Estudo da neuropatia periférica induzida por quimioterapia: possíveis preditores clínicos e validação de instrumento de avaliação

Abstract

This is a mixed design, concomitant, descriptive and comparative research, that had the objective of analyzing the influence of clinical parameters in the development of Chemotherapy Induced Peripheral Neuropathy (CIPN) and validating an evaluation instrument. This work is comprised of two analysis. Analyse I: longitudinal arm (n=55) of which participated oncologic patients who initiated therapeutic proposal with taxanes or oxaliplatin, evaluated at three times (before treatment, 6-12 weeks, 30-60 days after completion). Analyse II (mixed study): one longitudinal (n=55) and one cross-sectional arm (n=44) of which participated volunteers 6-9 months after the completion of the treatment with taxanes or oxaliplatin. Data collection was performed by means of interviews, consultation to medical records, clinical exam and ENG. As instruments, we opted, among others, for the Short McGill, HAD scale and the FACT/GOG-NTx. For the evaluation of CIPN, we used the symptom self-report, CINQ, SWM and ENG (only for the longitudinal arm). In the analysis for possible clinical and socio-demographic predictors, logistic regression analyses identified that, in T2, education might be considered a predictor for the symptom self-report of CIPN (p=0.040, OR=1.314, IC95%=1.002-1.723). In T3, the use of house medication was considered a protector for self-reported symptoms(p=0,041, OR=0,023, IC95%=0,001-0,862). In the monofilament validation, the sensorial loss was defined as cut-off point for the diagnosis of CIPN symptoms. When compared to the CINQ, the SWM showed VPP=93.5%. When compared to the ENG, the SWM showed sensitivity of 100% and specificity of 23.5%. In study II (development and persistence of neuropathic pain), we identified an increase of cases of neuropathic pain in the longitudinal arm when comparing T1 and T2 (p=0.004), T1 and T3 (p<0.001), save for T2 and T3 (p=0.109). The risk of developing neuropathic pain in patients presenting CIPN symptoms was of 43% (RR=1.429; IC95%=1.130-1.806). Upper limbs symptoms were considered predictors for the development of neuropathic pain (p=0.048; OR=1.122, IC95%=1.001-1.258), while orofacial symptoms (p=0.05; OR=1.220, IC95%=1.063-1.401) were considered predictors for persistence30-60 days after the treatment. In the cross-sectional arm, lower limbs symptoms were considered predictors for late persistence of neuropathic pain (p=0.001; OR=1.096, IC95%=1.040-1.156). The present study showed no cause-effect relation between different clinical parameters and the development of CIPN, sufficing the exposure to the drug for existing the risk of the syndrome. The SWM are valid and show high specificity however low sensitivity, probably due to the absence of a gold standard capable of detecting small fiber neuropathies.