Chemotherapy-induced peripheral neuropathy may be associated with sensory impairment. In Japan, it was tested whether the targeted use of cold during the drug infusion would bring about an improvement.
This was remedied by frozen gloves and socks worn on the dominant side of the body during the one-hour drug infusion and for fifteen minutes before/after each infusion. In half the time they replaced them with new ones. After a cumulative paclitaxel dose of 960 mg/m2, we compared tactile sensitivity (as an indicator of CIPN incidence) in the 36 breast cancer patients in the primary endpoint. The reference was the baseline measurement. The side of the body not treated with cold served as the control arm. Secondary measures included thermosensory deficits, subjective symptomatology, and dexterity.
Differences significant
Cold therapy alleviated both subjective and objective signs of CIPN. The main differences are shown in Table 1, and they are statistically and clinically significant. This includes patients who showed corresponding symptoms on both the control and test sides. None of the women discontinued the experiment due to cold intolerance.
Subjectively perceived marked CIPN was almost completely prevented at the time of a cumulative dose of 960 mg/m2. This was shown by the evaluation of the patient questionnaire. Nevertheless, when the neuropathy signs occurred, they appeared significantly later than on the control side. Finger dexterity was also better in the intervention group, i.e., the sensorimotor test was completed more quickly.
Self-control brings advantages
Of course, the sample of the study is very small. However, the self-control design has the advantage that potentially unknown confounding factors at the interindividual level may exert less influence on the final outcome. In addition, the effects were consistent and pronounced across the different endpoints, supporting the basic conclusion of efficacy of cold therapy. This could be explained by a regionally reduced blood flow or vasoconstriction during infusion and thus a reduced drug exposure.
It cannot be ruled out that the cooling on one side increased the overall body temperature and thus falsified the result of the control side. Although the control values were within the expected range, this can only be refuted by a direct comparison (patients with/without intervention). It is also not entirely clear whether the choice of the dominant half of the body as the intervention side played a role. Bilateral differences in CIPN symptomatology are not known to the authors. The activities of daily living (ADL, subjectively assessed by questionnaire), however, are likely to be more difficult to perform or compensate for due to an impairment of the dominant side. In general, the strongest confounding factors can be assumed for subjective measurement, since the placebo effect also plays a stronger role here.
In a nutshell
- Cold appears to be effective against symptoms of chemotherapy-induced peripheral neuropathy
- The small study must now be reproduced
Source: Hanai A, et al: JNCI 2018; 110(2): djx178.
InFo ONCOLOGY & HEMATOLOGY 2018; 6(1): 3.
