Please use this identifier to cite or link to this item: https://doi.org/10.1007/s00520-019-05177-2
Title: Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy
Authors: Bandla, Aishwarya
Tan, Stacey
Kumarakulasinghe, Nesaretnam Barr
Huang, Yiqing
Ang, Sally
Magarajah, Gayathiri
Hairom, Zarinah
Lim, Joline Si Jing
Wong, Alvin
Chan, Gloria
Ngoi, Natalie
Ang, Emily
Lee, Yee Mei 
Chan, Amanda 
Lee, Soo-Chin 
Thakor, Nitish 
Wilder-Smith, Einar
Sundar, Raghav
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Health Care Sciences & Services
Rehabilitation
Chemotherapy-induced peripheral neuropathy
Paclitaxel
Cryotherapy
Cryocompression
Nerve conduction
CRYOTHERAPY
PACLITAXEL
COMPRESSION
PREVENTION
SCORE
COLD
Issue Date: 1-Aug-2020
Publisher: SPRINGER
Citation: Bandla, Aishwarya, Tan, Stacey, Kumarakulasinghe, Nesaretnam Barr, Huang, Yiqing, Ang, Sally, Magarajah, Gayathiri, Hairom, Zarinah, Lim, Joline Si Jing, Wong, Alvin, Chan, Gloria, Ngoi, Natalie, Ang, Emily, Lee, Yee Mei, Chan, Amanda, Lee, Soo-Chin, Thakor, Nitish, Wilder-Smith, Einar, Sundar, Raghav (2020-08-01). Safety and tolerability of cryocompression as a method of enhanced limb hypothermia to reduce taxane-induced peripheral neuropathy. SUPPORTIVE CARE IN CANCER 28 (8) : 3691-3699. ScholarBank@NUS Repository. https://doi.org/10.1007/s00520-019-05177-2
Abstract: Purpose: Severe peripheral neuropathy is a common dose-limiting toxicity of taxane chemotherapy, with no effective treatment. Frozen gloves have shown to reduce the severity of neuropathy in several studies but comes with the incidence of undesired side effects such as cold intolerance and frostbite in extreme cases. A device with thermoregulatory features which can safely deliver tolerable amounts of cooling while ensuring efficacy is required to overcome the deficiencies of frozen gloves. The role of continuous-flow cooling in prevention of neurotoxicity caused by paclitaxel has been previously described. This study hypothesized that cryocompression (addition of dynamic pressure to cooling) may allow for delivery of lower temperatures with similar tolerance and potentially improve efficacy. Method: A proof-of-concept study was conducted in cancer patients receiving taxane chemotherapy. Each subject underwent four-limb cryocompression with each chemotherapy infusion (three hours) for a maximum of 12 cycles. Cryocompression was administered at 16 °C and cyclic pressure (5–15 mmHg). Skin surface temperature and tolerance scores were recorded. Neuropathy was assessed using clinician-graded peripheral sensory neuropathy scores, total neuropathy score (TNS) and nerve conduction studies (NCS) conducted before (NCSpre), after completion (NCSpost) and 3 months post-chemotherapy (NCS3m). Results were retrospectively compared with patients who underwent paclitaxel chemotherapy along with continuous-flow cooling and controls with no hypothermia. Results: In total, 13 patients underwent 142 cycles of cryocompression concomitant with chemotherapy. Limb hypothermia was well tolerated, and only 1 out of 13 patients required an intra-cycle temperature increase, with no early termination of cryocompression in any subject. Mean skin temperature reduction of 3.8 ± 1.7 °C was achieved. Cryocompression demonstrated significantly greater skin temperature reductions compared to continuous-flow cooling and control (p < 0.0001). None of the patients experienced severe neuropathy (clinician-assessed neuropathy scores of grade 2 or higher). NCS analysis showed preservation of motor amplitudes at NCS3m in subjects who underwent cryocompression, compared to the controls who showed significant deterioration (NCS3m cryocompression vs. NCS3m control: ankle stimulation: 8.1 ± 21.4%, p = 0.004; below fibula head stimulation: 12.7 ± 25.6%, p = 0.0008; above fibula head stimulation: 9.4 ± 24.3%, p = 0.002). Cryocompression did not significantly affect taxane-induced changes in sensory nerve amplitudes. Conclusion: When compared to continuous-flow cooling, cryocompression permitted delivery of lower temperatures with similar tolerability. The lower skin surface temperatures achieved potentially lead to improved efficacy in neurotoxicity amelioration. Larger studies investigating cryocompression are required to validate these findings.
Source Title: SUPPORTIVE CARE IN CANCER
URI: https://scholarbank.nus.edu.sg/handle/10635/206763
ISSN: 09414355
14337339
DOI: 10.1007/s00520-019-05177-2
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