Chemotherapy-induced Peripheral Neuropathy
Published: 26 February 2024
Published: 26 February 2024
Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of certain chemotherapy agents resulting in damage to peripheral nerves - nerves located away from the centre of the body, including sensory nerves, motor nerves and the autonomic nervous system (Loprinzi 2023; Cancer Council Australia 2020).
This damage causes issues with sensory, motor and/or autonomic functioning ranging from mild to severe, depending on which nerves have been damaged (Zajączkowska et al. 2019; Cancer Council Australia 2020).
Chemotherapy works by destroying fast-growing cells, which include cancer cells. However, other normal cells may also be damaged in this process. If nerve cells are badly damaged, they cannot be repaired or replaced easily, resulting in neuropathic issues (Zajączkowska et al. 2019; Cancer Council Australia 2020).
Certain chemotherapy agents have about a 70% chance of causing CIPN one month after treatment, and about 30% of these people will still experience symptoms six months after treatment. These agents include:
(Cancer Council Australia 2020)
Non-chemotherapy cancer-related causes of peripheral neuropathy may include:
(Cancer Council Australia 2020)
CIPN may affect any part of the peripheral nervous system, including sensory nerves, motor nerves or the autonomic nervous system. Therefore, symptoms can vary greatly and may include:
Sensory nerve symptoms |
|
Motor nerve symptoms |
|
Autonomic nervous system |
|
(Cancer Council Australia 2020)
The sensory nerves are most likely to be affected first, with symptoms predominantly involving the hands and feet (Zajączkowska et al. 2019).
Symptoms are typically mild upon onset but may eventually become more severe and disabling in some people (Cancer Australia Council 2020; ACS 2019).
The duration of symptoms depends on the type of chemotherapy used. Sometimes symptoms are acute, lasting for only a few days during or shortly after a chemotherapy session. In more severe cases, however, CIPN can worsen over time, even once treatment has concluded. In some cases, particularly if the chemotherapy was intensive, symptoms might be permanent or require years of recovery. It’s also possible for symptoms to commence months or years after undergoing treatment (Cancer Council Australia 2020; Cancer Institute NSW 2023).
In most cases, patients will recover in a few months (Cancer Institute NSW 2023).
Patients receiving chemotherapy agents that are associated with CIPN will be monitored for early signs and symptoms. If CIPN is suspected, the patient may need to complete a symptom checklist and undergo testing for spatial awareness, reflexes, balance and coordination, and blood pressure (Cancer Council Australia 2020).
Some patients might be referred to a neurologist to undergo nerve conduction studies, which test how many cells are functioning and how quickly they send electrical signals (Cancer Australia Council 2020).
CIPN may cause a variety of disturbances to daily activities and interfere with quality of life. Patients might experience:
(Cancer Council Australia 2020)
In severe cases, CIPN may lead to:
(ACS 2019; Loprinzi 2023)
The only known way to treat CIPN is to reduce the dose or frequency of chemotherapy or in severe cases, halt chemotherapy altogether (Cancer Council Australia 2020).
This could, however, have adverse oncologic outcomes (Loprinzi 2023).
In terms of symptom management, analgesics can be used but may prove ineffective. Stronger medicines like tramadol may be prescribed, but can have undesirable side effects and are not ideal as a long-term solution. Certain antidepressants, anticonvulsants and creams may be helpful, but there is limited evidence of their efficacy (Cancer Council Australia 2020).
Other symptom management techniques include:
(Cancer Council Australia 2020)
CIPN cannot be prevented (Cancer Council Australia 2020).
Patients experiencing CIPN may require additional help with daily tasks due to their symptoms. When caring for someone with CIPN:
(Cancer Council Australia 2020; Cancer Institute NSW 2023)
Question 1 of 3
True or false: Chemotherapy-induced peripheral neuropathy can increase the risk of falls.