Taxane chemotherapy neuropathy: numb or tingling hands and feet after paclitaxel or docetaxel

The NHS explains that peripheral neuropathy develops when nerves in the extremities, such as the hands, feet and arms, are damaged. The symptoms depend on which nerves are affected. The peripheral nervous system includes sensory nerves, which carry sensations such as pain and touch, motor nerves, which control muscles, and autonomic nerves, which regulate automatic functions such as blood pressure and bladder function.

When the damage is caused by an anti-cancer drug it is called chemotherapy-induced peripheral neuropathy. Macmillan says the drugs that most often cause it are platinum-based drugs, vinca alkaloids, some targeted therapies such as thalidomide and bortezomib, and the taxanes: docetaxel, paclitaxel and cabazitaxel.

Taxane neuropathy is mainly a sensory problem in the hands and feet. It is a side effect of treatment, not a sign that the cancer is progressing, although any new symptom during treatment should be mentioned so that your team can assess it.

Macmillan lists tingling, pins and needles or numbness in the affected area; difficulty doing up buttons or picking up small objects; a burning or warm feeling; pain that can be mild or more severe; skin that is very sensitive; muscle weakness that makes it hard to walk or climb stairs; and problems with balance, walking and co-ordination. Macmillan says that when other nerves are affected there can also be constipation and bloating, light-headedness when standing, or being less able to feel hot and cold.

Cancer Research UK says to tell your healthcare team if you are finding it difficult to walk or to complete fiddly tasks such as doing up buttons. Macmillan says it is important to tell your team about any new symptoms or if symptoms get worse, because this helps them decide whether to continue your treatment, reduce the dose or stop the drug.

Macmillan also notes that these symptoms may develop months or years after treatment, so a new numbness long after chemotherapy is still worth mentioning to your GP or oncology team.

• Report new numbness, tingling or pain in the hands or feet at your next appointment, or sooner by using your chemotherapy advice line if it is interfering with walking or daily tasks.

• Report any cut, blister or sore on a numb foot that does not heal; the NHS lists a cut or ulcer on the foot that is not getting better as a reason to see a GP.

• Seek urgent help for sudden weakness, trouble walking, or loss of bladder or bowel control, as these are not typical of taxane neuropathy and need prompt assessment.

Macmillan says that for most people the symptoms of cancer-related peripheral neuropathy will slowly improve when cancer treatment has finished, and that gradual improvement once the drug is stopped happens as the nerves slowly recover. It says this may take several months or longer, and that symptoms may get worse for a few weeks before they start to get better.

Cancer Research UK describes numbness or tingling with paclitaxel and docetaxel as often temporary and able to improve after treatment ends, but says that with paclitaxel it can continue for a long time and may be permanent. The NHS makes the same general point about peripheral neuropathy: the outlook varies with the cause and which nerves are damaged, and in some people the damage may be permanent.

So the honest answer to how long it lasts is that it varies between people. Your oncology team is the best source for what to expect given your drug, dose and any other risk factors, such as diabetes. Macmillan says it is important to tell your doctor if you already have peripheral neuropathy before you need anti-cancer treatment.

The sources read describe no treatment that reverses the nerve damage, so the aims are to adjust the cancer drug when appropriate, to ease symptoms and to prevent injuries. Macmillan says the doctors may continue treatment, reduce the dose or stop the drug depending on how severe the symptoms are.

For nerve pain, the NHS says standard painkillers often do not work and that nerve pain may be treated with prescribed medicines called neuropathic pain agents. Macmillan says a drug that has been shown to help in chemotherapy-related neuropathy is duloxetine, and it describes physiotherapy, TENS and occupational therapy as supports, with referral to an occupational therapist if daily tasks such as washing or dressing are hard.

Macmillan also says research is looking into cryotherapy, which cools the hands and feet before and during chemotherapy, to prevent neuropathy. It is described as research rather than routine care.

Reduced feeling makes injuries easier to miss. Macmillan advises protecting hands and feet from injury and lists practical steps that cover most everyday risks.

• Wear gloves and socks in cold weather to keep hands and feet warm, and gloves when gardening or washing up.

• Use oven gloves and take care to avoid burning your hands when cooking.

• Wear well-fitting shoes or boots, avoid walking barefoot, and check your feet often so scratches or injuries are treated promptly.

• Test the temperature of bath and shower water with your elbow rather than your fingers or toes.

• If balance or walking is affected, keep rooms well lit and ask a physiotherapist about walking aids; Macmillan says you may be more at risk of falls.

• Ask a physiotherapist or exercise specialist how to exercise safely.

Taxane neuropathy is usually managed by the oncology team that prescribed the chemotherapy, with help from the GP, physiotherapy, occupational therapy and pain services. Because the cancer drug decision matters most, symptoms are best reported to that team early rather than managed alone.

Some people also see a private neurologist or pain specialist for a second opinion on persistent symptoms. If you do, share the results with your oncology team so that treatment decisions stay co-ordinated.