Objectives: Approximately 60% of cancer survivors receiving neurotoxic chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN) (eg, hand and foot numbness, tingling, or pain). There is only one recommended pharmacological treatment (duloxetine) and one modestly beneficial nonpharmacological treatment (exercise) for CIPN. However, data suggest national guideline recommendations are not routinely practiced. Further, less is known about nurses' CIPN management practices. The purpose of this convergent mixed methods study was to explore oncology clinicians' self-reported practices and perceptions regarding CIPN prevention and management.
Methods: Oncology clinicians at three cancer centers completed a survey about their recommendations for CIPN prevention and management in practice. A subset of clinicians also participated in a semi-structured interview to explore their perspectives of and motivations for implementing CIPN assessment, prevention, and management in practice. Quantitative data were described (eg, frequency or median) and qualitative data were analyzed using inductive content analysis.
Results: This study (N = 44 survey responses; n = 9 interviews) resulted in four themes: (1) clinicians primarily recommend gabapentin for CIPN management and often observe cryotherapy used for CIPN prevention, but these interventions are complicated by discomfort, intolerable side effects, and efficacy concerns; (2) clinicians perceive CIPN as troublesome and desire additional information and resources regarding CIPN prevention and management; (3) CIPN-related education provided by clinicians may be limited by patient retention of the amount of education received about cancer treatment and other factors; (4) clinicians use subjective CIPN assessment to screen at each visit for common CIPN symptoms (eg, numbness or tingling) and the impact of symptoms on day-to-day activities.
Conclusions: Discrepancies persist between evidence-based guidelines on CIPN management and current oncology clinician practices.
Implications for Nursing Practice: Clinician involvement is needed when developing education and resources to help oncology clinicians provide the most evidence-based care to potentially prevent and manage their patients' CIPN.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Robert Knoerl reports financial support was provided by the National Cancer Institutes of Health under Award Number P30CA046592. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. John C. Krauss reports financial support was provided by Anal Cancer Research Fund. Robert Knoerl reports a relationship with Fors Marsh Group LLC that includes: consulting or advisory. Robert Knoerl reports a relationship with Comprehensive and Integrative Medicine Institute that includes: consulting or advisory. John C. Krauss reports a relationship with Innovative Cellular Therapeutics that includes: funding grants. John C. Krauss reports a relationship with Agenus Inc that includes: funding grants. John C. Krauss reports a relationship with Janssen Research and Development LLC that includes: funding grants. John C. Krauss reports a relationship with Bristol Myers Squibb Co that includes: funding grants. John C. Krauss reports a relationship with Novartis that includes: funding grants. John C. Krauss reports a relationship with Exelixis Inc that includes: funding grants. John C. Krauss reports a relationship with Gilead Sciences Inc that includes: funding grants. John C. Krauss reports a relationship with Amgen Inc that includes: funding grants. John C. Krauss reports a relationship with Pfizer that includes: funding grants. John C. Krauss reports a relationship with Hutchison MediPharma Ltd that includes: funding grants. John C. Krauss reports a relationship with AbbVie Inc that includes: funding grants. John C. Krauss reports a relationship with AstraZeneca that includes: funding grants. John C. Krauss reports a relationship with Merck Sharp & Dohme Corp that includes: funding grants. John C. Krauss reports a relationship with Genentech that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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