Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update

PURPOSE To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors. METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies. RESULTS The search strategy identified 257 new references, which led to a full-text review of 87 manuscripts. A total of 3 systematic reviews, 2 with meta-analyses, and 28 primary trials for prevention of CIPN in addition to 14 primary trials related to treatment of established CIPN, are included in this update. RECOMMENDATIONS The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment. Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited

ONLINE Special Article: Nursing care for patients with non-small cell lung cancer receiving adjuvant chemotherapy: Evidence–based implications for practice

Oncology nurses provide care to patients and their families across the cancer care continuum including counselling patients on issues related to treatment completion, providing education directed towards the prevention of side effects, assessing and managing symptoms, and follow-up. Believing that a nursing-specific perspective related to these concerns was necessary to improve care for patients with resected, non-small cell lung cancer (NSCLC) receiving adjuvant chemotherapy, a nursing guidance report was initiated. This report was developed by utilizing evidence retrieved in a practice guideline report, general principles established by CANO/ACIO, Fitch’s supportive care model, and the clinical experiences of Lung DSG members. Evidence on the toxicity and adverse events that are caused by adjuvant chemotherapy and side effects and symptoms that are amenable to nursing intervention are highlighted and discussed

Article offert EN LIGNE : Soins infirmiers pour patients atteints du cancer du poumon non à petites cellules recevant une chimiothérapie adjuvante : implications pour la pratique fondée sur les données probantes

Les infirmières en oncologie prodiguent des soins aux patients et à leur famille dans tout le continuum des soins de cancérologie, notamment en offrant des services de counseling aux patients relativement à l’achèvement du traitement, en dispensant de l’enseignement en vue de prévenir les effets secondaires, en évaluant et en gérant les symptômes et en effectuant le suivi nécessaire. Comme nous jugions qu’il était nécessaire d’explorer ces préoccupations du point de vue des soins infirmiers en vue d’améliorer les soins aux patients atteints d’un cancer du poumon non à petites cellules (CPNPC) avec résection tumorale recevant une chimiothérapie adjuvante, nous avons amorcé la préparation d’un rapport d’orientation pour les soins infirmiers. Ce dernier a été élaboré à partir des données d’un rapport sur les lignes directrices de pratique, des principes généraux établis par l’Association canadienne des infirmières en oncologie (ACIO), du modèle des soins de soutien de Fitch et de l’expérience clinique des membres du Groupe spécialisé dans le cancer pulmonaire. On y souligne et aborde les résultats liés à la toxicité et aux événements indésirables causés par la chimiothérapie adjuvante et les effets secondaires et symptômes qui peuvent se prêter à une intervention infirmière

Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.

PurposeThis guideline presents screening, assessment, and treatment approaches for the management of adult cancer survivors who are experiencing symptoms of fatigue after completion of primary treatment.MethodsA systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature identified the pan-Canadian guideline on screening, assessment, and care of cancer-related fatigue in adults with cancer, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines In Oncology (NCCN Guidelines) for Cancer-Related Fatigue and the NCCN Guidelines for Survivorship. These three guidelines were appraised and selected for adaptation.ResultsIt is recommended that all patients with cancer be evaluated for the presence of fatigue after completion of primary treatment and be offered specific information and strategies for fatigue management. For those who report moderate to severe fatigue, comprehensive assessment should be conducted, and medical and treatable contributing factors should be addressed. In terms of treatment strategies, evidence indicates that physical activity interventions, psychosocial interventions, and mind-body interventions may reduce cancer-related fatigue in post-treatment patients. There is limited evidence for use of psychostimulants in the management of fatigue in patients who are disease free after active treatment.ConclusionFatigue is prevalent in cancer survivors and often causes significant disruption in functioning and quality of life. Regular screening, assessment, and education and appropriate treatment of fatigue are important in managing this distressing symptom. Given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors

Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation.

PurposeThis guideline presents screening, assessment, and treatment approaches for the management of adult cancer survivors who are experiencing symptoms of fatigue after completion of primary treatment.MethodsA systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature identified the pan-Canadian guideline on screening, assessment, and care of cancer-related fatigue in adults with cancer, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines In Oncology (NCCN Guidelines) for Cancer-Related Fatigue and the NCCN Guidelines for Survivorship. These three guidelines were appraised and selected for adaptation.ResultsIt is recommended that all patients with cancer be evaluated for the presence of fatigue after completion of primary treatment and be offered specific information and strategies for fatigue management. For those who report moderate to severe fatigue, comprehensive assessment should be conducted, and medical and treatable contributing factors should be addressed. In terms of treatment strategies, evidence indicates that physical activity interventions, psychosocial interventions, and mind-body interventions may reduce cancer-related fatigue in post-treatment patients. There is limited evidence for use of psychostimulants in the management of fatigue in patients who are disease free after active treatment.ConclusionFatigue is prevalent in cancer survivors and often causes significant disruption in functioning and quality of life. Regular screening, assessment, and education and appropriate treatment of fatigue are important in managing this distressing symptom. Given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors