First line chemotherapy regimens for colon cancer include FOLFOX (leucovorin, 5-fluorouracil, and oxaliplatin). This combination of medications, more significantly oxaliplatin, has been linked to peripheral neuropathy. For patients with previous active lifestyles, peripheral neuropathy can cause a decreased quality of life. In addition, there are many other side effects of FOLFOX including nausea, diarrhea, and weight loss. Significant peripheral neuropathy in patients undergoing FOLFOX therapy may occur spontaneously after oxaliplatin infusions are discontinued. Current literature supports the need to clinically evaluate peripheral neuropathy in patients undergoing FOLFOX chemotherapy, but few studies have shown an effective way to treat the peripheral neuropathy experienced by many patients. Standard of care for chemotherapyinduced peripheral neuropathy (CIPN) includes dose reduction and/or discontinuation of the suspected neurotoxin. Such dose-limiting effects are poor prognostic indicators and often negatively affect a patient’s long-term survival.

Patient H is a 43-year-old male diagnosed with stage IV colon cancer in December 2003. After H was diagnosed he was treated with 20 cycles of FOLFOX (December 2003-October 2004). The FOLFOX was tolerated moderately well. The oxaliplatin dose was 85 mg/ m2 throughout the 20 cycle course. In February 2004, before the fifth cycle of FOLFOX, the oncologist referred H to the Integrative Medicine clinic; the referral was due to H’s desire to continue with the chemotherapy protocol with goals including weight optimization and alleviation of side effects from the medications causing decrease in daily activities and decreased quality of life.

The Integrative Medicine clinic is staffed with an internist, naturopathic doctors, acupuncturists, massage therapists, and a nutritionist. H saw Dr. Ken Weizer, a board certified Naturopathic Doctor (ND). H presented with chief complaints of weight loss over two months totaling 10% of body weight, nausea, diarrhea, and peripheral neuropathy. On exam, chemotherapy-induced peripheral neuropathy (CIPN) presented as paresthesia in the fingertips for 2-3 days post chemotherapy before complete resolution. However, the CIPN by the ninth cycle of FOLFOX was lasting a full week after chemotherapy treatments and the paresthesia progressed to include all fingers and toes. The CIPN subsequently progressed from the tips of the fingers and toes to involving the entire digits with mild to moderate pain and was affecting the patient’s activities of daily living (ADL). The CIPN associated with oxaliplatin is cumulative and dose dependent. The CIPN was graded using a subjective pain scale and through patient interview with specifics determined regarding location, duration, and effects on ADLs. There is controversy regarding the most sensitive scale to evaluate peripheral neuropathy, and many of the scales do not take into account ADLs,3 therefore in H’s case, no objective scale was used to evaluate the neuropathy.