[Effect of Oral Glutamine on Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: An Evidence-Based Appraisal].

BACKGROUND: Chemotherapy may induce peripheral neuropathy, which often results in the chemotherapy dose being reduced or the chemotherapy regimen being stopped. At present, there are no treatment guidelines for chemotherapy-induced peripheral neuropathy. Glutamine is one of the treatment strategies currently applied in practice. This strategy is expensive and lacks clear evidence as to its efficacy.

PURPOSE: To evaluate the effect of oral glutamine on CIPN in cancer patients.

METHODS: PICO (population- intervention- comparison- outcome) was used to focus the problem: P: cancer patient; I: glutamine, L-glutamine; C: usual care; O: alleviate, reduce, improve, and prevent. Databases searched included Airiti Library, Cochrane Library, CINAHL, and PubMed. Three randomized clinical trials and two quasi-experimental designs were evaluated using evidence-based appraisal.

RESULTS: Four studies used 30 g/day of glutamine either at the beginning of chemotherapy or at 24 hours after the beginning of chemotherapy. The shortest duration for taking glutamine was four days and longest duration was two months. The incidences of CIPN-induced pain were significantly different (risk ratio = 0.26; 95% CI [0.09, 0.70], Z = 2.65, p = .008) between the intervention and control groups. The incidences of CIPN grading, numbness, and muscle weakness were not significantly different between the intervention and control groups. From an economic point of view, the clinical efficacy of taking glutamine does not justify the additional daily cost to the patient of NT¤500 (about US¤17).

CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Because of the small sample size, minimal effects of glutamine, and no significant decrease in risk, we do not suggest routinely using oral glutamine to prevent or reduce CIPN symptoms in cancer patients.