Peripheral Neuropathy caused by chemotherapy medications and possible new treatment / preventative options

 When I was diagnosed with stage II-b invasive lobular breast cancer, my oncologist decided on chemotherapy after my bilateral mastectomies. I had chemotherapy treatments for three months following my surgery. Along with the five pre-treatment IV medications, I started out with Cytoxan and Taxotere ( docetaxal) as prescribed by my oncologist. Taxotere is a much used, and effective, chemotherapy drug used in treating breast, lung, stomach, prostate, head and neck cancers, among other types of cancers. Of course, as we all know, even the best medications have side effects. When I was practicing pharmacy, before I retired, I always said that it is a balancing act when starting any new  medication. One must look at the benefits versus the side effects of the drug, and decide on the appropriate action. I knew that Taxotere had some pretty bad side effects, but I felt that it was worth the risk of the possible side effects in order to kill the cancer cells. 

After my second treatment, though, I developed peripheral neuropathy in my toes, left foot, and some of my fingers. For those of you who wonder what peripheral neuropathy feels like, I think that it is somewhat different for each person. Some of my fingers were numb and tingling, and when I was barefoot, I felt that I was walking on carpet or cotton balls. In other words, my feet and toes were numb. I also experienced " pins and needles" feelings in my toes and feet at times.  My oncologist immediately stopped the Taxotere, and switched me to a regiment of Adriamycin ( doxorubicin) and Cytoxan. Adriamycin is " lovingly" referred to as the " Red Devil" by patients - probably due to it's high percentage of causing nausea and vomiting and the blood red color of the drug after it is reconstituted. It also can be very toxic to the heart, but peripheral neuropathy is not as common as it is with Taxotere.

I would love to say that my peripheral neuropathy went away, but it did not. Well, not in all locations. My fingers returned to normal, my right foot and affected toes still tingle sometimes, but not as badly. My left foot and toes are pretty much forever numb, and I still experience the "pins and needles" feeling at times.  This affects the type of shoes that I wear, among other things. I understood the risks of taking Taxotere, and for me it was at least, worth a try. I do not want a recurrence of my breast cancer or the risk of spread somewhere else, and there is the fact that the taxanes ( Taxotere is one of a class of these drugs) are very effective in killing cancer cells.

So, if cancer patients taking one these drugs develop peripheral neuropathy is there a treatment for this? The answer is no, not as yet. A more effective way is using  one or more treatments before the neuropathy starts. There are some studies that are trying to determine what type of patient might be more apt to develop neuropathy. Some possible red flags include patients who previously have had peripheral neuropathy, perhaps diabetics and older patients who might already have some nerve damage. Also, the neuropathy might be due to the number of chemotherapy cycles received. 

Some treatments that are being studied include the following: exercise, acupuncture, and cryotherapy ( or cold therapy). Exercise: a study involving aerobic exercise at home for a small group of patients for a period of six months reported significant improvement in their neuropathy. ( published in JAMA, August 1, 2023) There are no specific treatment guidelines for this in treating peripheral neuropathy. I think everyone would agree that exercise has many benefits, though. 

Acupuncture: there was a 2019 study in "Current Oncology "evaluating acupuncture in a small group of patients. The results were mixed- some benefited and some did not. This study concluded with the statement that more research is needed to determine the possible benefits of acupuncture and possible improvement of  neuropathy. There was an even smaller study conducted by researchers at Sloan Kettering Cancer Center in New York ( Jama Network Open, March 11, 2020) that concluded that after eight weeks of acupuncture, patients experienced less pain with their neuropathy. Acupuncture techniques vary, and clearly more studies are needed to determine the effectiveness of this treatment for neuropathy. 

Cryotherapy: where exercise and acupuncture are more treatments, cryotherapy is more of a preventative measure. I think a lot of people know about the " cold caps" that help prevent hair loss on the head 

 during chemotherapy. This is a similar technique, but instead of a cap, this involves frozen gloves and booties for the hands and feet. Again, more studies are needed to determine if this is an effective treatment to prevent peripheral neuropathy. 

I think an important take away from this and my personal story, is that patients need to be sure to tell their oncologists about ANY unusual symptoms that they may be experiencing during chemotherapy. Establishing a good relationship between patient and their oncologist is key in getting good treatment and having a good outcome. Quality of life after chemotherapy treatment is extremely important for the patient as well as the patient's family. 

Here are a few things that everyone needs to know about skin cancer.

 Everyone who reads by blogs, thank you- by the way!- knows that I am a thyroid cancer survivor as well as a breast cancer survivor. What I have not talked about is that I also am a skin cancer survivor. I had thyroid cancer in 2010, and breast cancer in 2015. In between those two cancers, I had squamous cell carcinoma on my leg, and basal cell carcinoma on my face. The treatment for both cancers was surgery; no other treatment was required, because they were detected early and had not spread to any of my lymph nodes. Early detection and treatment is KEY so I decided to provide some skin cancer facts, as well as suggested ways to prevent skin cancer. 

First of all, skin cancer is the MOST common cancer in the United States, according to the American Academy of Dermatology ( AAD). Listed below are some more facts about skin cancer from the AAD:

* It is estimated that one out of five Americans will develop skin cancer in their lifetimes.

*Approximately 9,500 people EVERY DAY in the U.S. are diagnosed with skin cancer.

*Non-melanoma skin cancers ( basal and squamous cell) affect more than 3 million Americans per year.

* Women have a greater increase of having basal and squamous cell cancer compared to men.

* Melanoma ( the most serious and deadly type of skin cancer) is said to be the fifth most commonly diagnosed cancer in men and women.

*Melanoma rates in the U.S. have doubled over the past 30 years.

* The good news is that melanoma incidence has begun to decline in adolescents and adults 30 years of age and younger.

* Skin cancer can affect anyone- regardless of skin color.

* Skin cancer rates are higher in women than in men before age 50, but are higher in men after age 50.

* It is estimated than melanoma will affect 1 in 27 men and 1 in 40 women during their lifetimes.

* Basal cell and squamous cell carcinomas, which are the two most common types of skin cancers, are highly treatable if detected early and treated appropriately.

The AAD encourages everyone to use sunscreen, wear protective clothing ( long sleeve shirts, pants, and a wide brimmed hat) as well as avoiding indoor tanning beds. The best, most protective outdoor clothing has ultraviolet protection factor ( UPF) on the label. Severe sunburns as a child increase the likelihood of skin cancer as an adult, so children need to be protected appropriately. 

* Risk factors for ALL types of skin cancer include people with skin that burns easily; blonde or red hair ( I have red hair!); a history of excessive sun exposure; frequent sunburns- especially as a child; tanning bed use; a weakened immune system; and a history of skin cancer.

I could not find, in the articles that I read, a consensus on how often a person should see a dermatologist for a skin check. Just from personal experience, I would recommend sooner rather than later, especially for cancer patients who have weakened immune systems. It is important to self check one's skin and pay attention to any moles or spots that change, darken or bleed, as well as irregularly shaped places that may be crusty and red in color. 

Personally, I go once a year to see my dermatologist ( I went more often right after my basal and squamous cell carcinomas were diagnosed) for a full body skin check. I can go more often if I need something checked out. Right before Christmas, I had a pre-cancerous lesion removed from my scalp. First, my dermatologist did a biopsy ( we cancer patients sure are familiar with THOSE) and in the abundance of caution, the lesion was removed. I had had this " spot" for quite some time, and my dermatologist felt that it was wise to remove it before it became cancerous. Yes, I had stitches in my head for Christmas...I did get two cute hats, though!

Seriously, skin cancer is , as the AAD said, the most common cancer in the United States. Survival rates for basal and squamous are very good if detected and treated early. Even with melanoma, according to AAD statistics, the five year survival rate for people whose melanoma is detected early with no spread to lymph nodes is 99%. That is compared to 68% if the melanoma has spread to the lymph nodes and 30% if the melanoma has spread to distant lymph nodes and other organs in the body. 

The take away from my blog would be this: use sun protection regularly, avoid tanning beds at all costs,  and get a full body skin check once a year or as often as your dermatologist recommends. The National Institutes of Health describes our skin as " the largest organ in the body, and covers the body's entire external surface." If we take care of our skin, it will take care of us.