title: A prospective surveillance model for physical rehabilitation of women with breast cancer: chemotherapy-induced peripheral neuropathy.
abstract: Chemotherapy-induced peripheral neuropathy (CIPN) results from damage to or dysfunction of the peripheral nerves. The development of CIPN is anticipated for the majority of breast cancer patients who receive neurotoxic chemotherapy, depending on the agent used, dose, and schedule. Sensory symptoms often predominate and include numbness, tingling, and distal extremity pain. Weakness, gait impairment, loss of functional abilities, and other deficits may develop with more severe CIPN. This article outlines a prospective surveillance model for physical rehabilitation of women with breast cancer who develop CIPN. Rehabilitative efforts for CIPN start at the time of breast cancer diagnosis and treatment planning. The prechemotherapy evaluation identifies patients with preexisting peripheral nervous system disorders that may place them at higher risk for the development of CIPN. This clinical evaluation should include a history focusing on symptoms and functional activities as well as a physical examination that objectively assesses the patient's strength, sensation, reflexes, and gait. Ongoing surveillance following the initiation of a neurotoxic agent is important to monitor for the development and progression of symptoms associated with CIPN, and to ensure its resolution over the long term. CIPN is managed best by a multidisciplinary team approach. Early identification of symptoms will ensure appropriate referral and timely symptom management. The prospective surveillance model promotes a patient-centered approach to care, from pretreatment through survivorship and palliative care. In this way, the model offers promise in addressing and minimizing both the acute and long-term morbidity associated with CIPN.
authors.affiliation: Department of Neurology, Rehabilitation Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA. stubblem@mskcc.org
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stubblefield
authors.forename: Margaret L
authors.initials: ML
authors.lastname: McNeely
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Alfano
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
mesh_terms: D000328:Adult; D000368:Aged; D000570:American Cancer Society; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000534:rehabilitation* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003226:Congresses as Topic; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000209:etiology / Q000534:rehabilitation; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome