The Nerves: Peripheral Neuropathy
Some cancer treatments can damage the nerves outside of your central nervous system. This is known as peripheral neuropathy.
When sensory nerves are affected (the nerves that help you feel pain, heat, cold, and pressure), you may experience tingling, numbness, or pins and needles in your feet and hands. This feeling can spread into your arms and legs. Peripheral neuropathy can also make it harder to feel heat, cold, or pain in your hands and feet, which can lead to burns or cuts.
“Neuropathic symptoms are most commonly caused by cisplatin, which is a platinum-based chemotherapy, and enfortumab,” says Dow. “About 50 percent of patients have clinically significant peripheral neuropathy.”
In addition to the hands and feet, peripheral nerves in other parts of the body can be affected. “It can also manifest as loss of vibration sensation, loss of balance and physical coordination, and bowel or bladder disturbances,” says Dow.
Preventive Care and Protective Care
While anyone undergoing therapy for metastatic bladder cancer can experience peripheral neuropathy, studies show that you may be at a higher risk if you have other health conditions. These include diabetes, high blood pressure, cardiovascular disease, anemia, and kidney problems.
With enfortumab vedotin, nerve symptoms typically emerge around 11 to 12 weeks into treatment, says Dr. Gosain. “Most cases are mild to moderate, though a smaller percentage are more severe, and neuropathy is actually the leading reason this medication gets dose adjusted or discontinued,” he says.
While your care team may recommend a change to your medication dose or schedule, Gosain says you can help lessen nerve symptoms by:
- Avoiding alcohol
- Keeping blood sugar well controlled
- Staying physically active
Some patients try cold therapy (cooling the hands and feet using ice or ice packs), which has evidence behind it for other drugs but not specifically for enfortumab vedotin. “Medications like gabapentin or pregabalin are also options your doctor may discuss,” Gosain says.
For pain, medication may be appropriate, and integrative medicine (like acupuncture, massage, physical therapy, and yoga) may also be a viable option.
Other steps you can take to protect yourself include:
- Fall Prevention In your home, move area rugs out of your path, put bath mats in the shower or tub, keep debris out of walkways, and rise slowly after sitting for a while or lying down.
- Protect Hands Use pot holders in the kitchen and take extra care with knives. If possible, have someone check the water in your shower to make sure it’s not too hot.
- Care for Hands and Feet Wear shoes when indoors and outside, and check your arms, legs, feet, and hands daily for cuts and scratches. In cold weather, make sure that your hands and feet are protected.
“Patients should loop in their doctor as soon as symptoms appear, rather than waiting,” says Gosain. “I always tell patients that early reporting is what allows for dose or schedule adjustments before symptoms progress.”
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