Chemotherapy-induced peripheral neuropathy

Peripheral nerves run from the spinal cord out to the skin, muscles and organs. Some chemotherapy and other cancer treatments are toxic to the nerve fibres as well as to cancer cells, interfering with how signals are sent. The National Cancer Institute describes the result as damage to the nerves that carry information from the brain through the body.

Because the longest nerves are the most exposed, the feet usually show changes first, followed by the hands. That is why symptoms are typically symmetrical and creep up from the fingertips and toes rather than appearing on one side.

A person may have one pattern or a mixture. Patients often describe the same symptom differently, so it helps to note when it started and what makes it worse.

Several drug families used in cancer care are known to affect nerves, including platinum-based drugs, taxanes and some other agents. Whether you develop neuropathy depends on the drug, the total amount you receive over time, your other health conditions and the way your body handles the treatment. Existing nerve problems, for example from diabetes or heavy alcohol use, make it more likely that symptoms will be noticed early.

The NHS lists medicines among the recognised causes of peripheral neuropathy alongside diabetes, infections such as shingles, injury and alcohol. Your team will usually check whether a second cause is contributing, because treating that cause can help even when chemotherapy is the main trigger. Our page on taxane-related nerve damage covers that drug family in more detail.

The National Cancer Institute advises reporting nerve symptoms promptly, as early diagnosis and treatment can prevent further damage and reduce complications. Before each cycle, the team may ask about numbness, buttoning clothes, walking and balance. Some centres use short questionnaires; others simply examine reflexes, vibration sense and walking.

Assessment is mostly clinical. Blood tests may be used to look for other causes such as vitamin deficiency, thyroid problems or diabetes, and nerve conduction studies are reserved for cases where the picture is unclear or another neurological condition is suspected.

• Keep a simple diary: date, which fingers or toes, whether it interferes with tasks.

• Mention falls, near-falls or objects dropped, not only tingling.

• Report new bowel, bladder or dizziness problems, which may signal autonomic involvement.

• Bring a list of all other medicines and supplements to the review.

The oncologist may decide to delay a cycle, lower the amount of a drug or switch to an alternative if symptoms are moving from mild to disruptive. This is a balance between controlling the cancer and protecting function, and the decision belongs with the treating team.

For nerve pain, the NHS notes that ordinary painkillers are often ineffective for neuropathic pain, and that specific nerve-pain medicines, physiotherapy and walking aids may be used. The National Cancer Institute adds that approaches such as acupuncture, massage, physical therapy and yoga may help with symptoms when used under medical guidance. Evidence for any single approach is mixed, so ask the team or a pain specialist what suits your situation.

• Check feet and hands daily for blisters, cuts or redness, especially if feeling is reduced.

• Test bath water with an elbow or thermometer rather than the feet; take care with heaters and hot-water bottles.

• Wear well-fitting, closed shoes and avoid walking barefoot indoors.

• Clear trip hazards, improve lighting, and move slowly on stairs and when getting up at night.

• Accept help with fiddly tasks while strength and sensation are reduced.

Outlook varies. In some people the symptoms ease gradually once the drug is stopped, while in others they plateau or persist, which the NHS also notes for peripheral neuropathy generally: some cases improve with treatment and others cause permanent damage. Symptoms occasionally continue to worsen for a short time after the final cycle before settling.

If numbness persists, referral to a neurologist, a physiotherapist or a pain clinic can help with function, footwear, balance training and symptom control. Living well with long-term neuropathy is largely about safety, pacing and keeping active.

Contact your cancer helpline or the team promptly if weakness is getting quickly worse, you cannot hold objects, you are falling, or you have a foot wound that is not healing. Sudden weakness in the legs with loss of bladder or bowel control, or severe back pain with leg numbness, needs emergency assessment through 999 or A&E, as it can indicate a different problem such as spinal cord compression, which needs separate urgent care.