Chemotherapy Induced Peripheral Neuropathy (CIPN)

Definition• Defined as any injury, inflammation ordegeneration of peripheral nerves• Nervous system has two main parts• CNS: brain and spinal cord.• PNS: nerves that carry messages betweenthe brain, spinal cord and the rest of thebody.

Chemotherapy induced peripheralneuropathy (C.I.P.N)• Sensory nerves: sense touch, pain.Temperature, position and vibration sense.• Motor nerves: responsible for voluntarymovement and muscle tone.• Autonomic nerves: control intestinalmotility, blood pressure and involuntarymuscles.

Contd• Chemotherapy must be able to cross theblood brain barrier to cause CIPN• CIPN usually presents at the point mostdistal from the trunk first, i.e fingertips andtoes.• 10 – 20 % patients receiving neurotoxicchemotherapy will develop CIPN.• 60% in patients receiving taxanes.

CIPN• A debilitating side effect which impactsgreatly on patient quality of life• Treatment options are limited• Early recognition and prevention areessential

CIPN• Oncology patients are living longer andreceiving multiple lines of treatmenttherefore the incidence of CIPN is likely tocontinue increasing.

CIPN• CIPN may result in dose delay, dosereduction or change in treatment plan.• Affect quality of life.• Psychological impact.

Chemotherapy drugs that cause CIPN.• Taxanes ie paclitaxel docetaxol• Platiums ie Cisplatin, oxaliplatin• Vinca alkaloids ie vinerolabine, vincristine.

Symptoms• Symptoms usually mild and gradually getworse as treatment continues.• Change in sensation: feeling ofheaviness, burning, pins needles.• Increased sensitivity: touch or pressuremay feel uncomfortable

Symptoms• Pain: mild or severe, may be sharp orburning sensation.• Numbness: loss of feeling or sensetivity inthe area.• Muscle weakness: muscle may losestrenght if it is not been stimulated by anerve.• Difficulty balance and coordination.

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

ASSESSMENT• Grade 0: No peripheral neuropathy• Grade 1: Parathesia present (includingtingling) not interfering with function.• Grade 2: Parathesia present (includingtingling) interfering with function but notwith ADL`s• Grade 3: Parathesia present and interferingwith ADL`s

ASSESSMENT• Grade 4: Disabling.

Assessment• Combination neurotoxic chemotherapy.• No known agents have proven toprevent/treat CIPN more than continualassessment 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 withMDT.

Education• Patients feel empowered when theyunderstand their disease states• Difficulty educating individuals aboutperipheral neuropathy arises because oflack of knowledge on parts of physiciansand nurses• Educate re: early reporting of symptoms,self care measures i.e. environmentalsafety

Medical management of CIPN• 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 bysending out electrical pulse

CIPN TREATMENT• Non pharmacologic treatment• Physical therapy, exercise gives improvedQOL, endurance, circulation and sensoryintegration• Massage techniques increase circulation,promote relaxation, well being relievestiffness• Occupational therapist.

Management of CIPN• Psychological support: may help reduceanxiety tension and fear caused by cipnand may make it more bearable.

CASE STUDY 1• PATIENT RD ACTIVE LADY GARDENING,COOKING, RECEIVING TAXOTERECYCLOPHOSPHAMIDE• CYCLE 4 COMPLAINING OFPERIPHERAL NEUROPATHYAFFECTING FUNCTION.• CAUSING FRUSTRATION UPSETDEPRESSION

CASE STUDY 2• PATIENT JJB FARMER, RECEIVINGOXALIPLATIN TAXOTERE• CYCLE 3 COMPLAINED OF PERIPHERALNEUROPATHY IN FEET• AFFECTING MOBILITY SEVERELYREQUIRING PHYSIO AND WALKINGSTICK. TREATMENT D/C.• GRADE 4

CASE STUDY 3• PATIENT AM, ACTIVE RETIRED LADYRECEVING TAXOL WEEKLY• COMPLAINED OF SEVERE ? CIPN• LOSS OF SENSATION IN HANDS ANDFEET• APPARENT SUDDEN ONSET GRADE 3• CHANGED TREATMENT TO AC

CASE STUDY 3• MRI SCAN SHOWED LEPTOMENIGEALDISEASE

CONCLUSION• No specific interventions are available forpreventing or treating CIPN .• Early identification of at-risk patients andsymptoms can effectively prevent mostevents progressing to severe neuropathy.• Nurses must accurately and continuouslyasses for signs of CIPN.• Must encourage patients to reportsymptoms.

Conclusion• Early nurse assesment and interventioncan make the crucial difference in whetherneuropathy significantly impacts patientsquality of life during their cancer treatment.