Ask the expert: Peripheral neuropathy

Dr Kate Webber is a medical oncologist at Monash Health and adjunct senior lecturer at Monash University. She has a keen interest in breast and gynaecological oncology, cancer survivorship and patient reported outcomes research. The Beacon asked Kate about peripheral neuropathy, a common side effect of some chemotherapy drugs.

What is peripheral neuropathy?

The term refers to damage to the fine nerves that go to the peripheries, i.e. our fingers and toes, which leads to a loss of sensation, along with tingling and pain. Peripheral neuropathy can significantly impact quality of life with pain, numbness and tingling affecting the use of fingers and hands, possibly leading to loss of balance and impaired sleep.

How common is it?

It’s very common, especially for those on taxane chemotherapy treatments, such as paclitaxel and docetaxel. Up to 80 per cent of women who are treated with paclitaxel will develop some degree of symptoms. There is no way of predicting who will develop peripheral neuropathy or when.

What are the symptoms?

The symptoms can vary greatly from one person to another, but it usually presents as numbness, tingling or pain in your hands or feet. Generally, people experience it on both sides of their body. One woman in my care described the peripheral neuropathy in her hands as her ‘champagne fingers’ because her fingers felt fizzy all the time.

Some patients develop mild symptoms, which they are able to tolerate, while about a third will experience functional impairment. This means they have trouble doing day-to-day tasks because of the numbness or tingling or pain in their hands or their feet. Where the symptoms are significant, we may discuss a dose reduction or stopping chemotherapy early to help manage the symptoms.

Can it be prevented?

There are no proven strategies for preventing peripheral neuropathy. Throughout treatment we carefully assess people to see if and when symptoms arise. Once they develop, the only options are to monitor them, reduce the dose of the drug or to stop the drug. These decisions will take into consideration the risks and benefits for each individual.

Does peripheral neuropathy just go away and, if not, can it be treated?

Once the nerve damage is done, it’s really difficult to repair. It can take a very long time for nerves to recover because they don’t regrow the way, for example, our hair does or blood counts recover after chemotherapy. So this damage can be a long-term side effect for many women.

The majority of people report improvement in, if not resolution of, their symptoms with time. For those who are left with long-term symptoms, many adapt and do their best to get by.

What can people do to alleviate their symptoms? 

Exercise is something I advocate for anyone who’s having trouble with neuropathy. While it probably won’t fix the underlying nerve damage, exercise can improve the key things you need to function day-to-day, such as improving your balance, strength and core stability and reducing your risk of falls. It’s also likely to improve your general health and mood, as well as other symptoms you may be experiencing during and after treatment, such as deconditioning, physical and cognitive fatigue, chemo brain, and menopausal symptoms.

Choose something you enjoy, will do regularly and ideally that helps your specific concern. People who have significant neuropathy in their feet might, for example, focus on exercises to improve core strength and balance, then try more aerobic exercises once you’re confident you won’t fall over.

Your treatment team may also be able to suggest medications that could alleviate your symptoms.

Some people also report improvement in symptoms with topical treatments and acupuncture, although more research is needed.

If someone is concerned about peripheral neuropathy, what would you recommend?

Let your doctors and treating team know as soon as you notice any symptoms that bother you, so they are aware of the impact your treatment is having on your quality of life and can make adjustments to your treatment if necessary.

Listen to BCNA’s Upfront About Breast Cancer podcast to learn more from Dr Kate Webber along with Sue Dowe’s personal experience of peripheral neuropathy. You can read more about peripheral neuropathy in My Journey.

Issue 88
Winter 2021