BACKGROUND Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish quality of life. Monitoring to identify CIPN before it progresses to life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained healthcare professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. OBJECTIVE The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via smartphone app. METHODS Twenty-six patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=16) or controls (n=10) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time including patient-reported surveys (CIPN20 and PRO-CTCAE) and functional assessments (Gait and Balance and 9 Hole Peg Test). RESULTS Exploratory comparisons between CIPN cases and controls indicate CIPN cases had shorter step length (P=.003), unique swaying acceleration patterns during a walking task, and shorter hand moving distance during a manual dexterity task. CONCLUSIONS Our results confirm that remote CIPN assessment via a smartphone app is feasible and suggest that functional data may be indicative of CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care.

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Purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is the major treatment-limiting toxicity of paclitaxel, which predominantly presents as sensory symptoms, with motor symptoms in some patients. Differentiating CIPN into subtypes has been recommended to direct CIPN research. The objective of this study was to investigate whether sensory and motor CIPN are distinct subtypes with different predictive biomarkers in patients with breast cancer receiving paclitaxel.Methods: European Organisation for Research and Treatment of Cancer Quality of Life questionnaire CIPN20 was used to evaluate CIPN. Clusters of the time course of sensory (CIPN S ), motor (CIPN M ), and the difference between sensory and motor (CIPN S -CIPN M ) were identi ed using k-means clustering on principal component scores. Predictive metabolomic biomarkers of maximum CIPN S and CIPN M were investigated using linear regressions adjusted for baseline CIPN, systemic paclitaxel exposure, and body mass index.Results: More sensory than motor CIPN was found (CIPN S change: mean=10.8, ranged [-3.3, 52.1]; CIPN M change: mean=3.5, range: [-7.5, 35.0]). Three groups were identi ed with No CIPN, Mixed CIPN, and Sensory-dominant CIPN (maximum CIPN S : mean=12.7 vs. 40.9 vs. 74.3, p<0.001; maximum CIPN M : mean=5.4 vs. 25.5 vs. 36.1, p<0.001; average CIPN S -CIPN M : mean=2.8 vs. 5.8 vs. 24.9, p<0.001).Biomarkers of motor CIPN were similar to previously identi ed biomarkers of sensory CIPN, including lower serum histidine (p=0.029). Conclusion: Our ndings suggest that sensory and motor CIPN co-occur and may not have differentiating metabolic biomarkers. These ndings need to be validated in larger cohorts of patients treated with paclitaxel and other neurotoxic agents to determine the optimal approach to predict, prevent, and treat CIPN and improve patients' outcomes.

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Background Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. Objective The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy. Methods A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app. Results Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ≥2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download. Conclusions Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care.