What is chemotherapy induced peripheral neurophathy?
Chemotherapy-induced peripheral neuropathy (CIPN) is defined as any injury, inflammation, or degeneration of the peripheral nerves because of the administration of a chemotherapeutic agent (Rodwin et al., 2022).
CIPN affects any of the three functions of peripheral nerves: sensory, motor, autonomic.
Which chemotherapies can cause CIPN
- Platinum agents (cisplatin, oxaliplatin)
- Vinca alkaloids (vincristine)
- Taxanes (paclitaxel, docetaxel)
- Epothilones
- Proteasome inhibitors (bortezomib)
- Immunomodulatory drugs (thalidomide)
(Molinares, Kurtevski & Zhu, 2023)
How do we recognise CIPN?
Symptoms may include:
- Numbness, tingling, loss of position sense, or pain (sensory nerves)
- Weakness or poor coordination (motor nerves)
- Altered thermoregulation, blood pressure, intestinal motility (autonomic nerves)
- Reduced or absent reflexes
- Early symptoms usually seen in hands and feet
- Seen in the arms and legs as it progresses and occasionally centrally in vocal cords
In general, but not always, CIPN is dose-related; that is, the more intense the treatment schedule, the more severe the symptoms.
Young children may have difficulty in reporting symptoms: dependent on vocabulary/language development, therefore functionally CIPN can present as refusing to walk, walking on tip toes, struggling to hold objects such as toothbrush or pen/pencil.
Diagnosis may be complicated by CNS (central nervous system) signs and symptoms if treatment includes intrathecal chemotherapy and / or if the cancer is within the CNS (e.g. brain tumour).
Assessing chemotherapy induced peripheral neuropathy
There are various assessment tools available although currently there is not one used nationally.
The paediatric CIPN tool: Ped-mTNS was developed specifically for use in paediatrics and is one of the most commonly used tools within the UK (Mao et al., 2025)
Other tools available are:
- ACTG Brief Peripheral Neuropathy Screening Tool
- Utah Early Neurophathy scale
- Criteria for Adverse Events (CTCAE) - Sensory and Motor Neuropathy Scales (see table)
| Peripheral motor/sensory neuropathy | ||||
| Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 |
| Mild symptoms; clinical or diagnostic observation only | Moderate symptoms; limiting instrumental ADL or mild/moderate impact on age-appropriate normal daily activity (paediatric) | Severe symptoms; limiting self-care ADL or severe impact on age-appropriate normal daily activity (paediatric) | Life-threatening consequences; urgent intervention indicated | Death |
(National Cancer Institute, 2025)
Electrophysiological testing (nerve conduction studies) are often used alongside the tools to confirm a diagnosis.
Management of CIPN
This is a challenge and will require input from CYP’s consultant and allied health professionals such as physiotherapists and occupational therapists. Prevention is the optimum management, dose limitations of chemotherapies known to cause CIPN and increased intervals in between doses. Dose omissions or reductions during the CYP treatment may need to be considered especially if there is grade 3 neurotoxicity on the CTCAE. With CIPN often comes neuropathic pain, this tends to be manged with medications, traditional analgesics are used alongside drugs such as gabapentin and pregabalin. It can take a while to get this type of pain under control and combinations of analgesics will often be required.
Management of physical signs and symptoms
- Referral to appropriate allied health professionals: occupational therapist, physiotherapist
- Intervention dependent on signs and symptoms and may include:
- Maintenance of range of movement: stretches, orthotic support (inner soles, ‘foot ups’, ankle foot orthoses)
- Transcutaneous electrical nerve stimulation (TENS) for pain relief
- Home exercise programme: balance, strength
- Activities of Daily Living assessment, particularly handwriting, fine motor activities affected by sensory alteration and distal muscle weakness
- May require assistive/adaptive equipment.
The long-term outcome for CIPN is difficult to predict due to the lack of prognostic indicators available for the paediatric population, however studies of adult survivors of childhood ALL show long term effects such as quality of life and physical activity levels. Persistent sensory loss and muscle weakness related to peripheral neuropathy are likely to be factors in these findings.
References
Gilchrist, L.S. and Tanner, L. (2012). The pediatric-modified total neuropathy score: a reliable and valid measure of chemotherapy-induced peripheral neuropathy in children with non-CNS cancers. Supportive Care in Cancer, 21(3), pp.847–856. doi:https://doi.org/10.1007/s00520-012-1591-8.
Mao, T., Yorke, J., Shi, Y., Shen, N., Wang, H., Wong, F.-K.-Y., Lam, K.K.W., Tang, L.N., Liu, Q., Abu-Odah, H., Belay, G.M., Yang, F., Wang, L., Cheng, F.W.T., Zhang, X. and Ho, K.Y. (2025). Assessment measures for chemotherapy-induced peripheral neuropathy among pediatric oncology patients: an updated systematic review. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, [online] 33(6), p.514. doi:https://doi.org/10.1007/s00520-025-09515-5.
Molinares, D., Kurtevski, S. and Zhu, Y. (2023). Chemotherapy-Induced Peripheral Neuropathy: Diagnosis, Agents, General Clinical Presentation, and Treatments. Current Oncology Reports, 25(11), pp.1227–1235. doi:https://doi.org/10.1007/s11912-023-01449-7.
National Cancer Institute (2025). Common Terminology Criteria for Adverse Events (CTCAE) v6.0 (MedDRA 28.0). [online] Available at: https://dctd.cancer.gov/research/ctep-trials/for-sites/adverse-events/ctcae-v6.pdf.
Page last updated February 2026