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既往研究发现，对于化疗所致周围神经病变，临床医师客观评定结果与患者自己报告的主观严重程度相比，存在显著差异，其具体原因尚不明确。 2020年3月17日，欧洲乳腺癌专科医师学会《乳腺》在线发表美国弗吉尼亚联邦大学、内布拉斯加大学、威斯康星大学、梅杰连锁药房、梅奥医学中心、武田制药、密歇根大学的研究报告，探讨了早期乳腺癌紫杉醇化疗女性向临床医师报告化疗所致周围神经病变严重程度的影响因素。 该前瞻观察研究对60例早期乳腺癌女性每周紫杉醇化疗第7、10、12周时欧洲癌症研究与治疗组织EORTC生活质量问卷QLQ化疗所致周围神经病变20项患者报告结局评分进行回顾分析。从电子病历提取临床医师根据美国国家癌症研究所NCI不良事件通用术语标准CTCAE记录的化疗所致周围神经病变评分，与患者的化疗所致周围神经病变20项评分数据进行匹配。治疗完成之后，通过问卷调查收集人口统计学、康复者顾虑评定、肿瘤医师信任量表、健康素养评定的数据。通过重复测量累积逻辑回归模型，确定患者报告化疗所致周围神经病变严重程度的影响因素。 结果，其中42例女性（70%）完成全部问卷调查。第7周和第10周分别有3例和9例患者的化疗所致周围神经病变20项评分高于八成患者，其影响因素包括：
因此，该小样本初步研究结果表明，离职赋闲、收入较低、信任肿瘤医师能力是患者对临床团队报告化疗所致周围神经病变严重程度主观评分偏高的可能影响因素，故有必要开展进一步研究阐明其相关性并对其他因素进行检验。记录患者与临床医师的沟通，将有助于确认患者高估化疗所致周围神经病变严重程度的影响因素。 Breast. 2020 Mar 17;51:21-28. [Epub ahead of print] Patient factors associated with discrepancies between patient-reported and clinician-documented peripheral neuropathy in women with breast cancer receiving paclitaxel: A pilot study. Teresa M. Salgado, Jin Liu, Holly L. Reed, Caroline S. Quinn, Jillian G. Syverson, Jennifer Le-Rademacher, Camden L. Lopez, Andreas S. Beutler, Charles L. Loprinzi, Kiran Vangipuram, Ellen M. Lavoie Smith, N Lynn Henry, Karen B. Farris, Daniel L. Hertz. Virginia Commonwealth University, Richmond, VA, USA; Nebraska Medical Center, Omaha, NE, USA; University of Wisconsin Health, Madison, WI, USA; Meijer Pharmacy, Ann Arbor, MI, USA; Mayo Clinic, Rochester, MN, USA; Takeda Pharmaceuticals Inc., Cambridge, MA, USA; University of Michigan, Ann Arbor, MI, USA. HIGHLIGHTS
PURPOSE: Discrepancies between clinicians' assessment of chemotherapy-induced peripheral neuropathy (CIPN) and patient-reported outcomes (PRO) have been described, though the underlying reasons are unknown. Our objective was to identify potential patient-specific factors associated with under-describing of CIPN to clinicians in women with non-metastatic breast cancer treated with paclitaxel. METHODS: Patients enrolled in an observational study (n = 60) completed weekly CIPN PRO using the EORTC CIPN20. Clinician-documented CIPN using the NCI CTCAE were abstracted from the electronic medical record and paired with CIPN20 data at weeks 7 and 10. Patients were classified as under-describers if their CIPN20 was above the 80th percentile of the CIPN20 distribution for that CTCAE grade from an independent clinical trial (N08CA). Demographics, Assessment of Survivor Concerns (ASC), Trust in Oncologist Scale (TiOS), and health literacy assessment were collected post-treatment via survey. Repeated measures cumulative logistic regression models were used to identify factors associated with under-describing CIPN. RESULTS: Forty-two women completed the survey (response rate 70%). Three and 9 patients were categorized as under-describers at weeks 7 and 10, respectively. Women who were not working (OR = 9.00, 95%CI 1.06-76.15), had lower income (OR = 7.04, 95%CI 1.5-32.99), and displayed higher trust in their oncologist's competence (OR = 1.29, 95%CI 1.03-1.62 for a 0.1-unit increase in score) were more likely to under-describe CIPN symptoms. CONCLUSIONS: This preliminary study identified non-working status, low income and trust in oncologist's competence as potential factors influencing under-description of CIPN to the clinical team. Further work is needed to clarify these relationships and test additional factors. KEYWORDS: Breast cancer, Chemotherapy-induced peripheral neuropathy, Patient reported outcome measures, Taxoids DOI: 10.1016/j.breast.2020.02.011
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