Exploring Outcome Priorities and Real-Life Management of Chemotherapy-Induced Peripheral Neurotoxicity: A Survey of the Italian Association for the Study of Pain members

Abstract

Introduction

Chemotherapy-induced peripheral neurotoxicity (CIPN) affects nearly 70% of cancer patients after chemotherapy, causing sensory, motor, autonomic dysfunction, and neuropathic pain. The Desirability of Outcome Ranking (DOOR) framework is proposed as a better way to assess preventive or therapeutic interventions for CIPN.

Methods

A survey was conducted among Italian healthcare professionals and researchers affiliated to the Italian Chapter of the International Association for the Study of Pain (AISD) to identify the most important outcomes in clinical management and research.

Results

Among the 73 respondents, 61 qualified for the survey, with an overall response rate of 1.2%. The vast majority were physicians (77%), most of whom were anesthesiologists (47.5%). The results showed that pain, survival, sensory impairment, motor impairment, and quality of life were consistently ranked as the most important outcomes, but there was significant disagreement in the outcomes relative ranking, making it difficult to develop a DOOR algorithm. The study also revealed that clinicians commonly use structured interviews to evaluate patients with CIPN, and the most prescribed drugs or supplements were palmitoylethanolamide, pregabalin, gabapentin and alpha lipoic acid as preventive agents and pregabalin, palmitoylethanolamide, duloxetine, gabapentin, and amitriptyline as therapeutic agents. However, many of these drugs have not been clinically proven to be effective for CIPN.

Discussion

This study suggests that the implementation of a DOOR framework for CIPN using healthcare professionals is more difficult than expected, given the significant disagreement in our respondents’ ranking of outcomes. Our work provides interesting topics for future research in CIPN, but its limitations include a small sample size, a low response rate, and a possible selection bias.

Keywords:

• neuropathic pain
• peripheral neuropathy
• cancer
• taxane
• Desirability of Outcome Ranking
• survey
• chemotherapy induced peripheral neuropathy

Institutional Review Board Statement

The Institutional Research Board (IRB) of the University of Cagliari considered this research to be exempt from formal evaluation because it was an anonymous online survey collecting the opinions of healthcare professionals without sensitive personally identifiable information.

Data Sharing Statement

Raw data without any identifier were uploaded to a public repository (Open Science Framework repository) under a CC-By Attribution 4.0 International license. They are freely accessible at the following website https://osf.io/hxdc5/.

Acknowledgments

This survey was endorsed by the Italian Chapter of the International Association for the Study of Pain AISD (Associazione Italiana per lo Studio del Dolore). The authors are particularly grateful to Lorenza Saini, AISD Secretary, for her valuable support in conducting our survey. We thank our colleagues for sharing with us details on their clinical or research practice and their personal views on outcomes priority.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Prof. Dr. Mario Scartozzi reports personal fees from MSD, MERCK, AMGEN, and GSK, outside the submitted work. The authors declare no other conflicts of interest in this work.

Additional information

Funding

This research received no external funding.