Department of Anesthesiology Pain- and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands.
Department of Anesthesiology Pain- and Palliative Medicine, AmsterdamUMC, Amsterdam, The Netherlands.
Support Care Cancer. 2024 Apr 22;32(5):301. doi: 10.1007/s00520-024-08493-4.
In treating cancer, different chemotherapy regimens cause chemotherapy-induced peripheral neuropathy (CIPN). Despite recent international guidelines, a gold standard for diagnosis, treatment, and care is lacking. To identify the current clinical practice and the physicians' point of view and ideas for improvement, we evaluated CIPN care by interviewing different specialists involved.
We performed semi-structured, audio-recorded, transcribed, and coded interviews with a purposive sample of oncologists, pain specialists, and neurologists involved in CIPN patients' care. Data is analyzed by a constant comparative method for content analysis, using ATLAS.ti software. Codes, categories, and themes are extracted, generating common denominators and conclusions.
With oncologists, pain specialists, and neurologists, nine, nine, and eight interviews were taken respectively (including three, two, and two interviews after thematic saturation occurred). While useful preventive measures and predictors are lacking, patient education (e.g., on symptoms and timely reporting) is deemed pivotal, as is low-threshold screening (e.g., anamnesis and questionnaires). Diagnosis focusses on a temporal relationship to chemotherapy, with adjuvant testing (e.g., EMG) used in severe or atypical cases. Symptomatic antineuropathic and topical medication are often prescribed, but personalized and multidimensional care based on individual symptoms and preferences is highly valued. The limited efficacy of existing treatments, and the lack of standardized protocols, interdisciplinary coordination, and awareness among healthcare providers pose significant challenges.
Besides the obvious need for better therapeutic options, and multidisciplinary exploration of patients' perspectives, a structured and collaborative approach towards diagnosis, treatment, referral, and follow-up, nurtured by improving knowledge and use of existing CIPN guidelines, could enhance care.
在治疗癌症时，不同的化疗方案会导致化疗引起的周围神经病变（CIPN）。尽管最近有国际指南，但缺乏诊断、治疗和护理的金标准。为了确定当前的临床实践以及医生对改进的观点和想法，我们评估了通过采访不同参与 CIPN 患者护理的专家来评估 CIPN 的护理。
我们对参与 CIPN 患者护理的肿瘤学家、疼痛专家和神经科医生进行了半结构化、录音、转录和编码访谈，采用目的抽样法。使用 ATLAS.ti 软件对数据进行内容分析的恒定比较方法进行分析。提取代码、类别和主题，生成共同的主旨和结论。
对肿瘤学家、疼痛专家和神经科医生进行了九次、九次和八次访谈（包括三次、两次和两次主题饱和后进行的访谈）。虽然缺乏有用的预防措施和预测因素，但患者教育（例如，关于症状和及时报告）被认为至关重要，还有低门槛筛查（例如，病史和问卷调查）。诊断侧重于与化疗的时间关系，在严重或非典型病例中使用辅助测试（例如，EMG）。经常开对症抗神经病变和局部药物治疗，但根据个人症状和偏好进行个性化和多维护理受到高度重视。现有治疗方法的疗效有限，缺乏标准化方案、跨学科协调以及医疗保健提供者的意识，这些都构成了重大挑战。
除了明显需要更好的治疗选择外，还需要多学科探索患者的观点，还需要通过提高对现有 CIPN 指南的了解和使用，以结构化和协作的方式来进行诊断、治疗、转介和随访，从而改善护理。
