Content of this journal is licensed under a Abstract
Aim:
One of the most common problems in individuals receiving neurotoxic chemotherapy is neuropathy. The study aimed to evaluate the peripheral neuropathy and the relationship between neuropathy, disability, and anxiety in patients receiving neurotoxic chemotherapy.
Methods:
The sample of the study consisted of individuals with cancer in the chemotherapy unit of a city hospital between March and July 2021. The study was conducted in 180 patients who underwent at least three cycles of neurotoxic chemotherapy and agreed to participate. The Introductory Information Form, Brief Disability Questionnaire, Beck Anxiety Inventory, and Common Terminology Criteria for Adverse Events were used to collect data.
Results:
The prevalence of peripheral neuropathy in patients undergoing neurotoxic chemotherapy was 73.3% in this study. According to the severity of peripheral neuropathy, disability and anxiety scores of the patients showed a significant difference ( p < .001). A positive, moderate significant correlation was determined between the scores for anxiety and disability. The variables affecting the neuropathy levels of individuals receiving chemotherapy were determined as marital status (odds ratio = 0.239), number of cycles (odds ratio = 0.125), and anxiety levels (odds ratio = 1.076).
Conclusion:
The results of the present study indicated that the frequency of neuropathy was high and the severity of neuropathy was associated with anxiety and disability levels. According to the holistic approach, the physical and psychosocial effects of neuropathy should be evaluated.
Keywords: Anxiety, chemotherapy, disability, health care, peripheral neuropathy
Introduction
Cancer is a serious health problem that increases morbidity and mortality both in the world and in Turkey (Sung et al., 2021; Turkish Statistical Institute, 2018). Chemotherapy, one of the cancer treatment procedures, is commonly used due to its high therapeutic effects. However, high-dose and combined chemotherapy regimens, administered therapeutically, increase the risk of developing acute and chronic toxicity (Baykara, 2016; Derksen et al., 2017). One of the major complications associated with widely used chemotherapy drugs is neurotoxicity. Neurotoxicity, which often results in damage to peripheral nerve fibers (sensory, motor, and autonomic), has been reported in 19%–85% of people undergoing chemotherapy (Arıkan, 2020). Chemotherapy-induced peripheral neuropathy (CIPN) and accompanying symptoms develop in cancer patients due to chemotherapy damage to peripheral nerve fibers, axons, myelin sheaths, or cell bodies (Zajączkowska et al., 2019; Abudayyak et al., 2018).
Patients in whom sensory nerves are affected suffer from symptoms, such as paresthesia in the extremities, a reduced deep tendon reflex, and pain (Hsu et al., 2020). Muscle weakness, atrophy, weakness in hand and foot muscles, difficulty in walking, and balance disorder are seen in patients whose motor nerves are affected (Arıkan, 2020). The studies have reported that individuals who suffer from symptoms such as tingling, numbness, cramps, or pain in their fingers or hands have difficulties with daily activities such as opening jars/bottles and doing chores, and individuals who experience similar symptoms in their toes or feet have difficulty in life areas such as standing, walking, and driving (Kolb et al., 2016; Hsu et al., 2020; Sacid & Arıkan, 2020). Neurotoxicity, which is one of the side effects of chemotherapy, affects the daily life of cancer patients as well as their psychological state. The symptoms of the patients who suffer from CIPN and the impairment of their daily life activities adversely affect their psychological well-being and social relations (Arıkan, 2020; Bao et al., 2016). The study by Bao et al. reported that patients with neuropathy suffer from sleeplessness and anxiety more (Bao et al., 2016). Neuropathy, on the other hand, lowers life satisfaction and increases the risk of depression since it serves as a reminder of cancer, impairs performance, and causes ambiguity about the future. It has also been reported that individuals with psychological problems experience neurotoxicity symptoms at a more severe level. Therefore, it is important to determine the relationship between neuropathy and psychological problems. Determining the psychological effects of neuropathy symptoms on patients will contribute to the identification of individuals in the risk group and the control of neurotoxicity symptoms (Bao et al., 2016; Bonhof et al., 2019; Oh et al., 2020).
Neuropathy evaluation and care strategies become more important as cancer prevalence increases, new chemotherapeutic agents with peripheral neuropathy side effects are developed, and there is no adequate treatment or preventative strategy for CIPN (Arıkan, 2020; Bonhof et al., 2019; Bulls et al., 2017; Oh et al., 2020). There are relatively few studies that assess the correlation between chemotherapy-induced neuropathy and psychological distress (Bonhof et al., 2020; Griffith et al., 2017; Oh et al., 2020). The study aimed to evaluate the relationship between peripheral neuropathy, disability, and anxiety levels in individuals receiving neurotoxic chemotherapy. It is important to be aware of the physical and psychological problems experienced by patients with neuropathy for quality nursing care. Oncology nurses should periodically evaluate patients receiving neurotoxic chemotherapy, plan interventions to prevent or manage functional impairments, and provide information on the management of neurotoxicity symptoms (Sacid & Arıkan, 2020; Yoo, & Cho, 2014).
Research Questions
What is the frequency of peripheral neuropathy in individuals undergoing neurotoxic chemotherapy?
Is there any correlation between peripheral neuropathy, disability, and anxiety in individuals undergoing neurotoxic chemotherapy?
Do demographic and disease-related characteristics affect anxiety and disability levels in individuals with peripheral neuropathy?
Methods
Study Design
This study was conducted as descriptive and correlational to determine the correlation of peripheral neuropathy with disability and anxiety in patients undergoing neurotoxic chemotherapy (taxane, platinum group).
Sample
The universe of the study consisted of individuals with cancer who underwent chemotherapy in the chemotherapy unit of Kahramanmaraş Necip Fazıl City Hospital. Patients between the ages of 18 and 65 who underwent at least three cycles of neurotoxic chemotherapy between March and July 2021 and agreed to participate in the study constituted the sample of the study. Before chemotherapy, individuals with neuropathy for different reasons (diabetic neuropathy, neuropathy due to neurological diseases, etc.), those with neuropsychiatric disease, those who received cranial radiotherapy, and those with brain metastases were excluded from the study. During the data collection process, 180 patients were reached, and the power of the study was found to be 91.2% at a CI of 95% and an effect size of d = .535 according to the results of the post hoc power analysis.
Data Collection Tools
Data were collected using The Introductory Information Form, The Brief Disability Questionnaire, The Beck Anxiety Inventory, and Common Terminology Criteria for Adverse Events (NCI-CTCAE v5.0) - Peripheral Neuropathy.
The Introductory Information Form
The Information Form assessed age, gender, marital status, body mass index, education level, smoking and alcohol use, cancer diagnosis, diagnosis time, metastasis status, surgery history, radiotherapy, chronic diseases, chemotherapy protocol, number of chemotherapy cycles, and doses.
Common Terminology Criteria for Adverse Events - Peripheral Neuropathy
Common Terminology Criteria for Adverse Events publishes standardized definitions for adverse events, as well as defines the severity of organ toxicities for patients undergoing cancer treatment. Common Terminology Criteria for Adverse Events assesses the severity of chemotherapy-related peripheral neuropathy, and the severity of the complaints that impede the patients’ daily lives and personal care is questioned (NCI, 2020).
Brief Disability Questionnaire
The Brief Disability Questionnaire, which comprises 11 questions, was developed to assess physical and social disability. The questionnaire inquires whether a person’s health problems hinder him from performing daily activities such as doing sports, pulling a table, climbing stairs and hills, bending over, straightening up, lifting heavy objects, walking long distances, bathing, going to the toilet, as well as the effects of health problems on hobbies, daily work, willingness to work, work efficiency, and interpersonal relations. The total score of the questionnaire ranges from 0 to 22. No disability is assessed as 0–4 points, mild disability as 5–7 points, moderate disability as 8–12 points, and severe disability as 13 points and over. A higher total score indicates a higher level of disability. The Turkish validity and reliability of the scale was performed, and the Cronbach’s alpha value was found to be 0.92 (Kaplan, 1995).
Beck Anxiety Inventory
Anxiety Inventory was developed to determine the anxiety levels of individuals and consists of 21 items. Each item of the scale is rated from 0 to 3, with a total score range of 0–63. A higher total score indicates high symptoms of anxiety. Normal or minimal anxiety is assessed as 0–7 points on the scale. In the scale, 8–15 points indicate mild anxiety, 16–25 points indicate moderate anxiety, and 26–63 points indicate severe anxiety. The Turkish validity and reliability study of the scale was performed, and the Cronbach’s alpha value was found to be .93 (Ulusoy, 1998).
Data Collection
Symptoms, such as paresthesia, presence of subjective weakness, and sensory loss, and their levels of restricting daily living activities and self-care were assessed based on NCI-CTCAE v5.0 peripheral neuropathy. Data collection forms were applied through face-to-face interviews. The interview lasted for around 1520 minutes. Some information about the patients was obtained from medical files (diagnosis time, chemotherapy protocol, and the number of chemotherapy cycles). Written and verbal consents were obtained from all participants.
Statistical Analysis
In the analysis of the data, the Statistical Package for the Social Sciences Statistics 21.0 (IBM SPSS Corp.; Armonk, NY, USA) program was used. Percentage, mean, median, minimum, and maximum values were used to summarize descriptive statistics. In order to compare the severity of neuropathy and the mean scores of Disability Questionnaire and Anxiety Inventory, the Kruskal–Wallis test was utilized. The “multiple comparison test” (Bonferonni) was used to determine between which groups the difference was. Spearman’s correlation analysis was used to evaluate the correlation between the scales. The independent effects of different variables on the level of neuropathy were examined by logistic regression analysis. Obtained results are presented with odds ratio (OR) and 95% CI. Statistical significance level p < .05 was accepted as significant.
Ethical Consideration
Ethical approval was received from the Ethics Committee of the Kahramanmaraş Sütçü İmam University (Approval No: 17, Date: July 8, 2020). Written informed consent was obtained from the patients.
Results
Participant Characteristics
The mean age of individuals was 51.05 ± 11.73. It was found that 58.9% of the patients were female, and the majority of them (90.6%) were married and 51.1% had graduated from primary school. 28.9% of the patients underwent chemotherapy for breast cancer, 20.6% for lung cancer, 19.5% for colon cancer, and 35.6% had metastases, with an average diagnostic time of 10.50 ± 10.48 months. It was determined that 56.7% of the patients participating in the study underwent platinum-based chemotherapy and 28.9% underwent taxane-based chemotherapy, 62.2% of the patients underwent chemotherapy once every 21 days, 42.2% underwent 3 cycles of chemotherapy, and 40% had 4–6 cycles of chemotherapy.
Neuropathy Level, Disability, and Anxiety
Peripheral neuropathy did not develop in 26.7% of the patients; grade 1 and higher peripheral neuropathy developed in 46.1%, 17.8%, and 9.4% of the patients, respectively. The severity of peripheral neuropathy showed a statistically significant difference in the disability scores ( p < .001). Individuals with grade 3 peripheral neuropathy had higher disability scores than those with grade 1 and grade 2 neuropathy ( p ≤ .001) (Table 1). The severity of peripheral neuropathy showed a significant difference in the patients’ anxiety scores ( p < .001). The patients with grade 1 peripheral neuropathy severity had significantly lower anxiety scores than the patients with grade 2 and grade 3 peripheral neuropathy ( p < .001) (Table 2).
Table 1.
Distribution of The Brief Disability Questionnaire Mean Scores by Peripheral Neuropathy Severity (N = 180)
| Peripheral Neuropathy | The Brief Disability Questionnaire | |
|---|---|---|
| Mean ± SD | Median (Minimum–Maximum) | |
| Grade 0a | 10.00 ± 5.46 | 11.00 (0–20) |
| Grade 1b | 10.15 ± 5.32 | 10.00 (1–22) |
| Grade 2c | 12.87 ± 4.98 | 14.00 (4–21) |
| Grade 3d | 16.94 ± 5.41 | 19.00 (7–22) |
| p | ≤.001 | |
| Difference | b-d: ≤.001 c-d: .004 |
|
Table 2.
Distribution of Beck Anxiety Scale Mean Scores By Peripheral Neuropathy Severity (N = 180)
| Peripheral Neuropathy | Beck Anxiety Scale | |
|---|---|---|
| Mean ± SD | Median (Minimum–Maximum) | |
| Grade 0a | 15.37 ± 9.67 | 13.00 (4–47) |
| Grade 1b | 15.84 ± 11.01 | 12.00 (1–44) |
| Grade 2c | 26.31 ± 10.44 | 25.50 (10–46) |
| Grade 3d | 31.52 ± 14.24 | 32.00 (5–58) |
| p | ≤.001 | |
| Difference | a–c: ≤.001 a–d: ≤.001 b–c: ≤.001 b–d: ≤.001 |
|
Disability and Anxiety of Patients With Peripheral Neuropathy by Patients’ Characteristics
No statistically significant difference was found in marital status, educational level, and disability and anxiety levels (p > .05). It was determined that the mean scores of disability and anxiety were significantly higher in women (p < .05). Disability and anxiety scores did not differ significantly according to the number of cycles, surgical history, presence of other chronic diseases, drug protocol, and frequency of treatment (p > .05). Disability median scores were significantly higher in patients who received radiotherapy (p < .05) (Table 3). There was not significant relationship between age, taxan, and platinum dose, and disability and anxiety levels. There was a significant, low-level positive relationship between the duration of diagnosis and disability levels (r = .240; p < .05).
Table 3.
Disability and Anxiety of Patients with Peripheral Neuropathy by Demographic/Treatment Characteristics (N = 180)
| Demographic/Treatment Characteristics | The Brief Disability Questionnaire | Beck Anxiety Scale | |||
|---|---|---|---|---|---|
| Mean ± SD | Median (Minimum–Maximum) |
Mean ± SD | Median (Minimum–Maximum) |
||
| Gender | Female | 10.16 ± 5.68 | 10.00 (1–21) | 14.18 ± 10.12 | 11.00 (1–46) |
| Male | 12.59 ± 5.56 | 13.00 (1–22) | 24.07 ± 12.87 | 24.00 (3–58) | |
| p | .019 | ≤.001 | |||
|
Educational level |
Illiterate | 14.08 ± 5.11 | 15.00 (4–22) | 22.70 ± 13.22 | 21.50 (3–54) |
| Primary | 11.63 ± 5.81 | 12.00 (1–22) | 20.85 ± 12.96 | 19.00 (1–58) | |
| High school | 12.01 ± 3.64 | 12.20 (4–20) | 15.42 ± 10.96 | 14.52 (6–41) | |
| p | .180 | .422 | |||
| Marital status | Married | 11.60 ± 5.86 | 12.00 (1–22) | 20.20 ± 12.52 | 18.00 (1–58) |
| Single | 12.63 ± 3.77 | 13.00 (7–18) | 22.54 ± 16.29 | 18.00 (2–46) | |
| p | .561 | .659 | |||
| Radiotherapy | Yes | 12.32 ± 6.90 | 13.00 (1–22) | 16.92 ± 14.16 | 13.00 (1–58) |
| No | 11.51 ± 5.37 | 11.00 (1–22) | 21.33 ± 12.33 | 19.00 (1–54) | |
| p | .040 | .475 | |||
| Chronic disease | No | 12.32 ± 5.23 | 12.50 (2–21) | 21.69 ± 11.84 | 20.50 (1–46) |
| Yes | 11.27 ± 6.00 | 10.50 (1–22) | 19.56 ± 13.41 | 16.00 (1–58) | |
| p | .278 | .171 | |||
| Number of cures |
3 | 11.71 ± 5.11 | 12 (2–21) | 18.34 ± 1.20 | 17.5 (1–44) |
| 4–6 | 11.82 ± 5.83 | 11.5 (1–22) | 21.98 ± 1.30 | 19.5 (5–54) | |
| 7–12 | 11.40 ± 6.49 | 12 (1–22) | 20.60 ± 1.34 | 17.5 (5–58) | |
| p | .953 | .474 | |||
|
Drug protocol |
Taxanes | 10.85 ± 5.34 | 12.00 (1–12) | 21.23 ± 12.95 | 19.00 (3–46) |
| Platinum | 11.89 ± 6.05 | 11.00 (1–22) | 19.40 ± 13.34 | 17.00 (1–58) | |
| Taxanes and platinum | 12.60 ± 5.39 | 13.00 (1–21) | 21.78 ± 11.18 | 19.00 (9–44) | |
| p | .446 | .482 | |||
| Chemotherapy frequency | 7 days | 14.37 ± 6.88 | 15.00 (2–21) | 22.87 ± 9.41 | 23.00 (11–42) |
| 14 days | 12.63 ± 6.70 | 11.00 (1–22) | 21.94 ± 14.41 | 20.00 (1–58) | |
| 21 days | 11.02 ± 5.02 | 11.50 (1–20) | 19.48 ± 12.37 | 17.00 (1–47) | |
| p | .167 | .430 | |||
A positive, moderate correlation was determined between the scores of the Anxiety Inventory and The Brief Disability Questionnaire (r = 0.424; p = .031).
Variables affecting neuropathy levels of individuals receiving chemotherapy: marital status (OR = 0.239), number of cycles (OR = 0.125), and anxiety levels (OR = 1.076). The independent variables and total anxiety scores explained 35.9% of the total variance in neuropathy levels according to the logistic regression model (Table 4).
Table 4.
Logistic Regression Analysis for Factors Affecting Neuropathy Levels (N = 180)
| B | SE | Wald | p | OR | 95.0% CI | ||
|---|---|---|---|---|---|---|---|
| Lower | Upper | ||||||
| Gender (female) | −0.323 | 0.454 | 0.507 | .477 | .724 | 0.297 | 1.762 |
| Age | 0.008 | 0.21 | 0.145 | .704 | 1.008 | 0.967 | 1.051 |
| Marital status (married) | −1.432 | 0.715 | 4.012 | .041 | .239 | 0.059 | 0.970 |
| Educational level (primary school) | 0.830 | 0.599 | 2.216 | .137 | 2.294 | 0.769 | 6.847 |
| Diagnosis time (12 months over) | 0.034 | 0.22 | 2.395 | .122 | 1.035 | 0.991 | 1.081 |
| Chronic disease (yes) | 0.220 | 0.450 | 0.239 | .625 | 1.246 | 0.516 | 3.009 |
| Radiation therapy (yes) | 0.622 | 0.592 | 1.104 | .293 | 1.862 | 0.584 | 5.938 |
| Chemotherapy protocol (taxan and platin) | 0.193 | 0.589 | 0.107 | .743 | 1.213 | 0.382 | 3.850 |
| Chemotherapy frequency | 0.473 | 0.435 | 1.180 | .277 | 1.604 | 0.684 | 3.762 |
| Number of cures (7–12 cures) | 1.575 | 0.611 | 6.558 | .010 | 1.125 | 0.79 | 1.863 |
| Total disability scores | 0.049 | 0.44 | 1.221 | .269 | 1.050 | 0.963 | 1.144 |
| Total anxiety scores | 0.76 | 0.020 | 14.686 | .001 | 1.076 | 1.038 | 1.121 |
| Constant | −4.279 | 1.463– | 8.560 | .003 | 0.14 | ||
Note: β = standardized regression coefficient; CI = confidence interval; OR = odds ratio; SE = standard error.
Discussion
It is important to evaluate peripheral neuropathy, which negatively affects the cancer treatment process, and to determine the physical and psychological discomfort it causes. In this study, the relationship of neuropathy with disability and anxiety in individuals receiving neurotoxic chemotherapy was revealed. Determining the relationship of neuropathy with disability and anxiety will contribute to the planning of necessary nursing interventions to increase the physical and psychological well-being of patients. The prevalence of peripheral neuropathy was found to be 73.3% in this study. Likewise, it has been reported that the prevalence of neuropathic neuropathy due to acute oxaliplatin toxicity is 84.6%, and the prevalence of peripheral neuropathy after platinum-based chemotherapy is 74.9% (Brozou et al., 2018).
Disability is a multidimensional issue that affects individuals’ functionality as well as their relationships with their surroundings. Individuals have difficulty walking and holding objects as a result of symptoms such as muscle weakness, numbness, tingling, and pain caused by neuropathy, which negatively affects their ability to manage their daily activities. In this study, it was determined that the patients’ disability scores differed significantly based on the severity of neuropathy (Arıkan, 2020). In the study of Hsu et al., the most common symptoms were burning sensation in the hands, numbness, tingling, visual disturbance, and throat discomfort. The individuals with neuropathy reported significantly lower functionality and general health status and significantly greater symptom scores(Hsu et al., 2020). Studies have shown that peripheral neuropathy causes loss of autonomy in daily and instrumental living activities of cancer patients and negatively affects their quality of life (Bulls et al., 2017; Sacid & Arıkan, 2020). Although no study has been conducted to examine the correlation between disability and neuropathy in the literature, this study shows the effects of neuropathy on quality of life and activities of daily living.
Patients’ psychological symptoms are also adversely affected by chemotherapy-induced neuropathic pain, numbness, tingling, and loss of function. In the study, the anxiety scores differed significantly according to the severity of neuropathy (p < .001). A study reported that patients with neuropathy symptoms were more likely to suffer from anxiety and depression (Bao et al., 2016). Patients with oxaliplatin-induced peripheral neuropathy and neuropathic pain had a reduction in the physical dimension of their quality of life, as well as their social, emotional, and role functions (Bao et al., 2016;Bonhof et al., 2019) Psychological conditions of patients are also adversely affected due to neuropathic pain, numbness, tingling, and loss of function associated with chemotherapy. Physical limitations and decrease in social relations due to neuropathy also negatively affect the psychological state of individuals. (Pulvers, & Marx, 2017; Yoo, & Cho, 2014) In this study, regression analysis shows that anxiety affects neuropathy levels of individuals.
The present study indicated that disability and anxiety levels of individuals with peripheral neuropathy showed a significant difference based on their gender. A study that evaluated female cancer survivors with and without CIPN symptoms reported that increased neuropathy symptom severity was linearly correlated with worsening functional status, increased disability, and increased risk of falling (Winters-Stone et al., 2017). The reason for higher disability scores in women could be that their functional life is more affected since the neuropathy symptoms are felt more strongly and they are more affected by impairments in their daily life activities due to disability. The fact that neuropathy-related limitations potentially increase stress and anxiety levels more in female cancer patients might explain why female cancer patients have higher anxiety levels.
In a study of breast cancer patients, it was reported that neurological symptoms persisted to be observed three years after treatment (Fontes et al., 2016). The reason individuals receiving radiotherapy had a higher level of disability in this study might be due to the effects of other cancer treatments. Additionally, since cancer metastasis complicates the disease-related symptoms, disability levels may have been adversely affected.
The capacity to work and independence of persons are affected by disability, which can result in a higher dependency on others, a decline in self-esteem, and depression. A positive, moderate significant correlation was determined between the scores of the Anxiety Inventory and The Brief Disability Questionnaire in this study. In a study conducted with colorectal cancer patients, a high correlation was found between a decrease in daily living activities due to CIPN and depression (Oh et al., 2020). This may be associated with the negative effect on the quality of life caused by neuropathy-related problems, as well as the negative effect on a person’s psychological state caused by the decrease of physical and social relations.
Study Limitations
The limitations of the study are that it was conducted in a single center, and evaluations could not be made during or after treatment because people were only assessed for neuropathy in a single time frame.
Conclusion and Recommendations
Neuropathy is an important problem for cancer patients and survivors due to its high prevalence among cancer patients. Evaluation of peripheral neuropathy, which has a negative effect on the cancer treatment process, and its early diagnosis and enhancement of patients’ quality of life are important for assuring the sustainability of the treatment. Peripheral neuropathy showed a significant difference in the patients’ disability and anxiety scores in the study. Meeting the physical and psychological care needs of individuals with neuropathy increases the quality of life by contributing to the reduction of side effects and increasing the success of treatment.
It is important to manage side effects that negatively affect the treatment continuation to get the full benefits of chemotherapy. Disability is a multidimensional issue that affects cancer patients’ functionality as well as their relationships with their surroundings. The oncology team should identify the effect of neuropathy on daily life and emotional reactions to neuropathy. Determining the correlation of neuropathy with anxiety and disability will contribute to the individual’s holistic assessment and the prevention of biopsychosocial problems that may arise. It is recommended that the symptoms of disability and anxiety that may develop due to CIPN be evaluated on a regular basis and more comprehensive studies on the effects of peripheral neuropathy on patients receiving neurotoxic chemotherapy be conducted. It is recommended to conduct further studies to evaluate the effects of neuropathy symptoms on patients.
Funding Statement
The authors declared that this study has received no financial support.
Footnotes
Ethics Committee Approval: Ethical committee approval was received from the Clinical Trials Ethics Committee of the Kahramanmaraş Sütçü İmam University (Approval No: 17, Date: July 8, 2020).
Informed Consent: Written informed consent was obtained from the patients who agreed to take part in the study.
Peer-review: Externally peer-reviewed.
Author Contributions: Concept – N.U., T.U.; Design – N.U., T.U.; Supervision – N.U.; Resources – N.U., T.U.; Materials – N.U., T.U.; Data Collection and/or Processing – T.U.; Analysis and/or Interpretation – N.U., T.U.; Literature Search – N.U., T.U.; Writing Manuscript – N.U., T.U.; Critical Review – N.U.
Declaration of Interests: The authors have no conflict of interest to declare.
References
- Abudayyak M., Yalçın C. Ö., & Korkut E. (2018). Pharmacological approaches to the treatment and prevention of chemotherapy-induced peripheral neuropathy. Journal of Pharmaceutical Sciences, 43(2), 203–217. [Google Scholar]
- Arıkan F. (2020). Peripheral neuropathy. In Kapucu S. & Kutlutürkan S. (Eds.). Oncology nursing (pp.255–260). Hipokrat Publishing. [Google Scholar]
- Bao T., Basal C., Seluzicki C., Li S. Q., Seidman A. D., & Mao J. J. (2016). Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: Prevalence, risk factors and fall risk. Breast Cancer Research and Treatment, 159(2), 327–333. ( 10.1007/s10549-016-3939-0) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Baykara O. (2016). Current approaches in cancer treatment. Balıkesir Journal of Health Science, 5(3), 154–165. [Google Scholar]
- Bonhof C. S., Trompetter H. R., Vreugdenhil G., van de Poll-Franse L. V., & Mols F. (2020). Painful and non-painful chemotherapy-induced peripheral neuropathy and quality of life in colorectal cancer survivors: Results from the population-based PROFILES registry. Supportive Care in Cancer, 28(12), 5933–5941. ( 10.1007/s00520-020-05438-5) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bonhof C. S., van de Poll-Franse L. V., Vissers P. A. J., Wasowicz D. K., Wegdam J. A., Révész D., Vreugdenhil G., & Mols F. (2019). Anxiety and depression mediate the association between chemotherapy-induced peripheral neuropathy and fatigue: Results from the population-based PROFILES registry. Psychooncology, 28(9), 1926–1933. ( 10.1002/pon.5176) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brozou V., Vadalouca A., & Zis P. (2018). Pain in platin-induced neuropathies: A systematic review and meta-analysis. Pain and Therapy, 7(1), 105–119. ( 10.1007/s40122-017-0092-3) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bulls H., Hoogland A., Chahal N., Small B., Gonzalez B., Kennedy B., & Lim H. (2017). Chemotherapy-induced peripheral neuropathy in gynecologic cancer patients: Risk factors and functional impact. Journal of Pain, 19(3), 101–102. [Google Scholar]
- Derksen T. M., Bours L. J., Mols F., & Weijnberg P. M. (2017). Lifestyle related factors in the self-management of chemothreapy induced peripheral neuorapthy in colorectal cancer: A systematic rewiev. Evidence-Based Complementary and Alternative Medicine: eCAM, 2017, 7916031. ( 10.1155/2017/7916031) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fontes F., Pereira S., Castro-Lopes J. M., & Lunet N. A. (2016). Prospective study on the neurological complications of breast cancer and ıts treatment: Updated analysis three years after cancer diagnosis. Breast, 29, 31–38. ( 10.1016/j.breast.2016.06.013) [DOI] [PubMed] [Google Scholar]
- Griffith K. A., Zhu S., Johantgen M., Kessler M. D., Renn C., Beutler A. S., Kanwar R., Ambulos N., Cavaletti G., Bruna J., Briani C., Argyriou A. A., Kalofonos H. P., Yerges-Armstrong L. M., & Dorsey S. G. (2017) Oxaliplatin-Induced Peripheral Neuropathy and Identification of Unique Severity Groups in Colorectal Cancer. Journal of Pain and Symptom Management, 54(5), 701–706.e1. ( 10.1016/j.jpainsymman.2017.07.033) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hsu H. T., Wu L. M., Lin P. C., Juan C. H., Huang Y. Y., Chou P. L., & Chen J. L. (2020). Emotional distress and quality of life during folinic acid, fluorouracil, and oxaliplatin in colorectal cancer patients with and without chemotherapy-induced peripheral neuropathy: A cross-sectional study. Medicine (Baltimore), 99(6), e19029. ( 10.1097/MD.0000000000019029) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kaplan İ. (1995). The relationship between mental disorders and disability in patients applying to a health center in a semi-rural area. Turkish Journal of Psychiatry, 6(3), 169–179. [Google Scholar]
- Kolb N. A., Smith A. G., Singleton J. R., Beck S. L., Stoddard G. J., Brown S., & Mooney K. (2016). The association of chemotherapy-induced peripheral neuropathy symptoms and the risk of falling. JAMA Neurology, 73(7), 860–866. ( 10.1001/jamaneurol.2016.0383) [DOI] [PMC free article] [PubMed] [Google Scholar]
- National Cancer Institute (2020). Common terminology criteria for adverse events. 10.32388/erjxiq [DOI] [Google Scholar]
- Oh P. J., Lee J. R., Kim S. K., & Kim J. H. (2020). Changes in chemotherapy-induced peripheral neuropathy, disturbance in activities of daily living, and depression following chemotherapy in patients with colorectal cancer: A prospective study. European Journal of Oncology Nursing, 44, 101676. ( 10.1016/j.ejon.2019.101676) [DOI] [PubMed] [Google Scholar]
- Pulvers J. N., & Marx G. (2017). Factors associated with the development and severity of oxaliplatin-ınduced peripheral neuropathy: A systematic review. Asia-Pacific Journal of Clinical Oncology, 13(6), 345–355. ( 10.1111/ajco.12694) [DOI] [PubMed] [Google Scholar]
- Sacid G., & Arıkan F. (2020). The evaluation of peripheral neuropathy, daily life activities and quality of life in cancer patients. Acta Oncologica Turcica, 53(3), 429–440. ( 10.5505/aot.2020.48992) [DOI] [Google Scholar]
- Sung H., Ferlay J., Siegel R. L., Laversanne M., Soerjomataram I., Jemal A., & Bray F. (2021). Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. ( 10.3322/caac.21660) [DOI] [PubMed] [Google Scholar]
- Turkish Statistical Institute (2018). Cause of death statistics. http://www.tuik.gov.tr/PreTablo.do?alt_id=1083 [Google Scholar]
- Ulusoy M., Şahin N., & Erkmen H. (1998). Turkish version of Beck Anxiety Inventory: psychometric properties. Journal of Cognitive Psychotherapy, 2, 163–172. [Google Scholar]
- Winters-Stone K. M., Horak F., Jacobs P. G., Trubowitz P., Dieckmann N. F., Stoyles S., & Faithfull S. (2017). Falls, functioning, and disability among women with persistent symptoms of chemotherapy-ınduced peripheral neuropathy. Journal of Clinical Oncology, 35(23), 2604–2612. ( 10.1200/JCO.2016.71.3552) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Yoo Y. S., & Cho O. H. (2014). Relationship between quality of life and nurse-led bedside symptom evaluations in patients with chemotherapy-induced peripheral neuropathy. Asian Nursing Research, 8(1), 36–41. ( 10.1016/j.anr.2013.11.002) [DOI] [PubMed] [Google Scholar]
- Zajączkowska R., Kocot-Kępska M., Leppert W., Wrzosek A., Mika J., & Wordliczek J. (2019). Mechanisms of chemotherapy-induced peripheral neuropathy. International Journal of Molecular Sciences, 20(6), 1451. ( 10.3390/ijms20061451) [DOI] [PMC free article] [PubMed] [Google Scholar]