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For the purpose of this review, studies were categorized as providing a relatively greater degree of cooling or a relatively lesser degree of cooling. Patients may be counseled that there are limited data on using regional cooling to reduce the severity of CIPN. Four out of six studies included in this review applied cooling far colder than the tolerable limit recommended in the Bandla study ( Eckhoff et al.

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Outcomes were measured with motor and sensory nerve conduction studies and were assessed at baseline and after 1, 3, and 6 months ( Sundar et al. However, the results do suggest that both methods are potentially of benefit and should be further explored.In this study, which began with 29 subjects and ended with seven, 10 out of 22 patients who dropped out did so due to the inability to tolerate the cold socks and gloves.

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The study by Hanai and colleagues (2018) examined the use of a relatively greater degree of cooling using cooled socks and gloves worn on the dominant hand and foot in a prospective, self-controlled trial of 36 breast cancer patients receiving weekly paclitaxel for at least twelve cycles. Recent studies have explored the benefits of applying cooling, or cryotherapy, to distal extremities to prevent CIPN. The compound motor action potential (cMAP) amplitudes of motor nerves were more preserved on the intervention side at 3 months post-treatment evaluation; however, these results also did not achieve statistical significance (extensor digitorum brevis cMAP amplitudes more preserved on intervention side below fibula head [ p = . An additional limitation is this review’s use of “colder” compared with “less cold” categories in interpreting findings. Five out of the six included studies provided direct application of cooling, using either precooled gloves and socks or a limb-cooling wrap with continuously flowing cooled water supplied to the wrap ( Eckhoff et al.Odds ratio of ≥ grade 2 peripheral neuropathy reduced if patients wore frozen socks and gloves during treatment following chemo cycle 1 (odds ratio: 0. The difference in drug regimens used within the studies is of particular concern since the mechanism of nerve injury is theorized to differ between peripherally neurotoxic chemotherapies ( Shah et al. It contributes to suboptimal chemotherapy dosing, and its symptoms negatively impact patients’ quality of life. Applying a relatively greater degree of regional cooling compared with a lesser amount may confer benefit in reducing the severity of CIPN.

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It should be noted that the majority of studies reviewed (four out of six) used relatively greater degrees of cooling, which limits comparison and moderates the strength of this finding. The results will be discussed by categories of degree of cooling and method of cooling (see Table 2 for a summary of results categorized by the degree of cooling and method of cooling). Patient Neurotoxicity Questionnaire results: significantly lower grades of peripheral neuropathy in the intervention side ( p< .This categorization of studies as providing a relatively greater or lesser degree of cooling was determined based on a wide gap that existed between applied or achieved cooling temperatures within the studies. At this time, there is insufficient evidence for or against the use of peripheral cooling to prevent CIPN.

The Impact of Peripheral Cooling on Chemotherapy-Induced

Compound motor action potential amplitudes of motor nerves more preserved at 3 months post treatment. Patients are entitled to understand available options that may reduce their risk of adverse events with peripherally neurotoxic chemotherapy agents. Patient Neuropathy Questionnaire results demonstrated significantly lower grades of peripheral neuropathy on the intervention side ( p< .Advanced practitioners may advise patients that to date, more studies have examined the benefits of applying greater degrees of cooling using cooled socks and gloves than other methods that apply less cooling, and that perhaps as a result, there is more evidence to suggest that applying a relatively greater degree of cooling using the same method may provide more benefit compared with less cooling. A relatively greater degree of cooling is defined in this review to be between –20°C and –30°C of applied cooling temperature and was used in four studies ( Eckhoff et al.