A New Scoring System Administered by Patients to Identify Moderate-to-Severe Chemotherapy-Induced Peripheral Neuropathy: Final Results of the NEURO-BREAC Trial

TL;DR

A new patient-administered scoring system accurately identifies moderate-to-severe chemotherapy-induced neuropathy in breast cancer survivors.

Contribution

A self-administered scoring system for CIPN detection with high accuracy and patient satisfaction is proposed and validated.

Findings

A cut-off score of 9 in the new system achieved 100% sensitivity, specificity, and predictive values for CIPN detection.

Patient dissatisfaction with the new tool was only 7.7%, indicating high usability.

The new system outperformed the Utah Early Neuropathy Scale in practical patient use.

Abstract

Breast cancer patients receiving taxane-based treatment often develop chemotherapy-induced peripheral neuropathy (CIPN). Since treatment options for CIPN are very limited, its early diagnosis appears important. This may be facilitated by scoring systems. The existing objective systems need to be applied by staff members. A tool that can be used by the patients themselves is desirable. Such an instrument was recently developed but not tested for the detection of CIPN. The definition of the most appropriate cut-off score to identify moderate-to-severe CIPN is an important step for the evaluation of the usability of the scoring system in patients with CIPN. In this prospective trial performed on breast cancer survivors, the optimal cut-off score was identified. It provided extremely high accuracy, achieving the maximum possible Youden index of 1.00. Moreover, patient satisfaction with the new scoring system was very high. Given the limitations of this study, the new instrument may be used in future studies.

Background/Objectives: Many breast cancer patients treated with taxanes experience chemotherapy-induced peripheral neuropathy (CIPN). The early detection of CIPN may be facilitated by scoring systems. The existing Utah Early Neuropathy Scale (UENS) requires the presence of medical staff members. A self-assessment tool usable by patients is desired. Such an instrument was recently developed but had not yet been evaluated for the detection of CIPN. This prospective study aimed to identify the optimal cut-off score for the identification of moderate-to-severe CIPN in breast cancer survivors. Methods: Twenty-six breast cancer survivors (patients) who previously received taxane-based chemotherapy were included. Eighteen patients presenting with moderate-to-severe CIPN and eight patients without CIPN used the new scoring system (0–44 points). For each cut-off score, sensitivity, specificity, Youden index, and positive (PPV) and negative (NPV) predictive values were calculated. Patients rated their satisfaction with the tool. Dissatisfaction rates of >20% and >40%, respectively, would mean that it needed optimization or could not be used. Afterwards, the UENS (0–42 points) was applied by medical staff members. Results: For the new tool, a cut-off score of 9 points was found to be optimal for identifying moderate-to-severe CIPN. The sensitivity, specificity, Youden index, and PPV and NPV were 100% in each case. The dissatisfaction rate was 7.7%. When applying the UENS, the sensitivity, specificity, Youden index, and PPV and NPV were each 100% for a cut-off score of 6 points. Conclusions: The new self-assessment scoring system was highly accurate regarding the identification of moderate-to-severe CIPN. Patient satisfaction was high. When considering the limitations of this trial, the new instrument may be used in future studies.

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