Which drugs are most likely to cause CIPN?
Platinum Drugs (-platin)
Vinca Alkaloids (vinc-)
(Sensory/Motor) nerves are more affected in CIPN. Thus, what kind of symptoms are you likely to see?
1. Cell bodies for motor nerves are protected by the blood-brain barrier
2. Motor axons in the PNS are more heavily myelinated than smaller diameter sensory fibers, myelin may serve as a form of protection
More likely to see numbness, tingling, and burning rather than loss of footdrop (etc.)
(Proximal/Distal) nerves are most vulnerable to damage with CIPN.
Distal (stocking glove > nerve root/peripheral nerve)
What other nerves are susceptible to damage with CIPN?
•Autonomic fibers are poorly myelinated and may be vulnerable to toxicity
•Symptoms include dry mouth, constipation, urinary retention, orthostatic hypotension, irregular pulse, ulcers
What drugs can cause CIPN?
What is the basis for CIPN/neurologic damage?
1. Microtubules are inhibited (good with cancer cells because it decreases replication but also interferes with axonal transport)
-cell sets up chromosomes so it can divide
2. May cause microtubule tangles in dorsal root ganglion & Schwann cells
Microtubules, DRG, schwann cells, excitable membrane (node of ranvier)
Patient Susceptibility Increased in patients with pre-existing neuropathy (specifically what)?
•Earlier treatment with chemotherapy
•Exposure to environmental toxins, e.g. -heavy metals
How is CIPN assessed?
-Electrophysiologic testing: NCV/ EMG
*not sensitive to small fibers (A-Delta and C fibers)
-Quantitative sensory testing
-Pin prick or temperature discrimination
-Deep tendon reflex testing
-Manual muscle testing
-Gait and balance assessment
What are common impairments in peripheral neuropathy?
1. Reduced proprioception at foot and ankle
2. Decreased reaction time increasing fall risk
3. Post-fall syndrome
How can you help CIPN?
1. Lower cumulative dose of chemotherapeutic agent (only take what you need)
2. Prolonged infusion rate per treatment to decrease concentration (2-3 hours vs. 1 hour)
3. Delivery of total dose over a longer period of time (6-8 vs. 4)
What is "coasting"?
Onset of symptoms or persistence of symptoms (usually sensory) weeks or months after chemotherapy Rx has been discontinued
May occur with platinum drugs making it difficult to change dose or discontinue therapy before damage becomes apparent
What are pharmacologic interventions for CIPN?
Vitamin and nutritional supplements
1. Vitamin E antioxidant sometimes used with cisplatin
2. Glutamine may increase amounts of NGF
3. Calcium and magnesium supplements to reduce neuronal hyperexcitability
What are Physical Therapy Interventions for CIPN?
1. Balance and gait training
2. Strength training/ therex
3. Modalities for analgesia
•Electrical stimulation (Gate)
•LILT? - infrared - growth factors
4. Patient and caregiver education
What about the "Lance Armstrong Effect"?
Most people never get back to their baseline physical activity or fitness level
What two things can be preventative against breast cancer?
1. Exercise (3-9 hours/week) - even after diagnosed (mortality and recurrence)
2. Low-fat diet