Improvement of Symptoms and Self-Management
Peripheral Neuropathy recognition (CAS-CIPN and GOG-Ntx scores) and DIT were measured as indicators of improvement in symptoms. In the two-way ANOVA of the CAS-CIPN and GOG-Ntx scores, no significant difference were found between the CG and SMG. As treatments increased, the scores in both groups indicated a stronger recognition of symptoms (over the course of T0,T2,T3 : F = 24.158 p = 0.000). In addition, the correlation coefficient between the GOG-Ntx and CAS-CIPN scores (CG: r = 0.691, p = 0.001; SMG: r = 0.821, p = 0.001) was also significantly higher in both groups. The participants thought that their symptom recognition was appropriate.
Two factors may have contributed to the lack of differences between the groups: first, the drugs used by the participants produced acute and chronic peripheral neuropathy, making them more aware of their symptoms. Taxanes such as docetaxel and paclitaxel were used in 22 patients (68.8%) for the CG, and 18 (55.2%) for the SMG; oxaliplatin in four patients (13.8%) for the CG and six (20.0%) for the SMG; and a combination of paclitaxel and carboplatin in four patients (13.8%) for the CG and nine (30.0%) for the SMG. Taxanes and oxaliplatin showed acute and chronic symptoms. The chronic symptom of taxanes involves numbness and tingling, characterized by a “glove and stocking syndrome” that extends to the lower extremities and wrists . This symptom is experienced by 60% of all treated patients . Symptoms occur in 97% of patients when the cumulative dose exceeds 1,400 mg/m2, which is easy to recognize because of the symmetrical damage to the axons and the bilateral nature of the symptoms.
On the other hand, as the cumulative dose of oxaliplatin increases, chronic sensory axonal neuropathy leads to persistent symptoms and subsequent functional impairment, including significant sensory dysfunction in the hands and feet. The incidence is approximately 40–93%, and the symptoms worsen within 3–6 months even after treatment . Characteristically, peripheral neuropathy leads to dose reduction, delay, and cessation of treatment . Therefore, it is essential that symptoms are understood effectively.
Second, in this study, both the CG and SMG were provided education on treatment and symptoms/prevention of peripheral neuropathy and self-management, which may have increased their interest in symptoms. A study by Tanay et al.  revealed that CIPN involves vague symptoms, an unknown experience, a lack of information, and an insignificant risk due to patients’ perception of risk. Researchers also reported that patients with CIPN experienced suffering from an inability to cope with the previously unknown sensation of numbness. They also reported that 75% of patients with CIPN experienced unpleasant emotions such as fear, helplessness, and dismay to the inability to manage numbness, and that it implied losing one’s sense of control . Therefore, it is suggested that there was no difference between the groups because both of them were provided with specific education related to symptom sensation and self-management of CIPN. The DIT also showed no difference between the groups.
Due to the cumulative nature of any drug, it is likely that the more a patient is treated, the more CIPN symptoms are recognized and the stronger the DIT becomes. For this reason, it is important for healthcare providers to monitor symptoms, including mental stability, over time and effectively use dose reduction and drug suspension as part of treatment.
Next, the results of symptom relief and daily life safety behaviors for peripheral neuropathy showed no difference between the groups. Self-monitoring has been applied to the self-management of chronic diseases such as arthritis, asthma, diabetes, blood pressure control, and overweight/obesity as a form of cognitive-behavioral therapy . Recently, web-based self-monitoring methods have been developed, and their application is expanding .
Cognitive-behavioral therapies have also been used to ameliorate the side effects of chemotherapy, such as taste disorders  and fatigue  in cancer disease. These interventions can improve knowledge, promote positive emotions, enhance skills in self-management behaviors, and reduce the severity or impact of symptoms.
In the present study, the effect of self-monitoring, one of the cognitive-behavioral therapies, was not clear in terms of reducing symptoms and restoring the mental stability of peripheral neuropathy patients for the two reasons mentioned earlier. This was in line with a self-monitoring intervention paper on the WEB [28, 49] that showed no effect on the perception of symptoms.
Conversely, the alleviation of depression  and reduction in the Distress score  have been indicated to maintain physical function. A review of behavioral interventions  reported that interventions included self-reporting of CIPN symptoms, education about CIPN and management, safety, and methods for reporting physical function and symptoms. We aim to continue refining our study by reviewing the control group and intervention content.
Improvement of self-efficacy and QOL
The effect of the intervention, as clarified in this study, was the maintenance of self-efficacy and QOL. In other words, there was an interaction effect between the CG and SMG (F = 5.689, p = 0.004) for self-efficacy scores. Scores were significantly higher in the SMG than in the CG after three weeks (t=-3.372, p = 0.001). QOL scores were also higher in the SMG than in the CG. The results of the two-way ANOVA showed a significant difference between the CG and SMG (F = 7.914, p = 0.007). The self-monitoring intervention thus maintained participants’ self-efficacy and QOL༎
The intervention group retained their self-efficacy and QOL compared to the CG, even if their symptoms did not improve. The SMG participants observed their symptoms at home, organized their feelings at that time, and recorded them as homework. Together with the researcher, we provided feedback and confirmed their coping strategies. At that time, we approved and praised the participants’ self-management. We believe that this helped the participants to maintain their self-efficacy because it gave them the confidence that they were doing the right thing. This was also the case in a previous self-monitoring intervention for taste disorders . By setting goals for how to spend time in a way that is unique to each individual, it is thought that a change in attitude toward “doing what I can” rather than emphasizing “what I cannot do” was created, and QOL, including daily life functions, was maintained.
As described above, the self-monitoring intervention was implemented according to the set research framework; although no change in the intensity of CIPN symptoms was observed, self-efficacy and QOL in terms of being able to cope with the symptoms were maintained. We believe this could have been achieved through timely feedback, educational activities including how to stay safe, and maintaining ongoing engagement and positive interaction.
Our findings suggest that self-monitoring interventions may be effective as nursing support for CIPN, particularly for those who have not been able to establish effective non-intervention methods.