Somatic sensory loss in palliative care

Patients with palliative care needs can experience somatic sensory loss from a variety of causes, including:

• central or peripheral neurological syndromes (eg multiple sclerosis)
• metabolic syndromes
• drug adverse effects or toxicity.

Cancer can cause somatic sensory loss through a range of mechanisms, including:

• local effects of tumour(s)—simple dermatomal or specific nerve distribution reflects peripheral lesions, whereas complex patterns are likely to be because of central disease. Leptomeningeal disease can cause multiple peripheral lesions, particularly of cranial nerves. Sensory loss can be caused by malignant spinal cord compressions requiring urgent investigation and management
• paraneoplastic syndromes
• local or systemic anticancer treatment—for example, taxanes, vinca alkaloids and platinum-based drugs may cause peripheral neuropathy. See Painful chemotherapy-induced peripheral neuropathies in the Pain and Analgesia guidelines for management advice.

Management of somatic sensory loss in palliative care depends on the cause(s), its distribution, impact and severity, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.