Cindy Tofthagen

Falls in persons with chemotherapy-induced peripheral neuropathy

PurposeThe purpose of this study was to evaluate possible risk factors for falls in a group of patients with chemotherapy-induced peripheral neuropathy (CIPN).MethodsThis prospective, descriptive study included persons receiving paclitaxel, docetaxel, oxaliplatin, or cispatin who reported at least one symptom of CIPN. Each patient was invited to complete the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT) and a demographic data questionnaire. Data were analyzed using descriptive statistics and logistic regression.ResultsIn this sample (n = 109), fallers (n = 21) had higher doses of chemotherapy(p = 0.045), more neuropathic symptoms (p = 0.016), higher scores on the symptom experience (p = 0.005) and interference items (=0.001) on the CIPNAT, more severe muscle weakness (p < 0.001) and loss of balance (p < 0.001), and higher interference with walking(p < 0.001) and driving (p = 0.022). Patients who received taxanes were more likely to have fallen than patients who received platinum-based chemotherapy (p = 0.022). No significant differences in age or disease stage between fallers and non-fallers were present. Severity of loss of balance and cycle number was independently associated with falling.ConclusionsThis study demonstrates that the risk of falls increases with each cycle of chemotherapy and that patients receiving taxanes may be at greater risk of falls than patients receiving neurotoxic platinum-based drugs. Patients who report muscle weakness and loss of balance or say that their symptoms interfere with walking or driving may be at a higher risk of falls.

Patient Perceptions Associated With Chemotherapy-Induced Peripheral Neuropathy

Peripheral neuropathies are a common side effect of certain types of chemotherapy drugs, including taxanes, platinum-based drugs, vinca alkaloids, and thalidomide. Neuropathies may last for months or years following treatment and can impact functional performance and quality of life. The purpose of this study was to explore the effects of chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain on the lives of patients with cancer. Participants were recruited from an urban outpatient medical oncology clinic in West Central Florida. Semistructured, private interviews with 14 participants were conducted and transcripts were reviewed for symptoms and effects. Participants often had difficulty describing neuropathic symptoms but reported simultaneous pain or discomfort and loss of sensation in the upper and lower extremities. Injuries secondary to numbness, muscle weakness, and loss of balance were reported. Neuropathic symptoms interfered with many aspects of daily life and participants voiced feelings of frustration, depression, and loss of purpose as a result of having to give up enjoyable activities. The results of this study emphasize the importance of ongoing assessment and communication with patients about their experiences with peripheral neuropathies. Knowledge of what patients with CIPN experience will guide nurses in suggesting interventions to promote safety and help alleviate symptoms.

Relationships Among Pain, Sleep Disturbances, and Depressive Symptoms in Outpatients From a Comprehensive Cancer Center

PURPOSE/OBJECTIVES To describe the pain experience of outpatients with cancer and explore the relationships with sleep disturbance, depression, and patient functioning. DESIGN Descriptive, cross-sectional study. SETTING Outpatient clinics at a large comprehensive cancer center in the southeastern United States. SAMPLE 85 patients with a pain intensity level of at least 3. METHODS Secondary analysis of baseline data. MAIN RESEARCH VARIABLES Pain intensity and distress, pain interference, sleep disturbance intensity, and distress and depression. FINDINGS The sample included men and women with a mean age of 54 years and 13 years of education. Mean present pain intensity on the Brief Pain Inventory scale was 4.6; mean pain at its worst was 8.3. Mean pain intensity measured with the Memorial Symptom Assessment Scale was 2.4 and pain distress was 2.2. Pain intensity and pain distress had a strong, positive correlation. The mean interference score for the group was 42.8. More than 63% of patients reported a problem with sleep disturbance. Distress from sleep disturbance was significantly correlated with pain intensity and pain distress. Pain interference also was correlated with sleep disturbance intensity and sleep disturbance distress. Pain severity, pain distress, pain right now, and pain interference total scores all were significantly correlated with depression scores. CONCLUSIONS Patients with cancer continue to experience pain during outpatient treatment and report sleep and depressive symptoms related to it. IMPLICATIONS FOR NURSING Improvements continue to be needed in assessment and treatment of pain.

Oxaliplatin-induced peripheral neuropathy’s effects on health-related quality of life of colorectal cancer survivors

Oxaliplatin is a highly neurotoxic chemotherapeutic agent routinely used for the treatment of colorectal cancer. Recent data suggest that oxaliplatin-induced peripheral neuropathy may be long-lasting; however, the effects of persistent neuropathy on colorectal cancer survivors’ physical and emotional well-being are not well understood. This cross sectional, descriptive study included persons who had received oxaliplatin-based chemotherapy for treatment of colorectal cancer at Moffitt Cancer Center between 2003 and 2010. Questionnaires including the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool, Center for Epidemiological Studies Depression Scale (CES-D), Insomnia Severity Index, Medical Outcomes Study Short Form 36, and a demographic survey were administered. Pearson’s correlations and linear regression analyses were used to examine relationships between neuropathy and depressive symptoms, sleep quality, and health-related quality of life (HRQOL). Eighty-nine percent of participants reported at least one symptom of peripheral neuropathy with a mean of 3.8 (±2.4) neuropathic symptoms. Depressive symptoms on the CES-D were significantly associated with more severe peripheral neuropathy(r = 0.38, p = 0.0001) and interference with activities (r = 0.59, p < 0.0001). Higher degrees of sleep disturbance on the Insomnia Severity Index (ISI) were significantly associated with more severe peripheral neuropathy (r = 0.35, p = 0.0004) and interference with activities(r = 0.52, p < 0.0001). HRQOL was significantly associated with peripheral neuropathy and interference with activities.

Strength and balance training for adults with peripheral neuropathy and high risk of fall: current evidence and implications for future research

PURPOSE/OBJECTIVES To evaluate the evidence for strength- and balance-training programs in patients at high risk for falls, discuss how results of existing studies might guide clinical practice, and discuss directions for additional research. DATA SOURCES A search of PubMed and CINAHL® databases was conducted in June 2011 using the terms strength, balance training, falls, elderly, and neuropathy. Only clinical trials conducted using specific strength- or balance-training exercises that included community-dwelling adults and examined falls, fall risk, balance, and/or strength as outcome measures were included in this review. DATA SYNTHESIS One matched case-control study and two randomized, controlled studies evaluating strength and balance training in patients with diabetes-related peripheral neuropathy were identified. Eleven studies evaluating strength and balance programs in community-dwelling adults at high risk for falls were identified. CONCLUSIONS The findings from the reviewed studies provide substantial evidence to support the use of strength and balance training for older adults at risk for falls, and detail early evidence to support strength and balance training for individuals with peripheral neuropathy. IMPLICATIONS FOR NURSING The evidence demonstrates that strength and balance training is safe and effective at reducing falls and improving lower extremity strength and balance in adults aged 50 years and older at high risk for falls, including patients with diabetic peripheral neuropathy. Future studies should evaluate the effects of strength and balance training in patients with cancer, particularly individuals with chemotherapy-induced peripheral neuropathy.

Peripheral Neuropathy in Patients With Colorectal Cancer Receiving Oxaliplatin

Neuropathic side effects are commonly reported in patients receiving oxaliplatin, but little is known about the characteristics of peripheral neuropathy in this patient population. The purpose of this descriptive study was to explore the prevalence of neuropathic symptoms in patients with colorectal cancer receiving oxaliplatin as well as to explore symptom severity, distress, frequency, and neuropathic interference with activities. Thirty-three patients receiving oxaliplatin at two outpatient facilities completed the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool. Data were analyzed using descriptive statistics. Cold sensitivity, tingling in the hands, and numbness in the hands were the most prevalent neuropathic symptoms, and cold sensitivity, nerve pain, and trouble with balance were the most severe symptoms. Trouble with balance, muscle or joint aches, and neuropathic pain were the most distressing symptoms, and numbness in the fingers and hands and in the toes and feet were the most frequent symptoms. Patients reported that neuropathic symptoms interfered with numerous activities. Oncology nurses can use this information to help educate patients and families about potential side effects of oxaliplatin and to coordinate the care of patients with peripheral neuropathy using a symptom-focused, multidisciplinary approach.

Surviving Chemotherapy for Colon Cancer and Living with the Consequences

BACKGROUND This article discusses peripheral neuropathy as a long-term side effect of oxaliplatin based chemotherapy, from a colon cancer survivors perspective. Peripheral neuropathy is a common side effect of chemotherapy that affects quality of life for many cancer survivors. Severe and debilitating neuropathy negatively impacts both physical and emotional well-being. DISCUSSION A better understanding of what cancer survivors with peripheral neuropathy experience is essential for health care professionals. More emphasis on symptom management and development of evidence based interventions will help improve quality of life for those who are affected by chemotherapy induced peripheral neuropathy.

The Symptom Experience of Patients with Cancer.

There is little doubt that despite advances in supportive cancer care, unrelieved symptoms continue to be prevalent and persistent in the cancer patient population. The purpose of this study was to describe the symptom experience of patients with cancer and pain. Secondary analysis of data gathered for a larger ongoing National Institutes of Health–funded study of medication-induced constipation was conducted to determine the following: the mean number of symptoms reported, the most commonly occurring symptoms, symptoms with the highest severity, and the symptoms causing the most distress. The sample consisted of 393 outpatients at an National Cancer Institute–designated cancer center in west-central Florida, 70% with advanced disease. The sample was predominantly female (57.7%); had either breast or lung cancer or lymphoma (53.7%); and had stage III or IV disease (51.3%). Two hundred ninety-eight of the 393 (75.8%) patients for whom data were available reported pain and were included in this analysis. Patients reported between two and 30 symptoms, each with a mean of 14.1 (SD, 5.5). As in earlier symptom studies of cancer patients, fatigue was the most commonly reported, occurring in more than 91% of the patients. The next most frequently reported symptoms were feeling drowsy (66.8%, n = 199), difficulty sleeping 65.8%, n = 196), and worrying (n = 193, 64.8%). Symptoms with the greatest severity were hair loss and impaired sexual activity, which were reported to be severe or very severe by more than 50% of the patients who had these symptoms. However, lack of energy/fatigue, pain, and difficulty sleeping were the most distressing problems and were reported to be quite a bit or very bothersome by at least 50% of patients with each symptom. Pain, fatigue, and difficulty sleeping continue to be among the most frequently reported and distressing symptoms for persons with cancer. In addition to asking about the presence of symptoms patients may be experiencing, nurses must also inquire about the associated distress. Knowing which symptoms are causing the most distress for patients will assist nurses in prioritizing their care and providing the much needed support and education for this population. Continued attention on treating these symptoms should be the focus of ongoing research as well as nursing education both in service areas and in schools of nursing.

Development and psychometric evaluation of the chemotherapy-induced peripheral neuropathy assessment tool.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) can be a debilitating and dose-limiting adverse effect of chemotherapy. Comprehensive self-report tools for CIPN are needed for research and clinical practice. Objective: The purpose of this psychometric study was to describe the development and evaluate the reliability and validity of a new self-report tool designed to measure CIPN, the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool (CIPNAT). Methods: One hundred sixty-seven patients receiving outpatient chemotherapy with paclitaxel, docetaxel, cisplatin, or oxaliplatin completed the CIPNAT. Content validity, convergent validity, discriminant validity, test-retest reliability, and internal consistency reliability were assessed. Results: Content validity index was very acceptable at 0.95. Convergent validity data were provided by correlation with a measure of the same concept (r = 0.83, P < .001), and differences between contrasting groups (t = 7.66, P < .001) provided evidence of discriminant validity. High test-retest correlations (r = 0.92, P < .001), Cronbach &agr; (&agr; = .95), and significant item-to-total correlations ranging from 0.38 to 0.70 provided evidence of reliability. Conclusions: Results provide evidence of the validity and reliability of the CIPNAT, which can be used for comprehensive assessment of CIPN. Implications for Practice: Use of the CIPNAT in research may lead to a better understanding of CIPN and guide nurses in developing and testing of interventions to relieve suffering and enhance quality of life for patients with CIPN.

Pain, Neuropathic Symptoms, and Physical and Mental Well-Being in Persons with Cancer

Background: Neuropathic pain is present in at least 25% to 40% of people with cancer pain and is thought to be more difficult to control than other types of cancer-related pain. Objective: The purpose of this study was to explore differences in the experience of cancer patients who describe their pain using neuropathic descriptors compared with those who do not. Methods: A secondary analysis of data from 234 outpatients from a large National Cancer Institute-designated cancer center in west central Florida was conducted to identify differences in pain, pain interference, symptoms, health-related quality of life, and depression between the 2 groups. Results: Patients with numbness, tingling, or electric-like sensations reported higher levels of current pain (P = .001), pain at its worst (P = .001), pain on average (P = .019), pain at its least (P = .008), and pain interference (P < .001). They reported problems with dizziness/lightheadedness significantly more often (P = .004) and also reported more severe problems with concentration (P = .047) and poorer physical (P = .019) and mental health (P = .024), although no differences in depressive symptoms were found. Conclusions: The results of this study indicate that cancer patients with numbness, tingling, or electric-like sensations have significantly higher levels of pain and pain interference and lower health-related quality of life than do patients without these symptoms. Implications for Practice: These results highlight the ongoing need for research evaluating methods of treating neuropathic pain, education regarding assessment and management of neuropathic pain, and aggressive efforts to relieve neuropathic pain in oncology settings.