 44 survey responses; n = 9 interviews) resulted in four themes: (1) clinicians primarily recommend gabapentin for CIPN management and often observe cryotherapy used for CIPN prevention, but these interventions are complicated by discomfort, intolerable side effects, and efficacy concerns; (2) clinicians perceive CIPN as troublesome and desire additional information and resources regarding CIPN prevention and management; (3) CIPN-related education provided by clinicians may be limited by patient retention of the amount of education received about cancer treatment and other factors; (4) clinicians use subjective CIPN assessment to screen at each visit for common CIPN symptoms (eg, numbness or tingling) and the impact of symptoms on day-to-day activities. CONCLUSIONS: Discrepancies persist between evidence-based guidelines on CIPN management and current oncology clinician practices. IMPLICATIONS FOR NURSING PRACTICE: Clinician involvement is needed when developing education and resources to help oncology clinicians provide the most evidence-based care to potentially prevent and manage their patients' CIPN.

[Preventive trial of preheating administration of oxaliplatin-diluted solution in combination with a hot compress for oxaliplatin-induced venous pain].

Venous pain induced by oxaliplatin (L-OHP) is a clinical problem in relation to adherence in the CapeOX regimen. We investigated the preventive effect of nursing care preheating administration of L-OHP a hot compress for colorectal cancer patients who received L-OHP via the peripheral venous route between January 2010 and January 2011. L-OHP was diluted in 500 mL of 5% glucose and administered by 2 hours. We evaluated a total of 64 courses among fifteen patients. The presence of any symptoms, any pain with or without touch, and some symptoms of numbness at the L-OHP-administered arm were defined as phlebitis, venous pain, and acute peripheral neuropathy, respectively. The prevalence of phlebitis, venous pain, and acute peripheral neuropathy in the nursing care group was 56.5%, 32.6%, and 25.8%, respectively, which was not significantly less in comparison with the control group (72.2%, 38.9%, and 54.5%, respectively). These results suggest that both types of nursing care, preheating administration and a hot compress, may be effective for the relief of acute peripheral neuropathy induced by L-OHP.

CE: Chemotherapy-Induced Peripheral Neuropathy.

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

Peripheral neuropathy associated with novel therapies in patients with multiple myeloma: consensus statement of the IMF Nurse Leadership Board.

The novel therapies thalidomide and bortezomib can cause peripheral neuropathy, a challenging adverse event that can affect quality of life and compromise optimal treatment for patients with multiple myeloma. At baseline, patients should be evaluated for signs and symptoms of peripheral neuropathy with a neurotoxicity assessment tool and educated about the symptoms and the importance of reporting them. Signs, symptoms, and the ability to perform activities of daily living should be evaluated regularly so that appropriate interventions can be employed if necessary. Specific management strategies for peripheral neuropathy are based on the grade of severity and on signs and symptoms; strategies include dose and schedule modifications, pharmacologic interventions, nonpharmacologic approaches, and patient education.

Brentuximab Vedotin: A Nursing Perspective on Best Practices and Management of Associated Adverse Events.

BACKGROUND: Brentuximab vedotin (BV) is an antibody-drug conjugate that targets CD30-expressing cells. OBJECTIVES: This article assesses the occurrence and management of the most frequent and clinically relevant BV-associated adverse events (AEs), with a focus on Hodgkin lymphoma and systemic anaplastic large cell lymphoma trials, and shares practical tips that may help decrease occurrence and severity. METHODS: Peer-reviewed literature was surveyed to collect safety data from sponsored clinical trials of BV and to compile associated management guidelines. FINDINGS: Peripheral neuropathy was the most common BV-associated AE across clinical trials. Other clinically relevant AEs included neutropenia, infection, and infusion-related reactions. Awareness of and preparedness for these common BV-associated AEs and other less common but significant AEs will help nurse clinicians and patients maximize the clinical benefit for patients receiving BV.

Assessment Tools for Peripheral Neuropathy in Pediatric Oncology: A Systematic Review From the Children's Oncology Group.

Peripheral neuropathy is a known side effect of several chemotherapy agents, including vinca alkaloids and platinum-based chemotherapy. Early recognition and monitoring of this side effect is an important role of the pediatric oncology nurse. There are a variety of peripheral neuropathy assessment tools currently in use, but the usefulness of these tools in identifying and grading neuropathy in children varies, and there is currently no standardized tool in place to evaluate peripheral neuropathy in pediatric oncology. A systematic review was performed to identify the peripheral neuropathy assessment tools that best evaluate the early onset and progression of peripheral neuropathy in pediatric patients receiving vincristine. Because of the limited information available in pediatric oncology, this review was extended to any pediatric patient with neuropathy. A total of 8 studies were included in the evidence synthesis. Based on available evidence, the pediatric-modified Total Neuropathy Scale (ped-m TNS) and the Total Neuropathy Score-pediatric version (TNS-PV) are recommended for the assessment of vincristine-induced peripheral neuropathy in children 6 years of age and older. In addition, several studies demonstrated that subjective symptoms alone are not adequate to assess for vincristine-induced peripheral neuropathy. Nursing assessment of peripheral neuropathy should be an integral and regular part of patient care throughout the course of chemotherapy treatment.

The processes by which persons with HIV-related peripheral neuropathy manage their symptoms: a qualitative study.

A variety of peripheral neuropathies occur throughout the course of HIV infection, with the most common peripheral nerve disorder of late HIV infection being distal symmetrical peripheral neuropathy (DSPN). Current management strategies often fail to achieve satisfactory pain relief. This study was designed to explore the everyday life experiences related to DSPN in persons with AIDS (PWAs) and the behaviors they initiate to alleviate the symptoms. A qualitative study using a grounded theory approach was used to better understand the impact DSPN has on PWAs. Many interventions were attempted and were ineffective; the effective ones were highly individualized. Emerging themes in the delimiting debilitation continuum included isolating the symptom cluster, inventing and testing interventions, and assimilating the annoyance. Results indicated a need for better DSPN assessment by nurses and teaching strategy development to manage the symptoms, and development of strategies to combat functional DSPN disabilities.

Peripheral neuropathy related to chemotherapy.

OBJECTIVES: To review the evidence base for prevention and intervention of chemotherapy-induced peripheral neuropathy (PN). DATA SOURCES: Medical and nursing literature. CONCLUSION: Many small studies that reported positive findings have either not been validated in large prospective, randomized controlled trials (RCT), or have not been further studied. Prevention strategies based on RCTs include the use of xaliproden to reduce the incidence of grade 3 PN in patients receiving oxaliplatin-based regimens, and dose reduction or interruption until recovery. There are gaps in the literature of nurse-sensitive outcome studies for nursing assessment and intervention IMPLICATIONS FOR NURSING PRACTICE: Nurses need to be knowledgeable about the evidence, or lack of it, on strategies to prevent and manage chemotherapy-induced PN. Nurses also need to measure the effectiveness of interventions for PN, such as exercise, patient teaching about self-care strategies, and develop and/or participate in well-designed intervention studies regarding the prevention and management of PN.

HIV-associated distal symmetrical polyneuropathy: clinical features and nursing management.

DSPN is a common manifestation of HIV infection and/or its treatment that can have adverse effects on quality of life and functional status. The pathogenesis remains unclear but likely involves the elaboration of neurotoxic inflammatory cytokines and their metabolites. DSPN is often refractory to available pharmacological treatments, although new treatments involving NGF hold promise for effecting sustained symptom relief and reversing axonal degeneration. Further research is needed to determine the efficacy of nonpharmacological treatments, such as cognitive-behavioral therapies, to alleviate DSPN-associated pain.

Quality improvement of painful peripheral neuropathy.

OBJECTIVES: To use quality improvement methodology to improve the assessment and treatment of neuropathic pain caused by chemotherapy-related nerve injury. DATA SOURCES: Review and research articles, assessment scales, and textbooks. CONCLUSIONS: Assessment and treatment algorithms improved peripheral neuropathy-related pain scores. Patient satisfaction with medication effectiveness decreased over time. Medication costs increased, but specialist-referral costs decreased. IMPLICATIONS FOR NURSING PRACTICE: Nurse-led quality improvement work can lead to positive changes in clinical practice.

Assessment of peripheral neuropathy in the diabetic foot.

Peripheral neuropathy is associated with major morbidity in the diabetic population. The detection of whether peripheral neuropathy is simply present or not in patients with diabetes is insufficient. What is required is a reliable measure of both the extent and severity of neuropathy, as this enables the appropriate allocation of resources and improves the quality of care for the patients who need it most. Standardized approaches involving the use of a neurothesiometer and a 10 g monofilament can provide a reliable and objective measure of the extent and severity of neuropathy, and should therefore be adopted into protocols for best practice in the assessment of neuropathy.

Peripheral neurologic complications and the human immunodeficiency virus: implications for community nursing care.

Increasingly, home healthcare nurses will be called on to assist HIV-infected clients to manage as independently as possible within their homes. Familiarity with the neurologic manifestations of HIV is vital to assessing, planning, and implementing effective nursing care.

Nursing knowledge, practice patterns, and learning preferences regarding chemotherapy-induced peripheral neuropathy.

PURPOSE/OBJECTIVES: To explore nurses' practice patterns, knowledge, and barriers related to chemotherapy-induced peripheral neuropathy (CIPN). DESIGN: Descriptive, cross-sectional. SETTING: The United States. SAMPLE: 408 oncology nurses. METHODS: A team of eight experts met and developed the CIPN nurse knowledge and preferences survey, which was electronically sent to randomly selected nurses. MAIN RESEARCH VARIABLES: The survey assessed nurses' knowledge and practice patterns regarding assessment strategies and barriers, evidence-based interventions, preferences for education, and perceived gaps in scientific knowledge. FINDINGS: Nurses in the survey lacked knowledge regarding neurotoxicity of specific agents and evidence-based treatments. CIPN-focused physical examinations and standardized measurement tools were infrequently used during assessment. The most frequently reported barriers to CIPN assessment included lack of access to measurement tools, lack of specialized skills needed for assessment, lack of confidence, and lack of time. Recommendations for future research included CIPN prevention research, exploration of CIPN-related effects on quality of life, and alternative treatments of CIPN. The majority of participants preferred online educational opportunities. CONCLUSIONS: Nurses do not consistently integrate evaluation and management of CIPN in their practices. IMPLICATIONS FOR NURSING: Educational offerings should incorporate web-based CIPN assessment and management content.

Chemotherapy-induced peripheral neuropathy: an algorithm to guide nursing management.

Oncology nurses play a critical role in the assessment and management of chemotherapy-induced peripheral neuropathy (CIPN). Baseline and ongoing evaluation of physical function is a critical but often overlooked aspect of assessment of CIPN. The diversity of symptoms and the complexity associated with neuromuscular assessment lead to challenges in evaluation and management of CIPN. To meet this challenge, the authors devised a feasible algorithm to guide oncology nurses in the assessment and management of CIPN using techniques that can easily be implemented in a variety of clinical settings. Managing pain, maintaining safety, and maximizing physical function are the primary goals for nursing management of CIPN.

Neurological complications associated with HIV and AIDS: clinical implications for nursing.

This article provides a clinical nursing update on major neurological complications associated with HIV and AIDS. Life expectancy for those with AIDS has increased as a consequence of antiretroviral therapy, and thus, neurological complications remain a clinical challenge. Four significant diseases associated with HIV and AIDS are addressed: HIV-associated dementia, peripheral neuropathy, cryptococcal meningitis, and toxoplasmosis. Updated statistics, a review of pathophysiology, common manifestations, diagnostic tests, and standard treatments are discussed for each disease. Nursing considerations when caring for this population are reviewed and include assessment, safety, activities of daily living, pain management, and treatment adherence.