Episode 290: Cancer Symptom Management Basics: Peripheral Neuropathy

"I think educating patients of what can happen and those are the symptoms you're really looking for to decrease this from getting to the severe level is like the sensory stuff. It's kind of your starting point and it progresses from there," Colleen Erb, MSN, CRNP, ACNP-BC, AOCNP®, hematology and oncology nurse practitioner at Jefferson Health Asplundh Cancer Pavilion in Willow Grove, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about what nurses need to know about cancer- and treatment-related peripheral neuropathy. This episode is part of a series on cancer symptom management basics; the rest are linked below. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: " Fireflies and Stardust " by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to peripheral neuropathy. Episode Notes The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities . Oncology Nursing Podcast Cancer Symptom Management Basics series Clinical Journal of Oncology Nursing articles: Balance and Gait Impairment: Sensor-Based Assessment for Patients With Peripheral Neuropathy Chemotherapy-Induced Peripheral Neuropathy: Use of an Electronic Care Planning System to Improve Adherence to Recommended Assessment and Management Practices Instruments for Assessing Chemotherapy-Induced Peripheral Neuropathy: A Review of the Literature Extremity Cooling: A Synthesis of Cryotherapy Interventions to Reduce Peripheral Neuropathy and Nail Changes From Taxane-Based Chemotherapy Oncology Nursing Forum article: Chemotherapy-Induced Peripheral Neuropathy Assessment Tools: A Systematic Review ONS Symptom Interventions and Guidelines™: Peripheral Neuropathy American Cancer Society's patient information for peripheral neuropathy American Society of Clinical Oncology (ASCO) Guideline: Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers Multinational Association of Supportive Care in Cancer (MASCC): Neurological Complications Overview of nursing skills for routine neurologic assessments To discuss the information in this episode with other oncology nurses, visit the ONS Communities . To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library . To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org . Highlights From Today's Episode "Our nervous system is sort of divided into three parts. The autonomic nervous system, which is kind of controlled homeostasis, blood pressure, your intestinal motility, things like that. The motor system, which is the efferent system, which is reflexes, muscle strength, sort of your big muscle movements, if you want to think of it that way. And then the sensory system, which is the afferent system, which is really what defines motion." TS 1:51 "I think patients tend to blow off the mild numbness and tingling because they're just like, 'Oh, it's just the side effect of my chemo' and they don't realize that that can get progressively worse. So, they tend to not tell you, you know, 'Oh do you have numbness and tingling? Yeah, I get it every visit.' But they're like, 'No, no, it's fine. It's just once in a while,' and all of a sudden, two months down the line, they come in and they can't walk as well." TS 6:53 "Some other disease-related comorbidities, things like diabetes, thyroid disease, there's nutritional deficiencies—like vitamin B is a big one. We tend to check B12, but B1, which is thiamin, can also cause this. Other things like inherited neurologic disease, toxin exposures like alcohol and people with alcohol dependance, infections like HIV and herpes or shingles as we all know it. Cardiac disease, which, you know, peripheral vascular particularly, but other cardiac diseases can do it too. And then medications that people have been on forever, you know, there's a list of like the highly likely ones, things like amiodarone, aminoglycosides, colchicine, hydralazine, metronidazole, linezolid, and statins can actually cause a preexisting peripheral neuropathy or make you more likely to develop it in the duration of your cancer treatment." TS 9:38 "I think the most important thing for any patient, but specifically when you're looking for peripheral neuropathy is a really good history and review of systems like other medications, any supplements, any comorbidities, any underlying diseases that they may not be treated for yet, or things like that. But a good history can really go a long way in finding out sort of your risk factors." TS 11:55 "I think nurses knowing how to do a basic neuro exam, you know, we all learn this. But do we actually do it all the time? Probably not. But I think really knowing how to like, you know, can they feel a light touch or a pinprick, test their muscle strength, watch them walk down the hallway and see if it changes over time? Like are they starting to sway a little bit when they walk? Can they get out of the chair without pushing on the handle and using their arms to get up? Things like that really can tell you a lot." TS 13:36 "Sadly, there's really nothing proven to prevent the development of neuropathy. You know, we know that you can't really catch it before people start having symptoms. Unfortunately, it's really when you start to detect symptoms that you can prevent it from getting to the severe point where it's really impacting their quality of life. And I think the biggest thing is proactive assessment and diagnosing it when it's early and being able to kind of intervene before it gets to the point of debilitating." TS 16:52 "It can really happen to anyone at any time. And generally, with any drug, not just those ones that it's the tough side effect; it really can affect any drugs. So, assessment is kind of key for everyone." TS 27:06