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Healthy living after treatment of childhood, adolescent, and young adult cancer

Raynaud’s Phenomenon after Cancer Treatment
What is Raynaud’s Phenomenon?
Raynaud’s is a condition that may cause some areas of your body to feel numb and cool in response to cold
temperatures or stress. Raynaud’s causes occasional narrowing of blood vessels, limiting blood flow for brief periodsof time. This is called a vasospasm. During periods of vasospasm, the skin is deprived of oxygen and may become paleand then turn a bluish color. As the blood vessels relax and blood flow resumes, the skin may become red. The hands
and feet are most affected, but Raynaud’s may also involve the nose, lips, cheeks, and earlobes.
Symptoms• Changes in skin color (often from white to blue to red)
• Changes in skin temperature (affected areas feel cooler)• Numbness or prickly feeling in the fingers (not thumbs) and toes•

Occasional episodes of pain (described as throbbing) and swelling

What happens during an attack?
For most people, cold temperature or stress triggers an attack. Typically, when the body is exposed to cold, the hands
and feet lose heat rapidly. To conserve heat, the body reduces blood flow near the skin surface and moves it deeper inthe body. For people with Raynaud’s, this normal response is exaggerated by sudden spasms of the small blood vesselsthat supply blood to the fingers and toes. This greatly reduces the blood supply to the hands and feet, causing changes
in the skin color and temperature. The first sign is often pallor (or whiteness), in response to the spasm. The skin may
then appear blue (cyanotic) and feel numb or cold, because of a lack of oxygen-rich blood. Finally, the skin may turn
red and become swollen, as the small blood vessels relax and dilate, and blood flow returns. Commonly, throbbing andtingling may occur in the fingers and toes as the attack ends. Raynaud’s attacks can last from seconds to hours.
Who is at risk?
Childhood cancer survivors who received treatment with vinblastine or vincristine sometimes develop Raynaud’s.
Prevention
Raynaud’s is usually a chronic condition that you may need to manage for life. Some people may see improvement
slowly over several years. Prevention of attacks is key:
• Dress warmly when outdoors.
• Take precautions indoors. Wear socks. Avoid drafts (i.e. refrigerator or freezer). Wear mittens when handlingcold items. Use the air conditioner sparingly. Use insulated drinking glasses.
• Avoid putting unprotected hands in cold water.
• Do not use tobacco or drugs as such as cocaine. Nicotine and cocaine constrict blood vessels and causes theskin temperature to drop, which may lead to an attack.
• Exercise. Regular exercise can enhance circulation and help control stress.
• Manage stress. Since stress is often a trigger for Raynaud’s attacks, managing stress may help make the attacks
shorter and less frequent.

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Healthy living after treatment of childhood, adolescent, and young adult cancer

Treatment
Treatment is directed at reducing the number and severity of attacks to prevent tissue damage. People with Raynaud’s
should follow all the above recommendations for preventing attacks. In addition, if attacks are triggered by exposure
to cold, placing the affected body part in warm water may help to stop symptoms. Other treatment methods include
medications and biofeedback.
Medications
Medications that help to dilate blood vessels and promote circulation are sometimes prescribed for management ofsevere symptoms.
Certain prescription medications can sometimes make symptoms worse. These include birth control pills and someheart and blood pressure medicines. If you are taking any of these medications and are having symptoms of Raynaud’s,
consult with your healthcare provider regarding possible alternatives.
Certain over-the-counter cold or diet pills can make symptoms worse and should be avoided. These include drugs that
contain pseudoephedrine (such as Actifed® and Sudafed®).
Biofeedback
Using your mind to control stress and body temperature may help to decrease the severity and frequency of attacks. This
may include guided imagery and/or deep breathing exercises. A psychologist may be helpful in designing a biofeedback
program that meets your needs.
Written by Susan V. Shannon, RN, MSN, CPNP, CPON®, Miller Children’s and Women’s Hospital Long Beach, Long Beach, CA.
Reviewed by Kayla L. Foster, MD, MPH; Beth Fisher, DNP, APRN, CPNP; and Melissa Acquazzino, MD, MS

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
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Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health Links
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