Article by Professor John Corbett

MB, BS (HONS), FRCP (UK), FRACP, MA (Oxford), D. Phil (Oxford), MACLM, Professor of Medicine (Griffith)

The concept of proprioception informs us that the central nervous system (most specifically the cerebellum) depends heavily on the peripheral nervous system to recognize its body’s position spatially.

Imagine a robot that’s motherboard is still in working order, yet it no longer has enough working sensors to inform its spatial position – it would likely begin falling over and bumping into things, damaging even more sensors as it does.

So too is the experience of many cancer patients. For a variety of reasons (such as an axonal peripheral neuropathy or reaction to chemotherapy drugs), the peripheral nervous system can begin slowing production and thus see a steady decline in the amplitude of its signals – much the way our robot experiences malfunction of its sensors over time.

What this primarily means for cancer patients is that maintaining good balance, which is integral in day-to-day life, becomes increasingly difficult. The body’s ability to remain stable while sitting, standing or moving (which helps to prevent falls and further injury which cancer patients are especially vulnerable to) is compromised.

Practitioners are aware that balance disorders in patients can commonly be attributed to innocuous disturbances to the vestibular system (such as an inner ear infection). Additionally, the vestibular system relies on the visual and skeletal systems to maintain the body’s stability and, when either of these is out of commission, a patient’s balance will be adversely affected.

While the vestibular, skeletal and visual systems are commonly checked for a multitude of underlying causes in patients with a balance disorder, an equally important, yet often overlooked consideration is the role of the peripheral nervous system in relation to balance (particularly in cancer patients).

Balance disorders may present in cancer patients in a number of ways including an irregular/erratic step, unsteady gait, the need for support when walking, clumsiness, falls, lethargy, dizziness (especially while standing) and vertigo.

While many of these symptoms may appear as post-treatment side-effects (such as with chemotherapy), they may also present pre-treatment (for example, a tumour applying excess pressure to a peripheral nerve). In such instances, it is imperative for the General Practitioner to consider the role of the peripheral nervous system in their diagnosis and seek appropriate testing. Such symptoms are, perhaps surprisingly, one of the biggest indicators of many forms of cancer (particularly in cancers of the head, neck and spine), which may actually assist in the cancer diagnosis itself being made.

There are varied reasons a patient may exhibit poor balance; and it’s clearly important to also rule out common neuropathies before a cancer diagnosis can be confirmed. In either instance, it is imperative that patients are properly tested.

Nerve testing conducted by an experienced Neurologist/Neurophysiologist to pinpoint any related damage can assist Oncologists to both locate and monitor the progress of any deterioration to the nerves, which can cause major complications for cancer patients if not adequately addressed. Patients can then commence treatment with their Oncology Rehabilitation Therapist to improve their mobility and stability.

Corbett Neurophysiology Services (CNS) has been servicing the local community for over 25 years and provides bulk-billed, premium-quality nerve conduction studies (NCS) performed by qualified Neurologists and Scientists who all specialise in neurophysiology.

Due to the recent expansion of our practice hours, we can currently book patients in for testing within weeks, not months. Additionally, emergency patients are always prioritised and WorkCover appointments are readily available.

CNS provides same-day results and specialist management-recommendations to referring practitioners. We also explain the comprehensive test results to patients in the same-day consultation.

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