Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Room 2560C, Ann Arbor, MI, 48109-1065, USA.
Department of Nursing, Mayo Clinic, Jacksonville, FL, USA.
Support Care Cancer. 2023 Dec 22;32(1):48. doi: 10.1007/s00520-023-08209-0.
Clinical practice guidelines recommend altering neurotoxic chemotherapy treatment in patients experiencing intolerable chemotherapy-induced peripheral neuropathy (CIPN). The primary objective of this survey was to understand patient's perspectives on altering neurotoxic chemotherapy treatment, including their perceptions of the benefits of preventing irreversible CIPN and the risks of reducing treatment efficacy.
A cross-sectional online survey was distributed via social networks to patients who were currently receiving or had previously received neurotoxic chemotherapy for cancer. Survey results were analyzed using descriptive statistics and qualitative analysis.
Following data cleaning, 447 participants were included in the analysis. The median age was 57 years, 93% were white, and most were from the UK (53%) or USA (38%). Most participants who were currently or recently treated expected some CIPN symptom resolution (86%), but 45% of those who had completed treatment more than a year ago reported experiencing no symptom resolution. Participants reported that they would discontinue chemotherapy treatment for less severe CIPN if they knew their symptoms would be permanent than if symptoms would disappear after treatment. Most patients stated that the decision to alter chemotherapy or not was usually made collaboratively between the patient and their treating clinician (61%). The most common reason participants were reluctant to talk with their clinician about CIPN was fear that treatment would be altered. Participants noted a need for improved understanding of CIPN symptoms and their permanence, better patient education relating to CIPN prior to and after treatment, and greater clinician understanding and empathy around CIPN.
This survey highlights the importance of shared decision-making, including a consideration of both the long-term benefits and risks of altering neurotoxic chemotherapy treatment due to CIPN. Additional work is needed to develop decision aids and other communication tools that can be used to improve shared decision making and help patients with cancer achieve their treatment goals.
临床实践指南建议改变正在经历无法耐受的化疗引起的周围神经病变（CIPN）的患者的神经毒性化疗治疗。这项调查的主要目的是了解患者对改变神经毒性化疗治疗的看法，包括他们对预防不可逆 CIPN 的益处以及降低治疗效果风险的看法。
通过社交网络向正在接受或之前接受过癌症神经毒性化疗的患者分发了一项横断面在线调查。使用描述性统计和定性分析对调查结果进行分析。
经过数据清理，共有 447 名参与者纳入分析。中位年龄为 57 岁，93%为白人，大多数来自英国（53%）或美国（38%）。大多数目前正在接受或最近接受治疗的参与者预计会有一些 CIPN 症状缓解（86%），但 45%的患者在一年前以上接受治疗后报告没有症状缓解。参与者报告说，如果他们知道自己的症状会永久存在，而不是在治疗后消失，他们会因为更轻微的 CIPN 而停止化疗。大多数患者表示，是否改变化疗通常是由患者和治疗医生共同决定的（61%）。大多数患者不愿意与他们的医生讨论 CIPN 的原因是担心治疗会改变。参与者指出，需要更好地了解 CIPN 症状及其永久性，在治疗前后为患者提供更好的 CIPN 教育，并更好地理解和同情 CIPN。
这项调查强调了共同决策的重要性，包括考虑由于 CIPN 改变神经毒性化疗治疗的长期益处和风险。需要开展更多工作，以开发决策辅助工具和其他沟通工具，以改善共同决策，并帮助癌症患者实现其治疗目标。
