Sunday, March 3, 2024

Neuropathy In Feet From Chemo

What Causes Peripheral Neuropathy

Chemotherapy Induced Peripheral Neuropathy Clinical Trial

There are different ways that cancer and its treatments can cause peripheral neuropathy:

  • Some anti-cancer drugs can cause nerve damage. This is the most common cause of peripheral neuropathy in people with cancer.
  • Cancer can cause peripheral neuropathy in one area of the body if the tumour is growing close to a nerve and presses on it.
  • Surgery may damage nerves and cause symptoms in the affected area. For example, breast cancer surgery may cause numbness or tingling and pain in the arm.
  • Rarely, radiotherapy may damage nerves in the treated area. This can cause symptoms such as numbness and weakness. These may develop months or years after treatment.
  • In some types of cancer, the body may make substances that damage peripheral nerves. This is called paraneoplastic syndrome. It may happen in people with lung cancer, myeloma or lymphoma.

Tips To Help You Cope With Nerve Changes

There are some things you can do to help ease discomfort and prevent injury:

  • Keep your hands and feet warm.
  • Take gentle exercise when possible.
  • Wear well fitting, protective shoes and inspect your feet regularly for cuts or broken areas to the skin.
  • Take care when using hot water you may not be able to feel how hot the water is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Keep your skin moisturised and soft.
  • Take care when cutting your nails.
  • Keep floors clear from clutter to prevent falls.
  • Make sure rooms are well lit and keep a light on during the night.
  • Stand up slowly when feeling dizzy.
  • Prevent constipation by eating enough fibre and drinking plenty of fluids.
  • See an occupational therapist for specialist equipment, for example, a tool to help you fasten buttons.
  • Talk to a counsellor or your specialist nurse if youre finding it hard to cope with the changes caused by peripheral neuropathy.

Clinical Services At Peter Mac Parkville

The following services are available to patients of Peter Mac, Parkville. If you are treated elsewhere, please speak with your oncology team, as you may have different clinical service options.

  • Physiotherapy services. Physiotherapists and exercise physiologists can assist with mobility and physical function before, during and after cancer treatment.
  • Occupational therapy services. Occupational therapists can help you to improve your independence, safety, control, wellbeing and quality of life.
  • Pain services. This service provides evidence-based, safe and effective pain management for people with current or past cancer.
  • Optimisation Clinic. This multidisciplinary outpatient clinic is for cancer survivors with complex needs. Services include a dietitian, psychologist, physiotherapist and occupational therapist. For referrals please email or for further information.

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How Common Is Cipn

Peripheral neuropathy after chemotherapy is very common. Experts estimate its experienced by 30% to 50% of patients who receive these types of chemotherapy.

The drugs most likely to cause CIPN are used to treat the most common types of cancer, including breast cancer, colon cancer, lung cancer, and prostate cancer.

Types Of Neuropathy After Chemo

Chemotherapy

The types of neuropathy vary depending on the nerves affected by the chemo-treatment. It can affect your motor, sensory, or autonomic nerves.

  • Motor Neuropathy: This is the chemotherapy damage affecting your movement muscles.
  • Sensory Neuropathy: It affects the nerves that transmit information like pain or touch.
  • Autonomic Neuropathy: Damage to the nerve fibers of your digestive and breathing systems.

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Nerve Changes And Cancer Drugs

Some cancer drugs, treatments or medical conditions can affect the way your nerves work. The medical name for these changes is peripheral neuropathy . Neuro means nerves and pathy means abnormal.

The changes can cause different symptoms depending on the nerves that are affected.

Cancer drugs most commonly affect the nerves of your hands and feet. This might mean you have a change in feeling and you might find it difficult to control fine movements, such as doing up buttons.

These changes can be difficult to cope with and affect your quality of life. There are treatments that can help and things you can do to help you to cope.

Coping With Nerve Problems

Managing symptoms, which can include nerve problems, is an important part of cancer care and treatment. This is called palliative care or supportive care. Talk with your health care team about any symptoms or side effects you or the person you are caring for experience. This is important to do both during your cancer treatment and after treatment is completed.

The right treatment for nerve problems depends on the cause, whether chemotherapy is completed, and your specific problems. You should know that these problems often go away a few months or years after treatment. But sometimes, they are long-lasting or permanent, so you need ways to make the best of your function and recovery.

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Lingering Effects Of Cancer Treatment

Women enrolled in the National Surgical Adjuvant Breast and Bowel Project clinical trial B-30 had breast cancer that could be removed with surgery but were deemed at high risk of recurrence because cancer cells had spread to nearby lymph nodes.

The trials main goal was to compare overall survival in women randomly assigned to one of three different chemotherapy regimens containing docetaxel, a type of taxane. Peripheral neuropathy is a common side effect of taxane chemotherapy.

Women in the trial were randomly assigned to receive doxorubicin and docetaxel at the same time doxorubicin, cyclophosphamide, and docetaxel at the same time or doxorubicin and cyclophosphamide at the same time followed by docetaxel . Participants in the ACT group received the highest doses of the taxane in the trial.

Information on neuropathy was collected from patients before treatment, during the fourth cycle of chemotherapy, and at 6, 12, 18, and 24 months after treatment initiation.

In the trials main analysis, patients who received ACT had the best overall survival measured 8 years after the start of therapy, with ACT coming in second. Women who received only doxorubicin and docetaxel had slightly worse survival than women who received either three-drug combination.

Percentage of Trial Participants Who Reported Any Neuropathy

doxorubicin + docetaxel
49.8%

Mechanisms Of Acupuncture In Cipn

Chemotherapy Induced Peripheral Neuropathy Manual Therapy Technique

It is generally accepted that chemotherapeutic agents cause cipn through oxidative stress within neurons, axonal degeneration, neuro-inflammation, and unbalanced calcium homeostasis1. Neuro-inflammation might be a mechanistic target of acupuncture. Chemotherapeutic agents cause neuro-inflammation by activating immune cells to release inflammatory cytokines1. Because acupuncture has been shown to have an anti-inflammatory effect by modulating cytokines and increasing calcitonin generelated peptide33, it is plausible that acupuncture might improve cipn symptoms by reducing neuro-inflammation.

Other mechanisms of acupuncture have also been hypothesized. Acupuncture might reduce pain by inhibition of cyclooxogenase-234, release of endogenous opioids35,36, and modulation of nociception35,37. Acupuncture for cipn might act through a combination of those mechanisms. Given that few studies have assessed the mechanism of acupuncture in cipn, the literature does not provide clear guidance in this area.

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How Your Neuropathy In Feet Is Treated

Its important to know that not all types of neuropathy can be cured. Many can be helped, and symptoms can be reduced, but curing the condition is not always possible.

Treatment is usually directed at the underlying cause. If the condition is due to a certain medication, the medication can be switched. If the condition is caused by a vitamin deficiency, vitamin supplements may help improve symptoms.

If the condition is caused by diabetes, treatment will include steps to control the diabetes. Its very important that you seek the help of an experienced neurologist if you are experiencing symptoms of neuropathy.

You may want to check yourself regularly for cuts or bruises you may not have felt due to the loss of sensation. Pain killers, anti-depressants, and drugs used to treat seizures are also helpful in controlling symptoms of neuropathy in your feet.

Diagnosing Neuropathy In Feet What To Expect

If you believe you are suffering from the symptoms of neuropathy in your feet, you should seek medical attention from your primary care physician, a podiatrist, or a neurologist.

Your doctor will begin the exam with a series of questions about your habits, the symptoms you are experoencing, your work environment, your family medical history, and risks you may have for inherited disorders or conditions.

After that, you will be given a physical exam. Your doctor will evaluate your ability to register vibrations, light touch, temperature, and pain in order to check for any sensory nerve damage. Additional tests may include:

  • Muscle strength tests
  • Examination of your cerebrospinal fluid to check for abnormal antibodies associated with neuropathy
  • Blood tests to check for systemic diseases like diabetes. Blood tests can also detect other potential causes such as vitamin deficiencies.
  • MRI, or Magnetic Resonance Imaging tests, which can examine your muscles and detect damage to your nerves
  • EMG, or electromyography, helps differentiate between muscle and nerve disorders.
  • NCV, or nerve conduction velocity tests, measure the degree of damage in larger nerve fibers.
  • Nerve biopsies are done to examine samples of nerve tissue.

Skin biopsies are used to examine nerve fiber endings through the skin.

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Dealing With Cognitive Changes And Neuropathy Due To Chemo

After you completed cancer treatment, you were probably able to say goodbye to many of the unpleasant aspects of having cancer frequent doctors appointments, anxiety about whether you would beat the disease, and many short-term side effects of cancer treatment. However, some side effects of treatment take much longer to go away, and these can affect your mental health as a cancer survivor. Two common examples of longer-lasting effects of chemotherapy cancer treatment are cancer-associated cognitive dysfunction and neuropathy.

What Role Does Complementary Medicine Play In Preventing Or Treating Cipn

How To Reverse Neuropathy From Chemo

Studies have suggested that acupuncture may help relieve some of the symptoms of CIPN. MSKs Integrative Medicine Service has specialists who can provide these treatments and are trained in working with people with cancer.

Some people take herbs or supplements that claim to prevent or treat CIPN, but these have not been shown to be effective in rigorous clinical trials. If you decide to take any herb or supplement, its important to talk to your medical team. These products may have harmful interactions with other medications you are taking, including chemotherapy drugs. You can also consult MSKs About Herbs database for more information.

Also Check: How To Beat Cancer Without Chemo

What Are The Symptoms Of Chemotherapy

The main symptoms are pain, tingling, numbness, and weakness. Many of my patients describe feeling pins and needles or a burning sensation.

Patients who experience numbness in their hands and fingers may have difficulty buttoning buttons, typing on a computer, or holding a pen or fork. Those with numbness in their legs and feet may have difficulty walking, especially on stairs or uneven surfaces. Weakness occurs when the nerves that carry information from the brain and spinal cord to the muscle fibers are damaged.

Having a problem with balance is another common symptom. This occurs because the brain is not getting normal sensory signals from the feet and legs, which may change the way the person walks or may reduce ones ability to sense location or movement .

All these symptoms can make it difficult to carry out basic everyday tasks.

How To Cope With Chemo Induced Neuropathy

Before delving into coping options, its important to note that there is no scientifically accepted cure for neuropathy after chemo. Early studies that have been completed require further research to substantiate any of their claims.

As of now, researchers are unsure as to how to reverse neuropathy from chemo and the standard option of choice is to simply reduce the amount of chemotherapy a patient receives.

Of course, this results in patients fearing their treatment will be drastically impacted and many simply never report their CIPN symptoms to their doctor or have their symptoms glossed over. In fact, a 2014 study involving patients receiving chemotherapy found that 6.7% of patients feel their CIPN symptoms are overlooked.

Despite this, there are a multitude of options to educate yourself on when it comes to how to treat chemo induced neuropathy as well as a range of different potential strategies that may help ease chemotherapy induced peripheral neuropathy symptoms.

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What Is Chemotherapy Induced Neuropathy

Chemo induced peripheral neuropathy is a debilitating condition felt by many undergoing treatment for cancer in fact, over 60% of patients report to suffer from at least one of the many CIPN symptoms. Unfortunately in some cases, symptoms dont subside at the conclusion of treatment, as 20-30% of surviving patients continue to feel the effects long after completion.

Neuropathy from chemo can have an extremely adverse impact on the quality of life of patients its also one of the most difficult side-effects of chemotherapy to counteract as there is no one universally accepted or proven cure.

In a basic sense, peripheral neuropathy is a condition that affects the nerves of patients undergoing chemotherapy. Distant nerves throughout the body are called peripheral nerves these nerves carry sensations to different parts of the body including the brain, as well as control the arms and legs.

The symptoms experienced with neuropathy from chemo are caused by damage to these distant nerves resulting in a multitude of unpleasant symptoms for the patient . The condition itself presents a challenge to doctors, as its impossible to determine when symptoms will begin and for how long theyll last for.

Prevention And Treatment Of Chemotherapy

Neuropathy from Chemotherapy Improved through Treatment at Team Health Care Clinic

Doctors plan chemotherapy and supportive care to reduce risk for nerve damage as much as possible while still effectively treating the cancer. Researchers are studying drugs and interventions that might be used to help protect nerves from toxic effects of chemotherapy. When possible, doctors try to limit the dose of medication, plan to have rest breaks, or avoid combinations of therapies that increase risk of neuropathy.

Current treatment of peripheral neuropathy centers on management of symptoms. Strategies may include:

  • Pain management Different types of medication may be tried for nerve pain including antidepressants, anticonvulsants such as gabapentin, and analgesics such as opioid pain relievers or lidocaine.
  • Rehabilitation support Physical therapy and occupational therapy offer treatments and support interventions for patients. Specific treatments include:
  • Exercises to improve strength, range of motion, and balance
  • Assistive devices to help with walking including walkers, crutches, or canes
  • Orthotics such as arch or ankle supports to align joints and improve function
  • Assistive devices to help with daily activities such as tools to help with writing, buttoning clothes, or brushing teeth
  • Mild electrical stimulation to stimulate weakened muscles
  • Home exercises and family education

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Challenges Of Acupuncture Studies

It is fundamentally difficult to objectively assess acupuncture, because there are many variations of acupuncture, and treatment methods are practitioner-dependent. That difficulty is evident from our review: the included studies show great variation with respect to acupuncture protocol and placebo therapy.

Placebo therapy varies because there is no generally agreed-upon placebo control. Placebos vary from acupressure, to sham acupuncture, to methylcobalamin injections, to placebo pills. Even within sham acupuncture, many variations are seen . Some of those placebos also prevent adequate participant blinding . Moreover, unless a machine is used to perform the acupuncture protocol, it is extremely difficult to blind the personnel administering acupuncture.

Dimitrova et al.21 recently published a standardized protocol that could be used as a guideline for future studies in peripheral neuropathy. Further studies establishing gold standard acupuncture protocols, placebos, and outcomes for peripheral neuropathy will allow for a more reliable, objective assessment of acupuncture. We recognize that achieving a good placebo control for acupuncture is challenging. However, it is our opinion that finding that placebo is still the approach that could establish a true sense of the specific effects of acupuncture in this setting and for other clinical conditions

Taking Risk Factors For Neuropathy Into Account

The researchers found that several patient characteristics increased the risk of lingering neuropathy 24 months after treatment initiation: the presence of neuropathy before treatment older age being overweight or obese having a mastectomy and a greater number of lymph nodes containing cancer cells.

Because patients treated outside clinical trials are often older and less healthy than patients who enroll in clinical studies, the real-world percentage of women who experience chronic neuropathy after taxane-based chemotherapy is likely higher than reported in this study, Dr. Ganz explained.

Unfortunately, we currently dont have much to offer patients in terms of treating peripheral neuropathy, said Dr. OMara.

Some patients find limited relief with the drug duloxetine, but the best strategy for now remains trying to prevent neuropathy from occurring in the first place, Dr. Ganz added.

A wide range of chemotherapy regimens are currently endorsed by professional groups for women with breast cancer who are at high risk of recurrence, and choosing one of these regimens over another may result in only a small difference in survival, Dr. Ganz noted. And given that most women will live a long time after treatment, its become increasingly important to consider how treatment will impact their future health in initial decisions about therapy, she added.

We need a strategic way in which these get incorporated into treatment decision-making, Dr. Ganz concluded.

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Where Can Msk Patients Go For Cipn Treatment

Specialists in our Rehabilitation Medicine, Occupational & Physical Therapy Service offer care at many of our outpatient sites in Manhattan, including the Rockefeller Outpatient Pavilion, the David H. Koch Center for Cancer Care at MSK, and the Evelyn H. Lauder Breast Center. Outside of Manhattan, MSK has physiatrists working at MSK Bergen, MSK Monmouth, MSK Nassau, and MSK Westchester.

You can also meet with a physical or occupational therapist who specializes in CIPN at these sites.

If you are not an MSK patient, you can ask your oncology team or primary care provider for a referral to doctors and therapists who specialize in CIPN.

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