The impact of cold therapy on the incidence and severity of paclitaxel induced peripheral neuropathy: A pilot study

Abstract

Background: Peripheral neuropathy is a common side effect induced by chemotherapy agents like Cisplatin, Paclitaxel and Docetaxel. At present, there is no preventive strategy available against the development of neuropathy. This pilot study was performed to evaluate the feasibility of cold therapy and its impact on the incidence and severity of neuropathy induced by paclitaxel in a dose dense adjuvant regimen among patients with breast cancer. Methods: All adult female patients with early breast cancer planned to be treated with dose-dense schedule of Adriamycin, cyclophosphamide and Paclitaxel were eligible. Ice boot and glove were applied for the duration of all four Paclitaxel infusions on one side while the contralateral limbs were taken as control. Peripheral neuropathy was evaluated and graded prior to each Paclitaxel infusion and then at 3 and 6 months post treatment. Results: A total of 23 patients were recruited. Cold therapy was found to be feasible as no patient discontinued the ice glove and boot during Paclitaxel infusions. Neuropathy symptoms were observed more frequently and with higher grade of severity on control limbs compared to experimental side. There were 5 patients who were switched to ice glove and boot therapy after they developed peripheral neuropathy in the control limbs. These patients observed improvement in their symptoms subsequently. Conclusion: Cold therapy appears to be feasible and appears to have some potential to prevent Paclitaxel induced peripheral neuropathy in this pilot study. This role of cold therapy may be further explored and confirmed in future randomized trials.

Editorial: Adverse Effects of Cancer Chemotherapy: Anything New to Improve Tolerance and Reduce Sequelae?

“…The results of this study suggest that continuous-flow limb hypothermia can preserve specific parameters of nerve conduction and significantly benefit some patients undergoing paclitaxel chemotherapy. These results are supported by another pilot study providing evidence that limb hypothermia has a potential to alleviate paclitaxel-induced symptoms of peripheral neuropathy in breast cancer patients (Younus et al, 2016 ). Kim et al demonstrated that systemic administration of a reactive oxygen species scavenger, tempol, which has previously been shown to be of benefit in a rat model of cancer-induced bone pain (Zhou et al, 2018 ), also ameliorated and prevented neuropathic pain induced by paclitaxel in rats.…”

Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy

“…Several studies have employed frozen gloves as a mode of cryotherapy in preventing CIPN [4,8,9,14,23,29,31,32]. These studies have demonstrated frozen gloves are able to deliver considerable regional hypothermia, however, this effect is not sustained or stable thereby potentially reducing the efficacy of vasoconstriction.…”

“…In a recent trial reported by Hanai et al (2018), cryotherapy in the form of frozen gloves was effective in preventing and reducing the occurrence of CIPN [9]. Similarly, inspired by scalp cooling therapy to combat chemotherapy-induced alopecia (CIA) [7,15], several groups have demonstrated promising results that the use of frozen gloves and socks concomitantly with the chemotherapy infusion is efficacious in reducing CIPN [4,9,23,29,31,32]. However, latest reports indicate that the frozen gloves have been recalled due to incidences of frostbite and other patient safety issues [10].…”

Cold Application and Exercise on Development of Peripheral Neuropathy during Taxane Chemotherapy in Breast Cancer Patients: A Randomized Controlled Trial

“…A variety of rehabilitative methods, such as exercise and cold application, have been tested with positive effects in reducing the impact of CIPN symptoms and in improving the life quality of the patient. [ 18 19 20 21 22 23 ] Literature suggests that a well-planned exercise program produces safe and effective results. [ 19 21 23 ] Here, the type and frequency of the exercise is an important determinant.…”

“…The cold application was reported to reduce the severity of neuropathy in previous studies. [ 20 25 26 ] Hanai et al . [ 26 ] indicated that the occurrences of paclitaxel-induced peripheral neuropathy were less frequent in the patients who used frozen gloves and socks.…”