Neuropathy is the medical term for nerve damage, usually to the peripheral nerves in the hands, feet, arms, and legs. Chemotherapy drugs commonly use in breast cancer treatment are toxic to healthy nerve cells as well as to cancer cells. When those nerves begin to stop working, the result is tingling, numbness, weakness, pain, and even an impaired sense of touch.
Loss of feeling in the hands and feet can make it hard to pick up small objects and cause clumsiness and difficulty walking. Some people with nerve damage first notice a "pins and needles" feeling, not unlike when an arm or leg falls asleep. This same nerve damage can also cause constipation and bladder problems.
Common chemotherapy drugs used to treat breast cancer such as paclitaxel (Taxol), vinorelbine (Navelbine), capecitabine (Xeloda) and others can strip the coatings from the nerves, particularly those in the hands, feet, arms, and legs. The higher or more frequent the dose of the chemotherapy drug, the greater chance it will cause neuropathy.
Radiation treatment can also lead to neuropathy, and conditions such as diabetes, kidney problems, and malnutrition can cause nerve damage too. In some people, the cancer itself may be the cause of neuropathy.
Doctors can't do much to prevent neuropathy from developing, but one medication, amifostine (Ethyol), has been shown to protect nerves and tissues from damage when given to patients before chemotherapy begins. If possible, before beginning chemotherapy, talk to the doctor about which chemotherapy agent she plans to use and, if it's one that's likely to cause neuropathy, request amifostine, as well.
A few small recent studies have shown that the minerals calcium and magnesium, given intravenously as part of hydration during chemotherapy, can help prevent neuropathy. This is also worth discussing with the doctor ahead of time.
If you -- or the person you're caring for -- experience numbness or tingling, tell the doctor, who will administer tests to evaluate the strength of sensation in your hands, feet, arms, and legs. The doctor may also test your reflexes to see whether muscles are affected.
It's important to recognize neuropathy as soon as possible because the loss of feeling can make it difficult to do certain tasks, such as buttoning clothes, holding onto pots and pans, and driving. It can be frightening and dangerous to spill a pot of hot water or to stumble and fall.
If someone you're caring for begins losing feeling in her hands and feet as a result of nerve damage, she's going to be prone to small injuries and infections that could go unnoticed. She should avoid using knives, scissors, and other sharp objects as much as possible. Make sure, too, that her fingernails and toenails are trimmed regularly, because with the loss of sensation, it's easy to scratch or hurt herself.
If it's your mother you're caring for, take her for a manicure and pedicure, but tell the manicurist not to cut her cuticles to avoid infection.
At home, keep an eye on the thermostat, as extremes of hot and cold can cause increased pain for some people with neuropathy.
When talking to the doctor, describe symptoms of nerve damage as accurately as possible. Fortunately, the doctor has a long list of medicines she can try, so if one doesn't work, don't hesitate to ask for another.
In addition, a topical cream made from chili pepper extract (capsaicin) works well to relieve pain in the hands and feet. Some patients don't like it because it causes a burning sensation on the skin, but this feeling will go away if it's used regularly.
Chemotherapy can deplete the body of B vitamins and magnesium, and these deficiencies can cause neuropathy. Some breast cancer patients find that it helps to take a combination B vitamin with plenty of folic acid and a magnesium supplement. Some cancer patients find that high doses of powdered glutamine also help.
Neuropathy can also be treated with medications. The doctor may start by prescribing a tricyclic antidepressant or anticonvulsant, depending on the symptoms. Tingling and numbness usually respond well to antidepressants, while sharp stabbing pains respond best to anticonvulsants.
Although neuropathy causes many breast cancer patients to feel less mobile, exercise is one of the best ways to prevent and treat neuropathy because it gets the blood flowing to the extremities. The most effective exercises for people with nerve damage are walking and swimming. When walking, though, be sure to choose comfortable, sturdy walking shoes that fit well.
Neuropathy can cause a great deal of pain. If you or the person you're caring for experiences pain, ask the doctor about prescription opioid pain medications, which can make day-to-day activities much easier to bear. Opioids can be given in combination with tricyclic antidepressants or anticonvulsants. Numbing lidocaine patches reduce pain in specific areas.
Many cancer patients have found acupuncture to be an effective means of controlling the pain of neuropathy. Doctors vary in their attitude toward such alternative therapies, but there's growing acceptance of acupuncture for pain relief at many major cancer centers. As long as the doctor doesn't actively oppose the use of acupuncture, it's worth a try.
In most cases, neuropathy triggered by chemotherapy goes away over time. However, long-term nerve damage sometimes results. If mobility is a problem, ask the doctor what services are available. Physical therapy can help many patients regain strength and flexibility, while occupational therapy can help patients learn strategies for daily tasks such as getting dressed and preparing meals.
