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Post-Cancer Treatment Care

Cancer Treatment–Induced Neuropathy

Cancer treatments save lives, but they can sometimes leave behind nerve problems—called neuropathy—that cause tingling, numbness, or pain in the hands and feet. These changes can make everyday activities, from buttoning a shirt to walking safely, much more challenging.

 

The good news is that with the right care—including physical therapy and self-management strategies—many people find relief and regain confidence in their daily lives.

What is cancer treatment–induced neuropathy?

​Cancer therapies—including chemotherapy, targeted or immune therapies, and radiation—can sometimes injure nerves. This may cause pins-and-needles, numbness, burning pain, cold sensitivity, weakness, or balance trouble. Symptoms often start in the toes and fingers, then may spread upward in a “stocking-glove” pattern. In daily life, this can mean tripping more easily, struggling with buttons, or feeling unsafe walking on uneven ground (Seretny et al., 2014; Burgess et al., 2021).

How do cancer treatments cause neuropathy?:

Different treatments affect nerves in different ways:

  • Chemotherapy

    • Platinum drugs (cisplatin, oxaliplatin) may damage sensory nerve cells, leading to numbness or cold sensitivity (Zajączkowska et al., 2019; Lazić et al., 2020).

    • Taxanes (paclitaxel, docetaxel) and vinca alkaloids (vincristine) interfere with nerve “transport lines,” causing tingling, numbness, and sometimes weakness (Starobova & Vetter, 2017; Sałat, 2020).

    • Bortezomib (for myeloma) can cause sensory neuropathy; giving it under the skin (instead of IV) lowers the risk (Merz et al., 2015).

  • Targeted / Antibody–Drug Conjugates

    • Brentuximab vedotin and some others can lead to dose-related neuropathy (Velasco et al., 2021).

  • Immunotherapy

    • Immune checkpoint inhibitors rarely trigger immune-related neuropathy, usually managed with treatment pause and corticosteroids (Schneider et al., 2021).

  • Radiation

    • Can cause scarring around nerve bundles months to years later, leading to weakness or numbness (Azzam et al., 2020).

 

Who is more likely to be affected?
High-risk cancer treatments include platinum drugs, taxanes, vinca alkaloids, bortezomib, thalidomide, and some antibody–drug conjugates (Burgess et al., 2021; Inoue et al., 2021).

Risk factors that make neuropathy worse:

Certain factors make neuropathy more likely or more severe:

  • Higher total dose of the drug

  • Older age

  • Higher body weight

  • Diabetes or pre-existing nerve problems

  • Low hemoglobin (anemia)

(Mizrahi et al., 2021; Dorand et al., 2023; Lemanska et al., 2023)

How common is it and what’s the usual course?:

Research shows that almost 2 out of 3 people experience neuropathy soon after chemotherapy. Across 31 studies, about 68% of people experienced neuropathy within 1 month, 60% at 3 months, and 30% at 6–12 months. For many, symptoms improve over time, but some people live with persistent numbness or tingling. Pain often improves before numbness (Seretny et al., 2014).

Evidence-based treatments:

A) Medications

  • Duloxetine is the only medication with consistent evidence for painful chemotherapy-induced neuropathy. Benefits are moderate but meaningful (Loprinzi et al., 2020; Jordan et al., 2020).

  • Other drugs (gabapentin, pregabalin, tricyclics) may help some patients, but results are mixed (Jordan et al., 2020).

  • Supplements are not routinely recommended. In fact, acetyl-L-carnitine may worsen neuropathy (Hershman et al., 2013).

 

B) Physical therapy & exercise (in depth)

Neuropathy affects sensation, balance, and strength. Physical therapy provides one of the best ways to regain confidence and reduce fall risk.

Core components include:

  1. Strength training (2–3 times per week): Target ankles, hips, and grip strength to support walking and hand function (Nakagawa et al., 2024; Huang et al., 2024).

  2. Balance training (≥3 days/week): Progress from static balance to stepping drills and uneven surfaces; improves stability and reduces falls (Müller et al., 2021; Winters-Stone et al., 2023).

  3. Gait training: Emphasize heel-to-toe walking, shorter steps, and treadmill practice (Teran-Wodzinski et al., 2022).

  4. Aerobic activity: Walking or cycling most days helps circulation and nerve health (Nakagawa et al., 2024).

  5. Desensitization and nerve-gliding: Gentle massage, textures, or vibration to reduce abnormal sensations (Huang et al., 2024).

  6. Home safety & footwear: Supportive shoes, clear walkways, and nightlights; braces may help with foot drop (Jordan et al., 2020).

  7. Assistive devices: Canes or larger-grip tools may improve independence (Huang et al., 2024).

 

Evidence strength: Meta-analyses show exercise and PT provide small-to-moderate improvements in neuropathy symptoms, balance, and daily function (Nakagawa et al., 2024; Huang et al., 2024; Amarelo et al., 2025).

 

C) Other non-drug options

  • Acupuncture: Some trials show improvement (Bao et al., 2020; Ben-Arye et al., 2022).

  • TENS (nerve stimulation): May reduce pain (Gewandter et al., 2024).

  • Scrambler therapy: Early trials suggest benefit in severe cases (Childs et al., 2021).

  • Cooling/compression during chemo: Mixed results; still under study (Michel et al., 2025).

 

D) Oncologist-directed strategies

If symptoms are severe, oncologists may reduce the drug dose, delay treatment, or change medications (Loprinzi et al., 2020).

Practical self-care checklist:

  • Feet first: Daily foot checks for cuts, moisturize, and wear shoes indoors.

  • Protect from cold: Gloves and socks may reduce discomfort.

  • Fall-proof your home: Use nightlights, remove loose rugs, and add grab bars if needed.

  • Stay active: Walk, practice balance, and do strengthening exercises most days.

  • Gentle self-massage: With lotion, use soft circular motions on hands and feet to improve circulation and reduce stiffness. Start lightly and increase only as comfortable.

  • Ask your care team: Always consult your physical therapist or oncologist before starting new exercises or self-care. They can tailor recommendations to your needs.

Prognosis: what to expect

For many, symptoms gradually improve after treatment ends. Pain usually lessens first, while numbness may remain longer. Even if some symptoms persist, early rehabilitation and the right self-care strategies allow most people to stay active and safe (Seretny et al., 2014; Jordan et al., 2020).

When to seek urgent care:

Chemotherapy can be tough, but you don’t have to go through it alone. Side effects vary by drug type, but physical therapy helps you stay strong, manage fatigue, and reduce problems like numbness, swelling, or pain. Combined with nutrition, emotional support, and medical care, physical therapy is a vital step toward recovery and living well during and after cancer treatment (Courneya & Friedenreich, 2011; Winters-Stone & Horak, 2019).

Key takeaways:

  • Neuropathy is a common side effect of cancer treatments.

  • High-risk treatments include platinum drugs, taxanes, vinca alkaloids, and bortezomib.

  • Risk factors include older age, higher doses, diabetes, and anemia.

  • Duloxetine is the most effective drug for painful neuropathy.

  • Physical therapy and exercise are highly effective for improving safety, balance, and confidence.

  • Self-care strategies—like foot checks, fall prevention, and gentle massage—make a difference.

  • Work with your oncology and rehab team for the best outcome.

Scientific References:

  • Azzam, P., et al. (2020). Radiation-induced neuropathies in head and neck cancer. Cancers, 12(10), 1–16.

  • Bao, T., et al. (2020). Effect of acupuncture vs sham on CIPN symptoms: RCT. JAMA Network Open, 3(3), e200681.

  • Ben-Arye, E., et al. (2022). Acupuncture & integrative therapies for CIPN: Multicenter RCT. Cancer, 128(18), 3641–3652.

  • Burgess, J., et al. (2021). Mechanisms and management of chemotherapy-induced peripheral neuropathy. Journal of Clinical Oncology, 39(7), 1666–1679.

  • Childs, D. S., et al. (2021). Randomized trial of Scrambler therapy vs TENS for CIPN. Journal of Pain and Symptom Management, 61(5), 961–971.

  • Dorand, R. D., et al. (2023). Correlates of taxane-induced neuropathy in EHR data. NPJ Precision Oncology, 7, 21.

  • Gewandter, J. S., et al. (2024). Home-based TENS for painful CIPN: Proof-of-concept RCT. The Journal of Pain, 25(7), 1251–1261.

  • Huang, Y., et al. (2024). Exercise for reducing CIPN: Systematic review & meta-analysis. Frontiers in Neurology, 14, 1252259.

  • Inoue, M., et al. (2021). Antibody–drug conjugates and peripheral neuropathy: Clinical review. International Journal of Cancer, 148(9), 2263–2275.

  • Jordan, B., et al. (2020). ESMO–EONS–EANO Clinical Practice Guidelines for therapy-induced neurotoxicity. Annals of Oncology, 31(10), 1306–1319.

  • Lemanska, A., et al. (2023). Long-term QOL & CIPN predictors in SCOT trial. ESMO Open, 8(5), 101304.

  • Loprinzi, C. L., et al. (2020). ASCO guideline: Prevention & management of CIPN. Journal of Clinical Oncology, 38(28), 3325–3348.

  • Merz, M., et al. (2015). Subcutaneous vs IV bortezomib: Better tolerance with SC. Haematologica, 100(6), 775–779.

  • Michel, L. L., et al. (2025). Hand cooling & compression to prevent taxane-induced neuropathy: RCT. [Study report/abstract].

  • Mizrahi, D., et al. (2021). Predictors of chemotherapy-induced neuropathy. Supportive Care in Cancer, 29(10), 5683–5692.

  • Müller, J., et al. (2021). Preventive effect of sensorimotor/resistance training on CIPN symptoms. British Journal of Cancer, 125, 1–9.

  • Nakagawa, N., et al. (2024). Exercise for CIPN: Systematic review & network meta-analysis. Supportive Care in Cancer, 32, 1–18.

  • Sałat, K. (2020). Chemotherapy-induced peripheral neuropathy: Pathophysiology and new treatments. Pharmacological Reports, 72(3), 490–502.

  • Schneider, B. J., et al. (2021). ASCO guideline: Management of immune-related adverse events. Journal of Clinical Oncology, 39(36), 4073–4126.

  • Seretny, M., et al. (2014). Incidence, prevalence & predictors of CIPN: Meta-analysis. PAIN, 155(12), 2461–2470.

  • Starobova, H., & Vetter, I. (2017). Pathophysiology of CIPN. Frontiers in Molecular Neuroscience, 10, 174.

  • Velasco, R., et al. (2021). Brentuximab vedotin-induced peripheral neuropathy: Clinical features and management. Cancer Chemotherapy and Pharmacology, 87(2), 201–209.

  • Winters-Stone, K. M., et al. (2023). Tai Ji Quan & fall reduction in cancer survivors with neuropathy. PM&R, 15(8), 971–983.

  • Zajączkowska, R., et al. (2019). Mechanisms of CIPN: Clinical and mechanistic review. Frontiers in Pharmacology, 10, 160.

 

Note on mixed/emerging areas: Cooling/compression during taxanes, TENS, scrambler therapy, and acupuncture show promising but still-evolving evidence; decisions should be individualized and coordinated with oncology and rehab teams (trials and reviews cited above).

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