Polyneuropathy, chemotherapy induced

• Anti-neoplastic neuropathy
• Drug-induced neuropathy or neuronopathy

• 357.6 Polyneuropathy due to drugs

• G62.0 Drug-induced polyneuropathy

• 5G: Impaired motor function and sensory integrity associated with acute or chronic polyneuropathies

Description

• 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

Essentials of Diagnosis

• 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

General Considerations

• Most common medications involved are
  • Cisplatin
  • Carboplatin
  • Paclitaxel
  • Docetaxel
  • Vincristine
  • Vinblastine
  • Vinorelbine
  • Thalidomide
• Most of these drugs cause axonal damage with secondary demyelination; may be partially reversible after the drug is discontinued
• Many are also ototoxic, cause autonomic dysfunction, or lead to seizures
• Chemotherapy-related fatigue is common and will impact assessment and treatment of those with chemotherapy-induced polyneuropathy

Demographics

• Adults more commonly affected than children

Signs and Symptoms

• Numbness of hand, feet, mouth area
• Tingling
• Loss of sensation to light touch
• Loss or impairment of deep-tendon reflexes
• Loss or impairment of vibration and proprioception
• Pain, burning, stabbing
• Impaired balance
• Altered gait pattern
• Constipation
• Impaired vestibular function

Functional Implications

• Difficulty with fine motor tasks (e.g., writing, grooming, cooking, feeding, bathing) due to loss of sensation
• Fall risk with mobility on uneven/unpredictable surfaces
• Injury risk with items of unknown sharpness or temperature
• Difficulty with gross motor tasks (e.g., transfers, gait, stair climbing, dressing) due to loss of sensation
• Balance problems due to loss of sensation or ototoxicity

Possible Contributing Causes

• Chemotherapy to treat cancers may cause polyneuropathy, depending on duration of chemotherapy treatment
• Diabetes
• Alcoholism
• Malnutrition

Differential Diagnosis

• Guillain–Barré syndrome
• Tabes dorsalis
• Peripheral vascular disease
• HIV-related neuropathy
• Polyarteritis nodosa
• Diabetes mellitus

Diagnostic Procedures

• Nerve conduction velocity (NCV) testing

• To oncologist if chemotherapy-related
• To occupational therapist for assistance with fine motor activities and activities of daily living (ADLs)

• Peripheral nerve integrity
• Gait training
• Balance
  • Static standing
  • Dynamic standing
  • Moving base-of-support standing
• Range of motion (ROM)
• Endurance
• Aerobic capacity
• Self-care
• Home management

• Sensory testing
• Cranial nerve testing
• Reflex testing
• Muscle tone
• Manual muscle test
• Active and passive ROM testing, muscle-length testing
• Functional assessment (assist, device, environment)
  • Bed mobility
  • Transitions
  • Sitting balance
  • Standing balance
  • Transfers
  • Gait
  • Stairs
• Pain assessment
• Postural assessment
...