The nurse's role of assessment of chemotherapy-induced peripheral neuropathy in children treated for cancer

Yıl 2022, Cilt: 15 Sayı: 3, 369 - 375, 15.07.2022

Bilge Özdemir , Gülçin Özalp Gerçeker

https://doi.org/10.46483/deuhfed.959493

Öz

Chemotherapy-induced peripheral neuropathy is a serious side effect of chemotherapeutic agents used in cancer treatment. Neuropathy symptoms, which gradually worsen with chemotherapy treatments, can damage the sensory-motor-autonomic regions of the peripheral nervous system. The aim of this review is to draw attention to the role of nurses who care for children receiving cancer treatment in the evaluation of chemotherapy-induced peripheral neuropathy. Chemotherapy-induced peripheral neuropathy has symptoms such as numbness in the hands and feet, tingling, muscle/joint pain, burning sensation, decreased peripheral reflexes, and constipation. These symptoms negatively affect the daily life and quality of life of children. The incidence of chemotherapy-induced peripheral neuropathy varies depending on the type of cancer and the chemotherapy agent used. Vincristine, cisplatin, taxane-based chemotherapeutic agents are known to develop peripheral neuropathy. Although peripheral neuropathies caused by some chemotherapeutic agents decrease after chemotherapy treatment is completed, peripheral neuropathy findings caused by some drugs continue for a long time. It is important for nurses to know the chemotherapy agents that cause peripheral neuropathy. Pediatric nurses working in the hematology-oncology service should use measurement tools that can objectively evaluate the symptoms of peripheral neuropathy in children. Neuropathy assessment should become a routine in nursing care. In Turkey, there is no measurement tool that evaluates chemotherapy-induced peripheral neuropathy. It is important to introduce peripheral neuropathy measurement tools into our language, nurses to know the symptoms of peripheral neuropathy (sensory, functional and autonomic symptoms such as tingling in the hands and feet, buttoning up, difficulty in going up and down stairs, staggering while walking, physical examination findings including decrease in muscle strength and deep tendon reflexes) and to evaluate neuropathy with neuropathy assessment tools. In the management of peripheral neuropathy, there are many non-pharmacological approaches such as acupuncture, reflexology, massage, footbath, cryotherapy, scrambler therapy, progressive muscle relaxation exercises, and physical activity but the evidence is still inadequate. More clinical based studies are needed for the evaluation and management of neuropathy.

Anahtar Kelimeler

Cancer, Child, Chemotherapy, Peripheral Neuropathy, Nursing

Kanser Tedavisi Alan Çocuklarda Kemoterapiyle İlişkili Periferik Nöropatinin Değerlendirilmesinde Hemşirenin Rolü

Öz

Kemoterapiyle ilişkili periferik nöropati, kanser tedavisinde kullanılan kemoterapik ajanların yol açtığı ciddi bir yan etkidir. Alınan kemoterapi kürleriyle giderek kötüleşen nöropati semptomları periferik sinir sisteminin duyu-motor-otonom bölgelerine hasar verebilmektedir. Bu derlemenin amacı kanser tedavisi alan çocuklara bakım veren hemşirelerin kemoterapiyle ilişkili periferik nöropati değerlendirmesindeki rolüne dikkat çekmektir. Kemoterapiyle ilişkili periferik nöropatinin ellerde-ayaklarda uyuşma, karıncalanma, kas/eklem ağrıları, yanma hissi, periferik reflekslerde azalma ve konstipasyon gibi belirtileri vardır. Bu belirtiler çocukların günlük yaşamını ve yaşam kalitelerini olumsuz yönde etkilemektedir. Kemoterapi ile ilişkili periferik nöropati görülme sıklığı kanserin tipine ve kullanılan kemoterapik ajana bağlı olarak değişmektedir. Vinkristin, sisplatin, taksan bazlı kemoterapik ajanların periferik nöropati geliştirdiği bilinmektedir. Kemoterapi tedavisi tamamlandıktan sonra bazı kemoterapik ajanların neden olduğu periferik nöropatiler azalsa da bazı ilaçların neden olduğu periferik nöropati bulguları uzun süre devam etmektedir. Hemşirelerin periferik nöropatiye yol açan kemoterapi ajanlarını bilmesi önemlidir. Hematoloji ve onkoloji servisinde çalışan pediatri hemşirelerinin, çocukların periferik nöropati semptomlarını nesnel olarak değerlendirebilecek ölçme araçlarından faydalanmaları gerekir. Nöropati değerlendirmesi hemşirelik bakımında bir rutin haline gelmelidir. Türkiye’de henüz kemoterapiyle ilişkili periferik nöropatiyi iyi bir şekilde değerlendiren bir ölçüm aracı bulunmamaktadır. Periferik nöropatiyi değerlendiren ölçüm araçlarının dilimize kazandırılması, hemşirelerin periferik nöropatinin semptomlarını (el ayaklarda karıncalanma, düğme ilikleme, merdiven inip çıkmada güçlük, yürürken sendeleme gibi duyusal, fonksiyonel ve otonom semptomlar, kas gücü ve derin tendon reflekslerinde azalmayı içeren fizik muayene bulguları) bilmesi ve nöropati değerlendirme araçlarıyla nöropatiyi değerlendirmesi önemlidir. Periferik nöropatinin yönetilmesinde farmakolojik yöntemlerin yanı sıra akupunktur, refleksoloji, masaj, ayak banyosu, kriyoterapi, scrambler terapi, progresif kas gevşeme egzersizleri, fiziksel aktivite gibi birçok farmakolojik olmayan yaklaşım bulunmaktadır ancak kanıtlar halen yetersizdir. Nöropatinin değerlendirilmesi ve yönetimi için klinik temelli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Kanser, Çocuk, Kemoterapi, Periferik Nöropati, hemşirelik

Kaynakça

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