What helps chemotherapy-induced peripheral neuropathy?

What is chemotherapy-induced peripheral neuropathy?

Some chemotherapy medicines, including platinum drugs, taxanes, vinca alkaloids and bortezomib, can damage peripheral nerves. This causes chemotherapy-induced peripheral neuropathy (CIPN), which typically starts in the fingers and toes and may spread up the hands and feet in a glove-and-stocking pattern.

Symptoms include numbness, tingling, burning or shooting pain, sensitivity to cold, difficulty with fine tasks such as buttoning, and reduced balance.

Can it be prevented?

The American Society of Clinical Oncology guideline update found that no agents are recommended for preventing CIPN, and it discourages the use of acetyl-L-carnitine for prevention 1.

Clinicians should assess whether to delay, reduce, substitute or stop chemotherapy in patients who develop intolerable neuropathy or functional impairment 1. Reporting symptoms early allows these decisions to be made in time.

Which medicines help painful neuropathy?

According to the same guideline, duloxetine is the only medicine with appropriate evidence to support its use for established painful CIPN, although the amount of benefit is limited 1.

Other pain medicines are sometimes tried on an individual basis. Discuss options and side effects with your oncology team or pain specialist.

Does exercise help neuropathy?

Exercise guidelines for cancer survivors concluded that the effects of exercise on peripheral neuropathy remain uncertain, although exercise improves many other outcomes such as fatigue and physical function 2.

In practice, balance and strength training, walking and hand dexterity exercises are used to maintain function and reduce the risk of falls in people whose sensation is affected. A physiotherapist can tailor exercises to safety needs.

How can falls and injuries be prevented?

Reduced sensation in the feet increases the risk of falls and unnoticed injuries. Good lighting, removing trip hazards, wearing supportive shoes indoors and outdoors, and using handrails help.

Check feet daily for cuts, blisters or redness, test bath water temperature with an elbow or thermometer, and wear gloves when handling hot or cold objects if hand sensation is reduced.

Does CIPN improve after treatment ends?

For many people, symptoms improve gradually over months after chemotherapy stops, but some have long-lasting symptoms. With certain drugs, symptoms may worsen for a few weeks after finishing treatment before improving.

Occupational therapy can help with daily tasks, and adaptive tools make activities such as writing and cooking easier.

How is neuropathy assessed during treatment?

Before each cycle of chemotherapy, the oncology team usually asks about numbness, tingling, pain, dropping objects, difficulty with buttons or writing, and unsteadiness. Some teams use questionnaires or simple tests of sensation, vibration, reflexes and balance to track changes over time.

Being specific helps. Describing which tasks have become harder, and whether symptoms settle between cycles or persist, gives the team the information needed to decide whether the chemotherapy dose or schedule should change.

What can help with daily tasks when hands are affected?

Occupational therapists can suggest adapted tools such as thicker pens and cutlery, button hooks, jar openers and non-slip mats. Using touchscreen devices with larger text, voice typing and pre-prepared ingredients can make everyday tasks less tiring.

Wearing gloves for cold weather and cold food, checking water temperature with a thermometer and keeping hands moisturised protect skin that may not sense heat, cold or injury normally. Simple hand exercises can help maintain grip and dexterity.

When should neuropathy symptoms be reported?

Report new or worsening numbness, tingling, pain or weakness to your oncology team before your next treatment, as the plan may need to change.

Seek prompt advice for sudden weakness, falls, difficulty walking, loss of bladder or bowel control, or severe pain, which may indicate other problems.

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