Nerve changes and cancer drugs

About nerve changes and cancer drugs

Some cancer drugs, treatments or medical conditions can affect the way your nerves work. The medical name for these changes is neuropathy (pronounced noo-rop-uh-thee). Neuro means nerve, and pathy means disease or condition.

The changes can cause different symptoms depending on the nerves that are affected.

Cancer drugs most commonly affect the nerves of your hands and feet. This is called peripheral neuropathy. This might mean you have a change in feeling such as numbness and tingling in your finger or toes. You might find it difficult to control fine movements or to complete fiddly tasks such as doing up buttons.

These changes can be difficult to cope with and might affect your quality of life. Some treatments can help and you can do things to help you cope.

The nervous system

The nervous system is made up of the:

• central nervous system – which includes the brain and spinal cord

• peripheral nervous system – which includes sensory, motor and autonomic nerves

Peripheral nerves send messages between the brain, spinal cord and the rest of the body. They have the following functions:

• sensory nerves – send messages from the skin or muscles to the brain and spinal cord where they are processed so that you feel sensations such as pain, temperature or touch

• motor nerves – send messages from the brain and spinal cord to the muscles to control movements like walking

• autonomic nerves – control processes in the body that happen without you thinking about them, such as digestion and your heartbeat

Causes of nerve changes

Some cancer drugs can cause changes to how the nerves work. But there are also other reasons for nerve changes, such as:

• radiotherapy

• cancer pressing on a nerve

• diabetes

• a lack of vitamin B12

• certain medical conditions such as Lyme disease

The types of cancer drugs that might cause nerve changes are some:

• chemotherapy drugs

• targeted cancer drugs

• immunotherapies

Chemotherapy drugs that are most likely to cause nerve changes are:

• platinum drugs such as cisplatin, carboplatin and oxaliplatin

• vinca alkaloids such as vinblastine, vincristine and vindesine

• taxane drugs such as paclitaxel and docetaxel

Targeted cancer drugs that can cause nerve changes include:

• proteasome inhibitors such as bortezomib, carfilzomib and ixazomib

• thalidomide

Immunotherapy drugs can also affect the nerves. Examples include:

• ipilimumab

• nivolumab

Some hormone therapies and bisphosphonates can cause mild nerve changes.

Even if a drug can cause nerve changes it doesn’t mean you’ll definitely get them. Drugs affect people in different ways. It’s not possible to tell in advance who will have side effects. It can depend on:

• the drug or combination of drugs you are having

• the dose

• how you react to the drug

• how you reacted to drug treatment in the past

• if you have any other conditions affecting the nerves such as diabetes

Find out about the side effects of your cancer drug

What are the symptoms of neuropathy?

The symptoms depend on what nerves are affected. Sensory nerve changes are the most common.

Sensory nerve changes

Sensory nerve changes can cause the following symptoms:

• numbness

• less control over fine movements of your hands, this might make doing up buttons difficult

• your fingers might feel like they are padded with cotton wool

• pins and needles (paraesthesia) in your hands and feet

• tingling feeling

• if your feet are numb, you may have a loss of balance, which could make you more likely to fall

• pain and be more sensitive to pain

• increased sensitivity to cold such as breathing in cold air, touching cold objects, or eating and drinking something cold

• an abnormal and unpleasant feeling such as burning, stabbing, crawling, prickling or feeling of an electric shock (dysesthesia)

Motor nerve changes

Motor nerve changes can cause you to:

• have muscle weakness

• feel less stable on your feet

• lose muscle

Autonomic nerve changes

Autonomic nerve changes can cause:

• constipation and stomach pain if the nerves to the bowel are affected

• loss of bladder or bowel control

• difficulty getting an erection (impotence) if it involves the nerves in the penis

• low blood pressure when standing up (postural hypotension)

• a slower than normal heartbeat (bradycardia)

Nerve changes are often temporary and improve once treatment stops. It is difficult to say how long it will take to get better. It can feel very slow and may take many months or even years.

Unfortunately, some people don’t recover fully and have permanent effects. It can stop you from being able to do certain things and affect your quality of life if it is severe.

What is the treatment for nerve changes?

Your healthcare team will keep a close eye on you to check for nerve changes. They may need to lower the dose of the drug if it is causing neuropathy that’s affecting your quality of life. This might stop your symptoms from getting worse. Or they might stop the drug temporarily to allow the nerves affected to recover.

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

For any nerve changes related to immunotherapy treatment you might have steroids. This will depend on the severity of the symptoms. In some cases, they may stop the immunotherapy treatment or change it.

Treatment for peripheral neuropathy

Peripheral neuropathy is the most common nerve change, and it is not always easy to manage. How well treatment works varies a great deal from person to person.

Doctors may use an anti depressant drug called duloxetine to treat nerve changes. If this doesn’t work, your doctor may try a different type of anti depressant or an anti epileptic drug called gabapentin. Some people might have treatment as part of a clinical trial. These drugs help with other types of nerve (neuropathic) conditions.

Other treatments for peripheral neuropathy

There is some evidence that acupuncture, scrambler therapy and exercise could help people with peripheral neuropathy caused by chemotherapy. Scrambler therapy is a way of treating pain by using a machine to block pain signals.

But we need good quality studies and more evidence before doctors can use these treatments.

Talk to your doctor or specialist nurse if you are thinking of using any other treatments.

Help at home for peripheral neuropathy

Talk to your doctor or nurse if you have problems managing at home because of difficulty using your hands or feet. They can refer you to an occupational therapist or physiotherapist.

An occupational therapist can offer specialist equipment. Special shoes or hand and foot braces might help to reduce discomfort. A physiotherapist can suggest a specialist exercise programme to help you build your muscle strength.

Can you prevent nerve changes to the hands and feet?

Doctors do not suggest any drugs to prevent peripheral neuropathy. Talk to your doctor if you are worried about getting nerve changes. They can tell you what can be done if you have any signs of peripheral neuropathy. It might include making changes to your treatment such as changing the:

• type of drug

• dose

• way you have it

Research into preventing nerve changes to the hands and feet

Researchers have been looking to see if cooling hands and feet during chemotherapy treatment may help to reduce the side effect of peripheral neuropathy.

When your body is cold, the blood vessels become narrow (vasoconstrict). This slows down the blood flow. By reducing blood flow to your hands and feet before, during and after chemotherapy this might reduce the side effects. Researchers have been looking at different cooling methods including:

• cooling gloves or socks

• devices that cool your hands and feet, such as the Hilotherm Chemocare device

Early research results are promising. They suggest cooling treatments may help prevent or reduce nerve damage caused by chemotherapy. However, we need more research and clinical trials.

These cooling techniques are not widely available in the UK at the moment. So this might not be an option at your hospital. You can ask your doctor or nurse for more information.

Other researchers are looking at a new pain-relieving gel you apply to the skin.

Tips to help you cope with nerve changes

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

• Keep your hands and feet warm by wearing gloves and socks, especially in the cold weather.

• Keep physically active when possible. Physical activity is important to help manage fatigue and strengthen your muscles.

• Wear well fitting, protective shoes. Avoid walking around barefoot. Check your feet regularly for cuts or broken areas to the skin.

• 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.

• Keep floors clear of clutter to prevent falls.

• Keep rooms well lit and a light on during the night.

• Stand up slowly when feeling dizzy.

• Prevent constipation by eating enough fibre and drinking plenty of fluids.

• See an occupational therapist for specialist equipment, for example, a tool to help you fasten buttons.

• Talk to a counsellor or your specialist nurse if you’re finding it hard to cope with the changes caused by neuropathy.