Dealing With Cognitive Changes and Neuropathy Due to Chemo

After you completed cancer treatment, you were probably able to say goodbye to many of the unpleasant aspects of having cancer – frequent doctors’ appointments, anxiety about whether you would beat the disease, and many short-term side effects of cancer treatment. However, some side effects of treatment take much longer to go away, and these can affect your mental health as a cancer survivor. Two common examples of longer-lasting effects of chemotherapy cancer treatment are cancer-associated cognitive dysfunction and neuropathy.

Chemobrain: Cancer-related Cognitive Dysfunction

During your cancer journey, you may have complained about suffering from “chemo brain.” Cognitive dysfunction is the medical term for the forgetfulness or absent-mindedness that often comes during chemotherapy treatments. Symptoms include having difficulty with:

• Short-term memory (finding the right word, remembering recent conversations)
• Your brain’s processing speed (how long it takes to draw conclusions or understand information)
• Multi-tasking
• Problem-solving
• Concentrating and focusing

Research shows that chemotherapy contributes to these symptoms and that they affect 20% to 60% of cancer patients and survivors who received chemotherapy. While cognitive dysfunction can negatively affect your moods, relationships, ability to work, and quality of life, most people begin to notice improvements about a year after chemotherapy ends.

If you’re a cancer survivor suffering from cognitive changes, there are steps you can take to improve your mental functioning. These include:

• Begin or gradually increase exercise, with a goal of exercising for at least 150 minutes per week
• Do crossword and/or Sudoku puzzles and seek out apps such as brainHQ.com or Lumosity.com to keep your mind active
• Use reminders, lists, notes, and calendars to help you remember
• Get enough sleep
• Seek medical help for depression, anxiety, and/or physical pain

Chemotherapy-induced Neuropathy

Another long-lasting side effect of cancer treatment is called chemotherapy-induced peripheral neuropathy (CIPN). Basically, this occurs when chemotherapy damages, inflames, or causes degeneration to outermost nerve fibers in your body. Peripheral nerves affect your arms, legs, hands, and feet. Symptoms of CIPN include:

• Numbness and tingling in the hands and feet that begins at the fingertips and toes but can move upward into the hands and feet
• Burning sensation in hands and feet
• Loss of sensations (inability to feel touch, pain, vibrations, and temperature) in the hands and feet

Neuropathy can also be caused by diabetes, liver disease, malnutrition and/or vitamin B and E deficiency, chronic alcohol use, and advanced age. If you’re experiencing neuropathy, experts say that cognitive behavioral therapy seems to be the most effective, non-medication way to manage the symptoms. Exercise, yoga, chiropractic care, acupuncture, and massage may also relieve symptoms. Be sure to tell your therapist or chiropractor about your neuropathy symptoms before they begin any treatments or services.

If medication is prescribed, the most effective medications to manage and treat neuropathy include:

• Duloxetine (the most effective medical treatment for CIPN)
• Pregabalin
• Tricyclic antidepressants
• Tapentadol
• Baclofen

Chemo-induced neuropathy symptoms are usually the worst 3-5 months after the last chemotherapy dose. After that, symptoms may disappear completely, lessen, or affect less of the body; if symptoms disappear or diminish, that occurs gradually, usually over several months.  In some cases, however, CIPN symptoms may be permanent.

Managing Day-to-Day Activities with Chemo-Induced Neuropathy

Numbness, tingling, and pain from neuropathy may make it difficult to perform some daily tasks, including dressing, preparing meals, driving, writing, and walking. If you’re experiencing these difficulties, the following can be helpful:

• Talk to your cancer care team about assistive devices that may be able to help you with difficult physical activities until you no longer need them
• Consider meeting with a physical and/or occupational therapist
• Consider counseling or joining a support group to help with the emotional impact of neuropathy
• Use nightlights in your home to avoid stepping on things and causing damage to your feet without knowing it.
• Remove small, loose rugs to prevent tripping
• Avoid scalding your skin by testing the water with your forearm before bathing, showering, or washing your hands
• Avoid using heating pads on your feet as you may become burned without realizing it
• Have your nails and toenails cared for by a professional
• Check your feet and hands for sores that may be present, since you may not be able to feel them. This allows you to care for them before they become infected.

Once you have completed cancer treatment, you are not completely free of the side effects of cancer. It can be helpful to remind yourself that you have survived the biggest hurdle: cancer. You can also survive and thrive despite these long-term side effects of cancer treatment.