Symptom Experiences, Management Strategies, and Outcomes on Oxaliplatin–Induced Peripheral Neuropathy among Persons with Cancer

Abstract

Oxaliplatin-induced peripheral neuropathy is a common and disabling neurotoxic effect that greatly affects the peripheral nervous system. Symptoms may appear quickly after drug administration and last long after treatment ends, with severity often linked to the total dose received. This condition greatly hampers patients’ ability to perform daily activities and diminishes their quality of life. Despite its high occurrence, effective pharmacological treatments for oxaliplatin-induced peripheral neuropathy remain limited. Therefore, a thorough investigation of patients’ symptom experiences, self-management strategies, and clinical outcomes is essential.This descriptive-comparative study aimed to compare symptom experiences, management strategies, and outcomes among cancer patients receiving oxaliplatin at four different time points,guided by Dodd and colleagues’ Symptom Management Theory.

The participants were 140 cancer patients from a university-affiliated hospital; those aged 16 years or older and those aged 60 years or older must pass the cognitive screening with the Mini-Cog, developed by Borson and colleagues. They were divided into four groups of 35 participants each: after receiving the 1st and 6th cycles of oxaliplatin, during follow-up at the 1st and 6th months after completing 12 cycles of oxaliplatin. Data were collected between September 2021 and May 2022 using three questionnaires: 1) the Demographic Characteristics and Information about Health, Disease, and Treatment developed by the researchers from the literature review; 2) the Oxaliplatin-Associated Neurotoxicity Questionnaire developed by Leonard and colleagues; and 3) the Management Strategies and Outcomes of Oxaliplatin-Induced Peripheral Neuropathy Questionnaire modified from Panyainkaew and colleagues. The latter two instruments were validated by three experts, with a content validity index of .92. The test-retest reliability for the Oxaliplatin-Associated Neurotoxicity Questionnaire for the symptom occurrence,severity, and interference with daily life was .89, .75, and .74, respectively. In addition, the test-retest reliability for the Management Strategies and Outcomes of Oxaliplatin-Induced Peripheral Neuropathy Questionnaire for the number of management strategies, frequency of strategies used, symptom status, and daily life interference after management was .97, .96, .99,and .97, respectively. Data analysis used descriptive statistics and the Kruskal–Wallis test.

The study revealed that the average age among 140 participants was 68.63 years(SD = 10.23). The majority of them were male (58.60%), had colorectal cancer (64.30%)and were at cancer stage III (58.60%). Participants were divided into four groups following the cycle of chemotherapy, each consisting of 35 individuals. Among patients receiving oxaliplatin at cycle 1, most reported mild symptoms, predominantly numbness in the hands and feet. Facial and oral symptoms were rare and transient. However, after the 6th cycle and during post-treatment follow-ups at 1 and 6 months, patients commonly reported persistent symptoms in the upper limbs—such as numbness, tingling, and burning pain or discomfort without cold stimulation.Symptoms in the lower limbs included numbness, burning pain, or discomfort without cold stimulation, as well as leg heaviness. Symptom severity gradually worsened and became chronic,significantly impacting daily functioning. The three most frequently used self-management strategies were physical exercise (61.42%), heat application (18.57%), and behavioral modification (12.85%). Among these, physical exercise and heat application were reported as the most effective in reducing symptom severity and enhancing patients’ ability to perform daily activities. When comparing each variable across time points, findings revealed statistically significant differences in symptom perceptions, symptom severity, symptom distress, the number of symptom management methods, and symptom outcomes. However, there were no statistically significant differences in the management frequency and symptom status across these time points.

These findings provide essential baseline data for developing nursing practice guidelines. Nurses play a key role in educating patients about symptom progression and practical management strategies before treatment. Implementing structured patient education and symptom-monitoring systems can enhance symptom control, help maintain functional independence, and ultimately improve the quality of life for patients experiencing oxaliplatin-induced peripheral neuropathy. Therefore, further longitudinal research is warranted to evaluate the long-term effectiveness of symptom management strategies in improving patients’ quality of life.

Keywords: Cancer, Management strategies, Outcomes, Oxaliplatin-induced peripheral neuropathy, Symptom experiences

Author Contributions:
CK: Conceptualization, Method and design, Tool validation, Data collection, Data analysis,Writing and revising the manuscript
BS: Conceptualization, Method and design, Data analysis, Writing, revising, and editing the manuscript, Corresponding with the editor-in-chief
SC: Conceptualization, Method and design, Conclusion, Recommendation, Revising the manuscript