As an oncology nurse, I see more and more people fighting—and winning—the battle against cancer these days thanks to earlier detection and a variety of new treatment approaches. But, like many healthcare professionals, I also see many cancer survivors struggle with the underappreciated long-term health effects often referred to as the “price of survival.”
Cancer-related neuropathy is a common long-term health effect impacting a third of cancer survivors. It can result from the tumor compressing on and/or infiltrating the peripheral nerves as well as from the cancer therapies (surgery, chemotherapy, or radiation).
Neuropathy symptoms include numbness, tingling, weakness, and pain in the extremities; muscle weakness and loss of balance can also occur. For some patients, the symptoms typically begin several weeks or months after initiation of cancer therapy and progress while therapy continues, compromising quality of life and the ability to complete cancer therapy regimen. But for other patients, the neuropathic symptoms continue long after cancer treatment has ended.
So, what do we do to help cancer survivors who go from battling cancer to battling cancer and neuropathy?
Recognize the symptoms early. This is an important first step for both patients and health care professionals. It is easy to overlook neuropathy’s initial symptoms when fighting cancer, but it is important to address the neuropathy and the cancer simultaneously. Cancer survivors should partner with their healthcare providers to:
- assess the neuropathy symptoms as soon as possible;
- confirm if the neuropathy is related to the cancer therapy, the cancer itself, or a pre-existing neuropathy (this may influence the development of cancer therapy-related neuropathy); and
- determine if the cancer therapy regimen should be modified to minimize neuropathy’s debilitating effects.
Provide pain relief and rehabilitative care. Neuropathy can interfere with just about every aspect of daily living, from buttoning a shirt to standing up for an extended period of time to enjoying an outing with family. Chronic neuropathic pain can, in turn, lead to sleep disturbances, anxiety, depression, and cognitive impairments, which further deteriorates quality of life as well as response to treatment. Pain management and rehabilitative care is essential to restoring psychological well being, quality of life, and function.
We are making progress in the fight against cancer as evidenced by the 14 million (and growing) cancer survivors in the U.S. But much more needs to be done to address the long-term health issues—like neuropathy—that cancer survivors and their caregivers are largely unprepared for. More research dollars must be spent on preventing neuropathy, relieving symptoms, improving physical function and quality of life of cancer survivors so that those of us who do research in this area can make a difference. It is not enough that we help patients beat cancer; we have to help them lead healthy and productive lives as cancer survivors.
Cindy Tofthagen is an oncology nurse and assistant professor at the University of South Florida College of Nursing and a post-doctoral fellow at the University of Massachusetts Boston and Dana-Farber Cancer Institute. She serves on The Neuropathy Association’s Neuropathic Pain Management Medical Advisory Council.