Peripheral neuropathy (chemotherapy-induced)

Overview

• Triple-negative breast cancer: paclitaxel is the usual cause. Macmillan says to tell the team about any new tingling, numbness or pain early, because the doctor may lower the dose or stop the drug, and that for most people symptoms slowly improve once treatment ends, sometimes worsening for a few weeks first (coasting). Practical points from Macmillan: test bath water with your elbow, use oven gloves, and take care with balance and falls.
• The ASCO guideline (Loprinzi 2020) found no agent prevents chemotherapy neuropathy and that duloxetine is the only drug with evidence for established painful neuropathy, with limited benefit.
• Pancreatic cancer: oxaliplatin (in FOLFIRINOX and NALIRIFOX) and nab-paclitaxel are the causes. Pancreatic Cancer UK says it may be worse in the cold, that gloves, warm socks and avoiding cold food and drinks help, that it normally improves after treatment but can worsen in the first months, and to tell the team early so the dose can be changed before it becomes long term. Macmillan adds that oxaliplatin can rarely cause a throat spasm in the cold in the first days after a dose.
• The ASCO guideline (Loprinzi 2020) found no agent prevents chemotherapy neuropathy and that duloxetine is the only drug with evidence for established painful neuropathy.
• Oxaliplatin (in FOLFOX and CAPOX) is the main cause in bowel cancer. Macmillan says the numbness, tingling or pain in hands and feet is often made worse by cold during treatment, so keep warm, avoid iced drinks, take care opening the fridge and use gloves for frozen food; rarely oxaliplatin causes a spasm around the voicebox with difficulty swallowing or breathing in the first days after treatment, and the next doses may then be given over 4 to 6 hours.
• Bowel Cancer UK says symptoms can appear during the cycle and for up to two weeks afterwards, may get worse before they get better, and in some people last months or years, making writing, picking up small items and walking difficult. NICE NG151 asks teams to monitor prolonged sensory symptoms after platinum chemotherapy because they can be a sign that the dose needs reducing to minimise future permanent neuropathy.