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

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

1. 1. Saklı K, Demir Zencirci A. Taksan ve platin alan hastalarda periferal nöropati ve nöropatik ağrıya yönelik hemşirelik girişimleri: sistematik derleme. Hemşirelikte Araştırma Geliştirme Dergisi 2013;1:61–73.
2. 2. Bjornard KL, Gilchrist LS, Inaba H, Diouf B, Hockenberry MJ, Kadan-Lottick NS et al. Peripheral neuropathy in children and adolescents treated for cancer. Lancet Child Adolesc Health 2018;2(10):744–754.
3. 3. Smolik S, Arland L, Hensley MA, Schissel D, Shepperd B, Thomas K et al. Assessment tools for peripheral neuropathy in pediatric oncology: a systematic review from the children’s oncology group. J Pediatr Oncol Nurs 2018;35(4):267–275.
4. 4. American Canser Society. What ıs peripheral neuropathy? [Internet]. 2020 [cited 2020 May 24]. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/peripheral-neuropathy/what-is- peripherial-neuropathy.html.
5. 5. McCrary JM, Goldstein D, Trinh T, Timmins HC, Li T, Friedlander M et al. Optimizing clinical screening for chemotherapy- ınduced peripheral neuropathy. J Pain Symptom Manage 2019;58(6):1023–1032.
6. 6. Özdemir Kayıkçı EE, Can G. Evidence based complementary approaches in the management of chemotherapy-ınduced peripheral neuropathy in cancer patients. J Educ Res Nurs 2020;17(1):59–65.
7. 7. Kandula T, Park SB, Cohn RJ, Krishnan AV, Farrar MA. Pediatric chemotherapy induced peripheral neuropathy: a systematic review of current knowledge. Cancer Treat Rev 2016;50:118–128.
8. 8. Smith EML, Kuisell C, Cho Y, Kanzawa-Lee GA, Gilchrist LS, Park SB et al. Characteristics and patterns of pediatric chemotherapy-induced peripheral neuropathy: A systematic review. Cancer Treat Res Commun 2021;28:100420.

9. 9. Dudeja S, Gupta S, Sharma S, Jain A, Sharma S, Jain P et al. Incidence of vincristine induced neurotoxicity in children with acute lymphoblastic leukemia and its correlation with nutritional deficiencies. Pediatr Hematol Oncol 2019;36(6):344–351.
10. 10. Howard RF, Wiener S, Walker SM. Neuropathic pain in children. Arch Dis Child 2014;99(1):84–89.
11. 11. Serletis D, Parkin P, Bouffet E, Shroff M, Drake JM, Rutka JT. Massive plexiform neurofibromas in childhood: natural history and management issues. J Neurosurg 2007;106:363–367.
12. 12. Mohrmann C, Armer J, Hayashi RJ. Challenges evaluating chemotherapy-ınduced peripheral neuropathy in childhood cancer survivors: which ınstrument should nurses use?. J Pediatr Oncol Nurs 2017;34(2):106–114.
13. 13. Murphy D, Lester D, Clay Smither F, Balakhanlou E. Peripheral neuropathic pain. Zasler N, editor. NeuroRehabilitation 2020;47(3):265–283.
14. 14. Gilchrist L. Chemotherapy-ınduced peripheral neuropathy in pediatric cancer patients. Semin Pediatr Neurol 2012;19(9):9– 17.
15. 15. Smith EML, Li L, Chiang C, Thomas K, Raymond J, Wells EM et al. Patterns and severity of vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia. J Peripher Nerv Syst 2015;20:37–46.
16. 16. Triarico S, Romano A, Attinà G, Capozza MA, Maurizi P, Mastrangelo S et al. Vincristine-ınduced peripheral neuropathy (VIPN) in pediatric tumors: mechanisms, risk factors, strategies of prevention and treatment. Int. J Mol Sci 2021;22(8):4112.
17. 17. Renbarger JL, McCammack KC, Rouse CE, Hall SD. Effect of race on vincristine-associated neurotoxicity in pediatric acute lymphoblastic leukemia patients. Pediatr Blood Cancer 2008;50(4):769–771.
18. 18. Schouten SM, van de Velde ME, Kaspers GJL, Mokkink LB, van der Sluis IM, van den Bos C et al. Measuring vincristine- induced peripheral neuropathy in children with cancer: validation of the Dutch pediatric–modified Total Neuropathy Score. Support Care Cancer 2020;28(6):2867–2873.
19. 19. Kandula T, Farrar MA, Cohn RJ, Mizrahi D, Carey K, Johnston K et al. Chemotherapy-induced peripheral neuropathy in long-term survivors of childhood cancer clinical, neurophysiological, functional, and patient-reported outcomes. JAMA Neurol 2018;75(8):980–988.
20. 20. Tofthagen CS, McMillan SC, Kip KE. Development and psychometric evaluation of the chemotherapy-induced peripheral neuropathy assessment tool. Cancer Nurs 2011;34(4):E10-E20.
21. 21. Clark PG, Cortese-Jimenez G, Cohen E. Effects of reiki, yoga, or meditation on the physical and psychological symptoms of chemotherapy-ınduced peripheral neuropathy: a randomized pilot study. Journal of Evidence-Based Complementary & Alternative Medicine 2012;17(3):161–171.
22. 22. Walker SM. Neuropathic pain in children: Steps towards improved recognition and management. EBioMedicine 2020;62:103124.
23. 23. Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain 2019;160(1):53–59.
24. 24. Courtemanche H, Magot A, Ollıver Y, Rıalland F, Leclaır-Vısonneau L, Fayet G et al. Vincristine-induced neuropathy: atypical electrophysiological patterns in children. Muscle Nerve 2015;52:981–985.
25. 25. Hoffman MC, Mulrooney DA, Steinberger J, Lee J, Baker KS, Ness KK et al. Deficits in physical function among young childhood cancer survivors. J Clin Oncol 2013;31(22):2799–2805.
26. 26. Kleckner IR, Kamen C, Gewandter JS, Mohile NA, Heckler CE, Culakova E et al. Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial. Support Care Cancer. 2018;26(4):1019–1028.
27. 27. Kerckhove N, Collin A, Condé S, Chaleteix C, Pezet D, Balayssac D. Long-term effects, pathophysiological mechanisms, and risk factors of chemotherapy-induced peripheral neuropathies: a comprehensive literature review. Front Pharmacol 2017;8(86):1–17.
28. 28. Beijers A, Mols F, Dercksen W, Driessen C, Vreugdenhil G. Chemotherapy-induced peripheral neuropathy and impact on quality of life 6 months after treatment with chemotherapy. J Community Support Oncol 2014;12(11):401–406. 29. Macy ME, Duncan T, Whitlock J, Hunger SP, Boklan J, Narendren A et al. A multi-center phase ıb study of oxaliplatin in combination with fluorouracil and leucovorin in pediatric patients with advanced solid tumors. Pediatr Blood Cancer 2013;60:230–236.
29. 30. Purser M, Johnston D, McMillan H. Chemotherapy-induced peripheral neuropathy among paediatric oncology patients. Can J Neurol Sci 2014;41(4):442–447.
30. 31. Tay CG, Lee VWM, Ong LC, Goh KJ, Ariffin H, Fong CY. Vincristine-induced peripheral neuropathy in survivors of childhood acute lymphoblastic leukaemia. Pediatr Blood Cancer 2017;64(8):1–7.
31. 32. v van de Velde ME, Kaspers GL, Abbink FCH, Wilhelm AJ, Ket JCF, van den Berg MH. Vincristine-induced peripheral neuropathy in children with cancer: A systematic review. Crit Rev Oncol Hematol 2017;114:114–130.
32. 33. Arzanian M., Mehdizadeh M, Zamani GR. Vincristine ınduced neurotoxicity: study of 75 cases. Iran J Child Neurol 2009;3(2):39–44.
33. 34. Jain P, Gulati S, Seth R, Bakhshi S, Toteja GS, Pandey RM. Vincristine-induced neuropathy in childhood all (acute lymphoblastic leukemia) survivors : prevalence and electrophysiological characteristics. J Child Neurol 2014;29(7):932–937.
34. 35. Coluzzi F, Rocco M, Gladden RG, Persiani P, Thur LA, Milano F. Pain management in childhood leukemia: diagnosis and available analgesic treatments. Cancers 2020;12(12):3671.
35. 36. Smith EML, Li L, Hutchinson RJ, Ho R, Burnette WB, Wells E et al. Measuring vincristine-induced peripheral neuropathy in children with acute lymphoblastic leukemia. Cancer Nurs 2013;36(5):E49-E60.
36. 37. Priolo T, Lamba LD, Giribaldi G, Negri E De, Grosso P, Grandis E De et al. Childhood thalidomide neuropathy: a clinical and neurophysiologic study. Pediatr Neurol 2008;38(3):196–199.
37. 38. Binner M, Ross D, Browner I. Chemotherapy-ınduced peripheral neuropathy: assessment of oncology nurses’ knowledge and practice. Oncol Nurs Forum 2011;38(4):448–454.
38. 39. Gilchrist LS, Tanner L. The pediatric-modified total neuropathy score: a reliable and valid measure of chemotherapy-induced peripheral neuropathy in children with non-CNS cancers. Support Care Cancer 2013;21(3):847–856.
39. 40. Chung T, Prasad K, Lloyd TE. Peripheral neuropathy. Clinical and electrophysiological considerations. Neuroimaging Clinics 2014;24:49–65.
40. 41. Smith EML, Kuisell C, Kanzawa-Lee G, Bridges CM, Cho Y, Swets J et al. Assessment of pediatric chemotherapy-ınduced peripheral neuropathy using a new patient-reported outcome measure: the P-CIN. J Pediatr Oncol Nurs 2021;38(2):131–141.
41. 42. Abdel J, Ahmed N, Khudair SH. Effectiveness of health educational program on nurses’ practices toward chemotherapy- ınduced peripheral neuropathy for children at hematology center in baghdad city. Iraqi Natl J Nurs Spec 2021;33(2):1–12.
42. 43. Dobson JL, McMillan J, Li L. Benefits of exercise intervention in reducing neuropathic pain. Front Cell Neurosci 2014;8:1- 9.
43. 44. Mokhtar GM, Shaaban SY, Elbarbary NS, Fayed WA. A trial to assess the efficacy of glutamic acid in prevention of vincristine-induced neurotoxicity in pediatric malignancies: a pilot study. J Pediatr Hematol Oncol 2010;32(8):594–600.
44. 45. Mohamed R, Zakaria M, Elkeblawy MM, Ahmed A. Post chemotherapy balance exercises in children with acute lymphoblastic leukemia. Egypt J Hosp Med 2021;82(3):399–403.
45. 46. Jung M, Rein N, Fuchs B. Physiotherapie bei chemotherapie-assoziierter peripherer neuropathie in der pädiatrischen onkologie-eine literaturrecherche. Phys Medizin Rehabil Kurortmedizin 2018;28(1):46–52.
46. 47. Oh PJ, Kim YL. Effectiveness of non-pharmacologic interventions in chemotherapy induced peripheral neuropathy: A systematic review and meta-analysis. J Korean Acad Nurs 2018;48(2):123–142.