Chemotherapy
Induced Peripheral
Neuropathy (CIPN)
Definition
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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)
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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
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A debilitating side effect which impacts
greatly on patient quality of life
Treatment options are limited
Early recognition and prevention are
essential
CIPN
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Oncology patients are living longer and
receiving multiple lines of treatment
therefore the incidence of CIPN is likely to
continue increasing.
CIPN
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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.
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Taxanes ie paclitaxel docetaxol
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Platiums ie Cisplatin, oxaliplatin
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Vinca alkaloids ie vinerolabine, vincristine.
Symptoms
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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
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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
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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
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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
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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
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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
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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
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Early nurse assesment and intervention
can make the crucial difference in whether
neuropathy significantly impacts patients
quality of life during their cancer treatment.