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

Peripheral Neuropathy after Cancer Treatment
What is peripheral neuropathy?
Peripheral neuropathy, or damage to the peripheral nerves (nerves outside the brain or spinal cord), is a potential side
effect of chemotherapy drugs and may cause the hands or feet to hurt, tingle, and feel numb or weak. Though thediscomfort is felt in a muscle or joint, the real damage is to the nerves that control the muscles. Nerves are made upof special cells that carry messages to and from the brain and spinal cord. Damage to the nerve is often caused by abreakdown of the myelin sheath, the coating around nerve fibers that acts as an electrical insulator. There may also
be direct damage to the nerve cells from pressure or trauma (for example from a tumor or surgery). Symptoms usually
start during treatment and persist and are not late in onset. Symptoms often improve once treatment has stopped, but
for some survivors, symptoms may persist for months or years.
Symptoms•Burning, tingling, or prickling sensation usually in the hands or feet•

Numbness or sensitivity to pain or temperature•

Extreme sensitivity to touch•

Sharp shooting pain•

Poor balance or coordination•

Loss of reflexes•

Muscle weakness•

Noticeable changes in the way you walkMuscle weakness may begin around the arch of the foot and in the palm of the hand. It may be difficult to grip thingsor to perform certain tasks or activities such as writing, buttoning clothes, or tying shoes. The muscles that pull the footup may weaken and the reflexes may be lost, causing the front part of the foot to fall flat to the floor. This may resultin poor balance or coordination, especially when tired. There may be a tendency to drag the feet or lift them high to prevent the feet from dragging.
Who is at risk?
People who have received any of the following chemotherapy drugs may be at risk:•Vincristine•

Vinblastine•

Cisplatin•

Carboplatin

People at highest risk for peripheral neuropathy are those who have received higher doses of these drugs or combinations of these drugs. Other risk factors include surgery, severe weight loss, and diabetes or a pre-existing nerve disease. Prolonged pressure on nerves from artificial limbs, wheelchairs, or crutches can also contribute to nerve damage.

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Treatment
Rehabilitation services
Because there is no treatment that can cure or reverse nerve damage, treatment is directed toward symptom management. Physical therapy is often helpful in providing exercises to improve strength, balance, and coordination. Occupational therapy can provide help to improve hand/eye coordination and other skills needed for daily life.
Orthotic devices
Support for feet or ankles can be improved with orthotic devices. Arch supports or splints help prevent the arch fromflattening and help improve walking. Splints called ankle-foot-orthoses (AFOs) may be recommended to prevent theankle from moving too much from side to side and to support the foot when walking.
Pain management
Your healthcare provider may prescribe medication to control the pain, tingling, and burning sensation. The type ofmedication depends on the frequency and severity of pain. It is also important to know that some medications will
have side effects of their own. Elastic stockings, warm packs, or exercise may also help with the discomfort. These
measures will not replace medication but may decrease the need for them. They may also assist in improving mobility
and independence.
Additional recommendations•Avoid shoes that are too tight or too loose—Just as shoes that are too tight can cause throbbing, rubbing,and cramping, shoes that are too loose can worsen pain and may not provide enough support for already wobbly
feet. Well-fitting sneakers or shoes that provide support but are also flexible are best.

•Be sensitive to temperature—Many people report that neuropathy feels worse in hot weather or when feet areheavily covered, which may prevent adequate air circulation.

•Keep feet uncovered in bed—Bed sheets resting on toes can cause discomfort due to friction between thesheet and toes.

•Massage—Massaging your hands or feet or having someone else massage them can be extremely soothing
and relaxing and can increase circulation and boost endorphins (chemicals produced in the body that help control pain).

•

Cool soaks—Cool water soaks to painful hands or feet can sometimes dull pain enough to fall asleep or until
pain medication has time to work.

For additional information, contact:
The Foundation for Peripheral Neuropathy
485 Half Day Road, Suite 350, Buffalo Grove, IL 60089
Phone: 877-883-9942
Website: www.foundationforpn.org

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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.
Disclaimer and Notice of Proprietary Rights
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 were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’s
Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
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