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CONDITION/DISORDER SYNONYMS
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PREFERRED PRACTICE PATTERN
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PATIENT PRESENTATION
A 69-year-old man reports increasing difficulty working in his woodshop. He was successfully treated for non-Hodgkin lymphoma with radiation and chemotherapy. All treatments ended 3 weeks ago. He noticed numbness in his hands and feet and felt clumsy shortly after starting his chemotherapy, but was told it would likely go away later. Yesterday, he felt like going for a walk but found he struggled with what used to be an easy distance. He regularly catches his toes on the carpet at home and on the grass in the yard when he is walking. His wife passed away 2 years ago and he is concerned about being able to live on his own. Other medical history includes osteoarthritis in his right knee, impingement in the left shoulder, and hyperlipidemia which is controlled by 20 mg Lipitor daily.
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Damage to nerve cells of the peripheral nervous system
Numbness, tingling in the hands and feet
Peripheral neuropathy
Patients may experience painful peripheral neuropathy
Predominantly sensory polyneuropathy beginning several weeks after the completion of antineoplastic drug therapy
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Essentials of Diagnosis
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Change in symptoms can be sudden or appear slowly.
Severity of polyneuropathy is dose- and time-dependent.
Concentration of platinum in the peripheral nervous system is correlated to degree of pathologic changes; greatest concentrations generally found in the dorsal root ganglia, but can become concentrated in dorsal columns of the spinal cord.
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General Considerations
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Most common medications involved are
Cisplatin
Carboplatin
Paclitaxel
Docetaxel
Vincristine
Vinblastine
Vinorelbine
Thalidomide
Many are also ototoxic, cause autonomic dysfunction, or lead to seizures.
Chemotherapy-related fatigue is common, will impact assessment and treatment of those with chemotherapy-induced polyneuropathy.
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SIGNS AND SYMPTOMS
Altered gait pattern
Constipation
Impaired balance
Impaired vestibular function
Loss of sensation to light touch
Loss or impairment of deep-tendon reflexes
Loss or impairment of vibration and proprioception
Numbness of hand, feet, mouth area
Pain, burning, stabbing
Tingling
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Functional Implications
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