Peripheral neuropathy and breast cancer

Peripheral neuropathy happens when the peripheral nerves are damaged.

The peripheral nerves are nerves close to the surface of the skin. They send messages between the brain and the spinal cord (the central nervous system) and the rest of the body.

Peripheral neuropathy is most common in the hands and feet.

Chemotherapy is the most likely cause of peripheral neuropathy for people with breast cancer. It can also be caused by some targeted therapies.

The most common chemotherapy drugs that cause peripheral neuropathy are:

Whether you develop peripheral neuropathy will depend on:

• The drug, or combination of drugs, you’re having
• The dose you’re prescribed
• Whether you have had previous cancer treatment that causes peripheral neuropathy
• Whether you have diabetes or another condition that can cause nerve damage

Other cancer treatments can cause peripheral neuropathy, such as surgery or radiotherapy to the armpit and lymph nodes.

Peripheral neuropathy can also be caused by the cancer pressing on a nerve.

You can discuss your risk of developing peripheral neuropathy with your treatment team.

Symptoms of peripheral neuropathy can include:

• Pain that's often burning, stabbing or shooting
• Numbness in your hands and feet
• Altered feelings in your hands and feet
• Loss of balance or feeling light-headed or dizzy when you stand up
• Pins and needles or tingling in your hands and feet
• A feeling of warmth or cold in your hands and feet
• Increased sensitivity to pain and hot or cold temperatures
• Difficulty doing "fiddly" tasks, such as doing up buttons
• Muscle weakness

Symptoms are often mild to start with and can gradually get worse.

Some people have mild symptoms that go away soon after treatment stops. However, for most people the symptoms will gradually improve over the weeks and months after treatment has finished.

In some cases, the symptoms of peripheral neuropathy may take longer to improve and may not go away completely.

You may also develop peripheral neuropathy after your treatment has finished.

Tell your treatment team if you develop any symptoms of peripheral neuropathy during or after treatment.

Unlike many other types of pain, nerve pain caused by peripheral neuropathy is not usually relieved by paracetamol or ibuprofen.

Instead, you may be given drugs that are usually prescribed for depression or epilepsy.

You may be prescribed:

• Amitriptyline
• Duloxetine
• Gabapentin
• Pregabalin
• Venlafaxine

You may also be prescribed gels and creams to help with pain relief.

Your treatment team may talk to you about delaying or reducing your treatment if you have symptoms of peripheral neuropathy. If your peripheral neuropathy is severe, your treatment team may recommend stopping a particular treatment. This is to try to prevent further damage caused by peripheral neuropathy.

You can also ask your treatment team to refer you to a specialist pain clinic. They may suggest other types of pain relief or alternative ways of trying to manage symptoms, such as physiotherapy or acupuncture.

There’s more information on the NHS website.

There are things you can do to manage the symptoms of peripheral neuropathy.

Avoiding injury

If you have loss of feeling in your hands and feet you might be more likely to be injured. The following may help:

• Wearing well-fitting shoes and slippers to protect your feet
• Taking care when cutting fingernails and toenails
• Checking the temperature of water with your elbow to make sure it isn’t too hot
• Using oven gloves when cooking to avoid burning your hands
• Using gloves for gardening or washing up
• If your balance is affected, making sure your home is well lit and floors are clear of trip hazards (you can ask to be referred to a physiotherapist who can advise you further)
• Checking regularly for injuries to your hands and feet so any injuries can be assessed quickly (this may prevent the injury getting worse or developing an infection)

Other things that may help

• Keeping your hands and feet warm by wearing socks and gloves
• Wearing seamless cotton or bamboo socks (these may help with circulation and breathability)
• If you’re having difficulty with fiddly tasks such as fastening buttons, asking for a referral to a physiotherapist or occupational therapist
• If you feel light-headed or dizzy, stand up slowly and make sure the dizziness has passed before you start to walk around

Some people find exercise improves circulation and coordination and can help with symptoms of peripheral neuropathy.

Other people have found complementary therapies, such as acupuncture, massage and reflexology, helpful.

Currently there’s no proven way to prevent or reverse peripheral neuropathy, though studies are looking into this.

You can speak to your treatment team about ways to reduce your risk of developing peripheral neuropathy.

You should let the Drivers and Vehicle Licensing Authority know if you have peripheral neuropathy.

You can talk to your treatment team about this or call our free helpline if you have any questions.