Peripheral neuropathy

Peripheral neuropathy is a condition that can sometimes occur as a result of cancer treatment. The following information has been developed to help you understand what peripheral neuropathy is and how it can be managed.

What is peripheral neuropathy?

Peripheral neuropathy refers to damage to the peripheral nerves. Peripheral nerves are nerves located away from the centre of the body such as in the feet and hands. Nerve cells, unlike other cells in the body, are not easily repaired or replaced if badly damaged.

What are the symptoms of peripheral neuropathy?

The symptoms you will experience if affected by peripheral neuropathy will depend on which peripheral nerves are damaged. The most common symptom caused by nerve damage is numbness, pain in the hands or feet or tingling (“pins and needles”).

Other symptoms may include:

dizziness
muscle weakness
ringing in the ears
hearing loss
trouble sensing where your body is in space
constipation.

Symptoms range from mild to severe and can occur during or after treatment. In severe cases, the symptoms of peripheral neuropathy can affect a person’s quality of life but there are ways to manage any changes experienced.

What causes peripheral nerve damage?

Some types of chemotherapy can damage peripheral nerves but other cancer treatments and even the cancer itself, can cause peripheral neuropathy. These can include:

certain chemotherapy drugs particularly taxanes, platinum drugs and vinca alkaloids
other cancer drugs such as bortezomib, brentuximab vedotin and thalidomide
tumors pressing on nerves
some cancer types, particularly lung cancer, lymphoma and myeloma
surgery or radiation therapy damaging nerves.

Cancer or cancer treatment are not the only causes of peripheral neuropathy. It can also be caused by diabetes, high-risk alcohol use or other drugs, shingles or a lack of certain vitamins or minerals.

How common is peripheral neuropathy?

For people affected by cancer, the main cause of peripheral neuropathy is treatment with certain chemotherapy drugs. In these cases about 7 out of 10 people will experience some symptoms a month after treatment, while 3 out of 10 will still have symptoms six months after treatment.

For some people, symptoms can be permanent and severe. This is more likely if you have had intensive treatment or have other risk factors such as diabetes.

How is peripheral neuropathy diagnosed?

Your treatment team will monitor you closely to for any signs of peripheral neuropathy if you are having chemotherapy that has a high risk of causing nerve damage.

Peripheral neuropathy may also be diagnosed after you report any symptoms. If your doctor suspects you have peripheral neuropathy, they will check how the symptoms are affecting your daily life. They may also check your blood pressure, balance and coordination and reflexes.

Can peripheral neuropathy be prevented?

To date, no treatment has been proven to prevent peripheral neuropathy. If you start to experience symptoms during chemotherapy, your doctor may reduce the doses of the drugs or give them to you further apart.

If you do experience any symptoms during treatment, talk to your treatment team. They may recommend pausing or stopping chemotherapy and can talk to you about alternative cancer treatments.

Managing the symptoms of peripheral neuropathy

There are a number of ways in which peripheral neuropathy can be managed. Some tips to help you manage symptoms can include:

medicines to help relieve symptoms
exercise is recommended to strengthen muscles, reduce pain and cramps and improve balance and circulation
protect your hands and feel
manage constipation by exercising, eat plenty of food rich in fibre such as fruit and vegetables
prevent dizziness by taking your time when standing up, drinking plenty of fluids and wearing supportive stockings during the day to improve circulation
avoid falls by keeping rooms well lit, using non-slip mats in the shower and bath and putting rails on stairs and in bathrooms
ask your doctor is if is safe for you to drive.

What health professionals will I see?

There are a number of health professionals who can help you manage peripheral neuropathy. These may include:

GP (General Practitioner) – looks after your general health and works with your specialists to coordinate treatment
a physiotherapist or exercise physiologist to help you develop an exercise regime
an occupational therapist to recommend appropriate aids or equipment and strategies
a podiatrist to help you look after your feet and check for injuries you may not have noticed
a psychologist can help with relaxation methods and other techniques to manage pain and to help you adjust to any lifestyle changes.