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Neurotoxicity

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Background

Neurotoxicity that is particularly associated with the administration of oxaliplatin can be dose limiting and occurs as either acute (classified as lasting less than 14 days; may be induced by exposure to cold) or chronic or persistent neuropathy (lasting more than 14 days).

Acute symptoms have a reported incidence of 90%,2 are non–life-threatening, and may present as:

  • Paresthesias or dysesthesias, often precipitated by cold exposure
  • Muscle cramping
  • Jaw, hand, or forearm spasms
  • Pharyngolaryngeal dysesthesia

Slowing the infusion rate to as much as 6 hours may reduce or eliminate the occurrence of acute neuropathy.

Neuropathy is seen in patients who have received cumulative doses of 800 mg/m2 or higher and may persist from one cycle to the next, affecting how vibration, position, and spatial relationships of the body are sensed.3 Patients also may experience:

  • Ataxia
  • Parasthesias in stocking-glove distribution
  • Functional impairments such as buttoning buttons and zipping zippers

Once patients report changes in function, careful neurologic examinations must be performed prior to each dose. If symptoms are allowed to progress, neuropathy may involve motor pathways with resulting disability.4

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Clinical Practice Guidelines

The National Comprehensive Cancer Network (NCCN) cancer pain treatment guidelines for patients are available here.

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Web site resources:

Oncology Nursing Society Web site for symptom management

A great Web site that discusses peripheral neuropathy in detail, its multiple causes, and current treatments may be found here.

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References

  1. Viale PH, Fung A, Zitella L. Advanced colorectal cancer: current treatment and nursing management with economic considerations. Clin J Oncol Nurs. 2005;9:541-552.
  2. Wilkes GM. Therapeutic options in the management of colon cancer: 2005 update. Clin J Oncol Nurs. 2005;9:31-44.
  3. Cersosimo RJ. Oxaliplatin-associated neuropathy: a review. Ann Pharmacother. 2005;39:128-135.
  4. Wilkes G. Oxaliplatin: third-generation platinum analog. Clin J Oncol Nurs. 2003;7:353-356.

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This page was last modified on 4/20/2007, at 4:44:58 pm ET.