Neuropathy During and After Cancer Treatment: Nerve Care

Some cancer treatments damage the peripheral nerves — the nerves that carry information from the brain to other parts of the body. The National Cancer Institute calls the result peripheral neuropathy. When chemotherapy is the cause, it is often called chemotherapy-induced peripheral neuropathy, or CIPN.

Cancer.Net, the patient site of the American Society of Clinical Oncology, lists these drugs among those that can cause peripheral neuropathy:

• Platinum drugs — cisplatin (Platinol), oxaliplatin (Eloxatin), carboplatin (Paraplatin)
• Taxanes — paclitaxel (Taxol), docetaxel (Docefrez, Taxotere)
• Vinca alkaloids — vincristine (Vincasar), vinblastine (Velban), vinorelbine (Navelbine)
• Bortezomib (Velcade)
• Thalidomide (Synovir, Thalomid)

Cancer.Net notes that risk is higher with high chemotherapy doses, and in people who already have diabetes, an inherited nerve condition, or nerve damage from before.

NCI groups the symptoms by which nerves are affected.

Sensory nerves help you feel pain, heat, cold, and pressure. Damage can cause "tingling, numbness, or a pins-and-needles feeling in your feet and hands that may spread to your legs and arms," an inability to feel hot or cold — "such as a hot stove" — and an inability to feel pain, "such as from a cut or sore on your foot."

Motor nerves move your muscles. Damage can cause weak or achy muscles that make you lose your balance, trip easily, or struggle to button a shirt or open a jar. Muscles may twitch and cramp. If chest or throat muscles are affected, swallowing or breathing can become difficult.

Autonomic nerves control things you do not think about — blood pressure, digestion, heart rate, temperature, urination. Damage can cause constipation or diarrhea, dizziness or faintness from low blood pressure, sexual problems, too much or too little sweating, and trouble emptying your bladder or leaking urine.

NCI is direct about this: "If you start to notice any of the problems listed above, talk with your doctor or nurse. Getting these problems diagnosed and treated early is the best way to control them, prevent further damage, and to reduce pain and other complications."

If neuropathy from ongoing chemotherapy "causes severe pain or affects your ability to function," Cancer.Net says your health care team "may choose to give your doses of chemotherapy further apart, lower the amount of chemotherapy you're receiving, or change your treatment plan."

That is a planned, standard adjustment — not a sign that you failed treatment or that your team is giving up on it.

Numb feet cannot warn you about a step, a sharp object, or hot water. NCI advises:

• Prevent falls. Move rugs out of your path. Put rails on walls and in the bathroom. Use bathmats in the shower or tub. Wear sturdy shoes with soft soles. Get up slowly after sitting or lying down, especially if you feel dizzy.
• Take extra care in the kitchen and shower. Use potholders. Be careful with knives and sharp objects. Ask someone to check the water temperature to make sure it is not too hot.
• Protect your hands and feet. Wear shoes indoors as well as outdoors. Check your arms, legs, and feet for cuts or scratches every day. Dress warmly in cold weather.
• Ask for help and slow down. Let people help with difficult tasks, and give yourself more time.

Cancer.Net adds good lighting and removing trip hazards to that list.

You may be prescribed pain medicine. NCI says acupuncture, massage, physical therapy, and yoga are sometimes advised as well, and that your team can tell you what fits your situation. Cancer.Net names duloxetine as a medicine used for this.

Be aware the evidence here is thinner than patients expect. NCI's Cancer Pain PDQ summary states plainly that "studies of drugs and natural products used to treat CIPN have shown mixed results." No treatment reliably reverses the nerve damage itself.

NCI notes that "in some people, CIPN may continue after chemotherapy has ended." For what long-term recovery looks like and how persistent neuropathy is managed after treatment finishes, see our companion article on neuropathy that continues after treatment.

• Does the drug in my regimen carry a known risk of neuropathy?
• Which symptoms should I call you about, and how soon?
• At what point would you change my dose or schedule?

• Call 911 or go to an emergency department if breathing becomes hard work, or food and drink start going down the wrong way. NCI puts swallowing and breathing trouble on its list of motor nerve damage, because the muscles of the chest and throat can be affected.
• Call your care team the same day if a hand or leg goes suddenly weak, your grip drops things it used to hold, or you find a burn or a cut you never felt happen.
• Call your care team within a day or two if numbness is creeping further up your arms or legs between cycles, or if nerve pain is keeping you awake despite the medicine you were given. This is the point where NCI says early treatment prevents further damage, and where your team may space out or lower your doses.

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• National Cancer Institute: Nerve Problems (Peripheral Neuropathy) and Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems
• National Cancer Institute: Cancer Pain (PDQ) — Patient Version. https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-pdq
• Cancer.Net (American Society of Clinical Oncology): Nerve Problems or Neuropathy. https://www.cancer.gov/about-cancer/treatment/side-effects/nerve-problems