A study by Bauman et al in JNCCN—Journal of the National Comprehensive Cancer Network found that patients who kept ice chips in their mouths—what the study authors called “oral cryotherapy”—during oxaliplatin infusions reported less trouble with eating and drinking cold things, less trouble eating and drinking overall, fewer negative effects on quality of life due to oral symptoms, and a shorter duration of oral symptoms.
“Our study highlights a low-tech, no-cost intervention that has the potential to improve quality of life for patients undergoing treatment with oxaliplatin-based therapy,” said study author Kim Reiss, MD, of the Abramson Cancer Center. “Patients being treated with chemotherapy often have reduced appetites and may have trouble finding foods or beverages that appeal to them. Not being able to tolerate anything cold can further limit their ability to eat and drink, which certainly lowers quality of life. Our findings suggest that it might make sense to educate patients about this strategy during standard chemotherapy teaching.”
Oral Thermal Hyperalgesia
Dr. Reiss speculated that this reduction in oral temperature sensitivity (also known as oral thermal hyperalgesia) could result from ice chips cooling the mouth’s internal temperature enough to cause the blood vessels inside the mucous membranes to constrict. That, in turn, may decrease the amount of chemotherapy that gets delivered directly to the mouth and throat.
The researchers were surprised to find that peripheral neuropathy symptoms were also reduced in the treatment group. However, they weren’t sure whether that could be a result of the placebo effect or an additional effect from lowering the core body temperature.
Study Methods and Results
This study was conducted with 50 patients randomly assigned to two groups: patients in group A were provided with ice chips continuously during chemotherapy infusions, and were encouraged to keep them in their mouths as long as possible, whereas those in group B were asked to avoid ingesting anything cooler than room temperature during their infusions. Oral symptoms were defined as prickling, burning, tingling, or pins and needles, and were scored on a scale of 1 to 5.
At baseline, none of the patients in either group reported any ongoing oral symptoms. After the first treatment cycle, only 32% of patients in group A experienced oral symptoms, compared with 72% in group B. By the second cycle, patients in the intervention group had statistically significantly fewer oral symptoms, less difficulty eating or drinking cold items, and less difficulty eating or drinking overall than those in the control group. The patients in group A also tracked how long they kept the ice in their mouths, with longer duration associated with further reduction in severity or existence of oral temperature sensitivity.
“Cryotherapy may be a simple, safe, and effective strategy for the prevention of oral temperature sensitivity in patients receiving treatment with oxaliplatin,” commented Eve Segal, PharmD, BCOP, clinical oncology pharmacist at the Seattle Cancer Care Alliance and Member of the National Comprehensive Cancer Network Chemotherapy Order Templates (NCCN Templates®) Committee. “Unfortunately, this study doesn’t fully elucidate if there is a prolonged benefit for using cryotherapy with oxaliplatin, since most patients discontinued treatment with oxaliplatin after four cycles. Additionally, this study emphasizes that the effectiveness of cryotherapy appears to be limited by the patient’s ability to tolerate cooling for the duration of the infusion. It is highly unlikely that patients will be able to tolerate consistent oral cooling for extended periods of time. Despite these compounding factors, Dr. Reiss and colleagues did highlight the potential benefit of incorporating oral cryotherapy. Future studies to confirm its feasibility are warranted.”
Disclosure: The study authors’ full disclosures can be found at jnccn.org.
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