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Nerve changes and cancer drugs

Some cancer drugs can affect the way your nerves work. Read more about the symptoms of nerve changes and how to treat them.

Cancer drugs and your nerves

Many different types of drugs are used to treat cancer. Some drugs can affect your nerves.

The nerves most commonly affected are in your hands and feet. This can mean that you lose some of the feeling in your hands and feet so they may feel numb.

This type of nerve damage is called peripheral neuropathy. Peripheral nerves send messages to and from the brain and spinal cord (the central nervous system) to the rest of the body. Neuro means nerves and pathy means abnormal. 

Other nerves in the body may also be affected and this is called autonomic neuropathy. It can cause:

  • constipation if the nerves to the bowel are affected
  • loss of bladder or bowel control, which is usually temporary
  • difficulty getting an erection (impotence) if the nerves to the penis are involved
  • difficulty chewing and swallowing if the nerves in the neck are affected

The drugs that can cause nerve changes

The types of cancer drugs that most commonly cause nerve changes are some biological therapies and some chemotherapy drugs.

Examples of biological therapy drugs causing nerve changes include:

  • bortezomib (Velcade)
  • thalidomide

Examples of chemotherapy drugs causing nerve changes include:

  • platinum based drugs, including cisplatin, carboplatin and oxaliplatin
  • vinca alkaloids, including vinblastine, vincristine, vindesine and vinorelbine
  • taxane drugs, including paclitaxel and docetaxel
  • antimetabolites, including cladribine, cytosine, fludarabine, and methotrexate
  • ifosfamide, procarbazine, etoposide and thiotepa

Hormone therapies and bisphosphonates are very unlikely to cause nerve changes.

Even if a drug can cause these effects, it may not affect you that way. Drugs affect people in different ways and it is not possible to tell in advance who will have side effects. It depends on:

  • the drug or combination of drugs you are having
  • the dose
  • how you react to the drug
  • how you have reacted to drug treatment in the past

Symptoms of nerve changes

Nerve changes can cause the following symptoms:

  • you might have less control over fine movements of your hands, so doing up buttons can be difficult
  • your fingers might feel like they are padded with cotton wool
  • your hands and feet might tingle like pins and needles
  • if your feet are numb you may have loss of balance, which could make you more likely to fall

Although peripheral neuropathy most commonly affects the nerves of the hands and feet, any nerves in the body can be affected.

Other symptoms include:

  • constipation if the nerves to the bowel are affected
  • difficulty getting an erection (impotence) if the nerves to the penis are involved

Peripheral neuropathy is often temporary and improves once treatment stops. It is difficult to say how long it will take to improve. It can feel very slow, and may take many months or even years.

Unfortunately some people don’t recover fully and have permanent effects. If it is severe it can stop you from being able to do particular things such as driving.

Treating nerve changes

Your doctors and nurses will keep a close eye on you. They may need to lower the dose of the drug causing the neuropathy to try to stop your symptoms getting worse. Or they might stop the drug temporarily to allow the nerve changes to recover.

If your symptoms do get worse, your doctor might suggest a different treatment for your cancer.

There are various ways to manage the effects of peripheral neuropathy. How well they work varies a great deal from person to person.

Painkillers

Your doctor might prescribe painkillers such as paracetamol if you have pain. They might prescribe more than one type of painkiller. 

Anti depressants

Doctors often use anti depressant drugs, such as duloxetine (Cymbalta), and anti epileptic drugs, such as gabapentin, to treat nerve pain.

Complementary therapies

Some people find that complementary therapies such as massage or reflexology can help to reduce pain. Talk to your doctor if you are thinking of using any complementary therapies to make sure it is safe for you to use them.

In some cases, your doctor might prescribe other treatments such as vitamin supplements, or drugs such as amifostine.  

Also special shoes or hand and foot braces might help to reduce discomfort.

If you are having problems managing at home because of difficulty using your hands, talk to your doctor or nurse. You may be able to get specialist help from an occupational therapist or physiotherapist. 

Preventing nerve changes

Researchers are looking at ways to prevent nerve damage during treatment with cancer drugs.

They are looking at using medicines such as:

  • amifostine
  • calcium gluconate
  • magnesium sulphate
  • xaliproden
  • venlafaxine

The trials are at an early stage, so we don’t know yet how helpful these substances will be in preventing nerve changes.

Tips to help cope with nerve changes

There are some things you can do yourself to help ease discomfort and prevent injury:

  • Keep your hands and feet warm
  • Take gentle exercise when possible
  • Wear well fitting, protective shoes
  • Take care when using hot water – you may not be able to feel how hot the water is, and could burn yourself
  • Use oven gloves when cooking and protective gloves when gardening
  • Keep your skin moisturised and soft
  • Take care when cutting your nails
  • Have counselling or chat to someone to help you cope with the feelings and emotions caused by the nerve changes
Last reviewed: 
11 Sep 2017
  • Electronic Medicines Compendium
    Accessed January 2017

  • British National Formulary
    Accessed January 2017

  • British Medical Association and the Royal Pharmaceutical Society of Great Britain
    Accessed January 2017

  • Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial.
    J Durand and others
    Annals of Oncology. 2012 January; Volume 23 Issue 1 Pages 200-5

  • Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline.
    D Hershman and others
    Journal of Clinical Oncology 2014 June 20 Volume 32, Issue 18, Pages 1941-67. 

  • Neuropathic pain in adults: pharmacological management in non-specialist settings
    NICE Guidelines, 2017
    Accessed September 2017

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular side effect you are interested in

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