Oxaliplatin Induced Neurotoxicity among Patients with Colorectal Cancer: Documentation in Medical Records—A Pilot Study

Abstract

Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively. Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxic side effects so they can be documented and action taken at an early stage. The study aimed to identify and explore neurotoxic side effects documented in the medical records of patients with colorectal cancer treated with oxaliplatin-based adjuvant chemotherapy. Data in this study were medical records; presenting documentation about patients treated at the University Hospital in the south of Sweden between 2009 and 2010. A summative content analysis approach was used to explore the neurotoxic side effects. Identification and quantification of the content of medical records were carried out by using a study-specific protocol. "Cold sensitivity" and "tingling in the hands" were the most frequently documented neurotoxicity-related terms in the medical records. This identification was followed by interpretation. Three categories were identified in the interpretive part of the study: acute, chronic, and degree of neurotoxicity. The results show the importance of awareness of neurotoxic side effects so that they can be documented and action taken at an early stage. The documentation could be more reliable if patient-reported structured measurements were used, combined with free descriptions in the medical records. Being able to follow the progression of the symptoms during and after treatment would improve patient's safety and also quality of life. The protocol that we developed and used in this review of medical records may be helpful to structure the documentation in the electronic system for documentation of neurotoxicity side effects. Keywords

Reliability testing of oxaliplatin-associated neurotoxicity questionnaire (OANQ), a pilot study

“…Free descriptions of the physician's estimation of the patient's neurotoxic symptoms in the medical records were analysed. All symptoms in the predetermined protocol influenced by the Swedish version of the OANQ were found in the medical records except "heat sensitivity" (24). This finding also strengthens the content validity of the questionnaire (27).…”

“…The scale ranges from 1 to 5 with a higher score indicating greater severity of the symptom and affect of daily activities. The original OANQ is in English (21) and was translated to Swedish and adjusted to Swedish settings (24). The translation of the OANQ to Swedish and back translation to English was conducted in three steps (25)(26).…”

“…The mentioned method used to elaborate the questionnaire indicates strong content validity (27). In 2013, a predetermined protocol influenced by the Swedish version of the OANQ was used in a retrospective study of patients with colorectal cancer treated with oxaliplatin-based adjuvant chemotherapy (24). The study aimed to investigate the presence of documented neurotoxic side effects in the patients' medical records.…”

The incidence of acute oxaliplatin-induced neuropathy and its impact on treatment in the first cycle: a systematic review

“…Furthermore, even though most studies applied dose reduction criteria in order to limit the degree of subsequent toxicity, the number of patients who received reduced dose, treatment delay and treatment cessation due to acute neuropathy was reported in one study only [ 25 ]. The lack of a systematic, detailed approach to presentation of the number of patients who received dose reduction (and when) and dropout rates within the first cycle, means that the impact of such parameters on subsequent treatment cannot be informed by comprehensive data sets, making dose modification difficult in order to limit the development of acute and chronic neuropathies [ 43 ].…”

“…In this review, no study reported the number of patients whose symptoms resolved and those who had persistent neuropathy in the second cycle among who developed acute neuropathy in the first 14 days of chemotherapy. This will hamper preventive actions and treatment optimization at the early stage of treatment [ 43 ]. Moreover, studies differed in starting dose (duration of infusion, amount/ total dose), type of combination of drugs in each regimen, study design, type of cancer patients (chemonaïve/ previously untreated), neuropathy assessment tool, time of assessment of toxicity after treatment initiation and result presentation (acute versus chronic, time of occurrence of toxicity, degree of severity of symptoms, and measures taken).…”