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Nerve damage

Dr. Christine Maheu, RN, PhD

Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.

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Ms. Rosemary Cashman

Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.

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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital

Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.

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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer

Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.

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Some cancers and cancer treatments can cause nerve damage (neuropathy). The most common type of cancer-related nerve damage causes numbness and tingling in the toes and fingers.1 Other nerve damage includes increased (or decreased) sensitivity to temperature, and more uncomfortable sensations such as burning or electric shock–type pain.2 Nerve damage can result in weakness of the limbs, balance problems and difficulty with fine muscle movements.2 The degree of damage may relate to the type and dose of treatment received. Patients may recover from nerve damage completely or incompletely over time.

Vocational implications

The changes in sensation and strength associated with nerve damage can reduce the patient’s dexterity in tasks that require fine motor skills, such as handling small materials and typing. Decreased sensation in the hands puts patients at a greater risk of injury. Lack of grip strength may make handling tools or climbing ladders more difficult. Changes in sensation may also affect balance when standing still and make it difficult to walk on uneven ground or stand for prolonged periods. Increases or decreases in temperature sensitivity may make it harder to work in extreme temperatures such as handling hot items while cooking food, working in refrigerated environments or outdoors. Nerve sensitivity may also affect pain levels.

What patients can do

Advise your patient to speak to their healthcare team if they notice changes in sensation or other symptoms that may be due to nerve damage. Medications may be helpful in treating pain. Assistive devices, occupational therapy and physiotherapy may help with managing muscle weakness, gait disturbance and fine motor clumsiness.

  • Keep hands warm and comfortable, even when indoors. Consider wearing thin, fingerless gloves. Use extra caution to keep hands warm when working outside.
  • Decreased sensation in the feet can disturb balance. Wear well fitting, supportive footwear with a closed heel and rubber sole to maximize stability. A mobility aid may also help improve stability.

More information on how to manage cancer treatment–induced peripheral neuropathy:

Job modifications

Modify work tasks to accommodate neuropathy in hands and fingertips:

  • Reduce risk of injury by requesting alternatives to tasks that involve sharp objects, tools or extreme temperatures (for example, boiling water or freezers).
  • Use safe electric tools in place of manual tools when possible (for example, an electric drill with screwdriver bit instead of a manual screwdriver, or a food processor instead of a knife).

Adapt equipment:

Modify work tasks to accommodate neuropathy in toes and feet:

  • Work sitting down when possible. Use a stand-lean chair or, if not possible, keep a rest chair nearby.
  • Request an anti-fatigue mat if the patient frequently stands.
  • Consider a mobility aid (cane, hiking stick, walker) if the patient has difficulties with balance.
  • Diab-A-Sheet or other insoles may help manage discomfort in the feet while standing or walking.

Modify the work environment:

  • Maintain comfortable temperatures by using a space heater, fan, portable air conditioner, humidifier or dehumidifier.
  • Request parking close to the building entrance.
  • Request a relocation of the employee’s workstation closer to the washroom, break room or other frequently used space.

Back to the list of common cancer treatment side effects