The Center for Podiatric Care and Sports Medicine

Chemotherapy Induced Peripheral Neuropathy Can Last For Years Following Cancer Treatments

Posted by on Monday, January 8th, 2018

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It’s no secret that a cancer diagnosis correlates with decreased quality of life in many areas. Of particular interest to us here at The Center For Podiatric Care and Sports Medicine is the emphasis US researchers are placing on the way cancer treatments may affect the feet years later. Up to 40 percent of cancer patients who receive chemotherapy endure pain that disrupts sleep and everyday activities like walking. Common complaints after chemo include shooting or burning pain in the feet, numbness, tingling, and extreme sensitivity to cold. The problem is that rather than fading after recovery, these feelings can become permanent.

If you are dealing with chemotherapy-induced peripheral neuropathy or chronic foot pain along with breast cancer, you may wonder what can be done or if you must simply accept “the new normal.” We don’t have all the answers, but we’re keeping up with the latest research, so you can make the most informed decisions regarding your care.

Chemotherapy can lead to peripheral neuropathy, but there are some treatments that can improve the situation.
Chemotherapy can lead to peripheral neuropathy, but there are some treatments that can improve the situation. Image Source: Wikimedia user Peter Isotalo.

Foot Pain Leads to Significantly Decreased Quality of Life

A study published in Cancer Management and Research September 10th, 2017 concluded that significant differences were seen among breast cancer chemotherapy patients in terms of foot pain, foot function, physical activity, social lives, and energy. “General health care and foot problem prevention for breast cancer survivors should be given more consideration,” researchers concluded.

What Types of Chemotherapy Lead to Peripheral Neuropathy?

A new study and systematic review, published online in the Journal of the National Cancer Institute’s in August 2017, noted that patients with early-stage breast cancer displayed symptoms of peripheral neuropathy for years after receiving adjuvant chemotherapy. Clinicians looked at more than 1,500 women for the review. Those given adjuvant doxorubicin and docetaxel or concurrent doxorubicin, cyclophosphamide, and docetaxel—as opposed to just high cumulative doses of docetaxel—are 50% less likely to develop severe, lasting neuropathy.

Risk Factors For Chemotherapy-Induced Peripheral Neuropathy

One study published in the journal Breast Cancer Research and Treatment identified the following risk factors for PN:

  • Obesity
  • Insomnia
  • Anxiety
  • Depression
  • A history of falls

The Journal of the National Cancer Institute study and review also found that patient age, Body Mass Index, menopausal status, nodal status, type of surgery, and receipt of radiotherapy all had a bearing on how well patients fared 24 months later.

Treatment Options for Peripheral Neuropathy

It seems prevention is the best medicine when it comes to chemotherapy-induced peripheral neuropathy. “There is very little treatment for neuropathy, and there’s nothing that’s actually proven to work,” said Patricia Ganz, MD, lead author and director of the Center for Cancer Prevention and Control Research. “Since we don’t have an effective treatment, ideally, it would be best to prevent it from happening by not administering chemotherapy if it is likely to have minimal additional benefit,” she added.

Multivitamins could be linked to another possible method of prevention. Researchers at the Roswell Park Cancer Institute in Buffalo, New York found that women who took multivitamin supplements before breast cancer diagnosis and/or during treatment were nearly 40% less likely to develop chemotherapy-induced peripheral neuropathy (CIPN). Less neurotoxicity was linked to multivitamins in general, not any one particular supplement. The 1,000 women in the study were treated with paclitaxel, and the study findings were published in the Journal of the National Cancer Institute. The results weren’t necessarily a slam-dunk, as the use of multivitamins could indicate other “healthy lifestyle” behaviors that reduced the risk of CIPN.

Although there is currently no approved therapy for prevention or relief of CIPN, certain drugs may be able to improve symptoms:

  • Antidepressants are often the first line of treatment, particularly in patients who experience depression. Venlafaxine and duloxetine have shown promise in breast cancer patients with neuropathic pain. However, side effects such as nausea, fatigue, dizziness, constipation, and sexual dysfunction can make this therapy impractical for some patients.
  • In our practice, we have seen Lidocaine work as a useful additional therapy for patients with cancer-related neuropathy. Up to three patches may be applied for 12 hours per day. The side effects are mild, with a small number of individuals experiencing skin irritation.
  • Opioids like oxycodone, morphine, methadone, or tramadol reduce the general discomfort cancer patients experience and may reduce neuropathic pain as well. Side effects may include sedation, constipation, drowsiness, physical dependence, and tolerance.
  • N-Methyl D-Aspartate Antagonists like ketamine and dextromethorphan have been successfully used with cancer patients with persistent pain that has not responded to other treatments. The downside is that some patients experience hallucinations, agitation, and confusion, particularly with higher daily doses of 300 mg.
  • Capsaicin cream applied directly to the feet (up to four times a day) can lead to decreased pain perception due to depletion of substance P in the body. Patients may experience burning pain after the first application, which decreases over time, and they may need to wait a few weeks to see progress.

The Importance of Continued Research

Perhaps what was most striking about the current review is how little data was available to researchers. The studies saw as little as 11% of patients experiencing peripheral neuropathy to as much as 80% one to three years after initial treatment. Variations were great in terms of measures to assess peripheral neuropathy severity, the chemo regimens used, the follow-up time, and outcome measures. 

The largest clinical trial involved more than 2,000 patients. Of them:

  • 20.7% received four cycles of doxorubicin 60 mg/m2, cyclophosphamide 600 mg/m2, and docetaxel 60 mg/m 2 every 3 weeks
  • 19.1% received four cycles of doxorubicin, 60 mg/m2 docetaxel and 60 mg/m2 every 3 weeks
  • 18.5% received four cycles of doxorubicin 60 mg/m2 plus cyclophosphamide 600 mg/m2every 3 weeks, followed by four cycles of docetaxel 100 mg/m2 every 3 weeks

Quality of life was assessed at 6, 12, 18, and 14 months. By the two-year mark, 41.9% reported peripheral neuropathy, with more than half of the patients saying they were “very much bothered” by their symptoms and 10.3% of those cases considered “severe.” The 18.5% of patients treated in the third group had a higher rate of PN than those in the other treatment groups (49.8% vs. roughly 35%). Although this information is useful in alerting us to the importance of the situation, it is clear that more research needs to be conducted.

Our offices in Manhattan and White Plains, New York offer many breakthrough pain therapies you won’t find elsewhere, including pain-mitigating lasers, TENS therapy, and biopuncture. We are committed to helping you overcome whatever foot pain you are suffering from. If you are experiencing peripheral neuropathy or another foot condition, stop by our office or contact us today.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.