CIPN — Nerve Damage Caused by Chemotherapy

Chemotherapy-induced peripheral neuropathy refers to toxic damage inflicted upon the peripheral nervous system by specific antineoplastic drugs. Neurotoxic agents disrupt cellular transport mechanisms, damage axonal microtubules, or induce mitochondrial oxidative stress within sensory nerve fibres. This process predominantly affects the longest axons in the body first, producing a characteristic symmetrical 'glove-and-stocking' distribution of symptoms.

While sensory nerves are most frequently affected, motor and autonomic nerves can also sustain injury. Patients may notice impaired temperature perception, loss of proprioception, diminished deep tendon reflexes, or fine motor clumsiness. Although symptoms often stabilise or improve following treatment completion, structural nerve regeneration is gradual, and some individuals experience persistent sensory deficits.

Recognising CIPN early is critical for treatment safety and everyday independence. Because there are limited interventions to reverse established chronic nerve damage, oncologists rely on patient reporting to modify chemotherapy doses, delay infusions, or switch medicines before deficits become permanent. CIPN also elevates fall risks and impacts functional abilities, making open communication, occupational safety adjustments, and supportive care interventions fundamental components of proactive cancer management.

CIPN is primarily identified through clinical neurological examinations, including evaluations of pinprick sensation, vibration perception using a tuning fork, and deep tendon reflexes. Validated patient-reported symptom scales are routinely used in clinics. Nerve conduction studies and electromyography are occasionally performed in complex presentations to quantify axonal damage or rule out alternative etiologies such as diabetic neuropathy.

CIPN is encountered across many malignancies treated with neurotoxic chemotherapy classes. These include taxanes used in breast, lung, and prostate cancers; platinum compounds utilised in colorectal, ovarian, and testicular cancers; vinca alkaloids prescribed in lymphomas and leukaemias; and proteasome inhibitors, such as bortezomib, used extensively in managing multiple myeloma.

The primary clinical strategy for managing worsening CIPN is dose modification, treatment interruption, or switching to non-neurotoxic alternative agents. For symptomatic neuropathic discomfort, guidelines recommend duloxetine as an evidence-based pharmacological option. Non-pharmacological approaches include physical therapy, occupational therapy, balance training, and preventive cryotherapy during drug infusions to decrease peripheral neurotoxicity.