Optimal clinical assessment strategies for chemotherapy-induced peripheral neuropathy (CIPN): a systematic review and Delphi survey
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Chemotherapy-induced peripheral neuropathy (CIPN) is a prominent side effect of the treatment of cancer. Despite this frequent complication, there has been no comprehensive review and quality appraisal of CIPN assessments. The purpose of this study is to provide a definitive quality appraisal of CIPN assessment strategies for clinical use.
Relevant studies were identified through database searches of Medline, Embase, CINAHL, and Cochrane. CIPN assessment strategies from included articles were extracted and initially rated by an oncologist and neurophysiologist according to criteria related to assessment depth, comprehensiveness, appropriateness, and reliability. The six highest scoring assessment strategies were the focus of a two-round Delphi survey of a working party of 32 physicians, nurses, and consumers to achieve consensus on the highest rated assessments for each criterion.
The database search yielded 117 distinct CIPN assessments that were extracted from 2373 articles. Three patient-reported outcome surveys and three clinician-based assessments were included in the Delphi survey. No consensus was generated regarding the best overall CIPN assessment, although good (≥70%) consensus was achieved regarding the best assessment within each criterion. The Participant Neurotoxicity Questionnaire (PNQ) was rated the highest overall and patient-reported outcome (PRO) assessment, while the Total Neuropathy Score clinical version (TNSc) was the highest rated clinician-based assessment.
A diverse range of CIPN assessments currently exists. While several assessments assess CIPN symptoms with adequate comprehensiveness, depth, language, and feasibility, the consensus ‘gold standard’ clinical assessment remains to be established.
KeywordsPeripheral nervous system diseases Symptom assessment Chemotherapy Neuropathy
This work was supported by a Cancer Institute NSW Translational Program Grant (14/TPG/1-05), National Health and Medical Research Council of Australia (NHMRC) project grant (#1080521), and NHMRC Program Grant (#1037746).
Special thanks to Monica O’Brien, medical librarian at UNSW Australia, for her assistance with the creation of the database search strategy and members of the IN FOCUS Delphi working party (Dr. Sally Baron-Hay, Hayley Beer, Dr. Stephen Begbie, Dr. Barbara Bennett, Dr. Adam Boyce, Professor Frances Boyle, Dr. Karen Briscoe, Dr. Carol Cheung, Keith Cox, Dr. Emma Devenney, Jo Gardiner, Dr. Nidhi Garg, Dr. Matthew George, Professor David Goldstein, Associate Professor Peter Grimison, Dr. William Huynh, Associate Professor Chris Karapetis, Professor Matthew Kiernan, Tracy King, Professor Arun Krishnan, Professor Craig Lewis, Associate Professor Cindy Lin, Dr. Rob Lindeman, Sue McCullough, Phil Mendoza-Jones, Dr. Susanna Park, Dr. Jenny Shannon, Professor Steve Vucic, Dr. Kate Webber, Carmel Woodrow, Dr. Craig Underhill, Professor Desmond Yip).
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