Q&A: How to cope with peripheral neuropathy during cancer treatment
Chemotherapy is a lifesaving treatment for many people with cancer. However, it comes with its own list of side effects that can occur both during and after treatment.
One of the most common of these is chemotherapy-induced peripheral neuropathy (CIPN). CIPN is caused by nerve damage to the periphery of the body, most often affecting hands and feet. Common symptoms include tingling, pain, hot or cold sensations, and a “pins and needles” feeling.
The good news is that CIPN often improves or goes away completely in the months after finishing chemotherapy, and there are several therapies that can ease symptoms, including acupuncture, physical and occupational therapy, and medication. We asked Stacie Heuer, PA-C, a cancer specialist and physician assistant at the M Health Fairview Cancer Center – Edina, what you should know.
What is chemotherapy-induced peripheral neuropathy (CIPN)?
It’s one possible side effect of some chemotherapy agents, including taxanes – for example, Taxol, Abraxane, and Taxotere – and platinum-based drugs – for example, Carboplatin. When people have prolonged or high-dose exposure to these agents, it can cause damage to their peripheral nerves. These are the nerves outside of the brain and spinal cord, for example in the arms, legs, and stomach.
It’s very common for people undergoing cancer treatment to develop peripheral neuropathy. Up to 30% of all cancer patients will develop some form of CIPN, and nearly 60% of patients receiving known neurotoxic agents (including taxanes and platinum) will experience it.
What are the symptoms of CIPN?
It most commonly affects the sensory nerves and can cause numbness, tingling, and other sensations – including the feeling of burning, cold, or “pins and needles.” Sensory neuropathy symptoms typically start in the fingers and toes and moves toward the center of the body as CIPN progresses.
It can also affect the nerves responsible for movement or fine motor skills, causing cramps, weakness, and tremors. Rarely, CIPN affects the organ nerves and may lead to a fast heart rate, low blood pressure, dizziness, difficulty exercising, a slow gut, and constipation, among other symptoms.
Symptoms worsen with increased exposure to the damaging agent and may even continue to worsen for up to two months after a patient finishes chemotherapy. The discomfort and effects on daily life can lead to a significant disruption for patients.
Is there a way to prevent CIPN?
Many infusion centers ask patients receiving chemotherapy with taxanes to place ice on their hands and feet during infusion. In theory, this prevents the chemotherapy from penetrating the small nerves of the extremities and doesn’t allow the damage to occur. Other than using ice during infusion, there are no other measures that are currently considered effective, although some studies support the idea that exercise can decrease the likelihood of CIPN.
If people already have neuropathy or another condition like diabetes that increases the likelihood of neuropathy, they are more likely to develop CIPN during treatment. It’s important for patients to discuss pre-existing conditions with their cancer care team, so treatment can be best tailored to their needs.
I also recommend that people avoid electrolyte infusions during chemotherapy, as they can negatively affect some treatments and may also increase the likelihood of CIPN.
How is CIPN treated?
There have been several small studies on treatment for CIPN. Exercise, vitamin B6, and acupuncture have all been shown to help heal the nerves and ease neuropathy symptoms. We have a team of knowledgeable acupuncturists at several locations throughout the Twin Cities, as well as resources for connecting patients to community-based acupuncture. Patients who are interested in receiving acupuncture can reach out to their care team or oncology social worker for support.
Many patients with CIPN also benefit from seeing a physical medicine doctor and going through physical or occupational therapy to manage their symptoms. We work very closely with our colleagues in physical medicine and rehabilitation to connect patients to care that can help them manage the side effects of both cancer and cancer treatment.
Duloxetine is currently the only medication recommended by the American Society of Clinical Oncology for treatment. It can be helpful for many patients, but some people develop dizziness and must discontinue use. Physicians have also historically used gabapentin to treat pain associated with CIPN. There are also a few topical remedies that can provide symptom relief, as well as new products like nerve stimulators that are being developed.
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Does neuropathy go away?
Fortunately, most people who develop CIPN see their symptoms improve with time. However, the healing process can take months, even one to two years after completing chemotherapy in rare cases. Many patients see their symptoms go away completely, but some have residual neuropathy. There are a small minority of patients whose full neuropathy persists long-term.
Throughout treatment, it’s important for patients to update their oncology team prior to each infusion about any neuropathy symptoms. This will help in decisions around dosing and duration of chemotherapy while trying to prevent excessive nerve damage.
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