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

Vocational implications

The changes in sensation and strength associated with nerve damage can cause lack of dexterity executing tasks that require fine motor skills, such as handling small materials and typing. Decreased sensation in your hands puts you 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 your balance when standing still, and make it difficult to walk on uneven ground or stand for prolonged periods of time. Nerve damage may increase or decrease sensitivity making it harder to work in extreme temperatures (such as handling hot items while cooking food, or working in refrigerated environments or outdoors). Nerve sensitivity may also affect your pain levels.

What you can do

Speak to your healthcare team if you 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 (walking) disturbance and fine motor clumsiness.

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

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

Job accommodations

Modify your work tasks and how you work:

Hands and fingertips:

  • Decreased sensation in your hands puts you at a greater risk of injury. Request alternative duties to work tasks that involve the use of sharp objects or tools, or extreme temperatures (boiling water, freezers).
  • Use safe electric tools in place of manual tools when possible (for example, an electric drill instead of a manual screwdriver, or food processor instead of a knife).
  • Adapt the handles of commonly used equipment by covering surfaces with fabric textures or padding to increase comfort.
  • Experiment with “building up” handles of tools with foam pipe insulation to increase the handle’s diameter, requiring less grip strength to hold on to.
  • Use a headset if you are frequently on the telephone.
  • For jobs that involve computer use where typing is difficult, consider using speech recognition software. Alternatives to mice and/or switches accessed by other body parts are options for very sensitive fingertips.

Toes and feet:

  • Work in a standing position? Sit down when you’re able to. Use a stand-lean chair if possible; if not, keep a rest chair nearby.
  • Use an anti-fatigue mat under surfaces where you frequently stand or add anti-fatigue surfaces to your shoes.
  • Consider using a mobility aid (cane, hiking stick, walker) if you are having difficulties with balance.
  • Diab-A-Sheet or other insoles may help manage discomfort in your feet while standing/walking.

Modify your work environment:

  • Maintain adequate temperature: consider using space heaters, fans, portable air conditioners or humidifiers/de-humidifiers for comfort.
  • Request parking close to your work entrance.
  • Relocate your workstation closer to the washroom, break room or other frequently used space.



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