Beyond symptoms: wearable digital biomarkers for subclinical detection of chemotherapy-induced peripheral neuropathy

Background Chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent dose-limiting toxicity of taxane-, platinum-, and proteasome inhibitor-based regimens, yet clinical management has a structural flaw: assessment depends on CTCAE clinician grading that registers symptoms only after axonal degeneration has reached an irreversible stage. Main body Quantitative sensory testing studies demonstrate that vibration perception, thermal detection, and sudomotor function deteriorate before patients report numbness or pain, suggesting a subclinical window of one to two chemotherapy cycles. Whether detection within this window can prevent permanent nerve injury remains biologically plausible but prospectively unestablished. Wearable sensors—inertial measurement units for gait, plantar pressure insoles, electrochemical skin conductance devices, and vibration sensors—have demonstrated proof-of-concept capacity to capture subclinical CIPN signals, but evidence remains largely cross-sectional with limited longitudinal validation. This Perspective distinguishes the conceptual framework for subclinical CIPN surveillance from the currently available clinical validation evidence. I systematically categorize four sensing modalities by neuropathological substrate, provide a cross-modality readiness comparison, and identify translational barriers including absent alert thresholds and confounding factors such as age, diabetes, anemia, and fatigue. I propose a phased prospective validation framework; specific monitoring recommendations should be regarded as hypotheses for testing rather than current clinical guidance. Conclusion Wearable sensors should not replace patient-reported outcomes but may add an objective neurotoxicity monitoring layer whose capacity to improve clinical outcomes requires prospective validation.