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.

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.

Valoración del riesgo de neuropatía periférica diabética: diseño y validación del procedimiento para cribado enfermero NeuDiaCan / Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure

Objetivo: Diseñar y validar un procedimiento enfermero de cribado de la neuropatía periférica diabética en atención primaria. Método: El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente. 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras. 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera. Resultados: El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, la validez de criterio y la validez predictiva alcanzaron valores aceptables. Conclusiones: NeuDiaCan como procedimiento de cribado enfermero de la neuropatía periférica diabética en atención primaria resulta válido, fiable y de fácil empleo

Objective: To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. Methods: The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. Results: The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. Conclusions: NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use

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.

[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.

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.

Catéter central de inserción periférica. Complicaciones en pacientes neurológicos / Complications of the picc in neurologic patients of the hospital Ramon y Cajal

Se abordan, a través de un estudio descriptivo, las complicaciones derivadas del uso del PICC (Peripherally Inserted Central Catheter / catéter central de inserción periférica) en una muestra de pacientes ingresados en la Unidad de Neurocirugía del Hospital Ramón y Cajal. Tras recopilar y analizar la información acerca del sexo y edad de los pacientes, indicación de implantación del PICC, grosor del mismo, días de permanencia hospitalaria, complicaciones encontradas, causa de retirada del catéter, y fecha de implantación y retirada del mismo, no se han encontrado complicaciones significativas derivadas de su uso. Este hecho demuestra que el PICC es un sistema seguro y viable para la administración de tratamiento intravenoso de larga duración y para cuyo uso cada vez está más capacitado el personal de enfermería. Estas circunstancias permiten la administración de un tratamiento intravenoso preservando la anatomía vascular del paciente, cumpliendo, de este modo, con la finalidad de todo catéter de larga duración(AU)

Descriptive study focused on the complications arising from the use of the PICC (peripherally inserted central catheter) in a sample of patients admitted to the neurology unit of the «Hospital Ramón y Cajal».After collecting and analyzing the information about the sex and age of the patients, indication of implantation of the PICC, thickness of the same, days of permanence, complications found, cause of withdrawal of the catheter, and date of introduction and removal of the same, we not found significant complications arising from the use of the same. PICC is a safe and viable system for the administration of intravenous treatment of long duration and nursing personnel is more qualified for which. This allows the administration of intravenous treatment while preserving the vascular anatomy of the patient, that is the purpose of all long-term catheters (AU)

Measuring vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia.

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.

[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.

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.

The relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among Israeli inpatients with cancer.

PURPOSE/OBJECTIVES: To examine the relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among inpatients with cancer. DESIGN: A descriptive, correlational, comparative design. SETTING: The oncology inpatient unit of a teaching hospital. SAMPLE: A convenience sample of 82 hospitalized patients. METHODS: Patients completed the Pittsburgh Sleep Quality Index (PSQI)-Home questionnaire, the MD Anderson Symptom Inventory (MDASI), and a demographic data information instrument within 72 hours of admission. Patients hospitalized for 10 days or more completed the PSQI-Hospitalization questionnaire and the MDASI. MAIN RESEARCH VARIABLES: Sleep disturbance, symptom severity, symptom interference, and hospitalization. FINDINGS: Although sleep disturbance scores were high at home and during hospitalization, the use of sleeping medication received the lowest score in the PSQI. Patients who were hospitalized for 10 days or more had significantly higher global PSQI scores at home than after being hospitalized for 10 days or more. A significant relationship was noted between global PSQI scores at home and symptom severity total mean scores, with the symptoms of numbness and tingling demonstrating the greatest correlation with sleep disturbance. A tendency existed for a significant relationship between global PSQI scores at hospital and symptom severity total mean scores. The symptom with the greatest correlation with global PSQI scores at hospital was sadness, followed closely by remembering. The interference items with the greatest correlation to global PSQI scores at hospital were patient's enjoyment of life, mood, and relations with others. CONCLUSIONS: Sleep disturbance was less of a problem for patients during their hospitalization than at home. Unlike other studies, numbness was found to be the symptom most closely correlated to sleep disturbance. IMPLICATIONS FOR NURSING: Additional investigation should be conducted to identify the factors that influence sleep disturbances in patients with cancer at home and the relationship between sleep disturbance and numbness and tingling.

Peripheral neuropathy: evidence-based treatment of a complex disorder.

Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat.

Bortezomib-induced peripheral neuropathy in patients with multiple myeloma.

Bortezomib-induced peripheral neuropathy (BIPN) often is difficult to manage or reverse once it occurs. Treatment usually involves dose-reduction, interruption, or cessation of therapy, as no other interventions have been proven effective. Oncology nurses must be vigilant and recognize BIPN early to prevent patients from experiencing symptoms and complications that may interfere with their quality of life.

Chemotherapy-induced peripheral neuropathy: assessment of oncology nurses' knowledge and practice.

PURPOSE/OBJECTIVES: To explore oncology nurses' practice behaviors and knowledge of chemotherapy-induced peripheral neuropathy (CIPN) in the assessment of patients with cancer. DESIGN: Cross-sectional, exploratory. SETTING: Two hospital-based outpatient chemotherapy clinics in Baltimore, MD. SAMPLE: Self-selected convenience sample of 39 oncology nurses. METHODS: Completion of the principal investigator-developed questionnaire consisting of 16 knowledge and 16 practice-behavior items, 8 instruction and perception items, and a 9-item demographic survey. MAIN RESEARCH VARIABLES: CIPN assessment practice behaviors and knowledge; tool reliability. FINDINGS: The mean CIPN knowledge score of 12.6 (SD=1.7) demonstrated knowledge deficits (maximum score of 16). All respondents indicated CIPN assessment is essential in their oncology role, but 75% rated their CIPN assessment skills as fair to poor. Assessment practices did not routinely include neurologic physical assessment. In addition, 82% believed CIPN is a significant problem for patients. Cronbach alpha for the tool was 0.84. CONCLUSIONS: Results indicated participants had knowledge deficits pertaining to CIPN and lacked training, proficiency, and confidence in neurologic physical assessment. Education and training programs are needed to improve knowledge and neurologic assessment skills. IMPLICATIONS FOR NURSING: To date, CIPN nursing assessment guidelines do not exist. Practice guidelines for CIPN nursing assessment and management should be efficient and appropriate to the role of the chemotherapy infusion oncology nurse working in a busy setting where chair turnover time, accuracy, safety, and quality service are competing priorities.

Peripheral neuropathy in patients with gynecologic cancer receiving chemotherapy: patient reports and provider assessments.

PURPOSE/OBJECTIVES: To analyze the incidence of chemotherapy-induced neuropathy in a set of patients with gynecologic cancer who were treated with known neurotoxic agents, to identify correlative factors related to patients' experience of neuropathy, and to analyze providers' assessment and treatment of neuropathy. DESIGN: Observational descriptive study of patient-reported neuropathy using a retrospective chart analysis. SETTING: A hospital-based outpatient infusion center in the southeastern United States. SAMPLE: A convenience sample of 171 patients with gynecologic cancer for a total of 302 chemotherapy treatments. METHODS: A mixed model and compound symmetry covariance matrix was used to adjust for correlations between neuropathy treatment scores and patients who completed more than one chemotherapy cycle. Backward elimination method was used to determine the final model. MAIN RESEARCH VARIABLES: Functional Assessment of Cancer Treatment/Gynecologic Oncology Group-Neuropathy Treatment scores, patients' demographic information, past medical history, and chemotherapy history. FINDINGS: Patients who were physically shorter and heavier than the average population had the highest rating of neuropathy. Patients who were treated with nontaxane and platinum therapies had less neuropathy than patients who were treated with first-line taxanes and platinums. Neuropathy was noted by providers early in the course of treatment, and providers' grading was consistent with the patients' scoring. CONCLUSIONS: First-line treatments for gynecologic malignancies resulted in the highest neuropathy scores; however, patients who had received previous treatment with taxane and platinum therapies had lower neuropathy scores than patients currently receiving taxanes and platinums, suggesting that neuropathy improved after completion of first-line therapy and that second-line therapies were not necessarily correlative with worsening scores. IMPLICATIONS FOR NURSING: Nurses must educate patients about symptoms of neuropathy and the need to report symptoms. Nurses must recognize patients at highest risk for neuropathy and advocate use of validated assessment tools.