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.
References
Argyriou, A., Polychronopoulos, P., Iconomou, G., Koutras, A., Kalofonos, H., & Chroni, E. (2005). Paclitaxel plus carboplatin-induced peripheral neuropathy: A prospective clinical and electrophysiological study in patients suffering from solid malignancies. Journal of Neurology, 252, 1459-1464. dx.doi.org/10.1007/s00415-005-0887-8
Bruner, D., Barsevick, A., Tian, C., Randall, M., Mannel, R., Cohn, D., … Spirtos, N. M. (2007). Randomized trial results of quality of life comparing whole abdominal radiation and combination chemotherapy in advanced endometrial carcinoma: A gynecologic oncology group study. Quality of Life Research, 1, 89-100. dx.doi.org/10.1007/s11136-006-9003-5
Calhoun, E., Fishman, D., Roland, P., Lurain, J., Chang, C., & Cella, D. (2000). Validity and selective sensitivity of the FACT/GOG-NTX [Abstract 1751]. Proceedings of the American Society of Clinical Oncology, 19, 446a. Retrieved from
http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&… http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=2&abstractID=202320Fujiwara, K., Suzuki, S., Ishikawa, H., Oda, T., Aotaniy, E., & Kohno, I. (2005). Preliminary toxicity analysis of intraperitoneal carboplatin in combination with intravenous paclitaxel chemotherapy for patients with carcinoma of the ovary, peritoneum, or fallopian tubes. International Journal of Gynecological Cancer, 15, 426-431. dx.doi.org/10.1111/j.1525-1438.2005.15304.x
Lenz, E., Pugh, L., Miligan, R., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-27.
Littell, R., Milliken, G., Stroup, W., & Wolfinger, R. (1996). SAS system for mixed models. Cary, NC: SAS Institute, Inc.
Martino, M., Miller, E., & Grendys, E. (2005). The administration of chemotherapy in a patient with Charcot-Marie tooth and ovarian cancer. Gynecologic Oncology, 97, 710-712. dx.doi.org/10.1016/j.ygyno.2005.01.017
Pan, Y., & Kao, M. (2007). Discordance of clinical symptoms and electrophysical findings in taxane plus platinum-induced neuropathy. International Journal of Gynecological Cancer, 17, 394-397. dx.doi.org/10.1111/j.1525-1438.2006.00766.x
Pignata, S., De Placido, S., Biamonte, R., Scambia, G., Di Vagno, G., Colucci, G., … Perrone, F. (2006). Residual neurotoxicity in ovarian cancer patients in clinical remission after first-line chemotherapy with carboplatin and paclitaxel: The Multicenter Italian Trial in Ovarian Cancer retrospective study. BMC Cancer, 6(5), 1-7. dx.doi.org/10.1186/1471-2407-6-5
Vasey, P., Jayson, G., Gordon, A., Gabra, H., Coleman, R., Atkinson, R., … Kaye, S. B. (2004). Phase III randomized trial of docetaxel-carboplatin versus paclitaxel-carboplatin as first-line chemotherapy for ovarian carcinoma. Journal of the National Cancer Institute, 96, 1682-1691. dx.doi.org/10.1093/jnci/djh323
Wickham, R. (2007). Chemotherapy-induced peripheral neuropathy: A review and implications for oncology nursing. Clinical Journal of Oncology Nursing, 11, 1092-1095. dx.doi.org/10.1188/07.CJON.361-376
