Patient factors associated with discrepancies between patient-reported and clinician-documented peripheral neuropathy in women with breast cancer receiving paclitaxel: A pilot study

• Published in: Breast (Edinburgh) Vol. 51; pp. 21 - 28
• Main Authors: Salgado, Teresa M., Liu, Jin, Reed, Holly L., Quinn, Caroline S., Syverson, Jillian G., Le-Rademacher, Jennifer, Lopez, Camden L., Beutler, Andreas S., Loprinzi, Charles L., Vangipuram, Kiran, Smith, Ellen M. Lavoie, Henry, N Lynn, Farris, Karen B., Hertz, Daniel L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-06-2020; Elsevier
• Subjects: Adult; Aged; Antineoplastic Agents - adverse effects; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - psychology; Chemotherapy-induced peripheral neuropathy; Electronic Health Records - statistics & numerical data; Female; Health Literacy - statistics & numerical data; Humans; Middle Aged; Original; Paclitaxel - adverse effects; Patient Reported Outcome Measures; Peripheral Nervous System Diseases - chemically induced; Pilot Projects; Socioeconomic Factors; Taxoids; Trust - psychology; Patient reported outcome measures; Breast cancer; Taxoids; Chemotherapy-induced peripheral neuropathy
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2020.02.011

Discrepancies between clinicians’ assessment of chemotherapy-induced peripheral neuropathy (CIPN) and patient-reported outcomes (PRO) have been described, though the underlying reasons are unknown. Our objective was to identify potential patient-specific factors associated with under-describing of CIPN to clinicians in women with non-metastatic breast cancer treated with paclitaxel.
Patients enrolled in an observational study (n = 60) completed weekly CIPN PRO using the EORTC CIPN20. Clinician-documented CIPN using the NCI CTCAE were abstracted from the electronic medical record and paired with CIPN20 data at weeks 7 and 10. Patients were classified as under-describers if their CIPN20 was above the 80th percentile of the CIPN20 distribution for that CTCAE grade from an independent clinical trial (N08CA). Demographics, Assessment of Survivor Concerns (ASC), Trust in Oncologist Scale (TiOS), and health literacy assessment were collected post-treatment via survey. Repeated measures cumulative logistic regression models were used to identify factors associated with under-describing CIPN.
Forty-two women completed the survey (response rate 70%). Three and 9 patients were categorized as under-describers at weeks 7 and 10, respectively. Women who were not working (OR = 9.00, 95%CI 1.06–76.15), had lower income (OR = 7.04, 95%CI 1.5–32.99), and displayed higher trust in their oncologist’s competence (OR = 1.29, 95%CI 1.03–1.62 for a 0.1-unit increase in score) were more likely to under-describe CIPN symptoms.
This preliminary study identified non-working status, low income and trust in oncologist’s competence as potential factors influencing under-description of CIPN to the clinical team. Further work is needed to clarify these relationships and test additional factors.
•This pilot study examined factors associated with under-describing of neuropathy.•Patient-reported and clinician-documented neuropathy severity were compared.•Non-working status and low income were associated with neuropathy under-describing.•Trust in oncologist’s competence was associated with neuropathy under-describing.•Recording patient-clinician interactions would confirm under-describing behavior.