Understanding and Managing Chemotherapy-Induced Neuropathy.
Chemotherapy is a powerful tool in the fight against cancer, but it often comes with side effects that can linger long after treatment ends. One of the most common and challenging long-term side effects is chemotherapy-induced peripheral neuropathy (CIPN). For many, neuropathy can significantly impact quality of life, making it difficult to perform everyday tasks or enjoy activities they once loved.
How one can manage these side-effects is one of the most common questions I get asked.
This article explores why chemotherapy affects the nerves, the types of drugs that increase the risk of neuropathy, when to talk to your oncologist, and practical strategies to reduce the risk and manage symptoms.
What Is Chemotherapy-Induced Neuropathy?
Peripheral neuropathy refers to damage to the peripheral nerves, which are responsible for transmitting signals between the brain, spinal cord, and the rest of the body. These are the nerves that exist outside of the brain and spinal cord. When these nerves are damaged, it can result in symptoms such as:
Tingling or "pins and needles" sensations in the hands and feet.
Numbness or reduced sensation.
Burning, stabbing, or shooting pain.
Muscle weakness or difficulty with coordination.
Sensitivity to touch or temperature.
CIPN most typically presents in a ‘stocking-glove pattern’, meaning it affects the distal extremities, such as the fingers, hands, arms, feet, and legs. For some, these symptoms are mild and temporary, but for others, they can be severe and long-lasting, persisting for months or even years after chemotherapy ends.
How Common Is Neuropathy After Chemotherapy?
The prevalence of chemotherapy-induced neuropathy varies depending on the type of chemotherapy used, the dosage, and individual factors. Studies estimate that:
Approximately 30-50% of patients undergoing chemotherapy experience some degree of neuropathy.
For certain chemotherapy drugs, the risk can be as high as 70%.
In about 20% of cases, neuropathy becomes a long-term or permanent condition.
Why Does Chemotherapy Affect the Nerves?
Chemotherapy drugs are designed to target rapidly dividing cells, which is a hallmark of cancer. However, these drugs can also affect healthy cells, including the nerves. Peripheral nerves are particularly vulnerable because they have long axons (nerve fibers) that are more susceptible to damage.
Chemotherapy can harm the nerves in several ways:
Oxidative stress: Chemotherapy can increase the production of free radicals, which damage nerve cells.
Inflammation: Some chemotherapy drugs trigger inflammation, which can impair nerve function.
Disruption of microtubules: Microtubules are structures within nerve cells that help transport nutrients and signals. Certain chemotherapy drugs disrupt these structures, leading to nerve damage.
Mitochondrial dysfunction: The mitochondria, which provide energy to cells, can be damaged by chemotherapy, further impairing nerve health.
Chemotherapy Drugs That Increase the Risk of Neuropathy
Not all chemotherapy drugs carry the same risk of neuropathy. The following classes of drugs are most commonly associated with this side effect:
Platinum-based drugs
Cisplatin, carboplatin, and oxaliplatin are widely used in cancer treatment and are known to cause neuropathy.
Oxaliplatin, in particular, is associated with cold sensitivity and acute neuropathy that can become chronic.
Taxanes
Paclitaxel and docetaxel are used to treat breast, ovarian, and lung cancers.
These drugs can cause sensory neuropathy, often presenting as tingling or numbness in the hands and feet.
Vinca alkaloids
Vincristine and vinblastine are used to treat leukemia, lymphoma, and other cancers.
These drugs can cause both sensory and motor neuropathy, leading to muscle weakness and coordination issues.
Proteasome inhibitors
Bortezomib, used to treat multiple myeloma, is another drug associated with neuropathy.
When to Talk to Your Oncologist
If you notice tingling, numbness, or any other symptoms of neuropathy during chemotherapy, it’s important to talk to your oncologist as soon as possible. Early intervention can help prevent symptoms from worsening and may allow for adjustments to your treatment plan.
Here are some signs that warrant a conversation with your oncologist:
Tingling or numbness that persists or worsens over time.
Difficulty with fine motor skills, such as buttoning a shirt or holding small objects.
Pain or burning sensations in your hands or feet.
Weakness or difficulty walking.
Sensitivity to touch or temperature that interferes with daily activities.
Your oncologist may recommend reducing the dose of chemotherapy, changing the treatment schedule, or switching to a different drug to minimise nerve damage. They may also suggest medications or therapies to help manage symptoms.
How to Reduce the Risk of Neuropathy
While it may not always be possible to prevent neuropathy, there are steps that can be taken to reduce the risk:
Dose adjustments: Your oncologist may adjust the dosage or schedule of chemotherapy to minimize nerve damage.
Cold therapy: Some studies suggest that wearing cold gloves and socks during chemotherapy infusions may reduce the risk of neuropathy by constricting blood vessels and limiting drug exposure to the nerves.
Supplements: Certain supplements, such as vitamin B6, alpha-lipoic acid, and glutamine, have shown promise in protecting nerve health. However, always consult your healthcare provider before starting any supplements.
Lifestyle factors: Maintaining a healthy diet, staying hydrated, and engaging in gentle exercise can support overall nerve health and reduce inflammation.
Managing and Relieving Neuropathy
If neuropathy develops, there are several strategies to help manage and relieve symptoms:
Medications
Prescription medications such as gabapentin, pregabalin, or duloxetine can help manage nerve pain.
Topical treatments, such as lidocaine patches or capsaicin cream, may provide localized relief.
Physical therapy
Working with a physical therapist can help improve strength, balance, and coordination, reducing the impact of neuropathy on daily life.
Acupuncture
Acupuncture has been shown to reduce pain and improve nerve function in some people with chemotherapy-induced neuropathy.
Mind-body practices
Practices such as yoga, meditation, and tai chi can help reduce stress and improve overall well-being, which may alleviate neuropathy symptoms.
Diet and supplements
A diet rich in anti-inflammatory foods, such as leafy greens, berries, and omega-3 fatty acids, can support nerve health.
Supplements like omega-3s, magnesium, and vitamin D may also help, but consult your healthcare provider before starting any new regimen.
Foot and hand care
Protect your hands and feet from extreme temperatures and avoid tight shoes or gloves.
Use cushioned insoles or padded socks to reduce pressure on your feet.
Regularly moisturize your skin to prevent dryness and cracking, which can exacerbate discomfort.
Alternative therapies
Some people find relief through therapies like massage, reflexology, or transcutaneous electrical nerve stimulation (TENS).
Holistic and Health Practitioners Who Can Help
Living with CIPN often requires a multidisciplinary approach. In addition to your oncologist, the following practitioners can provide valuable support:
Physical therapists: Help with exercises to improve strength, balance, and coordination.
Occupational therapists: Assist with strategies to adapt daily activities and improve fine motor skills.
Acupuncturists: Provide treatments to reduce pain and improve nerve function.
Naturopaths or integrative medicine practitioners: Offer guidance on supplements, nutrition, and holistic therapies to support nerve health.
Massage therapists: Help improve circulation and reduce muscle tension, which may alleviate some symptoms.
Cancer Coaches, counsellors or psychologists: Provide emotional support and stress management techniques, which can indirectly improve symptoms by reducing overall stress on the body.
Here, in Western Australia, there are several healthcare professionals and services your GP or oncologist can refer you to for support in managing chemotherapy-induced peripheral neuropathy (CIPN) and other cancer-related challenges. Similar practitioners and services will be available in most countries around the world. The likelihood is that your family doctor or oncology specialist will use a similar referral pathway. These referrals can help address both the physical and emotional aspects of living with neuropathy. Here’s a breakdown of who you could be referred to:
1. Allied Health Professionals
Physiotherapists:
Physiotherapists can help with exercises to improve strength, balance, and coordination, which are often affected by neuropathy. They can also provide strategies to manage pain and improve mobility.
Referral Pathway: Your GP or oncologist can refer you to a physiotherapist through public health services (e.g., hospitals or community health centres) or private practices.
Occupational Therapists (OTs):
OTs can assist with adapting daily activities, improving fine motor skills, and recommending tools or devices to make tasks easier. They can also provide advice on home modifications to improve safety if neuropathy affects your balance or mobility.
Referral Pathway: Available through public health services, cancer support organizations, or private practices.
Dietitians:
A dietitian can help you optimize your nutrition to support nerve health, reduce inflammation, and manage side effects like weight loss or digestive issues.
Referral Pathway: Many hospitals have oncology dietitians, or your GP can refer you to a private dietitian.
Podiatrists:
If neuropathy affects your feet, a podiatrist can help with foot care, recommend orthotics, and provide advice on footwear to reduce discomfort and prevent injury.
Referral Pathway: Available through public health services or private clinics.
Psychologists or Counsellors:
Living with neuropathy and cancer can take an emotional toll. Psychologists or counselors can help you manage stress, anxiety, or depression, which can indirectly improve your overall well-being and ability to cope with symptoms.
Referral Pathway: Your GP can provide a Mental Health Care Plan, which allows you to access subsidized sessions through Medicare.
2. Specialist Pain Clinics
If neuropathy pain is severe or difficult to manage, your GP or oncologist may refer you to a specialist pain clinic. These clinics often have a multidisciplinary team, including pain specialists, physiotherapists, and psychologists, who can provide tailored pain management strategies.
Referral Pathway: Pain clinics are available in major hospitals (e.g., Sir Charles Gairdner Hospital, Fiona Stanley Hospital) or private practices.
3. Cancer Support Services (Look for similar services in the country of your residence)
Cancer Council WA:
The Cancer Council offers a range of support services, including counselling, support groups, and access to allied health professionals. They also provide information on managing side effects like neuropathy.
Referral Pathway: Your GP or oncologist can recommend their services, or you can self-refer by contacting the Cancer Council directly.
Palliative Care Services:
For those with advanced cancer or significant symptoms, palliative care teams can provide holistic support, including pain management, emotional support, and coordination of care.
Referral Pathway: Available through hospitals, community health services, or private providers.
4. Complementary and Holistic Practitioners
Acupuncturists:
Acupuncture has been shown to help reduce neuropathy symptoms in some patients. Your GP or oncologist may refer you to a qualified acupuncturist who specializes in cancer care.
Referral Pathway: Acupuncture is often accessed privately, but some cancer centres may offer it as part of integrative care.
Exercise Physiologists:
Exercise physiologists can design a safe and effective exercise program tailored to your needs, helping to improve circulation, reduce inflammation, and support nerve health.
Referral Pathway: Your GP can refer you under a Chronic Disease Management Plan, which may provide Medicare-subsidized sessions.
Naturopaths or Integrative Medicine Practitioners:
These practitioners can provide advice on supplements, herbal remedies, and lifestyle changes to support nerve health and overall well-being. It’s important to ensure they are qualified and experienced in working with cancer patients.
Referral Pathway: Often accessed privately, but some integrative oncology centres may offer these services.
5. Community and Peer Support Groups
Cancer Council WA Support Groups:
These groups provide a space to connect with others who are experiencing similar challenges, share advice, and receive emotional support.
Pancare Foundation:
Pancare offers support specifically for those with pancreatic and upper gastrointestinal cancers, including resources for managing side effects like neuropathy.
Online Support Groups:
For those who prefer virtual support, there are online forums and groups where you can connect with others living with CIPN.
6. Public Health Services in WA
WA Health Cancer Services:
Public hospitals in WA, such as Fiona Stanley Hospital, Sir Charles Gairdner Hospital, and Royal Perth Hospital, have oncology departments that can provide access to allied health professionals, pain clinics, and palliative care teams.
Community Health Centres:
These centres often provide access to physiotherapists, occupational therapists, and other allied health professionals.
Solaris Cancer Care
Provide a range of opportunities to find peer support with those experiencing similar challenges and provide access to volunteers and practitioners who practice therapies that may bring you relief.
7. Financial Assistance for Services
Medicare:
Many allied health services can be subsidized through Medicare if your GP provides a Chronic Disease Management Plan or Mental Health Care Plan.
Private Health Insurance:
If you have private health insurance, check your policy for coverage of physiotherapy, occupational therapy, acupuncture, or other complementary therapies.
Cancer Council WA:
The Cancer Council may offer limited financial assistance for specific needs, such as transport to appointments or accessing certain therapies.
My Final Thoughts…
Chemotherapy-induced neuropathy can be a frustrating and debilitating side effect, but there are ways to reduce the risk and manage symptoms. By working closely with your healthcare team and exploring holistic approaches, you can take steps to protect your nerve health and improve your quality of life.
Remember, every person’s experience with neuropathy is unique, and what works for one person may not work for another. Be patient with yourself as you explore different strategies, and don’t hesitate to seek support from your medical team, physical therapists, or holistic health practitioners.
Your body has an incredible capacity to heal, and with the right tools and support, you can navigate this challenge with resilience and hope.
References:
"Chemotherapy-Induced Peripheral Neuropathy (CIPN)." Physiopedia, . 19 Dec 2024, 06:50 UTC. 3 Mar 2025,13:38 <https://www.physio-pedia.com/index.php?title=Chemotherapy-Induced_Peripheral_Neuropathy_(CIPN)&oldid=364226>.
