Neuropathy During Cancer Treatment
Ivo Tremont, M.D., and Karin Woodman, M.D., discuss some of the common neurologic and muscular disorders patients may experience during cancer treatment, and what can be done to help.
Peripheral Neuropathy & Chemotherapy
Certain chemotherapy treatments can cause damage to the peripheral nervous system, which include all nerves outside the brain and spinal cord. The condition is called peripheral neuropathy, which commonly causes tingling, burning, weakness or numbness in the hands and/or feet.
Other symptoms of peripheral neuropathy include:
- Loss of balance
- Clumsiness
- Difficulty picking up objects and buttoning clothing
- Walking problems
- Jaw pain
- Hearing loss
- Stomach pain
- Constipation
If you have one or more of these symptoms, report them to your doctor immediately. Medications may be able to reverse peripheral neuropathy, and physical therapy can help you maintain normal function.
Simple exercises may help cancer survivors struggling with peripheral neuropathy, a common cancer treatment side effect that causes muscle weakness, decreased feeling and trouble balancing.
While exercise can’t make peripheral neuropathy go away, studies show it can help minimize pain and improve strength and balance, says Whittney Thoman, an exercise physiologist at MD Anderson.
Talk to your doctor
Thoman stresses the importance of talking to your doctor before starting any new exercise program. He or she may have advice specific to your treatment or cancer.
For most cancer survivors, The American Cancer Society and the American College of Sports Medicine recommend avoiding inactivity and resuming exercise as soon as possible. Survivors should aim for 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise per week. The American Cancer Society also recommends including strength-building exercises in your routine at least two days per week.
In addition, patients who are able to exercise during treatment should do so, but they may need to make adjustments.
Work with a trainer or physical therapist
Once you receive your doctor’s permission to exercise, Thoman suggests meeting with a trainer, exercise physiologist or physical therapist. This way, you can work together to establish your exercise routine and ensure that you’re doing movements correctly.
Use a stable environment
Because neuropathy affects your balance, it’s important to exercise in a stable environment where you’re less likely to fall down or drop something.
Thoman recommends using weightlifting machines. “If you use free weights, you’re more likely to drop them and injure yourself,” Thoman says.
If you want a cardiovascular workout, try a stationary bike rather than a treadmill or elliptical machine.
“Anything where your body is stable is safer,” Thoman says.
Work on balance
To help improve your balance, Thoman recommends doing exercises that will help strengthen your stabilizing muscles.
“It doesn’t have to be anything complicated,” she says. “Try standing on one foot while you brush your teeth. If you mastered that, try standing on one foot with your eyes closed.”
Be consistent
To see results, Thoman recommends completing these exercises two to three times a week.
“Consistency is very important,” she says. This will help you make a habit of exercising. And that will help improve your strength and balance so that you start to see your neuropathy symptoms lessen.
Don’t overdo it
Depending on your cancer treatment, you may need more time to rest between exercise sessions, Thoman says. Give yourself 48 to 72 hours to recover between resistance training sessions.
Following all of these steps can help you ease neuropathy symptoms.
“Exercise can’t undo neuropathy,” Thoman says. “But it can make a big difference when it comes to functionality and daily life.”
For many of our patients, peripheral neuropathy is among the unexpected side effects of cancer treatment.
It's caused by damage to your peripheral nerves -- that is, the nerves that are farther away from your brain and spinal cord. Certain complications of cancer or cancer treatments can cause or worsen neuropathy. So can some health conditions, such as diabetes, alcoholism, AIDS, hypothyroidism, rheumatoid arthritis and carpel tunnel syndrome.
We recently spoke with Julie Walker, advanced practice nurse in Neuro-Oncology, about peripheral neuropathy. Here's what she had to say.
What causes peripheral neuropathy in cancer patients?
The nerve damage that causes peripheral neuropathy may be the result of many different factors, including some chemotherapy drugs using vinca alkaloids, platinum compounds, taxanes and thalidomide.
Tumors themselves can cause nerve damage as well if they grow close to and press on the nerve.
And, patients with cancers of the nervous system -- such as brain tumors, spine tumors and skill base tumors -- are more likely to develop peripheral neuropathy due to nerve damage resulting from the tumor.
What are common peripheral neuropathy symptoms?
Symptoms depend on the type(s) and location(s) of the damaged nerves. The most common peripheral neuropathy symptoms include:
- numbness
- tingling
- shooting pain or burning, especially in your fingers or toes.
Other peripheral neuropathy symptoms include:
- loss of balance, difficulty walking or frequent falls
- clumsiness
- difficulty picking up objects or buttoning your clothes
- facial pain
- hearing loss
- loss of sensitivity to hot and cold
- stomach pain
- constipation
What can cancer patients do to relieve peripheral neuropathy?
If the neuropathy is related to something you can control, try to control the cause.
If your neuropathy is chemo-related, your oncologist can decide whether it's beneficial to reduce your chemotherapy dosage or switch to a different treatment regimen.
If it's related to diabetes, you can often slow down or stop the progression of peripheral neuropathy with better blood sugar control.
Beyond that, physical activity can help by keeping blood flowing in the affected areas. Some people also try acupuncture.
Over-the-counter pain relievers and prescription medications like carbamazepine and Lyrica may help in some cases. Non-prescription-type treatments -- such as acetyl l-carnitine, alpha lipoic acid, glutamin, calcium and magnesium -- may help, too. But more research is needed to better gauge their effectiveness. Be sure to speak with your health care provider before trying any of these.
What can cancer patients do to lower their chances of developing peripheral neuropathy?
If you have other health conditions, such as diabetes, that can make the neuropathy worse, manage them appropriately. Limit alcohol use. Maintain a well-balanced diet. And, discuss your neuropathy risks with your health care provider.
How long do peripheral neuropathy symptoms last?
Every case is different. Because neuropathy is caused by nerve damage, it depends largely on how well your nerves recover. And, that depends on the length of your treatment, extent of the damage and, in the case of chemotherapy-induced neuropathy, dosage intensity.
It's usually possible to manage peripheral neuropathy up to a certain point, but for many people, it never goes away.
As the nerves heal, some people may actually experience more tingling in the affected area. Speak with your health care provider to find out if a prescription might help relieve symptoms during this time.
People with peripheral neuropathy lose the ability to feel pain or extreme temperatures in the affected areas.
What can cancer patients with peripheral neuropathy do to avoid burning or injuring themselves?
Always wear shoes to protect your feet from an injury. Also, make sure you examine your feet every day to look for any wounds or sores that aren't healing.
Be careful when using sharp utensils or avoid them altogether. Likewise, since neuropathy typically inhibits your fine motor movements, be cautious around or avoid dangerous machinery.
Before touching water with your hands or feet, feel the water with a part of your body -- such as the underside of your forearm -- that can sense how warm it is. And, avoid using heating pads and hot water bottles.
Any other advice for cancer patients who are experiencing neuropathy?
People with neuropathy are more prone to falls because they struggle to feel the ground beneath them, especially in the dark or an enclosed space. So:
- use a nightlight
- keep clutter and throw rugs off the floor
- use handrails when taking the stairs
- put handrails in the shower
- use skid-free shower and bath mats
Neuropathy also makes the body more prone to infection since circulation is decreased and wounds don't heal as well. So it's a good idea to keep your skin moist to prevent cracking and, in turn, infection.
The most important thing you can do, though, is to speak with your health care provider as soon as you start to experience neuropathy symptoms. Together, you can hopefully find ways to manage your symptoms.