Neuropathy

Peripheral neuropathy may develop at any phase of the cancer journey, even some time after treatment is finished. Knowing what some of the causes are and being able to describe your symptoms to your health care team can help you manage neuropathy. Symptoms are often ignored by both patients and health care professionals. If you have symptoms of neuropathy, it is important to discuss this with your health care team as soon as possible.

Symptoms of Neuropathy

Peripheral neuropathy can affect the nerves that tell you the position of your hands or feet that let you sense hot or cold or that senses pain. You can experience a tingling or numbness in certain areas of the body, commonly the hands and feet. These sensations can range from mild to painful and are almost always greatest at night.

Common symptoms include:

• Numbness or tingling, especially of the hands or feet.
• Pain or cramping, especially of the hands, feet or calf muscles.
• Sensitivity to touch or temperature.
• Loss of reflexes.
• Muscle wasting in the hands and feet.
• Weakness, especially in the feet or hands.
• Clumsiness.
• Loss of balance, particularly in the dark.
• Dizziness, especially when getting up from a bed or a chair.
• Sexual dysfunction.

It’s not easy to deal with neuropathy. If you notice symptoms, talk to your health care team immediately.

Factors that Increase Risk of Neuropathy

Neuropathy may occur from cancer or the treatment received. Cancer types with higher risk of neuropathy include: lung, breast, ovarian, myeloma, lymphoma and Hodgkin’s disease and testicular.

Life factors that may increase the chances of developing neuropathy:

• Advanced age.
• A family history of neuropathy (such as with familial diabetes).
• Malnourishment.
• Excessive use of alcohol.
• Having a preexisting medical condition such as diabetes or thyroid dysfunction.
• Some medications (including chemotherapy medications) also increase risk.

Medications that may increase the risk of neuropathy:

• Platinum compounds.
• Taxanes.
• Vinca alkaloids.
• Thalidomide.
• Velcade.
• Cytosine arabinoside.
• Misonidazole.
• Interferon.

Discuss all of these risks with your health care team.

Questions to Ask Your Health Care Team About Neuropathy

• What are the symptoms and treatment of neuropathy?
• What treatments might work for me?
• How do I manage the symptoms of neuropathy? Can I get physical and occupational therapy?
• Is there a long-term survivor group for living with neuropathy?

Treatments for Neuropathy

The peripheral nerves have a great ability to heal. Even though it may take months, recovery can occur. However, in some situations, symptoms of neuropathy may lessen but not completely go away. For example, nerve injury caused by radiation often does not recover well. Neuropathy caused by chemotherapy is also difficult to cure, and recovery may take 18 months to five years or longer. During recovery of platinum-induced neuropathy, patients may suffer increased symptoms.

Treatments for peripheral neuropathy depend on the cause. For instance:

• If it is related to nutritional deficiencies, supplements may help.
• If the neuropathy is related to a medical condition, such as diabetes or thyroid dysfunction, treating the condition can sometimes reverse the neuropathic symptoms.
• For neuropathy related to chemotherapy, most treatments are supportive and designed to improve symptoms and function.
• If problems develop during treatment and you continue to receive chemotherapy, the neuropathy can get worse.
• Clinical trials research shows promise in some treatments with medications that help peripheral nerves to heal and prevent the neuropathy associated with chemotherapy from occurring or being as severe.

Recovery may be helped by:

• Good nutrition including foods rich in thiamine, protein and antioxidants.
• Controlling and correcting contributing conditions such as diabetes or hypothyroidism.
• Appropriate pain medications.
• Physical and occupational therapy.

How Neuropathy Affects Your Life

Pain from neuropathy can greatly affect your daily activities and quality of life. Symptoms of neuropathy can range from mild to severe. Each survivor’s experience will be different. However, with appropriate treatment, the effects of neuropathy can be limited.

If you have neuropathy, you may have:

• Difficulty standing for long periods or walking without assistance.
• Problems with balance and an increased risk of falling.
• Difficulty with activities like buttoning and tying laces or ties.
• Sensitivity to heat or cold.
• Numbness or lack of pain sensation.
• Pain.

Survivors with temperature sensitivity should avoid extreme temperatures, and use protective clothing as needed. If there is numbness or an inability to feel pain, it is important to pay careful attention to the skin on the hands and feet because there could be an undetected wound or a break in the skin.

If there is pain, day-to-day activities such as putting on shoes or using covers over the feet at night can be difficult. Keep in mind that there are treatments that can lessen the pain. Talk with your health care team about potential treatments as soon as possible.

If neuropathy affects your ability to feel the foot pedals of a car, you should not drive unless your car is adapted for hand controls. Slowed reaction time in moving your foot from the accelerator to the brake pedal may cause an accident. If you lose the ability to drive, you may feel you are losing your independence. However, consider the increased risk to your safety and to the safety of others.

Ask your health care team to provide suggestions and special equipment to make daily tasks safe and easier to manage. The suggestions may include night lights, grab bars and other home safety measures to help reduce the risk of falling. Physical and occupational therapists can assist survivors with physical exercises that can help them maintain physical abilities.

For some, neuropathy can lead to physical and mental stress. Watch for signs of depression, and seek immediate help from your health care team. Together, you can deal with peripheral neuropathy.

Find a Neuropathy Support Group

• Ask your health care team for suggestions. Some cancer programs offer support groups for cancer survivors and their family members right in the clinic or hospital.
• Call a nearby cancer center or university hospital and ask about support groups.
• Contact a nonprofit cancer organization to request a list of support groups and cancer centers in your area.