Patient-reported outcomes for effective screening of chemotherapy-induced peripheral neuropathy.

Abstract

350 Background: Effective toxicity screening is necessary to improve cancer care. Chemotherapy-induced peripheral neuropathy (CIPN) frequently leads to cancer treatment modifications as well as long-term morbidity. However, CIPN screening varies widely between clinics, resulting in discrepancies in care. To optimise CIPN screening for real-world use, it is important to understand the reliability and validity of patient-reported outcome measures (PROMs), and to identify which specific questions may signal CIPN severity in routine practice. Methods: In a prospective study across two Australian sites, patients receiving neurotoxic therapy completed CIPN screening using the Cancer Institute NSW EviQ online neurotoxicity instrument and the validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy Induced Peripheral Neuropathy 20-item scale (EORTC-QLQ-CIPN20). Composite scores for CIPN-20 were generated by linearly converting scores. Reliability was assessed using Cronbach’s alpha. Spearman’s correlation was used to analyze item-level correlations with the CIPN20 composite score. Results: One hundred participants (median age: 53 years, 72% female) with predominantly breast (46%) or gastrointestinal (13%) malignancies, received taxane (58%) and/or platinum (33%) chemotherapy. Both screening tools showed good internal consistency (CIPN20 α=0.84; eviQ α=0.81). Only one individual item from EviQ was strongly correlated with CIPN20 composite score – “pain or discomfort in hands or feet” (r = 0.70). Multiple questions on sensory and motor function showed moderate correlation (r = 0.4 – 0.7, Table 1). However, items addressing autonomic function (e.g. constipation, dizziness) or breathing difficulties demonstrated low correlations (r < 0.4). Conclusions: Only a small subset of items showed a moderate-to-strong association with the CIPN20 composite score. It may be possible to use a concise set of PROM items to screen for CIPN severity, supporting better and more efficient clinical decision-making. The strength of correlation between EViQ questions with EORTC QLQ-CIPN20 composite score. EviQ Question Spearman's rho (p-value) 1) Numbness or tingling in hands or feet 0.62 (<0.001) 2) Pain or discomfort in hands or feet 0.70 (<0.001) 3) Weakness in arms or legs 0.49 (<0.001) 4) Problems walking 0.55 (<0.001) 5) Able to undertake activities of daily living independently (doing up buttons, writing etc.) 0.5 (<0.001) 6) Currently constipated 0.09 (0.4) 7) Hearing loss 0.33 (<0.001) 8) Ringing or buzzing in ears 0.20 (0.04) 9) Dizziness 0.26 (0.01) 10) Breathing/swallowing/ eating/drinking difficulties 0.25 (0.01) 11) Muscle spasms in mouth/jaw/hands/fingers/feet/ toes 0.42 (<0.001) Legend:. Grading scale:. EviQ: None (0) --> Disabling/life threatening (4). Strength of association: Strong (r ≥ 0.7) / Moderate (r =0-4 -0.7) / Weak (r < 0.4).