Sardo Salvatore, Varrassi Giustino, Scartozzi Mario, Pace Maria Caterina, Schweiger Vittorio, Tamburin Stefano, Musu Mario, Finco Gabriele
Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
Paolo Procacci Foundation, Rome, Italy.
J Pain Res. 2023 Sep 25;16:3227-3238. doi: 10.2147/JPR.S414389. eCollection 2023.
Chemotherapy-induced peripheral neurotoxicity (CIPN) affects nearly 70% of cancer patients after chemotherapy, causing sensory, motor, autonomic dysfunction, and neuropathic pain. The Desirability of Outcome Ranking (DOOR) framework is proposed as a better way to assess preventive or therapeutic interventions for CIPN.
A survey was conducted among Italian healthcare professionals and researchers affiliated to the Italian Chapter of the International Association for the Study of Pain (AISD) to identify the most important outcomes in clinical management and research.
Among the 73 respondents, 61 qualified for the survey, with an overall response rate of 1.2%. The vast majority were physicians (77%), most of whom were anesthesiologists (47.5%). The results showed that pain, survival, sensory impairment, motor impairment, and quality of life were consistently ranked as the most important outcomes, but there was significant disagreement in the outcomes relative ranking, making it difficult to develop a DOOR algorithm. The study also revealed that clinicians commonly use structured interviews to evaluate patients with CIPN, and the most prescribed drugs or supplements were palmitoylethanolamide, pregabalin, gabapentin and alpha lipoic acid as preventive agents and pregabalin, palmitoylethanolamide, duloxetine, gabapentin, and amitriptyline as therapeutic agents. However, many of these drugs have not been clinically proven to be effective for CIPN.
This study suggests that the implementation of a DOOR framework for CIPN using healthcare professionals is more difficult than expected, given the significant disagreement in our respondents' ranking of outcomes. Our work provides interesting topics for future research in CIPN, but its limitations include a small sample size, a low response rate, and a possible selection bias.
化疗引起的周围神经毒性（CIPN）影响了近70%接受化疗后的癌症患者，导致感觉、运动、自主神经功能障碍以及神经性疼痛。结果期望排名（DOOR）框架被提议作为一种更好的方法来评估CIPN的预防或治疗干预措施。
对隶属于国际疼痛研究协会意大利分会（AISD）的意大利医疗保健专业人员和研究人员进行了一项调查，以确定临床管理和研究中最重要的结果。
在73名受访者中，61人符合调查要求，总体回复率为1.2%。绝大多数是医生（77%），其中大多数是麻醉师（47.5%）。结果表明，疼痛、生存、感觉障碍、运动障碍和生活质量一直被列为最重要的结果，但在结果的相对排名上存在重大分歧，这使得难以制定DOOR算法。该研究还表明，临床医生通常使用结构化访谈来评估CIPN患者，最常用的药物或补充剂作为预防剂是棕榈酰乙醇胺、普瑞巴林、加巴喷丁和α硫辛酸，作为治疗剂是普瑞巴林、棕榈酰乙醇胺、度洛西汀、加巴喷丁和阿米替林。然而，这些药物中的许多尚未在临床上被证明对CIPN有效。
本研究表明，鉴于我们的受访者在结果排名上存在重大分歧，使用医疗保健专业人员实施CIPN的DOOR框架比预期更困难。我们的工作为CIPN的未来研究提供了有趣的话题，但其局限性包括样本量小、回复率低以及可能存在的选择偏差。
