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. Some people say they feel as though they are padded with cotton wool. You may have strange sensations in your hands and feet so that they tingle, like pins and needles. For some people, these feelings are actually painful. This type of nerve damage is called peripheral neuropathy.

You may have less control over fine movements of your hands. So doing things like fastening buttons can be difficult. If your feet are numb you may have loss of balance, which could make you more likely to fall. 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

 

 

Which drugs may cause nerve changes?

The types of cancer drugs that most commonly cause neuropathy are some biological therapy drugssuch as bortezomib (Velcade) and thalidomide.

And some chemotherapy drugs, such as

• Platinum based drugs – 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.

Our cancer drugs section has a separate page about each individual cancer drug, so you can see whether your drug is likely 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

 

 

Treating nerve changes

Your doctors and nurses will keep a close eye on you. Your doctor may need to lower the dose of the drug causing the neuropathy to try to stop your symptoms getting worse. Or they may 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.

Peripheral neuropathy is often temporary and improves once treatment ends. It is difficult to say how long it will take to improve. It can feel very slow, and take many months. Unfortunately some people don’t recover fully and may have permanent effects.

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

If you have pain, your doctor might prescribe painkillers such as paracetamol. You might have more than one type of painkiller prescribed. 

Doctors often use anti depressant drugs, such as gabapentin or duloxetine (Cymbalta), and anti epileptic drugs to treat nerve pain. Special shoes or hand and foot braces might help to reduce discomfort.

In some cases, your doctor might prescribe other treatments such as vitamin supplements or a drug called amifostine to help reduce symptoms, although it is not clear how helpful these are. A small study of 20 patients reported in 2012. The study found that a drug called lafutidine seemed to reduce neuropathy symptoms in some patients having taxane based chemotherapy for women's cancers. 

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.

 

 

 

Preventing nerve changes

Researchers are looking at ways to prevent nerve damage during treatment with cancer drugs. A recent trial looked at a drug called xaliproden. It reduced the risk of severe nerve changes by 39% in patients having oxaliplatin chemotherapy. It did not make the chemotherapy less effective. Another small trial used a drug called venlafaxine before, during and after oxaliplatin chemotherapy. This trial found that venlafaxine reduced the symptoms of neurotoxicity in some people. But we need larger trials to find out how helpful venlafaxine is and whether it can reduce neurotoxicity caused by other cancer drugs.

Doctors are researching other drugs such as amifostine, calcium gluconate, and magnesium sulphate to prevent peripheral neuropathy. The trials are at an early stage, so we don’t know yet how helpful these substances will be in preventing nerve changes.

 

 

Hints if you have 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