Background
Chemotherapy induced peripheral neuropathy (CIPN) impacts 68% of neurotoxic chemotherapy recipients and is a leading cause of reduced or ceased treatment. CIPN can persist for a long time and have a major impact on lower-limb health including balance deficits, falls and fall related injuries, and painful nail and skin concerns, all of which can benefit from podiatry services. We explored Medicare-funded podiatry service use among Australians with colorectal cancer (CRC) and surveyed Australian podiatrists to achieve consensus and agreement on management of CIPN.
Methods
Our retrospective cohort study using linked health datasets of 3,292 people diagnosed with CRC (2011-2013) comparing podiatry service before and after diagnosis showed the crude rate of podiatry service use among chemotherapy recipients did not exceed 20% across the 5 years post-diagnosis follow-up. Adjusting for potential confounders, no significant difference was found in the rates of podiatry service use between chemotherapy recipients and non-recipients, nor between those receiving neurotoxic and non-neurotoxic chemotherapy, at any timepoint post-diagnosis.
An online three-round modified Delphi survey of Australian podiatrists gathered consensus and agreement on a set of clinical recommendations for CIPN management these provided guidance on 1) identifying signs and symptoms; 2) diagnosis and assessment; and 3) best clinical practice and management strategies for CIPN identified by podiatrists including both podiatry and non-podiatry specific care.
Impact on practice
Lower than expected podiatry service use by chemotherapy recipients, and lack of difference according to whether chemotherapy was neurotoxic, likely indicates suboptimal follow-up care for this population. The expert-informed consensus-based recommendations are now available to guide podiatrists in the consistent care of people with CIPN.
Discussion
Inclusion of podiatrists and improved referral pathways in cancer survivorship care will enable better management for people impacted by the signs and symptoms of CIPN affecting quality of life.