Sir,
I read with interest the variety of articles published on a wide range of topics in Indian Journal of Palliative Care, and I wish to thank the editorial team of the Journal for their kind efforts towards promoting palliative care research and practice in developing countries.
Chemotherapy-induced peripheral neuropathy (CIPN) or chemotherapy-associated peripheral neuropathy (CAPN) is now recognized as a clinical condition often presenting in palliative care settings as a potential threat to provision of effective chemotherapy intervention for cancer. The dose-limiting effects on therapy and its subsequent debilitating effects on patients’ quality of life are well understood.[1]
Although, there is a widely acceptable controversy-whether the peripheral neurotoxicity and neuropathy in patients undergoing chemotherapy is chemotherapy-induced or chemotherapy associated? There are volumes of literature on pharmacological management focusing predominantly on symptomatic care, although experts opine otherwise.
Cavaletti and Marmiroli[2] opined, “no drugs capable of preventing the occurrence of CIPN or ameliorating its long-term course are available, and chemotherapy schedule modification is often required to limit its severity, which could potentially prevent patients from receiving the more effective treatment for cancer. Moreover, symptomatic therapy is often largely ineffective in reducing CIPN symptoms.” The authors thus emphasized a mechanistic approach to clinical management.
Visovsky et al.[3] in their systematic review extrapolated evidence from other peripheral neuropathies such as HIV-related peripheral neuropathy and diabetic peripheral neuropathy and concluded that inadequate and insufficient methodological reporting of studies on non-pharmacological interventions limited their external validity.
Can Mechanism-based classification[4] and its ensuing mechanism-based physical therapy management[5,6] of patients with painful symptoms in CIPN be of future interest for clinicians and researchers working in palliative care settings?
REFERENCES
- 1.Argyriou AA, Bruna J, Marmiroli P, Cavaletti G. Chemotherapy-induced peripheral neurotoxicity (CIPN): An update. Crit Rev Oncol Hematol. 2012;82:51–77. doi: 10.1016/j.critrevonc.2011.04.012. [DOI] [PubMed] [Google Scholar]
- 2.Cavaletti G, Marmiroli P. Chemotherapy-induced peripheral neurotoxicity. Nat Rev Neurol. 2010;6:657–66. doi: 10.1038/nrneurol.2010.160. [DOI] [PubMed] [Google Scholar]
- 3.Visovsky C, Collins M, Abbott L, Aschenbrenner J, Hart C. Putting evidence into practice: Evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clin J Oncol Nurs. 2007;11:901–13. doi: 10.1188/07.CJON.901-913. [DOI] [PubMed] [Google Scholar]
- 4.Kumar SP, Saha S. Mechanism-based classification of pain for physical therapy management in palliative care: A clinical commentary. Indian J Palliat Care. 2011;17:80–6. doi: 10.4103/0973-1075.78458. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kumar SP. Cancer Pain: A critical review of mechanism-based classification and physical therapy management in palliative care. Indian J Palliat Care. 2011;17:116–26. doi: 10.4103/0973-1075.84532. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Kumar SP, Prasad K, Kumar VK, Shenoy K, Sisodia V. Mechanism-based classification and physical therapy management of persons with cancer pain: A prospective case series. Indian J Palliat Care. 2013;19:20–6. doi: 10.4103/0973-1075.110225. [DOI] [PMC free article] [PubMed] [Google Scholar]