Table 3 Statements reaching consensus or agreement within three rounds
Category | Statement | Round accepted | (n = X/X no. of panellists)—% consensus/agreement |
|---|---|---|---|
Clinical factors and presentation of people with CIPN | |||
Common presenting signs and symptoms of people with CIPN | Sensory symptoms such as neuralgia, dysesthesia (abnormal sensation), paraesthesia (pins and needles), allodynia (abnormal response to stimulus) and/or hyperesthesia (exaggerated pain response) | One | (n = 18/19) – 95% consensus |
Loss of protective sensation (LOPS) and Loss of proprioception | Two | (n = 13/17) – 76.5% agreement | |
Autonomic changes including but not limited to: blood pressure and temperature regulation (cold feet/Raynaud's phenomenon) | Two | (n = 13/17) – 76.5% agreement | |
Nail changes including but not limited to: onychogryphosis, onychomycosis, Onychauxis, Onychocryptosis and nails that are friable, dystrophic, have reduced growth and flaking | Two | (n = 13/17) – 76.5% agreement | |
Skin changes including but not limited to; atrophy + rubor, skin shedding/peeling, dry skin, moccasin type cracking and painful blistering | Two | (n = 13/17) – 76.5% agreement | |
Clinical factors or presentation unique to CIPN | Sudden (acute) onset and quick progression of symptoms | Two | (n = 14/17) – 82% agreement |
In some people, symptoms may improve or resolve with chemotherapy dose reduction or cessation | Two | (n = 13/17) – 76.5% agreement | |
Skin anhidrosis with rubor, skin shedding and increased injuries | Three | (n = 12/16) – 75% agreement | |
Additional information on Clinical factors and presentation of people with CIPN | Can reduce patient's confidence and engagement in physical activity | Three | (n = 12/16) – 75% agreement |
Diagnosis and Assessment of CIPN | |||
Diagnostic and Assessment tools routinely utilised | Monofilament (10 g) | One | (n = 16/18) – 89% consensus |
Tuning fork (128 Hz) or graduated | One | (n = 14/18) – 78% consensus | |
Medical history and Subjective questioning including client reported signs and symptoms (changes to sensation), Visual Analogue Scale (VAS), and Quality of Life (QOL) questionnaires | One | (n = 13/18) – 72% consensus | |
Inspect for Callus, pre-ulcerative lesions and ulcers | Two | (n = 15/17) – 88% agreement | |
Changes to skin integrity following chemotherapy | Two | (n = 13/16) – 81% agreement | |
Muscle strength and Joint Range of Motion | Two | (n = 12/17) – 70.6% agreement | |
Diabetes foot assessment | Three | (n = 14/16) – 87.5% agreement | |
Footwear assessment | Three | (n = 13/16) – 81% agreement | |
Deep Tendon reflexes | Three | (n = 13/16) – 81% agreement | |
Assessment tools/pathways that could confirm diagnosis | Oncologist notification | One | (n = 17/18) – 94% consensus |
10gm Monofilament test | One | (n = 16/18) – 89% consensus | |
Presence of wounds/ulcers due to unfelt trauma | One | (n = 16/18) – 89% consensus | |
Self-reported neurological symptoms | One | (n = 15/18) – 83% consensus | |
Presence of comorbidities likely to worsen neuropathy e.g., diabetes | One | (n = 15/18) – 83% consensus | |
Tuning fork assessment | One | (n = 14/18) – 78% consensus | |
GP notification | Two | (n = 15/17) – 88% agreement | |
Nerve conduction study | Two | (n = 14/17) – 82% agreement | |
Patient reported diagnosis | Two | (n = 13/17) – 76.5% agreement | |
Biothesiometer or Neurothesiometer | Two | (n = 13/17) – 76.5% agreement | |
Patient reported signs and symptoms/outcomes using validated questionnaires e.g., Visual Analogue Scale (VAS) | Two | (n = 13/17) – 76.5% agreement | |
Podiatry Management of CIPN | |||
Podiatry Management of CIPN | Education including, changes to sensation, skin and nails, and how to avoid complications e.g. regular self-check of feet, avoid bare feet, regular emollient, use of socks and shoes. Education also on importance of regular neurological screens by professionals like podiatrist or neurologist | One | (n = 14/18) – 78% consensus |
Management and offloading of pressure lesions, wounds or blisters | Two | (n = 16/16) – 100% agreement | |
Communication with GP and oncology team, particularly where foot-related symptoms are severe | Two | (n = 16/16) – 100% agreement | |
Advise on escalation of care if needed in case of development of foot infection or ulceration | Two | (n = 16/16) – 100% agreement | |
Footwear assessment and education (properly fitting, supportive, light weight and comfortable) | Two | (n = 15/16) – 94% agreement | |
Engagement with possible referral to other allied health professionals as required (e.g., Physiotherapist, Occupational therapist, Exercise physiologist, psychologist and pain management clinics) | Two | (n = 15/16) – 94% agreement | |
Assessing that pharmacological pain management is in place and educate on non-pharmacological pain management modalities (heat packs, wheat bags, topical capsaicin etc.) | Two | (n = 13/16) – 81% agreement | |
Regular footcare (nails including ingrowing toenails and skin including hyperkeratosis) | Two | (n = 13/16) – 81% agreement | |
A targeted personalised management plan appropriate for severity of the condition and considering patient's finances | Two | (n = 13/16) – 81% agreement | |
Discuss options for use of mechanical aids like walkers and braces | Three | (n = 14/16) – 87.5% agreement | |
Discussion regarding their driving ability | Three | (n = 13/16) – 81% agreement | |
Advising on appropriate physical activity or exercise regimes | Three | (n = 13/16) – 81% agreement | |
Advise on lifestyle changes including alcohol, smoking, and diet | Three | (n = 12/16) – 75% agreement | |
Additional information on Podiatry management of CIPN | Multidisciplinary care is essential | Three | (n = 14/16) – 87.5% agreement |
Podiatrist-based resources on the management of CIPN are required | Three | (n = 12/16) – 75% agreement | |