Nurses Develop New Measure for Pediatric CIPN

While chemotherapy-related peripheral neuropathy (CIPN) is a common adverse event in pediatric patients with cancer, there is currently no patient-reported outcome measure on the malady, due, in part, to the difficulty children may have in explaining what they are experiencing.

“The signs are not always easily accessible, and the symptoms are difficult for kids to describe — numbness, tingling, pain – children often do not have words to be able to describe these symptoms to us,” said Ellen Lavoie Smith, PhD, MSN, RN, AOCN, FAAN, professor and PhD program director at the University of Michigan School of Nursing.

Smith and her team developed a new method of measuring pediatric CIPN called the P-CIN measure, which was tested at the University of Michigan and the Minnesota Children’s Cancer and Blood Disorders Center. Their results were presented at the 2020 ONS Bridge Virtual Meeting.

P-CIN is a 13-item electronic survey, where patients rate CIPN symptoms on a scale of 0-5; higher scores indicate a more severe case of CIPN. Some items in the survey asked children to complete a task (such as picking up a coin, standing with eyes closed, heel walk) and then rate the difficulty.

“Some of our items or functional tests were probably a little too easy, even for kids with neuropathy, so we later modified it to make the tasks more difficult,” Smith said.

Study participants were between the ages of 5 and 17, with the average age being 11.25 years. The majority (62.5%) of patients had acute leukemia, and 98.7% of them were treated with vincristine.

Patients’ scores were compared against the Bruiniks-Osertsky Test of Moto Proficiency (BOTMP) motor function assessment and the Pediatric Modified Total Neuropathy Score (ped-mTNS).

It was ultimately found that the P-CIN measure was valid, however it was not perfect. Smith explained that there was a lack of item response variation, which could lead to suboptimal sensitivity. Additionally, Smith mentioned that the measure should be tested in a larger population.

“In conclusion, we recommend that this piece be tested in a larger, more diverse sample, and that additional psychometric tests are conducted to test and retest reliability and the responsiveness of measures. And, of course, we still need to work on measures for younger children,” Smith said.