Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, United States.
Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, United States.
JMIR Mhealth Uhealth. 2021 Jul 5;9(7):e27502. doi: 10.2196/27502.
Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring.
The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy.
A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app.
Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ≥2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download.
Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care.
严重的化疗诱导的周围神经病（CIPN）可导致手足长期功能障碍，干扰日常生活活动，并降低生活质量。为了在病情发展到改变生活的严重程度之前识别 CIPN 并调整治疗，需要依靠患者向临床团队报告主观症状。由于需要专门的医疗保健专业人员和设备，客观评估并不是 CIPN 监测的标准组成部分。智能手机应用程序有可能直接从患者那里方便地收集主观和客观的 CIPN 数据，从而改善 CIPN 监测。
本横断面初步研究的目的是评估通过智能手机应用程序对接受神经毒性化疗的癌症患者进行功能性 CIPN 评估的可行性。
共有 26 名完成神经毒性化疗的患者入组，并根据自我报告的症状将其分为 CIPN 病例（n=17）或对照组（n=9）。所有参与者都在 NeuroDetect 应用程序中单次完成了 CIPN 评估，包括患者报告的调查（CIPN20[欧洲癌症研究与治疗组织化疗诱导周围神经病患者报告问卷 20 项量表]和 PRO-CTCAE[患者报告的不良反应通用术语标准的结果版本]）和功能评估（步态和平衡以及 9 孔钉测试）。功能评估数据被分解为特征。主要分析是使用偏最小二乘法分析来识别指示 CIPN 病例和对照组之间差异的特征。进行了探索性分析，以测试是否有任何特征与特定的症状亚型或患者报告的调查评分相关。还对患者进行了访谈，以了解他们在使用应用程序时遇到的挑战。
CIPN 病例与对照组的比较表明，CIPN 病例的步长更短（P=.007），在行走任务中具有独特的摇摆加速度模式，并且在手动灵巧任务中惯用手的手部移动距离更短（投影得分中的重要变量≥2）。探索性分析显示，与症状亚型、CIPN20 和 PRO-CTCAE 相关的相似特征。访谈结果表明，一些患者因技术问题而遇到困难，这表明在初始应用程序下载期间需要额外的培训或监督。
我们的结果支持通过智能手机应用程序进行远程 CIPN 评估的可行性，并表明功能评估可能表明手和脚的 CIPN 表现。需要进一步的工作来确定哪些功能评估最能指示 CIPN 并可用于临床护理中的 CIPN 监测。
