How to cope with Chemotherapy Induced Peripheral Neuropathy

With chemo induced peripheral neuropathy being a common side effect of chemotherapy for breast cancer patients this article explains the condition and suggests some ways to counter it.

By Kat Tunnicliffe

Chemotherapy Induced Peripheral Neuropathy (CIPN) is a very common side effect from chemotherapy and is due to neurotoxic damage to the sensory nerve linings.

Up to 68% of breast cancer patients can experience it within the first month of having chemotherapy; up to 60% within the first three months of having chemotherapy; an up to 30% within and beyond six months of having chemotherapy (source: CN-16 Incidence, prevalence and predictors of chemotherapy induced peripheral neuropathy: A systemic review and meta-analysis).

Typically, symptoms present in the hands and feet, but can also affect the lower legs.

“I was asked each time I had chemo if I had any problems with my hands and feet. When I mentioned I was experiencing some symptoms of peripheral neuropathy my oncologist gave me a break from treatment for a short time which really helped. My chemo dose was also reduced slightly, which did not affect my treatment overall.” Emma

Symptoms

Symptoms can range from mild to severe, usually on both sides and can present as pain, numbness, hypersensitivity, pins and needles, cold, burning or a glove/sock-like tightness. Incidence varies on the types of chemotherapy drugs and their dosages but is a very common side effect from chemotherapy regimes that involve Taxanes and Platinum based drugs. Symptoms can continue for months or even years after treatment and can have a real impact on function and quality of life.

Studies suggest there are other risk factors such as age, an increased BMI, a genetic predisposition and diabetes. There is limited evidence of preventing it, and it is not your fault if it occurs. Talk to your Oncology team before embarking upon treatment, as there may be some things you could try to reduce the impact such as Vitamin B6 or Vitamin E.

There are some studies looking at ways of preventing the development of CIPN by using low level laser treatment called Photobiomodulation Therapy, but standardisation and use, has not yet been established. If you do experience CIPN, inform your team as soon as possible as there may be something they can do to help reduce the impact to your day-to-day life or adjust your treatment regime.

In my experience these symptoms are often underreported as people have concerns that their chemotherapy dosage may be reduced or stopped, but this is not always the case. Your team may be able to prescribe medication or refer you to your local pain clinic. If your balance, ability to exercise or your fine motor skills like doing up buttons is affected, physiotherapy or occupational therapy can help.

Benefit of physical activity

Numerous clinical trials support the benefit of physical activity throughout treatment for breast cancer, and chemotherapy is no exception. Exercising during chemotherapy has shown to protect your heart, decreases fatigue, prevents muscles from getting weaker, decreases nausea and depression and helps you recover faster when it’s done. There are some small trials looking at the benefits of exercise for CIPN are showing promising results with little side effects. Watch this space!

CIPN affects the linings of the sensory nerves. It does not directly affect the joints and muscles. Exercise doesn’t directly lessen what you feel, but by not moving or exercising, you may experience joint stiffness and muscle weakness, potentially leading to further loss of function and poorer quality of life. When experiencing CIPN, on top of the numerous other side effects of chemotherapy, exercise may be the last thing you want to do. It is never too late to start, but ideally start exercising from day one. Exercise has not shown to make CIPN symptoms any worse.

Throughout Chemotherapy it is advised that you do 150 minutes of moderate intensity exercise per week. ‘Moderate intensity’ suggests that your heart, breathing and muscles are being challenged, but not to the point that you have to stop. ‘Chemo-moderate’ intensity will be very different from ‘pre-cancer treatment-moderate’, and that’s OK. 150 mins per week averages to about 30 mins per day. This can be broken up to smaller chunks. That’s OK. Do what works for you – experiment. There may be one day in a week that you can tolerate a 40-minute walk and 10 minutes of lifting weights, and another day that you can only tolerate walking around the house, doing five wall press ups and 10 sit-to-stands from your chair. Regardless of whether you are new to exercise or previously exercised to a high level anything is better than nothing.

A referral to a physiotherapist can help guide you to overcome challenges and experiment to do what works best for YOU. Here are a few tips you can experiment with or try to overcome the symptoms you are experiencing. Most importantly, ensure you are SAFE from injury and infection and seek guidance and support when needed.

Managing Pain

• Could you be referred to the local pain clinic or be prescribed medication?
• Could you try gentle massage of the area prior to exercising?
• Could you try wearing an extra pair of socks or exercising without shoes and socks?
• If you having difficulties walking, could you do cycling or swimming?

Taking care of your skin

• Could you bathe your hands or feet in bowls of hot (bath temperature) or iced water, alternating between the two every 10 seconds until the temperatures feel the same
• Could you try Acupuncture or Transcutaneous Electrical Nerve Stimulation (TENS)? Some have found these treatments helpful but clear this with your team before embarking on any treatment.

Improving Balance

• Is it safe to try standing on one leg whilst brushing your teeth? Or marching on the spot whilst the kettle’s boiling?
• Do I have straight lines I can ‘tightrope walk’ along? Walking heel to toe along a wooden or lino floor, progressing to not looking at your feet?
• Can you create and play a safer, toned-down version of ‘The Floor is Lava’ with your kids?

Improving Proprioception (Your brain’s perception of what your hands and feet are doing in space)

• Can you try picking pencils up with your toes?
• Can you ‘draw’ the letters of the alphabet with a plastic bag under your foot on the carpet? Can you do it with your eyes open or eyes closed?
• Can you put your hand on a duster and ‘wipe’ the letters of the alphabet on a table or window/mirror? Can you do it without looking?
• Can you stack coins with your hands from one pile to another? Can you do it looking at the pile and not looking at the pile?
• Can you thread paperclips or daisy chains? Can you undo big buttons by moving onto small ones? Can you do it looking and not looking?

The take home messages are there doesn’t seem to be a lot you can do to prevent CIPN – but talk to your team. If you do develop it, it is not your fault. CIPN is a very common side effect, which can have a tremendous impact on quality of life and function. There are studies looking at preventative measures and what can help the impact of symptoms, underway. Watch this space. Exercise doesn’t directly affect the CIPN symptoms but will not make them worse. Not being active leads to stiffness of joints and deconditioning of muscles. Anything is better than nothing. Speak up and get the support you need to live the best possible and active life whilst on treatment – as it will improve your resilience, response and recover.

About the author

Kat Tunnicliffe is a Clinical Specialist Physiotherapist in Musculoskeletal and Oncology. Over the last 18 years she has worked in a variety of NHS, GP and private clinics and currently works as the Physiotherapy Lead at Perci Health, a remote telehealth platform along with several other cancer professional experts. Perci Health aims to close the gap between cancer and wellness, and support cancer patients and those caring for those with cancer, at any of their treatment journey and beyond.

Future Dreams hold a range of support groups, classes, workshops and events to help you and your carers during your breast cancer diagnosis. These are held both online and in person at the London-based Future Dreams House. To see what’s on offer and to book your place, see here.

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December 2022

The information and content provided in all guest articles is intended for information and educational purposes only and is not intended to substitute for professional medical advice. It is important that all personalised care decisions should be made by your medical team. Please contact your medical team for advice on anything covered in this article and/or in relation to your personal situation. Please note that unless otherwise stated, Future Dreams has no affiliation to the guest author of this article and he/she/they have not been paid to write this article. There may be alternative options/products/information available which we encourage you to research when making decisions about treatment and support. The content of this article was created by Kat Tunnicliffe and we accept no responsibility for the accuracy or otherwise of the contents of this article.