Peripheral neuropathy is a condition affecting the nerves outside the brain and spinal cord. In people with cancer, it may be caused by the disease itself or by certain cancer treatments. Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most common forms.

Peripheral neuropathy can develop for several reasons:

  • As a side effect of certain cancer treatments, particularly some chemotherapy drugs (such as taxanes, platinum compounds, vinca alkaloids and bortezomib).
  • Due to compression of, or tumour invasion into, a nerve.
  • As a consequence of surgery or radiotherapy affecting nerve structures.
  • Less commonly, because of nutritional deficiencies, diabetes or other co-existing medical conditions.

Symptoms

Symptoms depend on which nerves are affected and may develop gradually during treatment or even after treatment has been completed.

Common symptoms include:

  • Tingling or pins-and-needles sensations in the hands and feet.
  • Numbness or reduced sensation.
  • Pain, burning sensations or electric shock-like pain.
  • Increased sensitivity to cold or touch.
  • Muscle weakness.
  • Difficulty handling small objects, fastening buttons or writing.
  • Problems with balance or an increased risk of falls.

In some cases, the autonomic nerves, which control involuntary body functions, may also be affected. This can lead to:

  • Dizziness when standing up.
  • Constipation or diarrhoea.
  • Urinary problems.
  • Changes in sweating or blood pressure.

Monitoring During Treatment

If you are receiving a treatment known to increase the risk of peripheral neuropathy, your healthcare team will regularly assess you for symptoms and monitor any changes over time.

It is important to report any new symptoms or worsening symptoms, even if they seem mild.

When neuropathy becomes severe or begins to affect everyday activities, it may be necessary to:

  • Temporarily delay treatment.
  • Reduce the treatment dose.
  • Switch to a different medication.
  • Stop the treatment causing the neuropathy if the risk of permanent nerve damage is considered high.

Treatment and Symptom Management

At present, there is no medication that has been shown to reliably prevent chemotherapy-induced peripheral neuropathy. For this reason, early recognition of symptoms is essential.

The following measures may help:

  • Adapted exercise programmes and physiotherapy.
  • Occupational therapy to improve function and safety during daily activities.
  • Fall-prevention strategies and home adaptations when balance is affected.
  • Protecting the hands and feet from extreme temperatures and accidental injury.
  • Wearing comfortable, supportive and safe footwear.

When Should You Inform Your Healthcare Team?

Contact your doctor or nurse if you experience:

  • Worsening tingling or numbness.
  • Difficulty walking or maintaining balance.
  • Weakness in the hands or legs.
  • Neuropathic pain that interferes with sleep or daily activities.
  • Falls or difficulty carrying out routine tasks.

Early identification of peripheral neuropathy allows treatment to be adjusted when necessary and helps reduce the risk of symptoms becoming permanent.