Neuropathy: Detailed Information

Neuropathy is a condition that occurs after peripheral nerve damage. Neuropathy may affect a single nerve or several.  A common type of neuropathy that occurs in people who have cancer is called peripheral neuropathy.

The nervous system is divided into central and peripheral parts:

• The brain and spinal cord make up the central nervous system.
• The peripheral nervous system includes the nerves that leave the brain and the nerve that come off the spinal cord and go to the internal organs, limbs and skin.

Diseases, injuries and toxins, such as chemotherapy, can cause neuropathy in cancer survivors. The damage may lead to changes in sensation or muscle function and can be mild or severe. Cancer survivors may experience this condition as tingling or numbness in certain areas of the body, especially the hands and feet. These sensations range from mild to painful.

Neuropathy can be an upsetting, and sometimes scary, condition for survivors. If you begin to notice symptoms, talk to your health care team immediately.

What causes neuropathy?

Neuropathy is a common disorder, affecting about 1 to 2 percent of Americans.

Some causes of peripheral neuropathy include:

• Diabetes mellitus (sugar diabetes) – the most common cause of neuropathy in the industrialized world
• Infections (such as leprosy, syphilis, HIV and some forms of hepatitis)
• Nutritional deficiency (particularly of thiamine)
• Inherited disorders of metabolism and other diseases passed down through families
• Alcohol
• Pesticides
• Drugs used in cancer treatment, particularly the platinum compounds, the taxanes, the vinca alkaloids and thalidomide
• Hypothyroidism
• Renal failure
• Extreme stress (such as the stress of living with a chronic illness)
• Radiation therapy (effects may be delayed for many years)
• Some cancer tumors are associated with neuropathy as a remote effect.

What are the symptoms of neuropathy?

The types and severity of neuropathy symptoms vary greatly. Determining the amount of peripheral nerve injury just by the amount of symptoms produced is difficult. Peripheral neuropathy can affect the nerves which allow you to tell the position of your hands or feet, the nerves that allow you to sense hot or cold, or the nerves that carry pain sensation.  For peripheral neuropathy, symptoms are almost always greatest at night. Common signs and symptoms of peripheral neuropathy include:

• Numbness, especially of 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

Which cancer survivors are at risk?

Neuropathy can affect almost any cancer survivor, but the following are high risk conditions either from the cancer or from the treatment received.

• Cancer types
  • Lung
  • Breast
  • Ovarian
  • Prostate
  • Myeloma
  • Lymphoma and Hodgkin’s disease
  • Testicular
    
• Having one or more of the following characteristics may increase the chances of developing neuropathy.
  • Advanced age
  • A family history of neuropathy (familial, diabetes)
  • Malnourishment
  • Excessive use of alcohol
  • Having a pre-existing medical condition such as diabetes or thyroid dysfunction
    
• Some medications, including chemotherapy medications, also increase risk. Discuss your medication-related risk with your health care team.
  
  Chemotherapy medications that increase your neuropathy risk include:
  • Platinum compounds
  • Taxanes
  • Vinca alkaloids
  • Thalidomide
  • Velcade
  • Cytosine arabinoside
  • Misonidazole
  • Interferon

Can a survivor experience neuropathy during, immediately after and/or years after treatment?

Neuropathy related to cancer may develop in the course of treatment (such as with vinca alkaloids) or shortly after (common with Platinum compounds).  Neuropathy may be delayed in onset, and often continues after the treatment has been completed.   Nerve injury from radiation therapy may be quite delayed, with symptoms occurring in some instances years after treatment.

Peripheral neuropathy symptoms are often ignored by both patients and health care professionals and frequently are not recognized as being related to peripheral nerve damage. For lung cancer, neuropathy may be the earliest sign of the cancer. If you have symptoms of neuropahthy, it is important to discuss with the health care team.

Can neuropathy be cured?

The peripheral nerves have a great ability to heal. Even though it may take months, most patients recover. However, in some situations, symptoms of neuropathy may lessen, but not completely go away. Nerve injury caused by radiation often does not recover well. Neuropathy caused by platinum chemotherapy is also difficult to cure — recovery may take 18 months to five years or longer. During recovery of platinum-induced neuropathy, patients may suffer increased symptoms. Unfortunately, some patients with neuropathy from chemotherapy never recover.

Even if your neuropathy cannot be cured, you may benefit from treatments to relieve your symptoms and from rehabilitation designed to help you maintain your physical abilities.

What are the treatments for neuropathy?

The treatment for peripheral neuropathy depends on the cause.  If the neuropathy is related to nutritional deficiences, supplements can help.  If relted to a medical condition such as diabetes or thyroid dysfunction, treating this can sometimes reverse the neuropathic symptoms.  For neuropathy related to chemotherapy, most treatments are supportive, designed to improve symptoms and function.  If neuropathy occurs during treatment, and you continue to receive the chemotherapty, the neuropathy can worsen.

Recovery can be helped by:

• Adequate nutrition (foods rich in thiamine, protein and antioxidants)
• Controlling and correcting contributing conditions such as diabetes or hypothyroidism
• Pain medications
• Physical and occupational therapy

Medications being researched in clinical trials show promise in helping peripheral nerves to heal and in preventing the neuropathy associated with chemotherapy from occurring or being as severe.

How will a cancer survivor’s life change if s/he has neuropathy?

Pain and other symptoms of neuropathy can be mild or severe. Each survivor’s experience will be different. However, with appropriate treatment, the effects of neuropathy can be limited. Medications, lifestyle changes, rehabilitation and other treatments can be used.

• Neuropathy can make standing for long periods or walking without assistance difficult.
• Balance can be affected, increasing the risk of falling.
• Activities like buttoning and tying laces or ties can be difficult.
• Survivors may be sensitive to heat or cold. Survivors with this sensitivity should avoid extreme temperatures if possible and use protective clothing and hats when needed.
• Neuropathy may cause a lack of pain sensation. Survivors should pay careful attention to the skin on their hands and feet because they could receive a wound or a break in the skin and not feel it.
• If neuropathy affects your ability to feel the foot pedals of your car, you should not drive unless your car is adapted for hand controls. Neuropathy can slow your reaction time in moving your foot from the accelerator to the break pedal and may cause an accident. Losing your ability to drive is upsetting. You may feel you are losing your independence. However, consider the increased risk to your safety and to the safety of others on the road. Talk to your health care team about your symptoms.
• Neuropathy can be painful.  Sometimes usual activities, such as putting your shoes on, or placing the covers over your feet at night can cause pain.  There are treatments which can lessen the pain.  It is important to talk with your health care team about potential treatments.

Physical and occupational therapists can 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. Therapists can assist survivors with physical exercises that can help them maintain physical abilities.

Pain from neuropathy can greatly affect your daily activities and quality of life. For some, the pain and changes required to manage it can lead to physical and mental stress. Watch for signs of depression and talk to your health care team or a mental health care professional about managing your feelings.

Good communication with your health care team about your symptoms and the changes they are bringing to your life is important. The team can help you manage these changes and provide referrals to other helpful resources.

This document was produced in collaboration with:
Arthur Foreman, M.D.

Neuropathy: Suggestions

Use the Cancer Survivor's Health Journal to prepare for your next visit with a member of your health care team:

• The Cancer Survivor's Health Journal can be found at www.livestrong.org/cancersupport in the Download Worksheets tab.
• Use the Health Care Team Appointment document to write down everything you want to ask your health care team. You can write notes and questions on the sheet between visits.
• Use the List of Medications to keep track of your medications. Bring this document to the visit along with all of your medication bottles. This lets the team know all the medications you are taking, including vitamins and over-the-counter medications.
• Use the Health Care Team Appointment document to take notes during the visit and to write down your next appointment date.
• Keep all of these documents together in a binder and bring it with you to your visits.
• Bring extra copies of all of these documents with you to give to the health care team. You can also fax or mail these documents in before the visit. Having the health care team read your documents may be an easier way for you to communicate.
• You can store pamphlets, medication side effect inserts and important phone numbers in your notebook so that everything is in one place.

Talk to your health care team.

• Ask your health care team to discuss the symptoms and treatment of neuropathy.
• Ask about what treatments might work for you.
• Ask how to manage the symptoms of neuropathy.
• Ask about physical and occupational therapy and whether they can help you.
• Ask if there is a long-term survivor group you can call to talk to about living with neuropathy.

Find a support group.

Support groups provide a safe environment to share experiences with other survivors, learn new ways to handle difficult situations and talk about emotions. You will see different styles of coping with stress and adjusting to life as a cancer survivor. If you are uncomfortable talking about certain subjects with your family or friends, a support group offers you a place to talk freely about what is important to you.

Cancer support groups exist in most communities.

Some ways to find out more about support groups in your area:

• 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.
• Call the American Cancer Society at 1-800-ACS-2345 (1-800-227-2345) and request a list of support groups and cancer centers in your area.
• Visit LIVESTRONG SurvivorCare at www.livestrong.org/survivorcare, or call 1-866-235-7205 for information on support groups.