Mixed-methods Study of the Effect of Chemotherapy-induced Peripheral Neuropathy SymptomPermanence on Patient’s Willingness to Alter Neurotoxic Chemotherapy Treatment

Mixed-methods Study of the Effect of Chemotherapy-induced Peripheral Neuropathy SymptomPermanence on Patient’s Willingness to Alter Neurotoxic Chemotherapy Treatment | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mixed-methods Study of the Effect of Chemotherapy-induced Peripheral Neuropathy SymptomPermanence on Patient’s Willingness to Alter Neurotoxic Chemotherapy Treatment Yerial Jun, Xueting Tao, Jaeyoung Choi, Kelley M. Kidwell, Daniel L. Hertz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6304310/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect from taxane and platinum chemotherapy, with symptoms that can persist for years after treatment and significantly diminish quality of life. This study aimed to evaluate how the potential permanence of CIPN influences patient preferences for continuing vs. altering neurotoxic chemotherapy. Methods A mixed-methods approach was adopted, which included surveys and semi-structured interviews. During treatment, surveys used the EORTC QLQ-CIPN20 questionnaire to assess CIPN severity and patient preferences for continuing, altering, or discontinuing chemotherapy under hypothetical scenarios of temporary vs. permanent CIPN. Post-treatment interviews investigated patients' perceptions of altering treatment due to temporary or permanent CIPN. Results Survey data from 66 participants revealed that CIPN permanence considerably increased the likelihood of patients preferring to alter treatment (Odds ratio [OR] = 29.14 [95% confidence interval: 15.31–55.46], p < 0.001). Among 29 post-interviewees, 62% decided to continue with their present regimen despite CIPN, citing treatment efficacy and a lack of concern for CIPN. However, in a hypothetical scenario that their CIPN would be permanent, only 8% preferred to continue treatment without alterations, whereas 50% preferred to alter treatment and 13% to discontinue treatment. Conclusion CIPN permanence substantially influences patient preferences for treatment decisions. Improved communication between oncology teams and patients regarding risks of permanent CIPN is essential to support shared decision making to achieve patient’s preferred therapeutic outcomes. Chemotherapy-induced peripheral neuropathy treatment alteration treatment discontinuation survey qualitative research shared decision making Figures Figure 1 Introduction National Comprehensive Cancer Network Guidelines recommend treatment with neurotoxic chemotherapy including taxanes and platinums for several tumor types such as breast, colorectal, lung, and ovarian cancer [ 1 , 2 ]. Although taxane treatment efficacy is well established, treatment is associated with a high rate of chemotherapy-induced peripheral neuropathy (CIPN) [ 19 ]. CIPN is characterized by numbness and tingling in the extremities that occurs in more than 50% of taxane-treated patients [ 16 ]. CIPN symptoms can improve after treatment but more than half of patients report residual symptoms more than 3 years later[ 10 ], including long-term effects on balance and stability [ 23 ] and diminished quality of life [ 3 ]. The risk of long-term CIPN may outweigh the incremental benefit of continuing taxane treatment, particularly in patients with early-stage breast cancer in whom the risk of long-term recurrence is relatively low. The only strategy recommended in American Society of Clinical Oncology (ASCO) guidelines for prevention of further CIPN progression in patients with intolerable symptoms is to alter treatment with the offending agent by delaying, decreasing, or discontinuing its administration [ 14 ] Up to a quarter of patients receive some treatment alteration due to CIPN [ 11 , 21 ]. However, prior work indicates that most taxane-treated patients are unaware of the potential long-term effects of CIPN [ 12 ] precluding informed discussion with their oncology team regarding the risks and benefits of continued treatment [ 20 ]. Including patients in the decision-making process is especially important when it involves an adverse effect that can impact their long-term function and quality of life. In order to develop tools that can assist in structuring conversations between patients and their medical oncologist, it is critical to understand the patient’s perspective on CIPN and their preferences for being involved in the decision-making process. The purpose of this mixed-methods study was to explore patients’ acceptance of treatment alteration when experiencing CIPN and how the potential permanence of CIPN symptoms affected their preferences. Methods Study Design and Participants Data collection was embedded within a prospective observational clinical study conducted for an unrelated purpose. The clinical study enrolled ambulatory patients initiating taxane and/or platinum chemotherapy for breast or colorectal cancer who had access to an iPhone[ 5 ]. The study was conducted at the University of Michigan Rogel Cancer Center and approved by the UM IRB-Med (PI: DL Hertz, HUM00171478). All participants completed written informed consent to participate. Quantitative Data Collection via Surveys During Treatment Surveys were completed within an iOS application (NeuroDetect Version 2.0). At the start of cycles 2, 3, and 4 of neurotoxic chemotherapy treatment, patients reported their neuropathy severity via the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) CIPN20 patient-reported outcome questionnaire. Each item was rated on a scale from 1 (not at all) to 4 (severe) and the sum score minus 8 (the minimum possible score) was used in the analysis (scale: 0–24, higher numbers indicating more severe CIPN) [ 18 ]. Immediately after completing the CIPN assessment, patients were asked about their preferences to continue, alter or discontinue chemotherapy treatment under two hypothetical scenarios: 1) their CIPN symptoms would be temporary or 2) their CIPN symptoms would be permanent. Qualitative Data Collection via Interviews After Treatment Post-treatment interviews were conducted by a study team member (J.C.) to understand patient’s perspectives on altering chemotherapy treatment due to CIPN. A semi-structured interview guide was developed in conjunction with a multidisciplinary research team comprised of experts in clinical-translational CIPN (DH) and outcomes (TS) research ( Appendix 1 ). The interview explored patient’s acceptance of treatment alteration due to CIPN and the effect of CIPN permanence on this decision. Specifically, patients were asked whether they would prefer to continue; delay the next cycle; decrease the dose; or discontinue chemotherapy if they were predicted to experience severe CIPN by the end of treatment. Participants who chose to continue with the chemotherapy without adjustment were then asked the same question under the assumption that their CIPN would be permanent. For both questions, participants’ were asked to explain the reasoning behind their preference. At the start of each interview, the researcher obtained verbal consent from the individuals to audio record. The audio files were transcribed verbatim except for removal of all identifying information. Interview recruitment was discontinued when thematic saturation was reached. Statistical Analysis The primary outcome of the quantitative analysis was whether patients chose to alter treatment (i.e., delay or discontinue) vs. continue treatment as planned. The main independent variable of interest was CIPN permanence vs. not (i.e., temporary). We analyzed the odds of altering treatment via generalized linear mixed effects models with a random intercept using time as a continuous variable. We additionally controlled for CIPN severity at that time (CIPN20 score), days since start of treatment (continuous), patient’s age (continuous), chemotherapy type (taxane, platinum, or both) and metastatic cancer (vs. non-metastatic) in multivariable analyses. Interview transcripts were reviewed, and a master codebook was created using Microsoft Excel. Each participants’ responses were coded based on the standardized questions asked during the interview. Response codes were analyzed using descriptive statistics and thematically. Results Patient Characteristics A total of 66 patients were enrolled in the study of whom 55 (83%) had breast and 11 (17%) had colorectal cancer (Table 1 ), and most (82%) had non-metastatic cancer of either type. Neurotoxic chemotherapy regimens were primarily taxane-containing (83%) with or without platinum. The mean age of patients was 50.0 years (Standard Deviation [SD] = 13.3), and the mean duration of chemotherapy treatment was 2.46 months (SD = 1.20). Quantitative Effect of CIPN Permanence on Chemotherapy Alteration Preference In the primary analysis, patients were dramatically more likely to choose to alter chemotherapy treatment under the hypothetical scenario that their CIPN symptoms would be permanent compared to when symptoms would be temporary (Odds Ratio [OR] = 29.14 [95% confidence interval: 15.31–55.46], p < 0.001) after adjusting for relevant covariates (Table 2 , Fig. 1 ). In multivariable analyses, CIPN severity, treatment duration, age, type of chemotherapy, and metastases were not associated with the odds of choosing to alter treatment (all p > 0.05). Qualitative Analysis of Patient’s Perception on Treatment Alteration Interviews were conducted September 2021 to September 2022. A total of 29 participants were interviewed (Female = 28, Male = 1). The interviews lasted 6 to 14 minutes with a mean duration of 10 minutes. When asked about their willingness to alter treatment due to CIPN, 62% (n = 18) of participants wanted to continue with their current regimen (Table 3 ). The most common themes that emerged regarding why patients wanted to continue treatment was Prioritizing Cancer Efficacy (n = 6) and Lack of Concern Regarding CIPN (n = 6). No patients indicated they would discontinue treatment due to CIPN but 21% (n = 6) were interested in altering (i.e., decreasing or delaying) dosing and 14% (n = 4) stated they would want to discuss what to do with their provider (see example quotes in Table 3 ). Twenty-four participants were then probed with a hypothetical statement that their CIPN would be permanent. Only 8% (n = 2) still wanted to continue treatment as-is, and these participants were highly motivated by Prioritizing Cancer Treatment Efficacy (Table 4 ). Higher percentages of patients wanted to alter treatment (50%, n = 12), discontinue treatment (13%, n = 3), and discuss with their provider (29%, n = 7). Several patients commented that the input from their provider was necessary to make this decision (see example quotes in Table 4 ). Discussion CIPN is a common dose-limiting side effect that can persist after treatment and irreversibly affect patient’s function and quality of life [ 3 , 10 , 23 ]. Many patients are unaware of the potential long-term impacts of CIPN when considering whether to continue, alter, or discontinue treatment [ 12 , 20 ]. The primary objective of this mixed-methods study was to evaluate how the permanence of CIPN symptoms influence patients’ preferences for altering chemotherapy during their treatment. We found that the permanence of CIPN symptoms made patients significantly more likely to want to alter chemotherapy and that patients wanted to make this decision collaboratively with their medical oncologist. This survey of patients currently undergoing neurotoxic chemotherapy found that permanence of CIPN symptoms had an extremely strong influence on their willingness to alter or discontinue chemotherapy (OR ~ 30). Similarly, post-treatment interviews support the effect of CIPN permeance on patient’s preference to alter or discontinue neurotoxic chemotherapy. These findings are consistent with prior research from our group on this topic. A previous survey of patients who had completed neurotoxic chemotherapy treatment found a dramatic decrease in the percentage of patients who would have wanted to continue chemotherapy if their CIPN would be permanent (58–34%) [ 12 ]. Additionally, a previous qualitative analysis found that informing patients about the potential for permanent CIPN affects increased their interest in adjusting or discontinuing treatment to preserve quality of life [ 20 ]. These interviews also highlighted the importance of shared-decision making when considering whether to alter treatment due to CIPN. Many patients emphasized the need for collaborative discussions with their oncologist to understand the risks of long-term side effects and the potential impact of alteration on treatment efficacy[ 22 ]. This supports previous findings that patients are interested in discussing the potential persistence of CIPN symptoms and options for altering treatment with their oncology team [ 20 ]. Shared-decision making could be an effective strategy to provide patients with the necessary understanding of the benefits and risks of continuing or altering treatment, so they can make an informed decision that will maximize their likelihood of achieving their personal treatment goals [ 7 ]. Currently, there is insufficient data to estimate a patient’s likelihood of experiencing persistent CIPN. The ~ 50% likelihood of CIPN symptoms remaining 3 + years post-treatment has been estimated primarily from large cross-sectional studies of patients many years after treatment or relatively small cohorts of patients followed longitudinally from the end of treatment[ 10 , 15 , 17 ]. Robust data are needed from large prospective cohorts with longitudinal CIPN assessment at the end of and for years post-treatment to understand the actual risk of persistent CIPN [ 10 ]. These risk estimates could be further personalized by identifying demographic, treatment, or genetic factors that affect the risk of CIPN persistence [ 10 ]. This data could be integrated into decision aids that provide patients with simple information about the risks of persistent CIPN and the potential benefits (reduced persistent CIPN [ 6 ]) and risks (reduced efficacy [ 13 ]) of treatment alteration [ 11 ]. Decision aids have assisted cancer patients and their clinicians with making high-quality shared-decisions in other areas with risk-benefit tradeoffs such as decisions around surgical mastectomy [ 4 , 8 , 9 ]. This study used a patient-centered mixed-methods approach to understand patient preferences around treatment alteration in the context of permanent CIPN. Using actual patients currently receiving treatment enhances the relevance and applicability of these findings whereas the semi-structured interviews allowed for in-depth exploration of patients’ perspectives. There are also limitations of this study that should be considered. The modest sample size, and predominance of women with early-stage breast cancer, limits the reliability of these findings and precludes subgroup analyses to further explore differences between patients or their cancer types or treatment regimens. Additionally, self-reported data can be subject to bias, as patients may provide socially desirable responses. In conclusion, the permanence of CIPN significantly influences patients’ preferences for altering chemotherapy treatment. There is a critical need for better data to support communication between patients and their oncology teams regarding the potential long-term effects of CIPN, perhaps assisted with decision aids. Prospective trials could then be conducted investigating the effectiveness of these tools to support shared decision-making that improves patient’s likelihood of achieving their goals of chemotherapy treatment. Table 1 Clinical Data for Patients Included in Analysis (n = 66) N (%) or Mean (SD) Age Years 50.0 (13.3) Cancer Type Breast 55 (83.3%) Colorectal 11 (16.7%) Cancer Stage Non-metastatic 54 (81.8%) Metastatic 12 (18.2%) Chemotherapy Type* Taxane 55 (83.3%) Platinum 23 (34.8%) Duration of Treatment Months 2.46 (1.20) *Some patients received combination treatment with both platinum and taxane Table 2 Odds of Preferring to Alter (Discontinue or Delay) Chemotherapy Treatment vs. Continue Without Alteration Odds Ratio (95% Confidence Interval) P-value CIPN Symptoms Permanent (vs. Temporary) 29.14 (15.31–55.46) < 0.001 CIPN Severity (CIPN20 Score) 1.09 (0.99–1.19) 0.07 Duration of Treatment 1.01 (1.00–1.01) 0.18 Age 1.01 (0.95–1.06) 0.84 Platinum-containing Chemotherapy (vs. Taxane) 0.81 (0.11–6.22) 0.84 Platinum-Taxane Combination Chemotherapy (vs. Taxane) 2.98 (0.45–19.8) 0.26 Metastasis (vs. No Metastasis) 0.15 (0.02–1.09) 0.06 Table 3 Patient Perceptions on Altering Treatment Based on Evidence of Future CIPN (n = 29) Continue Treatment Example Quotes Prioritizing Cancer Efficacy 31%, N = 9 “I’d rather get the cancer removed and deal later with the possibility of moderate to severe neuropathy” “Because I mean it's my life. I would want to go with the most aggressive treatment possible” Lack of Concern about CIPN 21%, N = 6 “I would accept it and continue with treatment” Finish Treatment on Schedule 10%, N = 3 “[Delaying] just makes the treatment go on longer.” Alter Treatment Example Quotes Prevent Severe CIPN 17%, N = 5 “I would probably want to decrease it if it would prevent [CIPN]” Appreciate Treatment Pause 7%, N = 2 “it's nice to have that week of decompression instead of a constant [treatment] every single week.” Discuss with Provider Example Quotes Trust in Provider Expertise 14%, N = 4 “I would want to discuss with my doctor … she could lower my dose or [discuss] what we should do.” Table 4 Patient Perceptions on Altering Treatment Based on Evidence of Future CIPN that would be Permanent (n = 24) Treatment Decision Example Quote Continue Treatment 8%, N = 2 “I would want to cure cancer first” Alter Treatment 50%, N = 12 “If permanent, decrease the dose or listen to the doctor. Stopping wouldn’t be an option unless alternative [treatment was available]” Discontinue Treatment 13%, N = 3 “I would consider stopping if it was impacting my quality of life and daily activities” Discuss with Provider 29%, N = 7 “I’m not the one who can make [that] decision” “I honestly believe it’s not really a patient decision. I mean they weigh in, but I don't know enough about it to decide” Declarations Funding This study was funded in part by the Michigan Institute for Clinical & Health Research (MICHR) via a pilot grant to DLH (UM1TR004404). Competing Interests The authors declare no relevant financial or non-financial interests to disclose. Author Contributions All authors contributed to the study conception and design. Kelley M. Kidwell and Xueting Tao provided statistical expertise and supported the development of the study methodology. Daniel L. Hertz conceptualized and supervised the study, provided critical revisions, and approved the final manuscript. The first draft of the manuscript was written by Yerial Jun, and all authors reviewed and approved the final version of the manuscript for submission. Ethics approval This project was conducted in accordance with the Declaration of Helsinki and approved by the UM IRB-Med (PI: DL Hertz, HUM00171478). Consent to participate Informed consent was obtained from all individual participants included in the study. Consent to publish Participants provided informed consent for the publication of anonymized data from this study. References Referenced from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Breast Cancer V.1.2019. © National Comprehensive Cancer Network, Inc 2019. All rights reserved. Accessed [June 27, 2019]. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc Referenced from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Colon Cancer V.2.2019. © National Comprehensive Cancer Network, Inc 2019. All rights reserved. Accessed [June 27, 2019]. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc Beijers A, Mols F, Dercksen W, Driessen C, Vreugdenhil G (2014) Chemotherapy-induced peripheral neuropathy and impact on quality of life 6 months after treatment with chemotherapy J Community Support Oncol 12: 401–406 Berlin NL, Tandon VJ, Hawley ST, Hamill JB, MacEachern MP, Lee CN, Wilkins EG (2019) Feasibility and Efficacy of Decision Aids to Improve Decision Making for Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis Medical decision making: an international journal of the Society for Medical Decision Making 39: 5–20 Chen C-S, Dorsch MP, Alsomairy S, Griggs JJ, Jagsi R, Sabel M, Stino A, Callaghan B, Hertz DL (2025) Remote Monitoring of Chemotherapy-Induced Peripheral Neuropathy by the NeuroDetect iOS App: Observational Cohort Study of Patients With Cancer Journal of medical Internet research 27: e65615 Eckhoff L, Knoop A, Jensen MB, Ewertz M (2015) Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors Eur J Cancer 51: 292–300 Epstein RM, Street RL, Jr. (2011) The values and value of patient-centered care Ann Fam Med 9: 100–103. doi: 110.1370/afm.1239. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6304310","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454462782,"identity":"577eb78e-63cc-4405-8f40-3eeb7fc5f6e5","order_by":0,"name":"Yerial Jun","email":"","orcid":"","institution":"University of Michigan College of Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Yerial","middleName":"","lastName":"Jun","suffix":""},{"id":454462783,"identity":"0ca67960-e685-4947-a02c-3dc82162163e","order_by":1,"name":"Xueting Tao","email":"","orcid":"","institution":"University of Michigan School of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Xueting","middleName":"","lastName":"Tao","suffix":""},{"id":454462784,"identity":"811f70ed-3375-4e9e-971b-64bcbd08a343","order_by":2,"name":"Jaeyoung Choi","email":"","orcid":"","institution":"University of Michigan College of Pharmacy","correspondingAuthor":false,"prefix":"","firstName":"Jaeyoung","middleName":"","lastName":"Choi","suffix":""},{"id":454462785,"identity":"ad87b6f2-da66-4e27-9e53-22871a8604d0","order_by":3,"name":"Kelley M. 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Hertz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDCC4zxgSg6IDYBYAkriA4dBWhIYjEnXktgA0cJAWAvfYd6Djyt/1KWvbW/ewMybYyFvzsB88DYPHi2Sh/mSDc8ksOVuO3OsgJl3m4Thzga2ZGt8WgwO85hJNiTw5G67kWMA0pJgcIDHTJqAFvOfDQkS6Wb338C08H8jpMWMsSHBIMHsBg/cFja8WiQP8xhLNqQlGG47k1ZwcC7QLxsOsxlbzsGjhe94j+HHBps6ebPjhzc+eLutTt7gePPDG2/waEEBB8AkM7HKR8EoGAWjYBTgBACFG0fFefRiRwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Michigan College of Pharmacy","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"L.","lastName":"Hertz","suffix":""}],"badges":[],"createdAt":"2025-03-25 13:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6304310/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6304310/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82608287,"identity":"d0c4ef6d-227b-4559-af50-40a5745cad0e","added_by":"auto","created_at":"2025-05-13 10:23:48","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":437358,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePreference for Altering Chemotherapy Treatment. \u003c/em\u003eThe relationship between treatment severity (x-axis) and likelihood of preferring to alter (i.e., delay or discontinue treatment [y-axis]), stratified by symptom permanence (permanent [red] vs. temporary [blue]). Preference for altering treatment is much higher when CIPN symptoms are expected to be permanent vs. temporary (Odds ratio: 29.14 (95% confidence interval: 15.31 - 55.46), p\u0026lt;0.001). Other covariates were fixed at their mean or reference value to depict only the three variables of interest (age=50, days since first day of treatment=41, taxane-only treatment, no metastasis).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6304310/v1/a294f0b9a6da96a3c3bf5866.jpeg"},{"id":84427893,"identity":"4a83ac14-d781-4edb-b5dc-5f9b3236b01d","added_by":"auto","created_at":"2025-06-11 21:01:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1088577,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6304310/v1/cd85d338-da5e-4c73-aae0-bad3c070c8a7.pdf"},{"id":82608255,"identity":"b72ccda6-c4b2-4c68-882a-13c6aaa406a8","added_by":"auto","created_at":"2025-05-13 10:23:47","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15062,"visible":true,"origin":"","legend":"","description":"","filename":"Appendixs.docx","url":"https://assets-eu.researchsquare.com/files/rs-6304310/v1/e4a95cdc4d7892842db67945.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mixed-methods Study of the Effect of Chemotherapy-induced Peripheral Neuropathy SymptomPermanence on Patient’s Willingness to Alter Neurotoxic Chemotherapy Treatment","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNational Comprehensive Cancer Network Guidelines recommend treatment with neurotoxic chemotherapy including taxanes and platinums for several tumor types such as breast, colorectal, lung, and ovarian cancer [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although taxane treatment efficacy is well established, treatment is associated with a high rate of chemotherapy-induced peripheral neuropathy (CIPN) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. CIPN is characterized by numbness and tingling in the extremities that occurs in more than 50% of taxane-treated patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. CIPN symptoms can improve after treatment but more than half of patients report residual symptoms more than 3 years later[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], including long-term effects on balance and stability [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and diminished quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The risk of long-term CIPN may outweigh the incremental benefit of continuing taxane treatment, particularly in patients with early-stage breast cancer in whom the risk of long-term recurrence is relatively low.\u003c/p\u003e \u003cp\u003eThe only strategy recommended in American Society of Clinical Oncology (ASCO) guidelines for prevention of further CIPN progression in patients with intolerable symptoms is to alter treatment with the offending agent by delaying, decreasing, or discontinuing its administration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Up to a quarter of patients receive some treatment alteration due to CIPN [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, prior work indicates that most taxane-treated patients are unaware of the potential long-term effects of CIPN [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] precluding informed discussion with their oncology team regarding the risks and benefits of continued treatment [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Including patients in the decision-making process is especially important when it involves an adverse effect that can impact their long-term function and quality of life.\u003c/p\u003e \u003cp\u003eIn order to develop tools that can assist in structuring conversations between patients and their medical oncologist, it is critical to understand the patient\u0026rsquo;s perspective on CIPN and their preferences for being involved in the decision-making process. The purpose of this mixed-methods study was to explore patients\u0026rsquo; acceptance of treatment alteration when experiencing CIPN and how the potential permanence of CIPN symptoms affected their preferences.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eData collection was embedded within a prospective observational clinical study conducted for an unrelated purpose. The clinical study enrolled ambulatory patients initiating taxane and/or platinum chemotherapy for breast or colorectal cancer who had access to an iPhone[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The study was conducted at the University of Michigan Rogel Cancer Center and approved by the UM IRB-Med (PI: DL Hertz, HUM00171478). All participants completed written informed consent to participate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuantitative Data Collection via Surveys During Treatment\u003c/h3\u003e\n\u003cp\u003eSurveys were completed within an iOS application (NeuroDetect Version 2.0). At the start of cycles 2, 3, and 4 of neurotoxic chemotherapy treatment, patients reported their neuropathy severity via the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) CIPN20 patient-reported outcome questionnaire. Each item was rated on a scale from 1 (not at all) to 4 (severe) and the sum score minus 8 (the minimum possible score) was used in the analysis (scale: 0\u0026ndash;24, higher numbers indicating more severe CIPN) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Immediately after completing the CIPN assessment, patients were asked about their preferences to continue, alter or discontinue chemotherapy treatment under two hypothetical scenarios: 1) their CIPN symptoms would be temporary or 2) their CIPN symptoms would be permanent.\u003c/p\u003e\n\u003ch3\u003eQualitative Data Collection via Interviews After Treatment\u003c/h3\u003e\n\u003cp\u003ePost-treatment interviews were conducted by a study team member (J.C.) to understand patient\u0026rsquo;s perspectives on altering chemotherapy treatment due to CIPN. A semi-structured interview guide was developed in conjunction with a multidisciplinary research team comprised of experts in clinical-translational CIPN (DH) and outcomes (TS) research (\u003cspan refid=\"Sec12\" class=\"InternalRef\"\u003eAppendix 1\u003c/span\u003e). The interview explored patient\u0026rsquo;s acceptance of treatment alteration due to CIPN and the effect of CIPN permanence on this decision. Specifically, patients were asked whether they would prefer to continue; delay the next cycle; decrease the dose; or discontinue chemotherapy if they were predicted to experience severe CIPN by the end of treatment. Participants who chose to continue with the chemotherapy without adjustment were then asked the same question under the assumption that their CIPN would be permanent. For both questions, participants\u0026rsquo; were asked to explain the reasoning behind their preference.\u003c/p\u003e \u003cp\u003e At the start of each interview, the researcher obtained verbal consent from the individuals to audio record. The audio files were transcribed verbatim except for removal of all identifying information. Interview recruitment was discontinued when thematic saturation was reached.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe primary outcome of the quantitative analysis was whether patients chose to alter treatment (i.e., delay or discontinue) vs. continue treatment as planned. The main independent variable of interest was CIPN permanence vs. not (i.e., temporary). We analyzed the odds of altering treatment via generalized linear mixed effects models with a random intercept using time as a continuous variable. We additionally controlled for CIPN severity at that time (CIPN20 score), days since start of treatment (continuous), patient\u0026rsquo;s age (continuous), chemotherapy type (taxane, platinum, or both) and metastatic cancer (vs. non-metastatic) in multivariable analyses.\u003c/p\u003e \u003cp\u003eInterview transcripts were reviewed, and a master codebook was created using Microsoft Excel. Each participants\u0026rsquo; responses were coded based on the standardized questions asked during the interview. Response codes were analyzed using descriptive statistics and thematically.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics\u003c/h2\u003e \u003cp\u003eA total of 66 patients were enrolled in the study of whom 55 (83%) had breast and 11 (17%) had colorectal cancer (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and most (82%) had non-metastatic cancer of either type. Neurotoxic chemotherapy regimens were primarily taxane-containing (83%) with or without platinum. The mean age of patients was 50.0 years (Standard Deviation [SD]\u0026thinsp;=\u0026thinsp;13.3), and the mean duration of chemotherapy treatment was 2.46 months (SD\u0026thinsp;=\u0026thinsp;1.20).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuantitative Effect of CIPN Permanence on Chemotherapy Alteration Preference\u003c/h3\u003e\n\u003cp\u003eIn the primary analysis, patients were dramatically more likely to choose to alter chemotherapy treatment under the hypothetical scenario that their CIPN symptoms would be permanent compared to when symptoms would be temporary (Odds Ratio [OR]\u0026thinsp;=\u0026thinsp;29.14 [95% confidence interval: 15.31\u0026ndash;55.46], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) after adjusting for relevant covariates (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In multivariable analyses, CIPN severity, treatment duration, age, type of chemotherapy, and metastases were not associated with the odds of choosing to alter treatment (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003ch3\u003eQualitative Analysis of Patient’s Perception on Treatment Alteration\u003c/h3\u003e\n\u003cp\u003eInterviews were conducted September 2021 to September 2022. A total of 29 participants were interviewed (Female\u0026thinsp;=\u0026thinsp;28, Male\u0026thinsp;=\u0026thinsp;1). The interviews lasted 6 to 14 minutes with a mean duration of 10 minutes.\u003c/p\u003e \u003cp\u003eWhen asked about their willingness to alter treatment due to CIPN, 62% (n\u0026thinsp;=\u0026thinsp;18) of participants wanted to continue with their current regimen (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The most common themes that emerged regarding why patients wanted to continue treatment was \u003cem\u003ePrioritizing Cancer Efficacy\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;6) and \u003cem\u003eLack of Concern Regarding CIPN\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;6). No patients indicated they would discontinue treatment due to CIPN but 21% (n\u0026thinsp;=\u0026thinsp;6) were interested in altering (i.e., decreasing or delaying) dosing and 14% (n\u0026thinsp;=\u0026thinsp;4) stated they would want to discuss what to do with their provider (see example quotes in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTwenty-four participants were then probed with a hypothetical statement that their CIPN would be permanent. Only 8% (n\u0026thinsp;=\u0026thinsp;2) still wanted to continue treatment as-is, and these participants were highly motivated by \u003cem\u003ePrioritizing Cancer Treatment Efficacy\u003c/em\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Higher percentages of patients wanted to alter treatment (50%, n\u0026thinsp;=\u0026thinsp;12), discontinue treatment (13%, n\u0026thinsp;=\u0026thinsp;3), and discuss with their provider (29%, n\u0026thinsp;=\u0026thinsp;7). Several patients commented that the input from their provider was necessary to make this decision (see example quotes in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCIPN is a common dose-limiting side effect that can persist after treatment and irreversibly affect patient\u0026rsquo;s function and quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Many patients are unaware of the potential long-term impacts of CIPN when considering whether to continue, alter, or discontinue treatment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The primary objective of this mixed-methods study was to evaluate how the permanence of CIPN symptoms influence patients\u0026rsquo; preferences for altering chemotherapy during their treatment. We found that the permanence of CIPN symptoms made patients significantly more likely to want to alter chemotherapy and that patients wanted to make this decision collaboratively with their medical oncologist.\u003c/p\u003e \u003cp\u003eThis survey of patients currently undergoing neurotoxic chemotherapy found that permanence of CIPN symptoms had an extremely strong influence on their willingness to alter or discontinue chemotherapy (OR\u0026thinsp;~\u0026thinsp;30). Similarly, post-treatment interviews support the effect of CIPN permeance on patient\u0026rsquo;s preference to alter or discontinue neurotoxic chemotherapy. These findings are consistent with prior research from our group on this topic. A previous survey of patients who had completed neurotoxic chemotherapy treatment found a dramatic decrease in the percentage of patients who would have wanted to continue chemotherapy if their CIPN would be permanent (58\u0026ndash;34%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, a previous qualitative analysis found that informing patients about the potential for permanent CIPN affects increased their interest in adjusting or discontinuing treatment to preserve quality of life [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese interviews also highlighted the importance of shared-decision making when considering whether to alter treatment due to CIPN. Many patients emphasized the need for collaborative discussions with their oncologist to understand the risks of long-term side effects and the potential impact of alteration on treatment efficacy[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This supports previous findings that patients are interested in discussing the potential persistence of CIPN symptoms and options for altering treatment with their oncology team [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Shared-decision making could be an effective strategy to provide patients with the necessary understanding of the benefits and risks of continuing or altering treatment, so they can make an informed decision that will maximize their likelihood of achieving their personal treatment goals [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Currently, there is insufficient data to estimate a patient\u0026rsquo;s likelihood of experiencing persistent CIPN. The ~\u0026thinsp;50% likelihood of CIPN symptoms remaining 3\u0026thinsp;+\u0026thinsp;years post-treatment has been estimated primarily from large cross-sectional studies of patients many years after treatment or relatively small cohorts of patients followed longitudinally from the end of treatment[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Robust data are needed from large prospective cohorts with longitudinal CIPN assessment at the end of and for years post-treatment to understand the actual risk of persistent CIPN [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These risk estimates could be further personalized by identifying demographic, treatment, or genetic factors that affect the risk of CIPN persistence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This data could be integrated into decision aids that provide patients with simple information about the risks of persistent CIPN and the potential benefits (reduced persistent CIPN [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]) and risks (reduced efficacy [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]) of treatment alteration [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Decision aids have assisted cancer patients and their clinicians with making high-quality shared-decisions in other areas with risk-benefit tradeoffs such as decisions around surgical mastectomy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study used a patient-centered mixed-methods approach to understand patient preferences around treatment alteration in the context of permanent CIPN. Using actual patients currently receiving treatment enhances the relevance and applicability of these findings whereas the semi-structured interviews allowed for in-depth exploration of patients\u0026rsquo; perspectives. There are also limitations of this study that should be considered. The modest sample size, and predominance of women with early-stage breast cancer, limits the reliability of these findings and precludes subgroup analyses to further explore differences between patients or their cancer types or treatment regimens. Additionally, self-reported data can be subject to bias, as patients may provide socially desirable responses.\u003c/p\u003e \u003cp\u003eIn conclusion, the permanence of CIPN significantly influences patients\u0026rsquo; preferences for altering chemotherapy treatment. There is a critical need for better data to support communication between patients and their oncology teams regarding the potential long-term effects of CIPN, perhaps assisted with decision aids. Prospective trials could then be conducted investigating the effectiveness of these tools to support shared decision-making that improves patient\u0026rsquo;s likelihood of achieving their goals of chemotherapy treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Data for Patients Included in Analysis (n\u0026thinsp;=\u0026thinsp;66)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (%) or Mean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYears\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0 (13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCancer Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColorectal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCancer Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-metastatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetastatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChemotherapy Type*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaxane\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlatinum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonths\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.46 (1.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*Some patients received combination treatment with both platinum and taxane\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOdds of Preferring to Alter (Discontinue or Delay) Chemotherapy Treatment vs. Continue Without Alteration\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds Ratio (95% Confidence Interval)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIPN Symptoms Permanent (vs. Temporary)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.14 (15.31\u0026ndash;55.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCIPN Severity (CIPN20 Score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09 (0.99\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01 (1.00\u0026ndash;1.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01 (0.95\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatinum-containing Chemotherapy (vs. Taxane)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.81 (0.11\u0026ndash;6.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatinum-Taxane Combination Chemotherapy (vs. Taxane)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.98 (0.45\u0026ndash;19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMetastasis (vs. No Metastasis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.15 (0.02\u0026ndash;1.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Perceptions on Altering Treatment Based on Evidence of Future CIPN (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinue Treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExample Quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrioritizing Cancer Efficacy\u003c/p\u003e \u003cp\u003e31%, N\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I\u0026rsquo;d rather get the cancer removed and deal later with the possibility of moderate to severe neuropathy\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Because I mean it's my life. I would want to go with the most aggressive treatment possible\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Concern about CIPN\u003c/p\u003e \u003cp\u003e21%, N\u0026thinsp;=\u0026thinsp;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I would accept it and continue with treatment\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinish Treatment on Schedule\u003c/p\u003e \u003cp\u003e10%, N\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;[Delaying] just makes the treatment go on longer.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlter Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExample Quotes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevent Severe CIPN\u003c/p\u003e \u003cp\u003e17%, N\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I would probably want to decrease it if it would prevent [CIPN]\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppreciate Treatment Pause\u003c/p\u003e \u003cp\u003e7%, N\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;it's nice to have that week of decompression instead of a constant [treatment] every single week.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiscuss with Provider\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eExample Quotes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust in Provider Expertise\u003c/p\u003e \u003cp\u003e14%, N\u0026thinsp;=\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I would want to discuss with my doctor \u0026hellip; she could lower my dose or [discuss] what we should do.\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Perceptions on Altering Treatment Based on Evidence of Future CIPN that would be Permanent (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment Decision\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExample Quote\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContinue Treatment\u003c/p\u003e \u003cp\u003e8%, N\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I would want to cure cancer first\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlter Treatment\u003c/p\u003e \u003cp\u003e50%, N\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;If permanent, decrease the dose or listen to the doctor. Stopping wouldn\u0026rsquo;t be an option unless alternative [treatment was available]\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscontinue Treatment\u003c/p\u003e \u003cp\u003e13%, N\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I would consider stopping if it was impacting my quality of life and daily activities\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscuss with Provider\u003c/p\u003e \u003cp\u003e29%, N\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;I\u0026rsquo;m not the one who can make [that] decision\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;I honestly believe it\u0026rsquo;s not really a patient decision. I mean they weigh in, but I don't know enough about it to decide\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded in part by the Michigan Institute for Clinical \u0026amp; Health Research (MICHR) via a pilot grant to DLH (UM1TR004404).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor Contributions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Kelley M. Kidwell and Xueting Tao provided statistical expertise and supported the development of the study methodology. Daniel L. Hertz conceptualized and supervised the study, provided critical revisions, and approved the final manuscript. The first draft of the manuscript was written by Yerial Jun, and all authors reviewed and approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis project was conducted in accordance with the Declaration of Helsinki and approved by the UM IRB-Med (PI: DL Hertz, HUM00171478).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent to publish\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided informed consent for the publication of anonymized data from this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eReferenced from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u0026reg;) for Breast Cancer V.1.2019. \u0026copy; National Comprehensive Cancer Network, Inc 2019. All rights reserved. Accessed [June 27, 2019]. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK\u0026reg;, NCCN\u0026reg;, NCCN GUIDELINES\u0026reg;, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReferenced from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u0026reg;) for Colon Cancer V.2.2019. \u0026copy; National Comprehensive Cancer Network, Inc 2019. All rights reserved. Accessed [June 27, 2019]. To view the most recent and complete version of the guideline, go online to www.nccn.org. NATIONAL COMPREHENSIVE CANCER NETWORK\u0026reg;, NCCN\u0026reg;, NCCN GUIDELINES\u0026reg;, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeijers A, Mols F, Dercksen W, Driessen C, Vreugdenhil G (2014) Chemotherapy-induced peripheral neuropathy and impact on quality of life 6 months after treatment with chemotherapy J Community Support Oncol 12: 401\u0026ndash;406\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerlin NL, Tandon VJ, Hawley ST, Hamill JB, MacEachern MP, Lee CN, Wilkins EG (2019) Feasibility and Efficacy of Decision Aids to Improve Decision Making for Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis Medical decision making: an international journal of the Society for Medical Decision Making 39: 5\u0026ndash;20\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C-S, Dorsch MP, Alsomairy S, Griggs JJ, Jagsi R, Sabel M, Stino A, Callaghan B, Hertz DL (2025) Remote Monitoring of Chemotherapy-Induced Peripheral Neuropathy by the NeuroDetect iOS App: Observational Cohort Study of Patients With Cancer Journal of medical Internet research 27: e65615\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEckhoff L, Knoop A, Jensen MB, Ewertz M (2015) Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors Eur J Cancer 51: 292\u0026ndash;300\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEpstein RM, Street RL, Jr. (2011) The values and value of patient-centered care Ann Fam Med 9: 100\u0026ndash;103. doi: 110.1370/afm.1239.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawley ST, Griggs JJ, Hamilton AS, Graff JJ, Janz NK, Morrow M, Jagsi R, Salem B, Katz SJ (2009) Decision involvement and receipt of mastectomy among racially and ethnically diverse breast cancer patients J Natl Cancer Inst 101: 1337\u0026ndash;1347\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawley ST, Newman L, Griggs JJ, Kosir MA, Katz SJ (2016) Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer The patient 9: 161\u0026ndash;169\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHertz DL (2024) Incidence, description, predictors, and consequences of persistent taxane-induced peripheral neuropathy Curr Opin Support Palliat Care 18: 30\u0026ndash;38. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SPC.0000000000000684\u003c/span\u003e\u003cspan address=\"10.1097/SPC.0000000000000684\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 0000000000002024 Dec 0000000000000686.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHertz DL, Childs DS, Park SB, Faithfull S, Ke Y, Ali NT, McGlown SM, Chan A, Grech LB, Loprinzi CL, Ruddy KJ, Lustberg M (2021) Patient-centric decision framework for treatment alterations in patients with Chemotherapy-induced Peripheral Neuropathy (CIPN) Cancer Treat Rev 99:102241.: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ctrv.2021.102241\u003c/span\u003e\u003cspan address=\"10.1016/j.ctrv.2021.102241\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHertz DL, Tofthagen C, Rossi E, Bernasconi DP, Lim J, Carlson M, Sheffield KE, Nekhlyudov L, Grech L, Von Ah D, Mayo SJ, Ruddy KJ, Chan A, Alberti P, Lustberg MB, Tanay M (2023) Patient perceptions of altering chemotherapy treatment due to peripheral neuropathy Support Care Cancer 32: 48. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00520-00023-08209-00520\u003c/span\u003e\u003cspan address=\"10.1007/s00520-00023-08209-00520\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoibl S, Skacel T, Nekljudova V, Luck HJ, Schwenkglenks M, Brodowicz T, Zielinski C, von Minckwitz G (2011) Evaluating the impact of Relative Total Dose Intensity (RTDI) on patients' short and long-term outcome in taxane- and anthracycline-based chemotherapy of metastatic breast cancer- a pooled analysis BMC Cancer 11: 131\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoprinzi CL, Lacchetti C, Bleeker J, Cavaletti G, Chauhan C, Hertz DL, Kelley MR, Lavino A, Lustberg MB, Paice JA, Schneider BP, Lavoie Smith EM, Smith ML, Smith TJ, Wagner-Johnston N, Hershman DL (2020) Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update J Clin Oncol 14: 01399\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMols F, Beijers T, Lemmens V, van den Hurk CJ, Vreugdenhil G, van de Poll-Franse LV (2013) Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: results from the population-based PROFILES registry Journal of clinical oncology: official journal of the American Society of Clinical Oncology 31: 2699\u0026ndash;2707\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SB, Goldstein D, Krishnan AV, Lin CS, Friedlander ML, Cassidy J, Koltzenburg M, Kiernan MC (2013) Chemotherapy-induced peripheral neurotoxicity: a critical analysis CA Cancer J Clin 63: 419\u0026ndash;437. doi: 410.3322/caac.21204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark SB, Lin CS, Krishnan AV, Goldstein D, Friedlander ML, Kiernan MC (2011) Long-term neuropathy after oxaliplatin treatment: challenging the dictum of reversibility Oncologist 16: 708\u0026ndash;716. doi: 710.1634/theoncologist.2010-0248. Epub 2011 Apr 1638.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePostma TJ, Aaronson NK, Heimans JJ, Muller MJ, Hildebrand JG, Delattre JY, Hoang-Xuan K, Lant\u0026eacute;ri-Minet M, Grant R, Huddart R, Moynihan C, Maher J, Lucey R (2005) The development of an EORTC quality of life questionnaire to assess chemotherapy-induced peripheral neuropathy: The QLQ-CIPN20 European journal of cancer 41: 1135\u0026ndash;1139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePostma TJ, Vermorken JB, Liefting AJM, Pinedo HM, Heimans JJ (1995) Paclitaxel-induced neuropathy Annals of Oncology 6: 489\u0026ndash;494\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalgado TM, Quinn CS, Krumbach EK, Wenceslao I, Gonzalez M, Reed HL, Syverson JG, Etz RS, Vangipuram K, Barker MR, Henry NL, Farris KB, Hertz DL (2020) Reporting of paclitaxel-induced peripheral neuropathy symptoms to clinicians among women with breast cancer: a qualitative study Support Care Cancer 28: 4163\u0026ndash;4172. doi: 4110.1007/s00520-00019-05254-00526. Epub 02020 Jan 00522.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpeck RM, Sammel MD, Farrar JT, Hennessy S, Mao JJ, Stineman MG, DeMichele A (2013) Impact of chemotherapy-induced peripheral neuropathy on treatment delivery in nonmetastatic breast cancer Journal of oncology practice 9: e234-240\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVicente RS, Freitas AR, Ferreira RMA, Prada SP, Martins TS, Martins TC, Duarte Mendes A, Vitorino MM, Chaves AF, Santos CC, Alpuim Costa D, Cust\u0026oacute;dio MP, Barbosa M (2023) Communication preferences and perceptions of cancer patient during their first medical oncology appointment Psychooncology 32: 1702\u0026ndash;1709. doi: 1710.1002/pon.6220. Epub 2023 Sep 1725.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinters-Stone KM, Horak F, Jacobs PG, Trubowitz P, Dieckmann NF, Stoyles S, Faithfull S (2017) Falls, Functioning, and Disability Among Women With Persistent Symptoms of Chemotherapy-Induced Peripheral Neuropathy J Clin Oncol 35: 2604\u0026ndash;2612\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chemotherapy-induced peripheral neuropathy, treatment alteration, treatment discontinuation, survey, qualitative research, shared decision making","lastPublishedDoi":"10.21203/rs.3.rs-6304310/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6304310/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eChemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect from taxane and platinum chemotherapy, with symptoms that can persist for years after treatment and significantly diminish quality of life. This study aimed to evaluate how the potential permanence of CIPN influences patient preferences for continuing vs. altering neurotoxic chemotherapy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA mixed-methods approach was adopted, which included surveys and semi-structured interviews. During treatment, surveys used the EORTC QLQ-CIPN20 questionnaire to assess CIPN severity and patient preferences for continuing, altering, or discontinuing chemotherapy under hypothetical scenarios of temporary vs. permanent CIPN. Post-treatment interviews investigated patients' perceptions of altering treatment due to temporary or permanent CIPN.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSurvey data from 66 participants revealed that CIPN permanence considerably increased the likelihood of patients preferring to alter treatment (Odds ratio [OR]\u0026thinsp;=\u0026thinsp;29.14 [95% confidence interval: 15.31\u0026ndash;55.46], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among 29 post-interviewees, 62% decided to continue with their present regimen despite CIPN, citing treatment efficacy and a lack of concern for CIPN. However, in a hypothetical scenario that their CIPN would be permanent, only 8% preferred to continue treatment without alterations, whereas 50% preferred to alter treatment and 13% to discontinue treatment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCIPN permanence substantially influences patient preferences for treatment decisions. Improved communication between oncology teams and patients regarding risks of permanent CIPN is essential to support shared decision making to achieve patient\u0026rsquo;s preferred therapeutic outcomes.\u003c/p\u003e","manuscriptTitle":"Mixed-methods Study of the Effect of Chemotherapy-induced Peripheral Neuropathy SymptomPermanence on Patient’s Willingness to Alter Neurotoxic Chemotherapy Treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 10:23:09","doi":"10.21203/rs.3.rs-6304310/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d82a0cb7-be52-4192-a2e3-e91827127e3c","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-11T20:53:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-13 10:23:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6304310","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6304310","identity":"rs-6304310","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}