Neuropathy as a Side Effect of Ovarian Cancer Treatment

Neuropathy (nerve damage causing numbness, tingling, burning, or weakness in hands and feet) can be a side effect of chemotherapy used for ovarian cancer, and it is relatively common with taxane drugs like paclitaxel, while less common with carboplatin. ^[1] Paclitaxel’s risk increases with cumulative dose, and symptoms often start within the first few cycles; carboplatin tends to cause fewer and milder nerve symptoms compared with cisplatin. ^{[2] [3]}

In practical terms, many users receiving paclitaxel experience some sensory changes, and older age or prior cisplatin exposure can raise risk with platinum drugs. ^{[2] [3]}

---

Why It Happens

Chemotherapy-induced peripheral neuropathy (CIPN) occurs because certain anti-cancer drugs irritate or injure peripheral nerves, most often in a “glove and stocking” pattern affecting fingers and toes. ^[4] These changes are typically sensory (numbness, tingling, pins-and-needles), and may progress to involve hands and feet with ongoing treatment. ^[4]

With taxanes like paclitaxel, neuropathy is dose-related and can appear early, even after one cycle at higher doses. ^[2] Carboplatin has a lower incidence of neuropathy than cisplatin and is considered less neurotoxic, although mild paresthesias can occur. ^[3]

---

How Common Is It?

• Paclitaxel (Taxol): Frequency and severity increase with total dose; a neurotoxic threshold around 1000 mg/m² has been described, and symptoms may develop after one high-dose cycle. ^[2]
• Carboplatin: Peripheral neuropathy is reported in about 4% overall, rising to roughly 6% in previously treated ovarian cancer populations; typically milder than with cisplatin. ^[3]
• General CIPN overview: Several classes of anti-cancer drugs can cause neuropathy, predominantly sensory, often symmetrical in distal extremities. ^[4]

Overall, neuropathy is common with paclitaxel regimens used in ovarian cancer; carboplatin adds a smaller contribution compared with cisplatin. ^{[2] [3] [4]}

---

Typical Symptoms to Watch For

• Numbness, tingling, burning, or “pins and needles” in toes and fingertips. ^[4]
• Pain with touch or temperature changes; sometimes balance issues due to loss of sensation. ^[4]
• In taxane regimens, symptoms can start early and worsen with cumulative exposure. ^[2]

Symptoms usually present symmetrically and may spread from toes/fingers to feet/hands over time. ^[4]

---

Clinical Course and Recovery

Some neuropathy improves after chemotherapy ends within several months, but in other cases it can persist long term. ^[2] Adjusting dose intensity or spacing cycles can help halt progression and allow partial recovery. ^[2]

Resolution is variable: while many see improvement within 6–12 months, a portion may have lingering symptoms. ^[2]

---

Evidence-Based Management Strategies

1) Dose and Schedule Adjustments

• Report symptoms early; clinicians may reduce dose, delay cycles, or switch schedules to limit nerve injury while maintaining cancer control. ^[4]
• With paclitaxel, lowering cumulative exposure reduces neuropathy risk and severity. ^[2]

Early communication enables safer modifications and may prevent long-term damage. ^{[4] [2]}

2) Pharmacologic Treatment for Painful CIPN

• Duloxetine (a serotonin-norepinephrine reuptake inhibitor) has demonstrated benefit for painful CIPN in randomized trials. [PM22]
• When first-line combinations (e.g., opioid plus pregabalin) are insufficient or poorly tolerated, adding duloxetine has shown improvement in cancer-related neuropathic pain. [PM19]

Duloxetine is one of the best-supported medications for painful chemotherapy neuropathy. [PM22] [PM19]

3) Supportive Therapies

• Physical therapy can help with balance, strength, and safety if sensation loss affects gait or daily activities. ^[5]
• Occupational therapy may recommend assistive devices and strategies to prevent falls and improve hand function. ^[5]

Rehabilitation reduces the impact of neuropathy on mobility and independence. ^[5]

4) Symptom Control and Self‑Care

• Regular foot and hand checks to avoid unnoticed injuries due to numbness. ^[6]
• Falls prevention: supportive footwear, home safety adjustments (remove loose rugs, install grab bars). ^[6]
• Protect extremities from extreme temperatures; avoid tight shoes/socks that compress nerves. ^[6]

Day-to-day strategies can meaningfully lower risks and discomfort from sensory loss. ^[6]

---

Are There Prevention Options?

Currently, no preventive strategy is universally recommended, but careful dose management and early symptom reporting are the most effective ways to limit CIPN. ^[4] Trials continue to explore preventive agents, but routine use isn’t established. ^[4]

The best prevention is timely communication and individualized dose adjustments during treatment. ^[4]

---

When to Seek Help

• New or worsening numbness, tingling, burning pain, or weakness in hands/feet. ^[4]
• Trouble with buttons, writing, balance, or frequent tripping. ^[4]
• Pain interfering with sleep or daily activities ask about duloxetine and referral to rehabilitation services. [PM22] ^[5]

Early reporting allows tailored changes that can protect nerve function and maintain treatment goals. ^[4] [PM22]

---

Key Takeaways

• Neuropathy is common with paclitaxel regimens used in ovarian cancer and less common with carboplatin. ^{[2] [3]}
• Managing CIPN involves dose adjustments, effective pain medications like duloxetine, and supportive rehab therapies. [PM22] ^[5]
• Symptoms may improve after treatment, but persistence can occur; proactive monitoring is essential. ^[2]

---

Quick Reference Table: Drug-Related Neuropathy in Ovarian Cancer

Agent	Neuropathy Risk	Pattern/Notes	Management Highlights
Paclitaxel (Taxol)	Common; dose-related; may start early	Sensory symptoms in toes/fingers; risk rises with cumulative dose (~1000 mg/m² threshold)	Report early; dose reduction/spacing; consider duloxetine for painful CIPN
Carboplatin	Uncommon at standard doses; milder vs. cisplatin	Mild paresthesias; higher risk if older or prior cisplatin	Monitor symptoms; dose adjustments if needed
General CIPN	Sensory, symmetrical “glove and stocking”	Often affects balance and fine motor tasks	Physical/occupational therapy; safety strategies

References: Paclitaxel risk and dose relationship. ^[2] Carboplatin incidence and severity. ^[3] Typical CIPN pattern and management approach. ^[4] Rehabilitation benefits. ^[5] Duloxetine efficacy. [PM22]