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FEATURE ARTICLE
Case Report: Painful Peripheral Neuropathy Following Treatment With Docetaxel for Breast Cancer Meredith A. Wampler, PT, Deborah Hamolsky, RN, MS, Kate Hamel, PhD, Michelle Melisko, MD, and Kimberly S. Topp, PT, PhD
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can be initiated early (Sweeney, n 2005, an estimated Peripheral neuropathy is a common side effect of many 2002; Wilkes, 1999). Common 211,240 women in the toxicity scores developed by United States will be dichemotherapy agents. As many as 60% of patients receivthe World Health Organization agnosed with breast cancer ing taxane therapy report symptoms such as numbness, and Eastern Cooperative On(American Cancer Society, tingling, burning, pain, and, in severe cases, weakness in cology Group often are used to 2005). The taxanes—paclitaxel monitor peripheral neuropathy and docetaxel—are chemotheraa stocking and glove pattern. These symptoms are assosymptoms (Miller, Hoogstraten, peutic drugs commonly used to ciated with problems in physical mobility and decreased Staquet, & Winkler, 1981; Oken treat breast cancer because of quality of life, yet few articles in the literature discuss colet al., 1982). These tools are increasing evidence that these laborative interdisciplinary assessment and treatment of limited because (a) the toxicity drugs reduce local recurrence score is subjectively determined and mortality rates (Goble & this population. This article describes the care of a patient by the healthcare provider, (b) Bear, 2003). Taxanes, however, with diabetes and docetaxel-induced, painful peripheral the categories are broad (0 = no commonly cause paresthesias neuropathy by a multidisciplinary team of nurses, physisymptoms to 4 = paralysis), and in a stocking and glove pattern cians, and physical therapists. Because nurses are often (c) little evidence indicates that (Chaudhry, Rowinsky, Sartorius, assessment beyond the presDonehower, & Cornblath, 1994; the first clinicians to recognize symptoms of chemotherence or absence of peripheral Hilkens et al., 1996; New, Jackapy-induced peripheral neuropathy, they provide the neuropathy is done uniformly in son, Rinaldi, Burris, & Barohn, essential coordination of care by appropriate medical and most clinical settings. Because 1996; Sahenk, Barohn, New, & of these limitations, nursing asMendell, 1994). As the cumularehabilitative services. This case also raises important sessment also should include a tive dose is increased, weakness questions about the relationship between diabetes mellitus patient history for risk factors also may occur (Forsyth et al., and persistent, painful peripheral neuropathy. that may predispose a patient to 1997; Lipton et al., 1989; van neuropathy, a record of patient Gerven et al., 1994). Sensorimotor signs and symptoms often are more se- alter microtubules also may impair axonal symptoms, and a physical examination of vere in patients with preexisting peripheral structure and/or cause endoneurial edema large and small peripheral nerve function neuropathy (Chaudhry, Chaudhry, Crawford, as has been demonstrated in animals treated (Sweeney). Large-fiber functions, including with vincristine and paclitaxel (Polomano, vibration and touch, can be measured easily Simmons-O’Brien, & Griffin, 2003). Taxanes are effective antineoplastic Mannes, Clark, & Bennett, 2001; Tanner, in the clinic using items such as a tuning fork agents partly because they polymerize free Levine, & Topp, 1998; Topp, Tanner, & over bony prominences and a cotton swab or cellular tubulin, stabilizing microtubules Levine, 2000). Axonal pathology, including fingertip brushed over the skin. Small-fiber in a polymerized state and thereby dis- atrophy and dying back of large-fiber axons, rupting the microtubular network essential has been documented in a peripheral nerve Submitted June 2004. Accepted for publicafor mitotic division of the cell (Goble & biopsy from a patient treated with paclitaxel tion November 29, 2004. (Mention of specific Bear, 2003). Therefore, rapidly dividing (Sahenk et al., 1994). products and opinions related to those prodMany nurses are cognizant of the probcells, such as breast cancer cells, undergo ucts do not indicate or imply endorsement by apoptosis (cell death) in the presence of lems caused by neurotoxic chemotherapeuthe Clinical Journal of Oncology Nursing or taxanes that have not been metabolized by tic drugs such as the taxanes and advocate the Oncology Nursing Society.) the hepatic system (Aventis Pharmaceuticals the assessment of patients during and after Inc., 2003). Chemotherapeutic drugs that chemotherapy treatment so that intervention Digital Object Identifier: 10.1188/05.CJON.189-193
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 9, NUMBER 2 • PAINFUL PERIPHERAL NEUROPATHY FOLLOWING TREATMENT WITH DOCETAXEL
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