Lecture on Chemotherapy-Induced Peripheral Neuropathy

Introduction

• Lecturer: Assistant Professor of Medicine at Cooper Medical School of Rowan University
• Specialty: Internal medicine, palliative medicine with a focus on symptom management for cancer patients

Topic Overview

• Title: Chemotherapy-Induced Peripheral Neuropathy
• Key Questions:
  • What is peripheral neuropathy and its causes?
  • Symptoms and duration
  • Relief and protection strategies
  • Additional advice for cancer survivors

Peripheral Neuropathy Overview

• Prevalence: Affects 5-10% of the general population
• Common Causes:
  • Diabetes (major cause)
  • Heavy alcohol use, nutritional problems, thyroid issues, rheumatoid arthritis
  • Rare genetic diseases
• Cancer Context: Up to 90% of cancer survivors experience neuropathy, primarily due to chemotherapy

Causes of Chemotherapy-Induced Neuropathy

• Mechanism: Chemotherapy damages nerves, especially in hands and feet due to long nerve pathways from the spinal cord
• Common Chemotherapy Drugs:
  • Platinum-based drugs (cisplatin, carboplatin)
  • Taxanes (docetaxel, paclitaxel)
  • Vinca alkaloids

Types of Nerves Affected

• Sensory Nerves: Most commonly affected
  • Symptoms: Tingling, burning, numbness, pain, coordination issues
• Motor Nerves: Affect movement
  • Symptoms: Difficulty walking, muscle weakness, cramps
• Autonomic Nerves: Less common
  • Symptoms: Sweating issues, digestive problems, blood pressure regulation, sexual dysfunction

Symptom Duration

• Prognosis:
  • 1/3 recover within months
  • 1/3 have residual symptoms that improve but persist
  • 1/3 have symptoms that do not improve

Management Strategies

• Exercise: Key recommendation
  • Work with trainers or physical therapists
  • Focus on balance, stable environments, avoid overexertion
  • American Cancer Society: 150 minutes of moderate or 75 minutes of vigorous exercise + strength training
• Other Non-Medication Approaches:
  • Acupuncture
  • Transcutaneous Electrical Nerve Stimulation (TENS)

Medications for Relief

• Anti-depressants: Nortriptyline, Duloxetine (Cymbalta)
• Seizure Medications: Gabapentin, Pregabalin (Lyrica)
• Topical Treatments: Lidocaine patches, Capsaicin
• Medicinal Cannabis
• Interventional Pain Management: Nerve injections, spinal cord stimulators
• Opioids: Used cautiously

Research and Future Directions

• Neurofeedback
• Scrambler Therapy
• Repetitive Transcranial Magnetic Stimulation (RTMS)

Safety and Injury Prevention

• Foot Care: Regular checks, proper footwear
• Environmental Safety: Avoid clutter, use night lights, secure handrails

Closing Thoughts

• Peripheral neuropathy is common post-cancer treatment
• Multiple management strategies available
• Emphasis on safety and exercise for maintaining function

Q&A Highlights

• Discussed the variability of symptoms and treatment effectiveness
• Insights on supplements and alternative therapies
• Saw common questions about symptom persistence and management options