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How Can We Help Patients Who Suffer from CIPN?

By Pam McMillan, RN, OCN
PUBLISHED THURSDAY, JANUARY 1, 1970
Sorry your hands, fingers, and feet are numb, but look on the bright side – you're alive!  Have you heard or ever thought that before?  Maybe you’ve heard one of your patient’s say that these side effects just come with the territory.  My question to you is - How often do we underestimate the effects of chemotherapy-induced peripheral neuropathy (CIPN)? 
 
Often, we hear our patients complain of the tingling and numbness in the hands and feet, but I know it can be more than that.  I recently had the privilege of taking care of a particular patient that opened my eyes to the effects of CIPN.  I can remember her telling me her story and expressing to me how the quality of her life changed significantly after her treatment for cancer.  The things she once loved to do she couldn't, thanks to CIPN.  She had to give up on her hobbies that she enjoyed.  She had to depend on others to drive her because she was afraid that she wouldn't be able to feel the pedals in the car and cause a wreck.  She couldn't sleep well because the sheets touching her feet caused pain. Her activities of daily living were much more than a chore.  She told me if she knew it would have been this bad she might have thought twice about taking the treatment that saved her life.  It was then that the light bulb went off.  Are we "blowing off” patient's CIPN?  I realized that although they may be grateful to be alive, is that the quality of life worth living?
 
Chemotherapy-induced peripheral neuropathy is characterized by damage to the nervous system that is a direct result of the medications associated with chemotherapy.  Studies state that 30-100% of patients can experience CIPN, depending on the agent, dose, and other factors.  Chemotherapy-induced peripheral neuropathy can affect patients walking, picking things up, driving, hobbies, relationships, work, writing, exercise, sleep and sexual activity.  It can disturb every aspect of a patients' quality of life. 
 
Understanding the effects of CIPN is imperative to be able to care for our patients better.  Many times, patients do not want to mention the numbness or pain they have been experiencing, because they don't want to delay or stop the treatment for fear of prolonging their treatment schedule or not receiving the full benefits of therapy.  Other times physicians fail to recognize the symptoms promptly. As a healthcare provider, we need to be proactive during and after treatment. It is imperative that we assess our patients.  Ask specific questions – what symptoms are you having? Is it one side or both?  How much of the extremity is involved?  How severe and distressing is each symptom? Are the symptoms constant or do they come and go?  How are your activities of daily living being affected?   Finding out the answers to specific questions can help guide physicians in treatment decisions.
 
What can patients do if they suffer from CIPN?  Unfortunately, there is not an easy fix, but patients do have options that can improve their neuropathy.  Because physicians are focused on controlling a patient’s pain, medical management is most often the first step for patients.  Treatment may include prescribing Cymbalta, Lyrica, or Gabapentin. There are alternative therapies such as acupuncture, massage, and reflexology that may ease their pain from neuropathy.  Patients may also benefit from Physical Therapy by improving balance, walking, and learning to use an assistive device. Occupational Therapy can also help patients with their activities of daily living, improving their fine motor skills, and teaching them how to use adaptive equipment.  They may also benefit from exercise programs such as water exercise, a strength & balance class, Tai Chi, and yoga.  Although patients survived their cancer, giving them their quality of life back should be a priority for those that are suffering from CIPN.
 
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