Post Chemotherapy Neuropathy

“I have tingling and numbness in my hands and feet, due to chemotherapy for breast and ovarian cancer. I take vitamin B-6, B-12, and experience no pain; just tingling and numbness.” I’m sure there’re many out there with similar concerns, who would appreciate knowing more about their condition.

Sensory neuropathy is a burden that affects a considerable number of cancer survivors treated with chemotherapy.

Chemotherapy has been one of the cornerstones in fighting and winning, to some extent, the battle against cancer. Despite its usefulness, chemotherapy frequently has long-term health effects also referred to as “the price of survival” that require medical attention. Neuropathy is one of the classic examples of these lasting effects.

Individuals at greatest risk of peripheral neuropathy associated with chemotherapy are those with pre-existing peripheral neuropathy from conditions such as:

• Diabetes
• Alcoholism
• Severe malnutrition
• Previous chemotherapy.

Symptoms

• Numbness, tingling (feeling of pins and needles) in hands and/or feet
• Burning in hands and/or feet
• Numbness around mouth
• Constipation
• Loss of sensation to touch
• Loss of positional sense (knowing where a body part is without looking).
• Weakness and leg cramping or any pain in hands and/or feet
• Difficulty manipulating small objects like keys, needlework, buttoning clothes, etc.
• Worsening of handwriting.
• Propensity to fall, particularly when bending or trying to pick up objects from the floor.

Affected Areas

• Fingers and toes (most common)
• This may move gradually upward in a stocking-glove type fashion.
• Bowel
• May cause or worsen constipation
• May lead to conditions such as intestinal blockage.

Although some of the signs of neuropathy may appear suddenly, this change in sensation usually builds gradually and can worsen with each additional dose of chemotherapy.  It is usually strongest right after a chemo treatment, but tends to lessen just before the next treatment.  The symptoms usually peak about 3-5 months after the last dose of treatment is taken.  The abnormal sensations may disappear completely, or lessen only partially; they may also involve less of the body.  If neuropathy diminishes, it is a gradual process usually requiring several months.  However, in some cases it may be irreversible, and never diminish in intensity or the area of the body affected.

Important precautions to note

• Protect areas where sensation is decreased. Do not walk around without foot wear and ensure you use well padded shoes.
• Extreme temperature changes may worsen symptoms.
• Exercise care when washing dishes or taking a bath or shower; don’t let the water get too hot.
• Use pot holders when cooking.
• Use gloves when washing dishes, sweeping, mopping or gardening.
• Inspect the skin for cuts and or burns daily; especially fingers, arms, toes and legs.

Treatments to minimize the effects

Various techniques have been tried by patients and recommended by physicians to prevent, lessen the severity, or treat chemotherapy side effects such as peripheral neuropathy.  There is no “one-size-fits-all” regimen that works for everyone.  Much of the treatment is based on trial and error; and finding what combination of interventions works for the individual.

• Report any unusual feeling you may have to your health care professional.  Let them know if you are experiencing any of the above symptoms, so they can assess it.
• Follow instructions regarding rest and delays in treatment.
• Be active in decisions regarding treatment versus quality of life.

The most commonly used treatment options for neuropathy include the following:

1. Supplements (vitamin B, vitamin E): Studies suggest possible benefits, but I have yet to find a patient who noticed any benefit from these supplements beyond the improvement brought by time. High doses of vitamin B-6 may actually cause neuropathy.

2. Gloves and socks: Keeping the extremities warm at night helps decrease the intensity of the neuropathy, even during the day.

3. Physical therapy: It may help with strengthening of muscles that are weak.  Exercises are range of motion, stretching and massage.  Assistive devices such as orthotic braces, canes, and appropriate splints can also be recommended. Physiotherapy is also quite helpful in re-learning how to manipulate small objects and to avoid falls.

4.  Electrical Therapy: It helps to stimulate the damaged nerve endings, reducing numbness along with alleviating pains and symptoms of burning and tingling.

5. Massage Therapy: The relationship between massage and chemotherapy induced neuropathy can show positive results in many cases. Sometimes massage may be combined with other physical exercises and treatments such as reflexology, and electrical therapy, to achieve better results. Massages enhance: blood circulation in the nerves affected by chemotherapy; induces activity in the underlying soft tissue; eases nerve traps; and curbs the pain triggers.

Measures to relieve constipation

• Eat foods high in fiber like fruits (bananas, prunes), cereals (especially oats), and vegetables.
• Drink two to three liters of non-alcoholic fluids (water, juices) each day; unless you are told otherwise by your doctor.
• Exercise at least thirty minutes 3-5 days of the week, as tolerated, and if okay with your doctor.  A lot of patients find that walking for exercise is convenient and easy to do; it’s really the best and most inexpensive way. Ensure however, that it’s done using proper walking sneakers.

It is very important that cancer survivors report to their doctor (either the oncologist or primary care doctor), for not only your neuropathy symptoms, but also how much it is affecting your quality of life. Sensory neuropathy is very hard to treat and needs to be tailored to the individual survivor’s symptoms, previous cancer treatment, other medical problems (like diabetes and constipation), and medications the patient may be receiving. The key is to discuss with your doctor so that the treatment plan specific to your needs can be optimised.

Your feet mirror your general health . . . cherish them!