SenseCheQ: Community-based sensory testing for early identification of Chemotherapy Induced Peripheral Neuropathy.

化疗是治疗癌症的重要手段。不幸的是，它也会引起副作用，包括慢性疼痛和触觉变化。这是由于神经损伤。在多达三分之一的人中，这些变化持续时间超过6个月，造成痛苦，残疾并增加癌症生存的负担。这些变化开始是模糊的，但早期发现是重要的，因为减少化疗剂量是减轻症状严重程度的唯一方法。然而，减少剂量必须与治疗不太成功的可能风险相平衡。这突出了早期和准确地发现这些迹象的重要性。检测这些变化的一种方法是仔细测试皮肤的感觉。这是通过询问患者何时感觉到温度或振动的微小变化，然后将其与化疗开始前的读数进行比较来实现的。这种测试在疼痛研究界是众所周知的，在那里它们被称为定量感觉测试（QST）。令人沮丧的是，QST需要很长的时间来执行，是昂贵的，并需要病人不断来到诊所在一个非常脆弱的时间在他们的癌症治疗。这些问题意味着这种正式的QST不适合常规临床使用。我们的患者、疼痛医生和工程师团队相信我们可以提供一种简单、廉价且有效的感觉测试试剂盒，我们称之为SenseCheQ。这将使患者能够在化疗期间在家中检查他们的神经健康。我们将设计SenseCHeQ，使其足够敏感，可以在患者注意到任何症状之前检测到早期变化，从而实现个性化治疗，最大限度地提高癌症治疗的成功率，同时最大限度地降低慢性疼痛和感觉丧失的风险。为了实现SenseCheQ，我们需要完成四个互补的工作计划。工作计划1（英国范围）将由患者合作伙伴领导和推动，以确保SenseCHeQ用户友好并满足患者的需求。这一工作计划还将纳入其余的工作计划，以确保患者仍然是我们关注的中心。工作计划2（纽卡斯尔）将设计解决方案，通过识别和集成现成的组件到合适的“可穿戴设备”，并提供电力和通信。工作计划3（布里斯托）将在健康志愿者中测试这些解决方案。最初，将单独测试单个组件，并与常用的感官测试设备进行比较。随着设计的进展，通过与WP 1和WP 2密切合作的测试和重新设计周期，该工作计划将转移到在神经损伤模型中验证早期SenseCHeQ版本，这将再次在健康志愿者中引起暂时的麻木或疼痛。工作计划4（邓迪）将在患者中进行可行性研究。工作计划4将与PAGIORM协同，PAGIORM是另一个Versus/MRC高级疼痛发现平台工作计划，旨在协调对神经损伤引起的疼痛的评估，而不仅仅是化疗引起的损伤。PACANORM获得资助，在患者化疗期间对他们进行QST。我们将要求其中一些患者同时在家中使用SenseCHeQ。我们最感兴趣的是患者如何使用该设备-它是否易于使用？健壮？我们还将比较SenseCHeQ与QST结果，以估计其检测早期神经病变的能力。如果成功，我们将申请进一步的资金来证实这些发现，从而使SenseCHeQ成为一种临床有用的工具，使患者能够在家中监测自己的神经健康，最大限度地降低他们患慢性疼痛和麻木的风险，并能够提供真正个性化的癌症治疗。

Chemotherapy is an important treatment for cancer. Unfortunately, it also causes side effects, including chronic pain and changes in the sense of touch. This is due to nerve damage. In up to 1 in 3 people, these changes last longer than 6 months, causing misery, disability and adding to the burden of cancer survivorship. These changes are vague to begin with, yet early detection is important, as reducing the chemotherapy dose is the only way to reduce the severity of symptoms. Reducing the dose, however, must be balanced against the possible risk of the treatment being less successful. This highlights how important it is to detect these signs early and accurately. One way of detecting these changes is with careful testing of the skin's senses. This is achieved by asking patients when they feel small changes in temperature or vibrations and then comparing that to readings taken before chemotherapy was started. Such tests are well known in the pain research community where they are called Quantitative Sensory Testing (QST). Frustratingly, QST takes a long time to perform, is expensive and needs the patients to keep coming into clinic during a very vulnerable time in their cancer treatment. These issues mean that this formal QST is not suitable for routine clinical use.Our team of patients, pain doctors and engineers believe that we can deliver a simple, cheap and effective sense testing kit, that we are calling SenseCheQ. This will enable patients to check the health of their nerves, at home, during their chemotherapy. We will design SenseCHeQ to be sensitive enough to detect early changes, potentially before the patient notices any symptoms, to enable personalised treatments that will maximise the success of cancer treatment, whilst minimising the risk of chronic pain and loss of sensation. To deliver SenseCheQ we need to complete four complementary workplans. Workplan 1 (UK wide) will be led and driven by patient partners to ensure that SenseCHeQ is user friendly and meets the needs of patients. This workplan will also feed into the remaining workplans to ensure that patients remain at the centre of our focus. Workplan 2 (Newcastle) will engineer solutions, by identifying and integrating off-the-shelf components into suitable 'wearables' and providing power and communications.Workplan 3 (Bristol) will test these solutions in healthy volunteers. Initially, individual components will be tested alone and compared to commonly used sensory testing equipment. As designs progress, through testing and re-design cycles working closely with WP1 and WP2, this workplan will move to validating early SenseCHeQ versions in models of nerve damage, which will cause temporary numbness or pain, again in healthy volunteers. Workplan 4 (Dundee) will perform a feasibility study in patients. Workplan 4 will synergise with PAINSTORM, another Versus/MRC advanced pain discovery platform program of work that is seeking to harmonise assessment of pain caused by nerve damage, not just damage caused by chemotherapy. PAINSTORM are funded to perform QST on patients as they move through their chemotherapy. We will ask some of these patients to use SenseCHeQ at home at the same time. We will be most interested in how patients get on with the device - is it easy to use? Robust? We will also compare SenseCHeQ to the QST results to estimate its ability to detect early neuropathy. If successful, we will apply for further funding to confirm these findings and thus move SenseCHeQ towards a clinically useful tool empowering patients to monitor their own nerve health, at home, minimise their risks of developing chronic pain and numbness and enabling delivery of truly personalised cancer treatment.