Cancer and Treatment-related Peripheral Neuropathy (numbness and tingling)

What is peripheral neuropathy?

Definition:

Peripheral neuropathy is swelling or damage to a nerve fiber and is associated with some cancer treatment side effects, such as chemotherapy or radiation. It occurs initially in the feet, and can progress to the ankles and calves, and fingers and hands, interfering with walking, driving, ability to sense temperature differences, and other normal daily activities.

How do people describe peripheral neuropathy?

People will use many words to describe this sensation such as burning, tingling, "pins and needles", numbness, sharp, jabbing, shooting, pricking and electric-shock-like. Some people describe peripheral neuropathy as a decreased ability to feel changes in temperature, touch, pain or vibration. Others may describe peripheral neuropathy as a painful sensation, which when present, begins in the toes and feet and may involve hands and fingers. Some may also describe peripheral neuropathy as weak arms or legs accompanied by pain (or loss of pain) or loss of feeling and loss of temperature sensation, which may or may not be accompanied by constipation (see toolkit sheet).

What causes peripheral neuropathy?

A number of chemotherapy drugs such as the Taxane drugs (Taxol, Taxotere), Cisplatin, Navelbine, Vincristine. Vinblastine and high doses of drugs such as ARA-C, Cytoxan and 5FU can cause peripheral neuropathy and other problems. Cancer tumors that press on nerves or radiation therapy can also cause damage to nerve endings. Disease such as Diabetes can also cause nerve damage.

How do people cope with peripheral neuropathy?

Although it’s not possible to prevent early nerve damage, it is possible to protect yourself and your affected hand or foot from worsening.

Here are some suggestions for numbness in hands and feet:

• Move furniture so you have a clear pathway at home.
• Remove objects from the floor to help prevent falls.
• Make sure you have adequate lighting for activities.
• Install a nightlight so a walking path is visible.
• Use a cane or walker if arm or leg is too numb or limp.
• Wear sturdy shoes; avoid slippers and running shoes with thick soles.
• Put a non-slip rubber mat or self-stick strips on the floor of the bathroom or shower.
• Test water temperature when showering or bathing to prevent burns.
• Be sure you have sufficient strength and coordination when driving.
• Use soap dispensers instead of bar soap.
• Inspect numb hand or foot daily for sores or lesions.

Here are some suggestions for tingling in hands and feet:

• Use cotton gloves when washing the dishes or gardening.
• Use a potholder when cooking to avoid further injury to nerve endings.
• Inspect your skin daily for abrasions, burns and cuts; especially your arms, legs, fingers and toes.
• Take time to complete daily activities, focus closely to the task at hand.
• Use a thicker sock to prevent further foot injury.
• Check hands or feet for sores or lesions, as you will have a diminished sensation to feel these.
• Try a complimentary therapy such as a massage or water therapy in a whirlpool or swimming pool.
• Buddy up with a friend for routine exercise such as walking to improve strength, balance and coordination.

What can family members and friends do to help me with my peripheral neuropathy?

Numbness:

• Ask family members and friends to prepare meals for you.
• Ask family members and friends to help with daily household chores such as gardening or dishwashing.
• Ask family members for help with buttoning pants or shirt as needed or to purchase Velcro closures.
• Ask family members to assist in getting objects off the floor and making sure rugs have tape to secure to the floor.
• Ask family members to test water temperatures before bathing or washing dishes.
• Ask family members to install brighter light bulbs.
• Ask family members to buy soft soap in a dispenser instead of bar soap.

Tingling:

• Ask family members and friends to purchase cotton gloves and thicker socks for added comfort and to help prevent injury.
• Ask family members and friends to wash dishes for you.
• Ask family members to encourage you in routine exercise such as walking or swimming.

How can I talk to my family members about my peripheral neuropathy?

Numbness:

• Be open and honest when telling family members about difficulties you have with peripheral neuropathy.
• Ask family members and friends for suggestions to help you function as close to normal activity level as possible.
• Tell family members and friends how the numbness is affecting your emotions.
• Ask family members how the numbness is affecting them.

Tingling:

• Discuss with family or friends how the tingling affects your life.
• Ask family members how the tingling may be interfering with their life.
• Talk with family about how the tingling is affecting your emotions.

What should I report to my doctor or nurse?

• Any changes in physical function, pain, numbness, prickling or tingling that interfere with your ability to care for yourself.
• Changes that keep you limited to your bed or chair.
• Peripheral neuropathy that interferes with your daily activities.
• Any falls, burns or other injuries to your affected hands and feet, or any other part of your body.

Where can I get more information?

• Contact your healthcare provider.
• Contact the American Cancer Society at 1-800-ACS-2345 or on the Internet at http://www.cancer.org/docroot/mbc/content/mbc_2_3x_sweating.asp?sitearea=mbc
• Visit the Family Care Research Program on the Internet at: http://www.cancercare.msu.edu/
• Visit the website: http://www.cancersourcern.com, click on patient education.
• Contact the National Cancer Institute at 1-800-4-CANCER or through the Internet at: http://www.cancer.gov/cancer_information/coping/

References:

1. Almadrones, LA, Armstrong, T, Gilbert, M & Schwartz, R. (2002). Chemotherapy-induced Neurotoxicity: Current Trends in Management: A Multidisciplinary Approach. (monograph)
2. Holley, S (2002). A look at problems of falls among people with cancer. Clinical Journal of Oncology Nursing, 23 (8): 193-197.
3. Smith, EL, Whadon, MB & Bookbinder, M. (2001). Improvement for painful peripheral neuropathy. Seminars in Oncology Nursing, 18(1): 36-43.
4. Wilkes, GM, Neurological Disturbances.(1999) In Yabro, CH, Frogge, MH, Goodman, M. Cancer Symptom Management, 2nd. Ed. Sudbury, MA: Jones and Bartlett Publishers, 344-81.