Chemotherapy Induced Peripheral Neuropathy (CIPN)

Definition    

Defined as any injury, inflammation or degeneration of peripheral nerves Nervous system has two main parts CNS: brain and spinal cord. PNS: nerves that carry messages between the brain, spinal cord and the rest of the body.

Chemotherapy induced peripheral neuropathy (C.I.P.N)   

Sensory nerves: sense touch, pain. Temperature, position and vibration sense. Motor nerves: responsible for voluntary movement and muscle tone. Autonomic nerves: control intestinal motility, blood pressure and involuntary muscles.

Contd  

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Chemotherapy must be able to cross the blood brain barrier to cause CIPN CIPN usually presents at the point most distal from the trunk first, i.e fingertips and toes. 10 – 20 % patients receiving neurotoxic chemotherapy will develop CIPN. 60% in patients receiving taxanes.

CIPN   

A debilitating side effect which impacts greatly on patient quality of life Treatment options are limited Early recognition and prevention are essential

CIPN 

Oncology patients are living longer and receiving multiple lines of treatment therefore the incidence of CIPN is likely to continue increasing.

CIPN 

CIPN may result in dose delay, dose reduction or change in treatment plan.

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Affect quality of life.

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Psychological impact.

Chemotherapy drugs that cause CIPN. 

Taxanes ie paclitaxel docetaxol

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Platiums ie Cisplatin, oxaliplatin

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Vinca alkaloids ie vinerolabine, vincristine.

Symptoms   

Symptoms usually mild and gradually get worse as treatment continues. Change in sensation: feeling of heaviness, burning, pins needles. Increased sensitivity: touch or pressure may feel uncomfortable

Symptoms   

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Pain: mild or severe, may be sharp or burning sensation. Numbness: loss of feeling or sensetivity in the area. Muscle weakness: muscle may lose strenght if it is not been stimulated by a nerve. Difficulty balance and coordination.

ASSESSMENT   

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Importance of baseline assessment Recognise co morbidities that may increase risk of CIPN. Existing diseases such as diabetes, alcoholism, reduced vit b12 levels act as risk factors Previous neurotoxic chemotherapy Pre-existing CIPN.

ASSESSMENT   

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Grade 0: No peripheral neuropathy Grade 1: Parathesia present (including tingling) not interfering with function. Grade 2: Parathesia present (including tingling) interfering with function but not with ADL`s Grade 3: Parathesia present and interfering with ADL`s

ASSESSMENT 

Grade 4: Disabling.

Assessment  

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Combination neurotoxic chemotherapy. No known agents have proven to prevent/treat CIPN more than continual assessment and early intervention. Nurses play a vital role in early detection, must be able to identify high risk patients. Assess for impaired fine movement: difficulity with buttons, laces.

Assessment   

Motor system: observe for shuffling, unsteady gait and high stepping. Documentation of findings. Appropiate and timely consulation with MDT.

Education  

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Patients feel empowered when they understand their disease states Difficulty educating individuals about peripheral neuropathy arises because of lack of knowledge on parts of physicians and nurses Educate re: early reporting of symptoms, self care measures i.e. environmental safety

Medical management of CIPN 

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Management involves decisions re: continuing planned doses, dose reduction, ceasing neurotoxic agents Pharmacologic treatment -antidepressants -anti convulsants -topical analgesics -Lyrica, neurontin

Medical management of CIPN 

Transcutaneous electrical nerve stimulation (TENS) aims to stimulate nerves by sending out electrical pulse

CIPN TREATMENT  

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Non pharmacologic treatment Physical therapy, exercise gives improved QOL, endurance, circulation and sensory integration Massage techniques increase circulation, promote relaxation, well being relieve stiffness Occupational therapist.

Management of CIPN 

Psychological support: may help reduce anxiety tension and fear caused by cipn and may make it more bearable.

CASE STUDY 1 

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PATIENT RD ACTIVE LADY GARDENING ,COOKING, RECEIVING TAXOTERE CYCLOPHOSPHAMIDE CYCLE 4 COMPLAINING OF PERIPHERAL NEUROPATHY AFFECTING FUNCTION. CAUSING FRUSTRATION UPSET DEPRESSION

CASE STUDY 2   

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PATIENT JJB FARMER, RECEIVING OXALIPLATIN TAXOTERE CYCLE 3 COMPLAINED OF PERIPHERAL NEUROPATHY IN FEET AFFECTING MOBILITY SEVERELY REQUIRING PHYSIO AND WALKING STICK. TREATMENT D/C. GRADE 4

CASE STUDY 3     

PATIENT AM, ACTIVE RETIRED LADY RECEVING TAXOL WEEKLY COMPLAINED OF SEVERE ? CIPN LOSS OF SENSATION IN HANDS AND FEET APPARENT SUDDEN ONSET GRADE 3 CHANGED TREATMENT TO AC

CASE STUDY 3 

MRI SCAN SHOWED LEPTOMENIGEAL DISEASE

CONCLUSION  

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No specific interventions are available for preventing or treating CIPN . Early identification of at-risk patients and symptoms can effectively prevent most events progressing to severe neuropathy. Nurses must accurately and continuously asses for signs of CIPN. Must encourage patients to report symptoms.

Conclusion 

Early nurse assesment and intervention can make the crucial difference in whether neuropathy significantly impacts patients quality of life during their cancer treatment.