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Tingling Hands And Feet After Chemo

Cancer And Peripheral Neuropathy

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You have some risk of peripheral neuropathy if you have cancer. Certain factors raise your risk of getting it from cancer or its treatment. These include:

Where the tumor is. A tumor might press on or grow into a nerve. This could cause nerve damage.

Some chemotherapy drugs. Some chemotherapy drugs can damage your nerves, especially in high doses. These include:

  • Platinums, including cisplatin , oxaliplatin , and carboplatin

  • Taxanes, including docetaxel and paclitaxel

  • Vinca alkaloids, including vincristine , vinorelbine , and vinblastine

Before cancer treatment begins, ask your doctor if your chemotherapy includes any drugs on this list. If so, talk with your doctor about your risk for developing peripheral neuropathy after receiving chemotherapy. This is especially important for people who already have neuropathy or who have conditions that may put them at greater risk for developing neuropathy, such as diabetes or a personal or family history of neuropathy.

ASCO does not recommend the use of the dietary supplement acetyl-L-carnitine or any other medication or supplement to prevent peripheral neuropathy caused by chemotherapy. Always talk with your doctor before taking any supplement or over-the-counter medication, because they can interact with cancer treatments.

Radiation therapy. Radiation therapy might damage nerves. It might be years before you notice signs of nerve damage.

Surgery. Lung or breast surgery can cause nerve problems. So can removing an arm or leg.

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.

Chemotherapy And Sore Feet: Some Tips That May Help

I finished Chemo Nov 08 but still have the pain in my feet, says survivor Kim.

I finished chemo in Oct 08, says Kinden, and still have sore feet.For me it is inside the skin, not really on the outside.

Sore feet can be the result of a side effect called hand-foot syndrome, or palmar-plantar erythrodysesthesia . Certain types of chemotherapy drugs cause the condition by leaking out of small blood vessels in the palms of the hands and the soles of the feet. The leakage results in redness, tenderness, and sometimes peeling.

The symptoms of PPE can eventually cause swelling of the palms and soles as well, and in severe cases, move into blistering. In these cases treatment may be delayed or drug dosage reduced until symptoms subside. In the meantime, patients should report any discomfort to the doctor as soon as possible , and ask about possible medications.

There are several things you can do at home to reduce discomfort from PPE. Avoid long exposure to hot water, use ice packs or frozen veggies on the bottoms of feet, try thicker moisturizers and healing balms, like CV Skinlabs Restorative Skin Balm for cracking and peeling, and use over-the-counter pain relievers. Vitamin B6 is reputed to help reduce symptoms , as is elevating the legs or using compression socks if you have swelling. In addition, avoid pressure on your hands and feet, limit rubbing, and put off hot showers and sun exposure.

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Symptoms Of Nerve Problems

Nerve problems, or neuropathy, are different for every person. Which problems you have and how serious they are depend on which nerves are damaged. It also depends on how many are affected.

You might have nerve problems during cancer treatment or a short time afterward. They might also get worse after your treatment ends.

Treatments For Nerve Problems

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Medicines. Medicines can relieve pain. Your doctor might recommend non-prescription medicines if your pain is mild. These include pills you take by mouth and creams you put on the skin, depending on the type of nerve problems.

Your doctor might also prescribe medicines for you. For painful neuropathy related to previous chemotherapy, ASCO recommends the antidepressant duloxetine .

You might take prescription medicines if the pain is severe. They might be anti-inflammatory drugs or painkillers. Prescription medicines can include pills you take by mouth and creams or patches you put on the skin, such as a lidocaine patch.

Medicines can relieve pain, but they do not help numbness.

Adjusting your chemotherapy treatment plan. If you develop peripheral neuropathy from ongoing chemotherapy that causes severe pain or affects your ability to function, your health care team may choose to give your doses of chemotherapy further apart, lower the amount of chemotherapy youre receiving, or change your treatment plan. Talk with your doctor about what they recommend and if you can receive a treatment that does not cause peripheral neuropathy instead.

Better nutrition. Eating a diet that includes specific nutrients might help your nerve problems.For example, you might need more B vitamins, including B1, B12, and folic acid . Or you might need more antioxidants. These are found in many fruits and vegetables.

  • Relaxation and mindfulness meditation

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How Long Do Symptoms Last

Often, the neuropathy goes away soon after your chemotherapy treatments are complete. But in some cases, the symptoms continue. Luckily, there are treatments to relieve the pain and unusual sensations associated with chemotherapy-induced peripheral neuropathy. Your doctor may prescribe steroids for short-term use. You can apply patches or creams that contain numbing medicine directly to the painful area. Antidepressants and anti-seizure medications are also options.

People react differently to medications. It may take more than one attempt to find the approach that works best for you, says Geisinger oncologist Dr. Shreya Sinha. We might also recommend treatments like relaxation therapy, guided imagery, electric nerve stimulation, occupational and physical therapy, and even acupuncture, which require no medication at all and have been shown to ease nerve pain brought on by a variety of conditions.

Can Cipn Be Prevented

Unfortunately, we dont know of anything that can completely prevent the symptoms of peripheral neuropathy caused by chemotherapy. However, we believe that treating it early, before symptoms become too severe, can help reduce its effects. If your peripheral neuropathy is severe, your doctor may need to adjust your chemotherapy treatments.

Some small studies have suggested that cryotherapy may reduce the occurrence of CIPN, particularly in people receiving taxane-based chemotherapy. More research is needed on this topic.

Promising new research to learn more about how chemotherapy damages the nerves at the cellular level in order to find ways to prevent it is ongoing. We hope that in the future we will have drugs that reduce or eliminate this nerve damage.

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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.

Causes Of Peripheral Neuropathy

Chemotherapy Induced Peripheral Neuropathy Clinical Trial

Peripheral nerves carry signals from the brain to different parts of the body and back again. These signals can have different functions including motor , sensory , or autonomic .

Chemotherapy medicines can harm these nerves. Drugs that pose the highest risk in childhood cancer include:

Higher doses and combinations of medicines can increase the likelihood of neuropathy. Younger children may be especially susceptible because their nervous systems are still developing. Radiation therapy and medical conditions such as diabetes can also cause nerve damage and increase the risk of peripheral neuropathy with chemotherapy.

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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%

What Causes Peripheral Neuropathy

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.

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Staying Safe Is Important

If youre having chemotherapy-induced peripheral neuropathy, its important to take precautions to avoid injury. Always wear shoes that cover your whole foot, even at home. If you have problems with stumbling, consider installing handrails in hallways and bathrooms to help you keep your balance and think about using a walker or cane for extra support.

Be sure to protect your hands and feet from extreme temperatures, says Dr. Rowling. Set hot water heaters in your house between 105°F and 102°F to reduce scalding risk and check your bath water with a thermometer. She also recommends examining your feet often to make sure you do not have any injuries or open sores. If open sores develop, call your doctor right away, she says.

Good nutrition is always important. But when youre undergoing treatment for cancer, eating well gives your body the strength it needs and might also minimize some treatment-related side effects. Avoid alcohol if youre having any symptoms related to chemotherapy-induced peripheral neuropathy, as it can make them much worse.

What Are The Treatments For Cipn

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There are several treatments, depending on your particular symptoms. For pain and tingling, there are medicines offering relief, which can be prescribed by a physiatrist or a neurologist.

Physical therapy, occupational therapy, and exercise can help you cope with numbness, loss of balance, or loss of strength. Exercises like yoga and tai chi can help maintain or restore your balance.

Some symptoms of CIPN may get better over time, but others may be permanent.

Learn more about ways to manage symptoms and get tips for staying safe while you have peripheral neuropathy.

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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.

Talk To Someone About Your Side Effects

If you develop any symptoms let your specialist team know. At the moment theres no sure way to prevent or reverse peripheral neuropathy, though there are studies looking into this. For most people symptoms are likely to slowly and gradually improve over time once the drug is stopped. However some symptoms may not improve and for some people nerve damage can be permanent. If you have symptoms that are particularly affecting your quality of life your doctor may talk to you about delaying, reducing or stopping treatment to make sure it doesnt get any worse.

Treatment is mostly given to relieve pain. Doctors often use drugs more commonly used to help treat depression or epilepsy which are known to help pain caused by damage to nerves. They can also ask for advice from a specialist pain team who may suggest other ways of trying to manage symptoms such as physiotherapy or acupuncture.

If youre experiencing numbness in your hands and feet its important to limit the possibility of injury. For example, not going bare foot and protecting your hands and feet from extremes of temperature. Its also important to check regularly for injuries to your hands and feet so that if you do hurt yourself, injuries can be dealt with promptly preventing the injury from worsening or you developing an infection.

A referral to an occupational therapist may also be useful for those with persistent problems for support and ideas for ways of helping with everyday activities.

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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.

How Do We Manage Cipn

Breakthrough in Treating Chemo-Induced Neuropathy

The importance of discussing with the admitting team, if symptoms of CIPN develop during treatment, has already been discussed. This provides an opportunity to modify treatment and prevent further damage rather than dealing with an irreversible situation later.

IF CIPN develops, pain can often be helped with treatments but the numbness is usually resistant to treatment. Some of the modalities which can be used for treatment include

  • Medications used to treat nerve pain such as antiepileptics, antidepressants, topical gels, patches or creams of numbing medicine, strong painkillers such as opioids, steroids
  • Drug infusions or pain relieving medications which act on nerves
  • Physical therapy can help with balance, strength and safety.
  • Occupational therapy can help improve fine motor skills like buttoning shirts
  • Relaxation therapy, distraction, biofeedback

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Causes Of Tingling In The Hands And Feet

Diabetes is one of the most common causes of peripheral neuropathy, accounting for about 30% of cases. In diabetic neuropathy, tingling and other symptoms often first develop in both feet and go up the legs, followed by tingling and other symptoms that affect both hands and go up the arms. About two-thirds of people with diabetes have mild to severe forms of nerve damage. In many cases, these symptoms are the first signs of diabetes.

In another 30% of peripheral neuropathy cases, the cause is unknown, or “idiopathic.”

The remaining 40% of cases have a variety of causes such as:

Nerve entrapment syndromes. These include carpal tunnel syndrome, ulnar nerve palsy, peroneal nerve palsy, and radial nerve palsy.

Systemic diseases. These include kidney disorders, liver disease, vascular damage and blood diseases, amyloidosis, connective tissue disorders and chronic inflammation, hormonal imbalances , and cancers and benign tumors that impinge on nerves.

Vitamin deficiencies. You need vitamins E, B1, B6, B12, and niacin for healthy nerves. A B12 deficiency, for example, can lead to pernicious anemia, an important cause of peripheral neuropathy. But too much B6 also can cause tingling in the hands and feet.

Toxins. These include heavy metals such as lead, arsenic, mercury, and thallium, and some industrial and environmental chemicals. They also include certain medications — especially chemotherapy drugs used for lung cancer — but also some antiviral and antibiotic drugs.

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