Dana-Farber Cancer Institute, 2015
How can cancer patients cope with the symptoms of neuropathy? Clare Sullivan, MPH, BSN, CRRN, hosted a live chat on chemotherapy-induced peripheral neuropathy (CIPN). Sullivan, who is the clinical program manager for Patient Education at Dana-Farber, answered questions about prevention, safety, and managing side effects. A transcript of the chat follows:
Q: What are the most common symptoms of chemotherapy induced peripheral neuropathy (CIPN)? Are the symptoms the same for every patient?
A: CIPN symptoms vary from patient to patient, but in general, side effects include: feeling of numbness or "pins and needles" in your hands and feet; difficulty picking up an object or buttoning clothing; ringing in your ears or loss of hearing; changes in vision; sudden, stabbing pains in your hands or feet; constipation/difficulty urinating; muscle weakness or cramps; loss of balance or having difficulty walking; and feeling heat and cold, more or less than usual.
Q: Does CIPN affect every cancer patient? Do certain cancer diagnoses increase risk for neuropathy?
A: Neuropathy does not affect every patient and symptoms can differ depending on the chemotherapy type, dosage, frequency, or other pre-existing health issues.
The risk for neuropathy depends not on the diagnosis, but the type of treatment used to treat the cancer.
Q: What are other risk factors for developing CIPN?
A: Specific types of chemotherapy, radiation, and surgery can cause damage to nerves that can lead to neuropathy Patients with pre-existing conditions, such as diabetes or peripheral vascular disease, may already have neuropathy as a result of these diseases. If you already have neuropathy and are starting cancer treatment, speak to your team about your specific symptoms.
Prior to treatment, it is important that all patients talk with their oncologists about any diseases or conditions they may have.
Q: Are there certain chemotherapy drugs that are more likely to cause neuropathy?
A: Yes. The chemotherapy drugs linked to CIPN include:
Carboplatin
Cisplatin
Oxaliplatin
Taxotere (docetaxel)
Jevtana (carbazitaxel)
Velban (vinblastine)
Vincristine
Vinorelbine
Etoposide
Ixempra (ixabepilone)
Thalomid (thalidomide)
Revlimid (lenalidomide)
Velcade (bortezomib)
Pomalyst (promalidomide)
Halaven (eribulin)
Kyprolis (carfilzomib)
Q: Are there medications to treat neuropathy?
A: There is no clear treatment for neuropathy that will improve nerve damage, but a combination of pain medications, vitamins, lotions and exercise can help you manage symptoms.
Q: Does neuropathy happen right away, or soon after chemotherapy treatment? Or, is it possible for patients to get neuropathy years after treatment is finished?
A: Neuropathy can happen at any time during or after your chemotherapy treatment (it is drug specific). While it is rare, it is possible for symptoms to develop several years after treatment.
Q: Is neuropathy genetic?
A: There is a genetic type of neuropathy that is called I-A Type and is linked to auto-immune diseases. The type of neuropathy we are discussing today is related to specific chemotherapy medicines.
Q: Is there anything patients can do to prevent neuropathy?
A: The most important prevention tip is to be attentive to your symptoms and to report any concerns to your doctor right away. Your cancer team will be able to create a treatment plan that will protect you from injury and possibly prevent your symptoms from worsening.
Q: Aside from medications, what are some tips for managing the numbness, tingling or pain patients experience with neuropathy?
A: Physical therapy is one of the most effective treatments for neuropathy — it can help with balance, strength and safety. Occupational therapy can also be beneficial and can help patients improve fine motor skills like buttoning shirts. In both cases, it is very important for patients to advocate for themselves by asking their doctor or care team for a referral to a physical and/or occupational therapist.
In addition to these therapies, low-impact exercise like swimming and biking, as well as acupuncture, relaxation techniques, meditation, and guided imagery exercises can all help with the side effects of neuropathy.
Remember, there are lots more options than just taking a pain pill.
Q: You mention exercise is one way to reduce the numbness and tingling of neuropathy – what type of exercises do you recommend?
A: Low-impact exercises are best; swimming and biking are two examples. For leg and/or foot neuropathy, patients should try calf stretches, ankle circles, gentle walking, leg lifts, and balancing exercises.
For neuropathy in the hands, patients can try finger taps (tap each finger to the thumb, one at a time) or finger rolls (bend fingers, one at a time, into a fist).
More information on exercises to help neuropathy
Q: Are there ways to modify my diet to prevent or manage symptoms of neuropathy?
A: There is some evidence that a well-balanced diet can help prevent or reduce symptoms of neuropathy. It is also important to avoid alcohol and smoking, as they can make neuropathy worse.
Q: Do you have any recommendations on how to deal with neuropathy pain?
A: Commonly used medications include Lyrica, Neurontin, Cymbalta, Celebrex, Elavil, and Lipoderm Patch. Remember, it the combinations of medications, vitamins, lotions, and exercise that may be most helpful.
Q: Are there certain vitamins or supplements that could help with neuropathy?
A: There is no clear CIPN treatment that can improve nerve damage, but a combination of vitamins, supplements, pain medicines, adaptive techniques, and complementary therapies may help reduce symptoms. Many vitamins or supplements have little scientific evidence but many patients use them and to find relief. Work with your cancer team to create a treatment plan that works for you.
Caution: There are many devices and supplements advertised for neuropathic pain that are experimental. Before making a purchase, discuss with your cancer team.
B-Complex vitamins, Folic acid, Vitamin E, D, and some Fish oils are the most common, but you should not begin any supplements without first consulting with your cancer team, because many are contraindicated during treatment.
Magnesium potassium and tonic water (with quinine) can also help specifically with cramping.
Q: Are there any topical treatments I can use to manage neuropathy symptoms?
A: You can use cocoa butter or menthol-based creams twice a day, or olbas oil.
Q: In addition to reducing symptoms, safety is also a concern for patients with neuropathy — especially those who have lost feeling in their hands or feet. Do you have any safety tips to prevent accidents?
A: It is very important for patients with CIPN to protect their hands and feet from injury. Some suggestions:
Use gloves to protect your hands when doing yard work or household repairs.
Be extra cautious with sharp objects.
Use well-padded potholders when cooking.
Inspect your fingers and feet regularly for cuts and scrapes.
Check the weather and wear gloves and warm socks in cold weather.
Wear shoes with a rubber sole both inside and outside.
Always use cold water first and gradually move to warmer water — you can also check the water temperature with another part of your body.
Other safety tips to consider:
If you cannot feel the gas pedal or brake, do not drive.
Avoid walking on uneven surfaces.
Keep floors clear of throw rugs, cords and other obstacles.
Consider handrails in stairways or grab bars in bathtub or toilet.
If you need one, use a cane, walker or wheelchair.
Set the water heater in your home between 105-120 degrees.
Keep dark areas well lit and use a night light as needed.
Q: Is CIPN permanent? Is there a cure?
A: Unfortunately, there is no clear cure or treatment that will repair nerve damage. In most cases, CIPN will go away. It will depend on upon the dose, but usually the symptoms will dissipate over time. Sometimes it takes a few months after treatment. In some rare cases, it is permanent.
Q: What other, important discussions should patients have with their doctors if they are experiencing neuropathy?
A: Neuropathy can cause other side effects, such as constipation and sexual health issues, so patients should speak with their doctors about care plans for these specific problems, should they arise.
Q: Has there been any recent, promising research on neuropathy and treating its side effects?
A: There are several clinical trials looking at new treatments for neuropathy. One trial is looking at the combination of Duloxetine and Tetrodotoxin and another is looking at electro-chemical therapies. Both have had some success, but patients with CIPN should make sure to speak with their doctors about any other clinical trials looking at new treatments for neuropathy
Q: What is the difference between chemotherapy induced neuropathy versus diabetic neuropathy? Should both types be managed similarly?
A: Symptoms for many neuropathies can be similar, but important parts of the treatment plan will differ depending on the root cause. Cancer patients who are also diabetic should work with their oncologist and endocrinologist to make sure they are on the right complement of treatments for both diabetes and cancer. It is also important that patients keep both doctors informed of any signs of neuropathy.
Q: Are there support groups or other ways to connect with patients who have neuropathy?
A: Support groups can help you connect with others and you can share ideas and strategies for managing symptoms. There are many support groups throughout the country, and you can find a list through the Neuropathy Support Network. Locally in Massachusetts there is a group at the Orleans Senior Center in Orleans, the Council for Aging in Salem, and the Council for Aging in Weston. Remember, just because these groups are held at senior centers or a council on aging doesn't necessarily mean you have to be older to attend; they can be helpful for all ages.
More information on managing neuropathy:
Alleviating Peripheral Neuropathy Symptoms
Glutamine for Peripheral Neuropathy
Lebed Method: Simple exercises for cancer patients
http://www.dana-farber.org/Health-Library/Tips-for-Managing-Neuropathy.aspx?track=neuropathychat
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