Chemotherapy is an important treatment for cancer. Sadly, 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 hugely 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 again how important it is to detect these vague 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 they are 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 workplan 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.