Abstract P4-11-06: The role of patient perceptions in under reporting chemotherapy induced peripheral neuropathy (CIPN)
Authors: Hertz DL , Krumbach E , Nobles B , Erickson S , Farris KB 
Published: February 2018

Background: Although paclitaxel remains one of the most efficacious and commonly used agents in the treatment of breast cancer, it can cause a number of side effects. Decisions to delay, decrease, or discontinue treatment are made based on the severity of chemotherapy induced peripheral neuropathy (CIPN), which is not objectively measured but relies on patient's accurately reporting symptoms to their clinical team. There is some concern that patients do not accurately or completely report CIPN symptoms during treatment. A previous study reported that 3 of 24 patients (12.5%) considered or could understand another patient's decision to under-report CIPN symptoms to avoid treatment disruption. The objective of this follow-up study was to determine whether under-reporting occurred and to understand patient perspectives on topics previously found relevant to a patient's decision to under-report CIPN.

Methods: Ten patients with early stage breast cancer who received adjuvant paclitaxel 80 mg/m2 for up to 12 weeks, who had no prior neuropathy or neurotoxic chemotherapy participated in a recorded, semi-structured, phone-based interview that followed an interview guide designed to cover topics relevant to patient under-reporting

Themes identified in patient perceptions of objectives found relevant to under reportingObjectiveResultPatient Understanding1. Patients had consistent descriptions of their expectations for CIPN prior to treatment. 2. Understanding of the long-term potential of CIPN varied among patients.Patient Education1. Patients used a variety of sources to find information about CIPN, with the most commonly used sources being medical staff and patient handouts.Patient Input1. Patients agree on the importance of reporting side effects, but not to what extent. 2. Patients felt included in the treatment decision-making process, but some felt the doctor ultimately made the decision. 3. Providers may plan an important role in the extent to which patients report their symptoms.Treatment Cycles1. Patients recognized that they may not complete all 12 cycles, but were determined to do so.Perception Changes1. Before treatment, patients are much more focused on efficacy and were not particularly concerned with side effects. 2. During treatment, patients reflected on their desire to complete treatment and the tolerability of the side effects they were experiencing. 3. After treatment, patients felt they should have asked more questions before starting treatment.

. The interviews were then transcribed and qualitatively analyzed using NVivo software to identify common themes.

Results: No patients in this study admitted to under-reporting neuropathy. Themes that emerged from the interviews are presented in Table 1.

Conclusion: Insight as to how patients perceive various aspects of paclitaxel treatment revealed that comfort level with providers, inclusion in the decision-making process, and encouragement to fully disclose all symptoms played an important role when patients considered whether to report adverse effects. Future research may focus on whether a lack of health literacy and/or health care related work experience predisposes to CIPN under-reporting.

Citation Format: Hertz DL, Krumbach E, Nobles B, Erickson S, Farris KB. The role of patient perceptions in under reporting chemotherapy induced peripheral neuropathy (CIPN) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-11-06.