Webpage on Platinum . . . Sue and Beth

[Guest guest]

Excerpt: Neuropathy caused by platinum chemotherapy is

also difficult to cure — recovery may take 18 months

to five years or longer.

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What is neuropathy?

Neuropathy – sometimes called peripheral neuropathy –

is a condition that occurs after peripheral nerve

damage. Neuropathy may affect a single nerve or

several.

The nervous system is divided into central and

peripheral parts:

* The brain and spinal cord make up the central

nervous system.

* The peripheral nervous system includes the

nerves that leave the brain and the nerve roots that

come off the spinal cord and go to the internal

organs, limbs and skin.

Diseases, injuries and toxins, such as chemotherapy,

can cause neuropathy in cancer survivors. The damage

may lead to changes in sensation or muscle function

and can be mild or severe. Cancer survivors may

experience this condition as tingling or numbness in

certain areas of the body, especially the hands and

feet. These sensations range from mild to painful.

Neuropathy can be an upsetting, and sometimes scary,

condition for survivors. If you begin to notice

symptoms, talk to your health care team immediately.

What causes neuropathy?

Neuropathy is a common disorder, affecting about 1 to

2 percent of Americans.

Some causes include:

* Diabetes mellitus (sugar diabetes) – the most

common cause of neuropathy in the industrialized world

* Infections (such as leprosy, syphilis, HIV and

some forms of hepatitis)

* Nutritional deficiency (particularly of

thiamine)

* Inherited disorders of metabolism and other

diseases passed down through families

* Alcohol

* Pesticides

* Drugs used in cancer treatment, particularly the

platinum compounds, the taxanes, the vinca alkaloids

and thalidomide

* Hypothyroidism

* Renal failure

* Extreme stress (such as the stress of living

with a chronic illness)

* Radiation therapy (effects may be delayed for

many years)

* Some cancer tumors are associated with

neuropathy as a remote effect.

What are the symptoms of neuropathy?

The types and severity of neuropathy symptoms vary

greatly. Determining the amount of peripheral nerve

injury just by the amount of symptoms produced is

difficult. Symptoms are almost always greatest at

night. Common signs and symptoms of peripheral

neuropathy include:

* Fatigue

* Weakness

* Clumsiness

* Loss of balance, particularly in the dark

* Dizziness, especially when getting up from a bed

or a chair

* Numbness, especially of hands or feet

* Cramps, commonly in the calf muscles

* Pain, often burning or shooting in quality

* Sexual dysfunction

* Sensitivity to temperature

* Muscle wasting in the hands and feet

* Loss of reflexes

* Smooth, dry and red skin of hands and feet

Which cancer survivors are at risk?

Neuropathy can affect almost any cancer survivor, but

the following are high risk conditions.

* Cancer types

o Lung

o Breast

o Ovarian

o Prostate

o Myeloma

o Lymphoma and Hodgkin’s disease

o Testicular

* Having one or more of the following

characteristics may increase the chances of developing

neuropathy.

o Advanced age

o A family history of neuropathy (familial,

diabetes)

o Malnourishment

o Excessive use of alcohol

* Some medications, including chemotherapy

medications, also increase risk. Discuss your

medication-related risk with your health care team.

Chemotherapy medications that increase your

neuropathy risk include:

o Platinum

o Taxanes

o Vinca alkaloids

o Thalidomide

o Cytosine arabinoside

o Misonidazole

o Interferon

Can a survivor experience neuropathy during,

immediately after and/or years after treatment?

Neuropathy related to cancer may develop in the course

of treatment (such as with vinca alkaloids) or shortly

after. More often, neuropathy has a delayed onset,

with symptoms developing weeks or months after therapy

has ended. Nerve injury from radiation therapy may be

quite delayed, with symptoms occurring in some

instances years after treatment.

Peripheral neuropathy symptoms are often ignored by

both patients and health care professionals and

frequently are not recognized as being related to

peripheral nerve damage. For lung cancer, neuropathy

may be the earliest sign of the cancer. Report any

symptoms to your health care team right away.

Can neuropathy be cured?

The peripheral nerves have a great ability to heal.

Even though it may take months, most patients recover.

However, in some situations, neuropathy is difficult

to cure. Nerve injury caused by radiation often does

not recover well. Neuropathy caused by platinum

chemotherapy is also difficult to cure — recovery may

take 18 months to five years or longer. During

recovery of platinum-induced neuropathy, patients may

suffer increased symptoms. Unfortunately, some

patients with platinum neuropathy never recover.

Even if your neuropathy cannot be cured, you may

benefit from treatments to relieve your symptoms and

from rehabilitation designed to help you maintain your

physical abilities.

What are the treatments for neuropathy?

The treatment for peripheral neuropathy depends on the

cause.

Recovery can be helped by:

* Adequate nutrition (foods rich in thiamine,

protein and antioxidants)

* Controlling and correcting contributing

conditions such as diabetes or hypothyroidism

* Pain medications

* Physical therapy

Medications being researched in clinical trials show

promise in helping peripheral nerves to heal.

How will a cancer survivor’s life change if s/he has

neuropathy?

Pain and other symptoms of neuropathy can be mild or

severe. Each survivor’s experience will be different.

However, with appropriate treatment, the effects of

neuropathy can be limited. Medications, lifestyle

changes, rehabilitation and other treatments can be

used.

* Neuropathy can make standing for long periods or

walking without assistance difficult.

* Balance can be affected, increasing the risk of

falling.

* Activities like buttoning and tying laces or

ties can be difficult.

* Survivors may be sensitive to heat or cold.

Survivors with this sensitivity should avoid extreme

temperatures if possible and use protective clothing

and hats when needed.

* Neuropathy may cause a lack of pain sensation.

Survivors should pay careful attention to the skin on

their hands and feet because they could receive a

wound or a break in the skin and not feel it.

* If neuropathy affects your ability to feel the

foot pedals of your car, you should not drive unless

your car is adapted for hand controls. Neuropathy can

slow your reaction time in moving your foot from the

accelerator to the break pedal and may cause an

accident. Losing your ability to drive is upsetting.

You may feel you are losing your independence.

However, consider the increased risk to your safety

and to the safety of others on the road. Talk to your

health care team about your symptoms.

Physical and occupational therapists can provide

suggestions and special equipment to make daily tasks

safe and easier to manage. The suggestions may include

night lights, grab bars and other home safety measures

to help reduce the risk of falling. Therapists can

assist survivors with physical exercises that can help

them maintain physical abilities.

Pain from neuropathy can greatly affect your daily

activities and quality of life. For some, the pain and

changes required to manage it can lead to physical and

mental stress. Watch for signs of depression and talk

to your health care team or a mental health care

professional about managing your feelings.

Good communication with your health care team about

your symptoms and the changes they are bringing to

your life is important. The team can help you manage

these changes and provide referrals to other helpful

resources.

This document was produced in collaboration with:

Arthur Foreman, M.D.