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.
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