Aims: Chemotherapy-induced peripheral neuropathy (CIPN) is a prominent side effect of the treatment of cancer. Current methods of CIPN assessment are inadequate yet no comprehensive review of CIPN assessments presently exists. Accordingly, the aim of this study was to provide a definitive survey and quality appraisal of CIPN assessment strategies.
Method: Relevant studies were identified through a search strategy developed in consultation with a UNSW medical librarian including Medline, Embase, CINAHL, and Cochrane. Inclusion criteria were English language studies of human subjects involving the assessment of CIPN in any capacity (i.e. as a study focus or as part of adverse event reporting). All assessment strategies from included articles were 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 Delphi survey of 32 clinicians, nurses, and consumers in which assessments were rated on a 5-point scale according to similar criteria.
Results: Database searches yielded 8720 articles after duplicate removal; 4332 articles entered full text review, and 154 distinct CIPN assessments pulled from 2404 articles were included in the qualitative synthesis. The GOG toxicity criteria, Patient Neurotoxicity Questionnaire (PNQ), FACT/GOG-Ntx, Total Neuropathy Score-reduced (TNSr), Total Neuropathy Score-clinical (TNSc), and CIPN Assessment Tool (CIPNAT) were included in the Delphi survey. The PNQ was the highest rated overall and patient-based assessment (4.2/5), while the TNSc was the highest rated clinical assessment (3.6/5). The PNQ was highly rated for requiring appropriate effort and cost, while the TNSc was highly rated for comprehensiveness, as well as appropriate effort and language for the clinical setting. No assessment was consistently rated highly across all assessment criteria.
Conclusions: The current best CIPN assessment strategies are identified, but limitations remain in their comprehensiveness, depth and likelihood of widespread adoption in clinical practice.