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Some chemotherapy drugs can affect cells of the nervous system (neurotoxicity or neuropathy).
The nervous system is made up of the central nervous system and the peripheral nervous system. Chemotherapy drugs can affect or damage the central nervous system, the peripheral nervous system and part of the peripheral nervous system called the cranial nerves.
The central nervous system (CNS) is made up of the brain and spinal cord. It functions as the control centre for the body. It controls thought and emotion, is responsible for coordination, controls many activities and interprets information from the senses, such as sight, hearing or smell.
The peripheral nervous system (PNS) is made up the parts of the nervous system outside the brain and spinal cord. It includes the cranial nerves, spinal nerves and peripheral nerves.
Nervous system damage is often related to the dose of the chemotherapy drug given. Drugs differ in their potential to cause nerve damage. Drugs most often associated with nervous system changes or damage include:
Central nervous system damage is more likely to occur in people who received radiation therapy to the brain or when chemotherapy is injected into the cerebrospinal fluid (CSF).
Symptoms of nervous system changes depend on the nerves that are damaged.
Most people experience temporary nervous system problems. However, a few people may develop long-term problems. Nervous system damage can develop months or years after treatment and may take months to go away.
The doctor will do a neurological examination to assess nervous system function and look for changes. Sometimes hearing tests are done to check for changes to hearing.
When nerve damage occurs, and to prevent any lasting nerve damage, it may be necessary to stop the drug until symptoms go away, lower the dose of the drug or completely stop the chemotherapy. Sometimes this damage cannot be reversed.
Tell the doctor or healthcare team about any symptoms of nerve damage, such as hearing loss, weak muscles or numbness or tingling of hands or feet.
To help prevent injury if nerve damage occurs, you can try the following:
Sometimes medicines are used to help relieve pain associated with peripheral neuropathy. A physiotherapist or occupational therapist can help people adapt to loss of muscle skills and strength. Sometimes a hearing aid may be needed if hearing loss is permanent.
For more detailed information on specific drugs, go to sources of drug information.
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.