Of the many side effects that can accompany treatment for breast cancer is a condition called neuropathy, a “general term for pain or discomfort caused by damage to the nerves of the peripheral nervous system,” according to Breastcancer.org. The peripheral nervous system is the network that helps your brain communicate with the rest of your body. These nerves can sustain damage from chemotherapy and radiation treatment that results in pain, loss of sensation and weakness in the extremities.
The condition typically starts with tingling and numbness in the fingers and toes that progresses up the hands and feet and into the arms and legs. Some patients report feeling intense, stabbing pains or increased sensitivity to heat or cold. The National Cancer Institute reports that neuropathy “can make it difficult to perform normal day-to-day tasks like buttoning a shirt, sorting coins in a purse or walking. An estimated 30 to 40 percent of cancer patients treated with chemotherapy experience these symptoms, a condition called chemotherapy-induced peripheral neuropathy.”
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Why exactly some people experience neuropathy and others do not is still being studied. Memorial Sloan Kettering Cancer Center physical therapist Laryssa Buoneto told the hospital’s “On Cancer” blog that, “the likelihood that a person will develop neuropathy after cancer treatment varies widely, and is largely dependent on what kinds of chemotherapy drugs were given and the dosage that was used.”
For those who do experience it, neuropathy can happen any time after treatment commences. The NCI notes it’s the number one reason that chemotherapy patients stop treatment early. For most neuropathy symptoms will slowly improve over time after administration of the drug causing it has stopped. But some patients experience permanent damage that can reduce quality of life.
Dr. Maryam Lustberg, breast medical oncologist and director of the survivorship clinic at the Stefanie Spielman Comprehensive Breast Center at Ohio State University, has studied chemotherapy-induced peripheral neuropathy and says that although the use of chemotherapy has “dramatically improved our outcomes in terms of achieving long-term cure in breast cancer,” there’s a “flip side. Many patients experience toxicity from chemotherapy including the commonly encountered chemo-induced neuropathy, which can present as numbness, tingling pain in the fingertips and toes, but also difficulty walking and balance issues.”
To get a better understanding of exactly when these balance and gait issues begin, Lustberg and co-author Dr. Ajit Chaudhari, a biomedical engineering researcher who’s studied balance and gait issues in athletes and older patients, designed a clinical trial for breast cancer patients. “We have a lot of data about gait and balance problems in patients with other neuropathies and patients who are older, but these balance changes have not been very well defined in the cancer population, so we decided to study the breast cancer population,” Lustberg says. Participants in the study had nonmetastatic breast cancer and were receiving chemotherapy “with a curative intent.”
The team “tracked how [participants’] balance changed with additional doses of chemotherapy,” by asking the patients to “stand quietly on a balanced plane.” In patients with no issues, they should be able to stand still. But in patients who have balance problems, “there’s a very subtle sway,” Lustberg explains. Using a specific measure of balance, the team charted changes as participants progressed through their courses of chemotherapy.
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Their results were published in the journal Breast Cancer Research and Treatment in April 2017 and showed that subtle changes to balance and gait could be the early signs of neuropathy. “We found that balance, particularly, changes very early on with chemotherapy exposure. So that even after one dose of chemotherapy, when we compare patients’ balance from what it was before chemotherapy exposure, there were already changes that had happened,” she says.
These subtle balance changes could be identified prior to the patient experiencing any of the symptoms that typically signal neuropathy, such as tingling or numbness. Therefore, Lustberg posits, assessing balance could be “an earlier measure of toxicity.”
Already, this information could be applied in clinical settings to help doctors identify patients who are experiencing toxicity from chemotherapy treatment before the pain and tingling of neuropathy actually takes hold and potentially curtails treatment. Lustberg says a subsequent study is investigating whether intervening early with certain exercises will make a difference.
Lustberg hastens to add, “we’re not saying chemo is bad. We’re saying if we can identify toxicities before they’re debilitating, we can essentially cure the cancer but also give patients a better quality of life. If we can intervene earlier, potentially patients can complete their therapy in a successful way.” She says in some cases, certain patients will accumulate toxicity and “get to the point where actually no more chemo can be given, and their therapy is cut short.”
But if intervention can stop or slow the progression of this toxicity, that could buy patients needed time to complete their course of treatment. “These quality-of-life measures are not just about quality of life,” Lustberg says. “They’re also about improving cure rates because if we can reduce toxicity, then patients can finish the treatment and essentially have a higher chance of survival and better outcomes from the cancer standpoint as well.”
[See: Breast Pain? Stop Worrying About Cancer.]
Until some of these questions have more solid answers, the best thing to do if you’re undergoing chemotherapy for breast cancer is to pay attention to your body. If you notice any changes or if you start having any tingling or numbness in your fingers or toes, tell your doctor right away. Your doctor may conduct a series of tests to determine whether you’re experiencing neuropathy and how best to approach the problem.
The American Cancer Society reports “so far, there’s no sure way to prevent CIPN. But this is a major problem for some people, and doctors are looking for medicines that work.” Nevertheless, there are some ways for your doctor to help lower the risk of CIPN such as breaking a single, large dose of chemotherapy drugs into two or three smaller doses given over the course of a week. Slowing the rate of infusion from one hour to six hours or even extending the infusion over the course of a few days may also help.
And if you do have neuropathy, pay attention to your hands and feet. It’s easy to cut yourself and not realize it if you’re experiencing a lack of sensation. You should also protect yourself from heat and cold injuries on the affected body parts. Stay vigilant and communicate with your doctor.
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What Is Breast Cancer-Related Chemo-Induced Peripheral Neuropathy? originally appeared on usnews.com
