Background and Introduction

Oxaliplatin, a platinum-based chemotherapy agent, is frequently used in the treatment of colorectal cancer, particularly in Stage III cases. While it is effective in combating cancer, Oxaliplatin is associated with significant neurotoxic effects, often leading to chemotherapy-induced peripheral neuropathy (CIPN). CIPN can result in sensory and motor impairments that persist long after treatment, severely impacting patients' ability to perform daily activities and maintain independence. This case study explores the integrative approach utilized at Advanced Nerve and Health Center to manage CIPN in a colorectal cancer survivor, focusing on restoring nerve function, reducing symptoms, and enhancing overall quality of life.

Patient Case Overview

• Patient: Male, 58 years old

• Cancer Type: Colorectal Cancer (Stage III)

• Chemotherapy Regimen: Oxaliplatin-based therapy, completed 18 months ago

• Current Status: Cancer-free, in remission for 12 months

• Onset of Neuropathy: Symptoms began during chemotherapy and progressively worsened after treatment completion

• Symptoms: Persistent numbness, tingling in the feet and hands, muscle weakness, and difficulty with coordination

• Impact on Life: Significant challenges with daily tasks such as dressing and walking, leading to a more sedentary lifestyle and reduced participation in social activities

Initial Presentation and Assessment

The patient was referred to our clinic for ongoing CIPN, which had substantially affected his ability to maintain an active lifestyle. A thorough assessment revealed:

Symptom Severity: 7/10 on the pain scale

Areas of Involvement: Hands, feet, and lower legs

Physical Findings:

• Sensory Loss: Marked reduction in sensation, especially in a "glove and stocking" distribution affecting the distal extremities. Both light touch and vibration sense were impaired

• Motor Impairment: Notable muscle weakness in the upper and lower extremities, particularly in the distal muscles of the hands and feet, making fine motor tasks like buttoning a shirt or grasping small objects difficult

• Reflexes: Diminished reflexes in the Achilles tendon and patellar regions, indicating significant neuropathic involvement

• Balance and Coordination: Impaired balance and coordination, evidenced by a broad-based gait and difficulty performing tandem walking. Proprioceptive deficits further contributed to balance issues

• Medical History: Hyperlipidemia managed with statins, no other significant comorbidities

Holistic Treatment Protocol at Advanced Nerve and Health Center

The treatment strategy was designed to address the multifaceted aspects of CIPN through a comprehensive, integrative approach:

Class IV Laser Therapy

• Objective: Promote axonal regeneration, reduce chronic pain, and improve sensory function

• Procedure: Administered twice weekly for 12 weeks, focusing on affected areas, particularly the hands and feet. Dual-wavelength lasers targeted both superficial and deep nerve fibers, delivering 6000 joules of energy per treatment area to enhance nerve cell repair and reduce neuropathic symptoms by modulating inflammation and promoting tissue healing

Pulsed Electromagnetic Field (PEMF) Therapy

• Objective: Enhance nerve repair, reduce inflammation, and improve microcirculation

• Procedure: Customized PEMF sessions conducted twice weekly in conjunction with laser therapy to optimize neuro-regenerative effects. The therapy targeted areas of significant neuropathic involvement, with frequency and intensity adjustments based on the patient’s response. This approach aimed to reduce oxidative stress and improve cellular energy production, key factors in nerve healing

Neurolight Therapy

• Objective: Improve circulation, support nerve healing, and enhance peripheral blood flow

• Procedure: Daily at-home use of a Neurolight unit to supplement in-clinic treatments. The infrared therapy was designed to improve tissue oxygenation and promote the delivery of essential nutrients to affected nerves, facilitating repair and regeneration

Nutritional Support

• Objective: Reduce systemic inflammation, support nerve health, and enhance overall well-being

• Plan: A balanced, anti-inflammatory diet rich in omega-3 fatty acids, antioxidants, and vitamins B and D was recommended. Supplements including alpha-lipoic acid, N-acetylcysteine, and magnesium were advised to support nerve health and reduce oxidative damage

Physical and Occupational Therapy

• Objective: Restore strength, coordination, and functional independence to enable the patient to resume normal daily activities

• Procedure: A tailored exercise program was developed, focusing on improving fine motor skills, balance, and muscle strength. The program included resistance training, balance exercises, and functional tasks to help the patient regain independence in daily activities. Occupational therapy was integrated to address specific challenges in daily living, such as dressing and personal care

Psychosocial Support

• Objective: Address the psychological impact of CIPN and promote emotional well-being

• Procedure: Referral to a counselor specializing in chronic pain and cancer survivorship. Counseling focused on coping with the emotional burden of CIPN and improving overall mental health, particularly in managing the loss of independence and reduced quality of life

Treatment Outcomes and Patient Progress

After 12 weeks of intensive, multidisciplinary treatment, the patient demonstrated significant improvements:

• Pain and Sensory Symptoms: Pain levels were reduced from 7/10 to 3/10, with a notable decrease in numbness and tingling. Sensory function improved, allowing the patient to regain some proprioception and tactile sensitivity

• Motor Function: Increased muscle strength and coordination enabled the patient to resume independent living activities. The patient showed improved ability to perform fine motor tasks, such as dressing and handling small objects, which were previously challenging

• Balance and Mobility: Significant improvements in balance, with a more stable gait and increased confidence in walking. The patient was able to resume walking for exercise and engage in light physical activities, enhancing cardiovascular health and overall fitness

• Quality of Life: Enhanced ability to engage in hobbies and social activities, leading to improved overall well-being. Increased independence in daily activities reduced the emotional burden of CIPN, fostering a more positive outlook and greater satisfaction with life post-treatment

Discussion and Implications for Oncology Practice

CIPN is a prevalent and often debilitating side effect in colorectal cancer patients treated with Oxaliplatin, persisting beyond cancer remission. Addressing these symptoms is vital for helping survivors regain independence and improve their quality of life. This case underscores the significance of incorporating specialized neuropathy treatment into survivorship care plans to manage the long-term effects of chemotherapy effectively.

Benefits of Collaboration

• Enhanced Patient Outcomes: Effective CIPN management can significantly improve the long-term quality of life for colorectal cancer survivors, enabling them to regain independence and fully participate in daily life

• Complementary Care: Our holistic approach provides non-invasive treatment options that can seamlessly integrate with oncology care, offering a comprehensive solution to the complex challenges faced by cancer survivors

Conclusion

The Advanced Nerve and Health Center specializes in targeted treatment for CIPN, aiding colorectal cancer survivors in overcoming the long-term effects of chemotherapy. Our approach focuses on restoring nerve function, enhancing quality of life, and supporting a return to normalcy post-cancer treatment. Through personalized, comprehensive care, we strive to improve the well-being of cancer survivors, ensuring they can lead fulfilling lives after their cancer journey.