Preventing Chemotherapy-Induced Peripheral Neuropathy
- Patti Kurtz
- Apr 21
- 3 min read
When chemotherapy is administered, powerful anticancer drugs circulate and destroy cancer cells. However, with long treatment, the drug can also destroy peripheral nerve cells (specifically in the hands and feet). Which leads to chemotherapy-induced peripheral neuropathy. Early symptoms start out mild, such as tingling or subtle numbness. But, it is crucial to recognize them early as prolonged chemotherapy treatment can cause worsening symptoms. That’s why promptly reporting signs to your oncologist is key for treating and reducing the chances of high grade CIPN.
Once the patient presents symptoms of CIPN, the first step for many oncologists is to reduce the dosage of chemo or to stop the chemo treatment altogether. While lowering the dosage of chemo might seem like a practical solution for those with the most extreme and painful symptoms, it also holds the possibility that a lower dosage might allow the cancer cells to persist rather than killing them. In a recent study, of 123 patients with breast cancer 17% needed dosage reduction due to chemotherapy induced peripheral neuropathy, and the median adjusted intensity was 73% of the original dose. However, in most cases this approach doesn’t lead to improved conditions.
Research on weekly paclitaxel treatments (a form of chemotherapy), showed that patients who had dosage reduction due to neuropathy faced worse clinical and patient reported outcomes. Therefore, reducing chemo will likely improve CIPN symptoms, but could potentially lead to delayed cancer remission. There are other options for preventing and easing CIPN that still allow the continuation of treatment instead of scaling back the chemotherapy treatment.
One such treatment is Compression therapy. The idea is that by squeezing the hands and feet it will reduce circulation and reduce the amount of chemo that reaches the sensitive peripheral nerves. Usually done by wearing tight surgical gloves and tight socks, the strategy shows mixed results for preventing CIPN. A recent analysis of multiple different clinical trials revealed that compression socks and gloves cut the risk of CIPN in half. However, this strategy performs differently based on the specific chemo drug the patient is taking. For example, in a trial with 49 women using taxane based chemotherapy, compression was highly effective in preventing CIPN.
While in a trial with patients using paclitaxel based chemo, using surgical gloves to compress the hands during chemotherapy treatment was shown to have little effect on the chances of CIPN. Compression therapy for helping prevent CIPN can be a good cost efficient preventative measure for some, though it depends on the person and what chemo they are using for how beneficial the practice can be.
The second preventative method for CIPN is Cryotherapy, in this method the goal is to chill the body rather than compressing it. By cooling hands and feet it constricts the blood vessels, which stops the chemo from reaching the fragile nerves. Usually done by applying a variety of different prechilled items to the patients hands and feet, like ice water, frozen vegetables, cold packs, and freezable gloves and socks. An early small study shows that cryotherapy can significantly decrease the risk of CIPN compared to the controls, with about a 41-73% risk reduction. Patients using paclitaxel and carboplatin based chemos showed milder symptoms of CIPN, even after initial symptoms began. Making cryotherapy not only a preventing strategy for CIPN but also potentially a solution for some of the pain and discomfort of CIPN.
Unfortunately, there is concern amongst oncologists on whether or not cryotherapy is a reliable method because there is still a lack of solid evidence and testing. In addition, many patients will use frozen vegetables or ice water, where the temperature cannot stay consistently cold for the entire chemo session. Chemo sessions are often long and tiring, ranging multiple hours, and not being able to use your hands for the session can be impractical and annoying. Though cryotherapy offers a promising solution for helping to prevent CIPN, gloves and socks are inconsistent in temperature, the initial temperature is often uncomfortable for patients when first applying the gloves and socks to skin, and prevents the use of hands and feet during treatment. Ultimately, making the practice uncommon at infusion centers.
In summary, despite limited and inconsistent research, there are two main methods that help prevent chemotherapy-induced peripheral neuropathy while still allowing the continuation of treatment: compression therapy, it's easy to administer but inconsistent; and cryotherapy, which shows promise as the most effective method though its harder to use throughout the treatments.
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