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.
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:
- Managing Neuropathy after Cancer Treatment (PDF) – University Health Network
- Symptom Management Guidelines: Chemotherapy-induced peripheral neuropathy (PDF) – BC Cancer Agency
- Communicate with your healthcare team on your neuropathy (video) – Livestrong
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 commonly used equipment by covering handles with fabric or padding to increase comfort.
- “Build up” tool handles with foam pipe insulation to increase the handles’ diameter. Built-up handles require less grip strength.
- Request a headset if the patient frequently uses a telephone.
- Reduce typing by using speech recognition software.
- Request alternatives to a standard keyboard and mice, and switches accessed by body parts other than very sensitive fingertips.
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.