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Chemotherapy-induced peripheral neuropathy is a type of nerve damage that sometimes occurs as a side effect of chemotherapy. Symptoms include pain, numbness, or tingling in the hands or feet. As nerve damage increases, the muscles in the feet or hands may become weak. Children may walk differently because they are unable to lift the front of the foot, a condition known as “foot drop”. Peripheral neuropathy usually improves after chemotherapy ends as nerves are able to heal. However, symptoms may not completely go away, and new symptoms can sometimes develop as late effects of therapy.
There are ways to manage peripheral neuropathy. A doctor may prescribe medicine to help with pain. Physical therapy and occupational therapy can also help patients address physical limitations due to pain, loss of sensation, and muscle weakness.
Specific symptoms of peripheral neuropathy depend on the type and severity of nerve damage. Symptoms may include:
Problems tend to start in the ends of nerves, farthest away from the spinal cord. This is why the hands and feet tend to be most affected. Similarly, weakness tends to occur in legs before arms.
Peripheral nerves carry signals from the brain to different parts of the body and back again. These signals can have different functions including motor (movement), sensory (pain, touch), or autonomic (blood pressure, temperature).
Chemotherapy medicines can harm these nerves. Drugs that pose the highest risk in childhood cancer include:
Higher doses and combinations of medicines can increase the likelihood of neuropathy. Younger children may be especially susceptible because their nervous systems are still developing. Radiation therapy and medical conditions such as diabetes can also cause nerve damage and increase the risk of peripheral neuropathy with chemotherapy.
In general, assessment of peripheral neuropathy considers:
Patients with symptoms of peripheral neuropathy may be referred to a neurologist for additional screening. A neurological exam includes tests that measure reflexes, sensations, and nerve signals (conduction). Based on this information, doctors may use a rating scale to assign a grade, or measure of severity, to nerve damage.
A physical therapist may also perform an exam to assess:
Information from the patient, family, and care team members helps decide next steps.
Doctors plan chemotherapy and supportive care to reduce risk for nerve damage as much as possible while still effectively treating the cancer. Researchers are studying drugs and interventions that might be used to help protect nerves from toxic effects of chemotherapy. When possible, doctors try to limit the dose of medication, plan to have rest breaks, or avoid combinations of therapies that increase risk of neuropathy.
Current treatment of peripheral neuropathy centers on management of symptoms. Strategies may include:
Muscle weakness, changes in gait, and poor joint alignment can lead to long-term health problems for pediatric cancer survivors. When joints and muscles don’t work properly, the knees, hips, and spine may become damaged over time. This causes pain and loss of function and can increase risk of falls. Pain and reduced mobility can affect work and family life. Peripheral neuropathy often leads to low levels of physical activity, which contributes to other health problems.
For survivors of childhood cancer, management of peripheral neuropathy and regular monitoring of symptoms is important for lifelong health and quality of life.
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Reviewed: August 2018