Evaluation of chemotherapy-induced peripheral neuropathy

Measurement of chemotherapy-induced neuropathy can be based on patient report, clinician report, or objective assessment of nerve function. In this chapter, we discuss patient-reported outcomes (PROs), including the European Organization for Research and Treatment of Cancer Quality of Life-Chemotherapy-Induced Peripheral Neuropathy questionnaire (EORTC QLQ-CIPN20), the Functional Assessment of Cancer Therapy/Gynecological Cancer Group-Neurotoxicity questionnaire (FACT/GOG-Ntx), and the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE). In addition, we describe clinician-reported scales: the CTCAE, the Eastern Cooperative Oncology Group (ECOG) criteria, the World Health Organization (WHO) neurotoxicity scale, and the Ajani scale. Two scales that are specifically used for oxaliplatin-induced neurotoxicity are also discussed: the Oxaliplatin Neurological Toxicity Scale (ONTS] and the Neurotoxicity Criteria of Debiopharm (DEB-NTC). We also explain how nerve conduction studies assess peripheral nerve action potential amplitudes and velocity, and we describe the use of quantitative sensory testing, in which patients report whether they can detect sensations of vibration, mechanical stimuli, and warmth/cold applied to the skin at different locations. We discuss how these two types of studies can augment patient-and clinician-reported assessments, in part because they can detect abnormalities before they become clinically evident. Further, we highlight important biomarkers of CIPN, discuss options for nerve imaging, and make recommendations for clinical practice.