Physician-assessed and patient-reported outcome measures in chemotherapy-induced sensory peripheral neurotoxicity: two sides of the same coin

Abstract

Background: The different perception and assessment of chemotherapy-induced peripheral neurotoxicity (CIPN) between healthcare providers and patients has not yet been fully addressed, although these two approaches might eventually lead to inconsistent, possibly conflicting interpretation, especially regarding sensory impairment.

Patients and methods: A cohort of 281 subjects with stable CIPN was evaluated with the National Cancer Institute-Common Toxicity Criteria (NCI-CTC v. 2.0) sensory scale, the clinical Total Neuropathy Score (TNSc©), the modified Inflammatory Neuropathy Cause and Treatment (INCAT) sensory sumscore (mISS) and the European Organization for Research and Treatment of Cancer CIPN specific self-report questionnaire (EORTC QOL-CIPN20).

Results: Patients' probability estimates showed that the EORTC QLQ-CIPN20 sensory score was overall more highly related to the NCI-CTC sensory score. However, the vibration perception item of the TNSc had a higher probability to be scored 0 for EORTC QLQ-CIPN20 scores lower than 35, as vibration score 2 for EORTC QLQ-CIPN20 scores between 35 and 50 and as grade 3 or 4 for EORTC QLQ-CIPN20 scores higher than 50. The linear models showed a significant trend between each mISS item and increasing EORTC QLQ-CIPN20 sensory scores.

Conclusion: None of the clinical items had a perfect relationship with patients' perception, and most of the discrepancies stood in the intermediate levels of CIPN severity. Our data indicate that to achieve a comprehensive knowledge of CIPN including a reliable assessment of both the severity and the quality of CIPN-related sensory impairment, clinical and PRO measures should be always combined.

Keywords: assessment; chemotherapy; neuropathy; neurotoxicity; patient-reported outcome measure.

Figure 1.

EORTC QLQ-CIPN20 sensory score distribution by NCI-CTC sensory, TNS pin and vibration item scores (upper panel, in brackets is reported the number of patients available for comparison). Upper panel: each box represents the first and third quartile, the central line the median, the white square the mean and the whiskers are located at the maximum and minimum observation (outside observations indicated with dots are those out of the 1.5 × interquartile range). Lower panel: the probability for a patient, with a given EORTC Lower panel: QLQ-CIPN20 sensory score, to be classified as score 0 to 4 of NCI-CTC sensory, TNS PIN and VIBRATION item is reported.

Figure 2.

EORTC QLQ-CIPN20 sensory submodule results distribution by each mISS item (see first three upper lines of panels; in brackets is reported the number of patients available for comparison). The box represents the first and third quartile, the central line the median, the white square the mean and the whiskers are located at the maximum and minimum observation (outside observations indicated with dots are those out of the 1.5 × interquartile range). Probability for a patient, with a given EORTC QLQ-CIPN20 sensory score, to be classified as score 0 to 4 of each mISS item, is reported in the last three lines of panels.