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Some people with breast cancer develop a condition called peripheral neuropathy. The most common cause of peripheral neuropathy in people who have been treated for cancer is chemotherapy.1 Symptoms of peripheral neuropathy may include numbness, tingling, or pain in the hands or feet. For many people, peripheral neuropathy is reversible.
It’s important to let your doctor know if you’re experiencing any symptoms of this condition so that they can make some changes to help you feel better.
Read on to learn more about what causes peripheral neuropathy and how we can treat it.
What is peripheral neuropathy?
Peripheral neuropathy is a condition that occurs when nerves in the peripheral nervous system (PNS) are damaged. 2
The nervous system
The human body’s nervous system is broken down into two parts: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord, and the PNS contains all the nerves outside the brain and spinal cord. 3
The nerves in the PNS carry messages from the brain and spinal cord to the rest of the body. These messages tell the body to move or perform bodily functions like digestion. These nerves can also carry sensory signals from the body back to the spinal cord and brain. This allows us to feel sensations like pain or when something is hot to the touch. 3
Damage to the peripheral nerves can affect the signals sent between the CNS and PNS. This can cause tingling, numbness, pain, or muscle weakness.3
What causes peripheral neuropathy?
For people with breast cancer, peripheral nerve damage is most often caused by chemotherapy. Chemotherapy drugs travel through the blood to cells all over the body. While these drugs treat the cancer cells, they can also harm healthy cells, including those of the PNS. When chemotherapy causes damage to the peripheral nerves, we call this chemotherapy-induced peripheral neuropathy. The chemotherapy drugs most associated with neuropathy are platinum chemotherapies and taxanes. 4
Chemotherapy-induced peripheral neuropathy is generally reversible, at least in part. It usually gets better after stopping or finishing chemotherapy. However, this is not the case for everyone. Some people may experience long-term neuropathy. We’ll talk more about how neuropathy can be treated below. 4
While chemotherapy is generally the main cause of peripheral neuropathy in people with breast cancer, other potential causes exist. Some drugs used in targeted therapies can affect the nerves. Tumors that press on nerves can also cause neuropathy. In some cases, surgery or radiation can damage nerves in the chest or armpit, which can cause the patient to feel neuropathic symptoms.2
Risk factors for peripheral neuropathy
Recent studies show that people with diabetes are more likely to develop chemotherapy-induced peripheral neuropathy than those without diabetes.5
Age may also be a factor. In a study of people who received taxane-based chemotherapy, people 60 and older were more likely to develop neuropathic symptoms than those younger than 60. 6
What are the symptoms of peripheral neuropathy?
Peripheral neuropathy often begins with numbness in the fingers or toes. This feeling may spread, moving up from the fingers and toes to the hands and feet. Symptoms can begin at any time during breast cancer treatment. They vary from person to person in terms of severity and how long they last. 4
In addition to numbness, symptoms of peripheral neuropathy may also include (2,4,7)
- pain, which can be burning, sharp, or shooting
- tingling (pins and needles sensation)
- itching
- muscle weakness
- more sensitivity to heat or cold
- difficulty picking up small objects
- difficulty with fine motor tasks such as buttoning clothes
- loss of balance
- digestive issues
- feeling of warmth or cold in hands or feet
- loss of touch sensation
- ringing in ears
If you experience neuropathic symptoms, we suggest keeping a journal to track your symptoms. Keep track of when and how often your symptoms occur, which part of your body is affected, what it feels like, and the intensity of your symptoms. 4
It’s important to let your doctor know about these symptoms right away so they can make some changes to make you more comfortable.
How is peripheral neuropathy treated?
Addressing the cause of the neuropathy
If you experience symptoms that sound like peripheral neuropathy while getting chemotherapy, your doctor may decrease the dose of the medicine you receive or try a new kind of medicine. Your doctor may also decide to change your treatment schedule or delay your treatments until the neuropathy is better.4
Some people might be concerned that stopping chemotherapy may disrupt their progress in their cancer treatment. However, stopping chemotherapy doesn’t take away its benefit. Continuing with chemotherapy while you’re experiencing symptoms of neuropathy is likely to make symptoms worse. Taking a break from chemotherapy and resuming later can help prevent long-term pain and numbness and the substantial impact pain and numbness can have on your quality of life.
Peripheral nerves can repair themselves after they have been damaged. 3 As a result, neuropathic symptoms generally subside after finishing chemotherapy treatment. One exception is the “coasting” effect, in which someone’s neuropathy gets worse even after stopping chemotherapy. This is generally seen with the platinum drugs.
Treating the symptoms
Your care team can help you find ways to treat your symptoms and refer you to specialists or other resources you may need. If you’re living with long-term neuropathy, it will be graded in terms of severity. If your neuropathy is associated with pain, an oncologist, cancer rehabilitation doctor, or palliative care doctor can help you medically manage the pain. Medications, creams, and patches can help treat nerve-related pain. 7
Common pain relief drugs, including opioids, do not help with nerve pain. Your medical team may prescribe a medicine that treats unrelated conditions like epilepsy or depression but also helps with nerve pain. Commonly prescribed medicines for neuropathic pain relief include amitriptyline, duloxetine, pregabalin, and gabapentin. 7
As with any medicine, there is the potential for side effects. Medicine to treat neuropathy as a side effect of cancer treatment can have its own side effects. However, these side effects may go away over time. If one medicine doesn’t work for you, you can work with your doctor to find another.
If your neuropathy is moderate and associated mostly with numbness, it’s not generally treated with medications. Working with a specialist can help you find other methods of treating your discomfort. These may include nerve stimulation treatments, physical or occupational therapy, massage, or acupuncture. (7-8)
For some, the nerve damage caused by chemotherapy can be permanent. 8 Living with a long-term side effect of breast cancer treatment can be difficult, especially if symptoms significantly impact your quality of life. Talking with your loved ones, a counselor, or a breast cancer support group can help.
What can I do to manage my symptoms?
Because peripheral neuropathy can affect your balance, movements, and handling of things, doing the following can help manage your symptoms and keep you safe: (2,4,7)
- clear any tripping hazards in your home to prevent falls
- be extra careful when using sharp objects like scissors and knives
- use mats in your bathroom or shower to prevent slipping
- check water temperature with your elbow or with a thermometer
- wear socks and gloves to keep your hands and feet warm
- when walking up and down stairs, use the handrail
- avoid tight-fitting clothes
- wear comfortable shoes or slippers
- use oven mitts when cooking
- avoid standing or walking for long periods
- regularly check your hands and feet for any injuries you may not have noticed
Summary
Peripheral neuropathy is a condition that can cause pain, numbness, or tingling, often in the hands and feet. The main cause of peripheral neuropathy for people with breast cancer is chemotherapy, which can damage the peripheral nerves. For many, this side effect is reversible and lets up after finishing treatment, but some people experience long-term effects. Be sure to let your doctor know if you’re experiencing any signs of peripheral neuropathy right away. Your care team can connect you with resources and help you find ways to manage your symptoms.
References
- Kamgar M, Greenwald MK, Assad H, et al. Prevalence and predictors of peripheral neuropathy after breast cancer treatment. Cancer Medicine. 2021;10(19):6666-6676. doi:10.1002/cam4.4202
- Neuropathy. Breastcancer.org. https://www.breastcancer.org/treatment-side-effects/neuropathy. Published August 2, 2022. Accessed November 15, 2022.
- About Peripheral Nerves. UC San Diego Health.
https://health.ucsd.edu/specialties/neuro/specialty-programs/peripheral-nerve-disorders/pages/about-peripheral-nerves.aspx. Published 2022. Accessed November 15, 2022.
- Neuropathy: Breast cancer side effects. Living Beyond Breast Cancer.
https://www.lbbc.org/about-breast-cancer/side-effects/neuropathy. Published September 16, 2022. Accessed November 15, 2022.
- Gu J, Lu H, Chen C, et al. Diabetes mellitus as a risk factor for chemotherapy-induced peripheral neuropathy: A meta-analysis. Supportive Care in Cancer. 2021;29(12):7461-7469. doi:10.1007/s00520-021-06321-7
- Rattanakrong N, Siriphorn A, Boonyong S. Incidence density and factors associated with peripheral neuropathy among women with breast cancer during Taxane-based chemotherapy. Scientific Reports. 2022;12(1). doi:10.1038/s41598-022-14870-y
- Peripheral neuropathy and breast cancer. Breast Cancer Now.
https://breastcancernow.org/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/side-effects/side-effects-chemotherapy/peripheral-neuropathy. Published May 17, 2022. Accessed November 15, 2022.
- Peripheral neuropathy. Macmillan Cancer Support. https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/peripheral-neuropathy. Published November 1, 2020. Accessed November 15, 2022.
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