Key questions about peripheral neuropathy

Find answers to essential questions about peripheral neuropathy:

• What causes peripheral neuropathy?
• How common is peripheral neuropathy after chemotherapy?
• Will it get better?
• Can it be prevented?

What causes peripheral neuropathy?

There are many causes of peripheral neuropathy. Some types of chemotherapy used to treat cancer may damage peripheral nerves. This side effect is called chemotherapy-induced peripheral neuropathy (CIPN). Sometimes, other treatments such as immunotherapy, or the cancer itself, are the cause.

Possible cancer-related causes of peripheral neuropathy include:

• certain chemotherapy drugs, in particular taxanes (e.g. docetaxel, paclitaxel), platinum drugs (e.g. carboplatin, cisplatin, oxaliplatin) and vinca alkaloids (e.g. vincristine)
• the use of immunotherapy drugs
• some other cancer drugs, such as thalidomide, bortezomib and brentuximab vedotin
• some types of cancer (e.g. lung cancer, myeloma and lymphoma)
• tumours pressing on nerves
• surgery or radiation therapy damaging nerves.

Diabetes, shingles, heavy use of alcohol and some drugs, and a lack of certain vitamins and minerals (especially vitamin D and some B vitamins) can also cause, or contribute to, your risk of peripheral neuropathy. Smoking may also increase your risk.

Will I get it if I have chemotherapy?

About 40% of people who have chemotherapy will have symptoms of peripheral neuropathy. But the risk varies with different chemotherapy drugs. In people treated with certain chemotherapy drugs, the rate is higher, with about 70% of these people experiencing some symptoms a month after treatment, and about 30% still having symptoms 6 months after treatment finishes.

Will it get better?

Some types of chemotherapy cause short (acute) episodes of peripheral neuropathy during, or soon after, a cancer treatment session. These episodes tend to last a few days. For other types of chemotherapy, peripheral neuropathy may

be longer-lasting (chronic). It may start during treatment and the risk increases the more treatment cycles that you have. In some cases, peripheral neuropathy can develop or get worse over time, even after treatment has finished.

When cancer treatment ends, the peripheral neuropathy symptoms may begin to improve over 6–12 months. In some people, symptoms are permanent and may be mild to severe. This is more likely if you have had intensive treatment, such as a high-dose chemotherapy, or if you have diabetes or other risk factors for peripheral neuropathy.

Can it be prevented?

So far, no therapy has been proven to prevent peripheral neuropathy, although studies suggest that exercise may help (see page 5). Researchers are studying whether ice mitts and booties (gloves and socks) worn during chemotherapy could help, but there is not enough evidence yet to tell if this works.

It may help to be checked for any existing nerve damage before starting treatment, so that any changes can be checked against this baseline.

If you start having symptoms during chemotherapy treatment, your doctor may reduce the doses of chemotherapy drugs, or increase the time between treatment cycles. This sometimes allows the nerves to recover and prevents permanent damage.

Some people may need to stop having a particular chemotherapy drug. You can talk to your doctor about how they will balance the risk of changing the chemotherapy plan against the risk of the nerve damage becoming permanent.

→ READ MORE: Symptoms of peripheral neuropathy