Background and Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of platinum-based chemotherapy agents like Cisplatin and Carboplatin, often used in conjunction with Paclitaxel for treating ovarian cancer. CIPN can significantly impact a patient’s quality of life, with symptoms such as pain, numbness, and motor dysfunction persisting long after treatment ends. These symptoms can hinder a patient’s ability to return to their pre-cancer lifestyle, affecting independence and overall well-being. This case study explores a holistic approach to managing CIPN in an ovarian cancer survivor, highlighting the strategies used to restore function and enhance quality of life.

Patient Case Overview

Patient: Female, 60 years old

Cancer Type: Ovarian Cancer (Stage III)

Chemotherapy Regimen: Cisplatin and Paclitaxel, completed 12 months ago

Current Status: Cancer-free, in remission for 8 months

Onset of Neuropathy: Symptoms began during chemotherapy and persisted post-treatment

Symptoms: Persistent numbness, tingling in the feet and hands, balance issues, and difficulty walking

Impact on Life: Inability to engage in hobbies like gardening and walking, increased dependence on family members for daily tasks

Initial Presentation and Assessment

The patient presented with significant ongoing CIPN, with no improvement in symptoms since completing chemotherapy. A comprehensive assessment revealed:

• Symptom Severity: 6/10 on the pain scale

• Areas of Involvement: Bilateral lower extremities and hands

Physical Findings:

• Sensory Examination: Loss of sensation in a "glove and stocking" distribution, particularly in the distal extremities. Light touch and vibration sense were notably diminished, indicating involvement of both small and large nerve fibers

• Motor Function Tests: Mild weakness in the distal muscles of the hands and feet, with difficulty performing fine motor tasks such as buttoning clothes or picking up small objects

• Gait Analysis: Unsteady gait with a widened stance and a tendency to lose balance when walking in a straight line, indicative of proprioceptive deficits

• Reflex Testing: Reduced reflexes in both upper and lower extremities, particularly in the Achilles tendon, confirming neuropathic involvement

• Medical History: Mild hypertension managed with lifestyle changes, no other significant comorbidities

Holistic Treatment Protocol at Advanced Nerve and Health Center

Our treatment approach aimed to address the multiple facets of CIPN through a comprehensive, non-pharmacological protocol:

Class IV Laser Therapy

• Objective: Stimulate nerve regeneration, reduce chronic pain, and improve sensory function

• Procedure: Administered twice weekly for 12 weeks, focusing on affected limbs. Dual-wavelength lasers were used to penetrate deep tissues, targeting both superficial and deep nerve fibers. Each session delivered 6000 joules of energy per treatment area, utilizing photobiomodulation to maximize regenerative effects

Pulsed Electromagnetic Field (PEMF) Therapy

• Objective: Enhance cellular repair processes, reduce inflammation, and alleviate neuropathic pain

• Procedure: Sessions were conducted twice weekly, with frequency and intensity settings tailored to the patient’s specific symptoms. The therapy focused on improving microcirculation and reducing oxidative stress within nerve tissues, critical for healing post-chemotherapy nerve damage

Neurolight Therapy

• Objective: Improve peripheral circulation and support nerve health through consistent infrared therapy

• Procedure: Daily at-home use of a Neurolight unit, supplementing in-clinic treatments. This therapy aimed to enhance blood flow to peripheral nerves, promoting oxygenation and nutrient delivery essential for nerve repair

Nutritional and Lifestyle Support

• Objective: Reduce systemic inflammation and support nerve regeneration

• Plan: The patient was advised to follow a low-carb, anti-inflammatory diet rich in antioxidants, omega-3 fatty acids, and vitamins B and D. Supplements included alpha-lipoic acid, acetyl-L-carnitine, and curcumin, aimed at reducing oxidative stress and supporting mitochondrial function within nerve cells

Physical Therapy and Balance Training

• Objective: Restore balance, improve coordination, and regain mobility

• Procedure: A customized exercise regimen was developed, focusing on balance, strength, and proprioception. The program included tandem walking, balance board exercises, and resistance training for the lower extremities, with the goal of helping the patient regain independence in walking and other daily activities

Psychological Support

• Objective: Address the emotional and psychological impact of chronic CIPN

• Procedure: Referral to a counselor specializing in chronic pain management and cancer survivorship. Counseling sessions were aimed at helping the patient cope with the emotional burden of CIPN, improving overall mental well-being

Treatment Outcomes and Patient Progress

After 12 weeks of comprehensive treatment, the patient reported significant improvements:

• Pain and Sensory Symptoms: Pain levels reduced from 6/10 to 3/10, with a marked improvement in numbness and tingling sensations. The patient regained partial sensation in the hands, enhancing dexterity and fine motor function

• Motor Function: Substantial improvement in balance and mobility, allowing the patient to resume activities like walking and gardening. The patient showed enhanced coordination and was able to perform more complex motor tasks with reduced difficulty

• Quality of Life: Increased independence in daily activities, reducing reliance on family members. Emotional well-being improved significantly, with decreased anxiety and depression related to CIPN. The patient also reported better sleep quality and overall higher energy levels

Discussion and Implications for Oncology Practice

Ovarian cancer patients treated with neurotoxic agents like Cisplatin and Paclitaxel often face prolonged CIPN, significantly impacting survivorship quality. This case demonstrates the critical importance of addressing CIPN not only to manage symptoms but also to enhance long-term quality of life. Integrating specialized neuropathy care into oncology treatment plans can help patients regain independence and return to their pre-cancer lifestyles.

Benefits of Collaboration

• Enhanced Survivorship Quality: Effective management of CIPN enables cancer survivors to lead fulfilling lives post-treatment, minimizing long-term disability and enhancing overall well-being

• Non-Pharmacological Approach: Our treatments offer a drug-free option for managing persistent neuropathic symptoms, reducing the medication burden on cancer survivors who may already be managing other chronic conditions

Conclusion

The Advanced Nerve and Health Center provides a comprehensive approach to managing CIPN, aiding cancer survivors in recovering from the long-term effects of chemotherapy. Our integrative treatments complement oncology care, helping patients not just survive cancer but thrive in their post-cancer lives. Through personalized and holistic care, we aim to restore function, improve quality of life, and support the overall health of cancer survivors dealing with CIPN.