Any of the body’s nerve systems—motor, autonomic, and sensory—can be impacted by chemotherapy and result in peripheral neuropathy. While anyone taking chemotherapy containing platinum may experience CIPN, there are some risk factors that may predispose you to neuropathy, such as:

FOLFOX and CapeOX are first-line treatments for stage III colorectal cancer patients, and oxaliplatin is part of both regimens. Oxaliplatin can cause toxicity of the nerves. Neuropathy depends on how much chemotherapy you receive, and for how long. The higher the dose, and the longer you receive treatment, the worse neuropathy can become.

Most patients who receive oxaliplatin will experience some type of acute neuropathy. It may hit right away, but it typically does not last long, and symptoms subside within a few days after an infusion. It begins shortly after an infusion of oxaliplatin and gets better within a few days triggered by eating, drinking, or touching something cold or breathing cold air.

Chronic neuropathy often begins around cycle six (on average). For some, it starts earlier, for some it starts later, and some patients never experience chronic neuropathy at all. Chronic neuropathy tends to impact the feet more than the hands. Some experience a slow onset of symptoms that build over time, and others may face extreme symptoms right away.

The risk of longer-lasting sensory neuropathy in your hands and feet increases as the amount of chemotherapy increases in your body. Symptoms may take 18 months to 2 years to go away completely. It is important to let your doctor know if symptoms last beyond a few days after treatment.

Neuropathy can get worse after you stop oxaliplatin because it continues to affect the nerves for anywhere between three to nine months after the last infusion.

Like the onset of neuropathy, every patient is different. Some people do not have any problems with neuropathy after their last infusion. Some patients experience minimal issues, where neuropathy doesn’t bother them unless they do certain things. Others experience debilitating neuropathy, and it doesn’t go away. It’s important to both keep your health care team updated on your neuropathy symptoms, and to learn effective ways to manage them.

There are several neuroprotective strategies for patients, meaning steps to take before and during some of the first chemotherapy cycles that may help reduce side effects. Vitamin B can help provide protection for nerves prior to starting treatment. Physical activity before, during, and after treatment can also help flush out toxins from chemotherapy that are causing nerve damage. Begin a practice of nerve glide exercises before starting oxaliplatin and ask your doctor about prescription medication options and how to know when to try them.

There is likely not one single strategy that will ease neuropathy symptoms or reduce the long-term symptoms. But several strategies working together can ease discomfort. Many patients suggest trying a couple of therapies for at least two weeks, and then see if the nerves respond. Nerves typically need time and patience. If you notice mild or moderate improvement, continue the strategy to see if it helps.

If any of these strategies make symptoms worse, discontinue right away. Always consult your doctor about the side effect management strategies you plan on attempting.

Many of these strategies will have maximum limits and can give you additional problems, like heart conditions and increased nerve pain, if taken without the guidance of a health care practitioner.