Avaliação dos monofilamentos de Semmes-Weinstein e de um questionário de neurotoxicidade como instrumentos de detecção de neuropatia periférica induzida por quimioterapia

Abstract

This transversal and comparative study investigated the use of the Semmes-Weinstein Monofilaments (SWM) and the Antineoplastic Induced Neurotoxicity Questionnaire (AINQ) to detect sensory neuropathy in persons receiving neurotoxic chemotherapy. A sample of 117 persons were divided into 02 groups: patient and control. The patient group included 87 persons who had completed at least one chemotherapy cycle with oxaliplatin or taxanes (paclitaxel or docetaxel). The control group included 30 people who had never received any antineoplastic treatment. The project had IRB approval and met the Resolution 196/96 recommendations. The data were collected using the following tools: a Sociodemographic Form, a Clinical Data Form, the ECOG Performance Scale, the AINQ, and a SWM Kit. Data were entered into the SPSS version 15.0, cleared up and analyzed using descriptive, correlational and comparative statistics, with a significance level of 5%. The mean age of the patients was 54 years (SD=11.9 years) and of the control group was 44 years (SD=12.7 years). Both groups were composed mainly by married women, with low socioeconomic and educational level. Functional performance was significantly different between the two groups (p=0,000). Breast cancer was the most frequent type of cancer in the patients, followed by colorectal and gynecologic tumors. The majority were in paclitaxel (68.9%; n=60) and oxaliplatin (28.73%; n=25) protocols. The AINQ was validated and showed good reliability, with a Cronbach alpha of 0.863. The results of the paired samples T- test confirmed good internal consistence. There were statistically significant differences (p<0.001) for all symptoms between the groups. Chemotherapy Induced Peripheral Neuropathy (CIPN) symptoms were not related to the type of the chemotherapy drug (p=0.478). In the patients group, the hand esthesiometry showed higher sensory changes frequency in all points of the ulnar, median and radial nerves (p<0.05). The patients hand sensory changes varied from the blue monofilament (0.2g) to the red x (4g). In the control group, the worst sensory change was detected by the violet monofilament (2g). Results of the feet estesiometry showed significant differences between the groups (p<0.05). Sensory changes were more severe in the patients, ranging from the violet monofilament (2g) to complete sensory loss in certain points. A comparison between the tools had Kappa values of 0.193 in the patients group, 0.204 in the control group, and of 0.320 for the total sample (p<0.05). The correlation between the AINQ and the Esthesiometer was positive and moderate (=0.357, p<0.001). The study showed that both the AINQ and the Esthesiometer can be useful tools for CIPN detection in oncology.