Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Development and consensus of ‘CIPN-Path’: a clinical pathway for the assessment and management of chemotherapy-induced Peripheral Neuropathy (#313)

David Mizrahi 1 2 , David Goldstein 2 3 , Matthew C Kiernan 4 5 , Louisa Robinson 3 , Omali Pitiyarachchi 3 , Susan McCullough 6 , Phil Mendoza-Jones 6 , Peter Grimison 7 8 , Frances Boyle 8 9 , Susanna B Park 4
  1. The Daffodil Centre, a joint venture with Cancer Council NSW, The University of Sydney, Sydney, NSW, Australia
  2. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
  3. Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
  4. Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
  5. Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  6. Translational Cancer Research Network Consumer Advisory Panel, Sydney, NSW, Australia
  7. Chris O'Brien Lifehouse, Sydney, NSW, Australia
  8. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
  9. Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, NSW, Australia

Aims: Patients with cancer treated with neurotoxic chemotherapy are at-risk of developing neurological symptoms that can impact their functional capacity and quality of life (QoL). However, there are no standardised clinical pathways to assess and manage chemotherapy-induced peripheral neurotoxicity (CIPN). This study aimed to determine consensus on statements regarding a CIPN assessment and management clinical pathway.

Methods: A CIPN clinical pathway (CIPN-Path) was developed based on current evidence and reviewed by a 10-member expert multi-disciplinary and consumer panel. The CIPN-Path is a health service delivery pathway for CIPN assessment, management and decision-making. Agreement with 18 statements regarding four content themes (‘pre-treatment review’, ‘screening and assessment’, ‘management and referral’, ‘CIPN-Path feasibility’) were assessed using a 2-stage Delphi survey process to reach consensus. Respondents rated statements using a 5-point Likert scale to determine level of agreement, with consensus defined as ≥80% of respondent agreement with each statement.

Results: 70 Australian respondents participated (medical oncologists/haematologists (31%), nurses (24%), neurologists (16%), allied health (11%)). Consensus was reached for 14 of 18 items after stage 1, and all items after stage 2. Feedback was obtained for all items to refine the CIPN-Path. There was agreement for important characteristics of the CIPN-Path including pre-treatment screening, regular patient-reported assessment, and a stepped-care approach to investigating and managing symptom burden. There was a lack of agreement in who should oversee CIPN assessment. Open-text responses highlighted timely access to specialised services (e.g. neurology or allied health) may not be practical for all, as access to care will differ by site-based resources.

Conclusions: There was overall agreement regarding the CIPN-Path to assess and manage CIPN, which can be adapted accordingly to the resources of each site. The CIPN-Path may assist teams across different health services to identify CIPN symptoms, aid decision-making, reduce morbidity and improve QoL of patients with CIPN.