New Research in JNCCN Touts Ice Chips as a Simple, Inexpensive Way to Reduce a Common Chemotherapy Side Effect

In In The News by Barbara Jacoby

Researchers from Abramson Cancer Center at the University of Pennsylvania find patients who kept ice chips in their mouths during infusion with oxaliplatin reported less trouble eating and drinking than patients who were not exposed to this intervention.

A new study in the April 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network from the Abramson Cancer Center at the University of Pennsylvania found that cancer patients who kept ice chips in their mouths (termed ‘oral cryotherapy’ by the authors) during oxaliplatin chemotherapy 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 for 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 Kim Reiss (Kim Reiss Binder), MD, 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.”

Dr. Reiss speculates 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 see that peripheral neuropathy symptoms were also reduced in the treatment group, but weren’t sure if that could be a result of the placebo effect, or an additional effect from lowering the core body temperature. These results follow previous studies which found that applying a “cold cap” during chemotherapy infusion reduced alopecia up to 50% in patients with breast cancer.

This study was conducted with 50 patients randomized into 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. 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 one-to-five. 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, Seattle Cancer Care Alliance, and Member of the NCCN Chemotherapy Order Templates (NCCN Templates¼) 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.”

To read the entire study, visit JNCCN.org. Complimentary access to “Efficacy of Oral Cryotherapy During Oxaliplatin Infusion in Preventing Oral Thermal Hyperalgesia: A Randomized Trial” is available until July 10, 2019.

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About JNCCN—Journal of the National Comprehensive Cancer Network More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines¼), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network The National Comprehensive Cancer NetworkÂź (NCCNÂź) is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. By defining and advancing high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers around the world.

The NCCN Member Institutions are: Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA; Fred & Pamela Buffett Cancer Center, Omaha, NE; Case ComprehensiveCancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope National Medical Center, Duarte, CA; Dana- Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Comprehensive Cancer Center, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Rogel Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.