This study investigated the awareness and utilization of cryotherapy and compression therapy for taxane and oxaliplatin-induced peripheral neuropathy. Overall, there was relatively high awareness and recommendation of cryotherapy compared to compression therapy among participants. Awareness for the use of cryotherapy for taxane-induced peripheral neuropathy was highest among participants living in Europe, identifying as non-physicians, and not practicing in an inpatient setting. The higher awareness of cryotherapy can be attributed to the multiple published studies investigating cryotherapy compared to compression therapy.5,8,9 Very few studies compared one cryotherapy versus compression therapy for prevention of CIPN. One study compared the efficacy of cryotherapy using frozen gloves and compression therapy using surgical gloves in preventing paclitaxel-induced peripheral neuropathy.10 The investigators found no significant difference in incidences of paclitaxel-induced peripheral neuropathy using cryotherapy or compression therapy.
Our results demonstrated that there are varying modes and methods in the delivery of cryotherapy and compression therapy among cancer centers around the world. Commercial cooling gloves and socks was the most used cryotherapy modality in Europe and bags with ice was the most used modality in the Unites States. Although compression therapy was not as commonly recommended as cryotherapy, compression gloves and socks were the most used compression therapy modality. Notable compression therapy methods include tight surgical gloves which provide a potentially more feasible and less costly option. There are limited studies that compared the efficacy of one modality versus the other for the prevention of CIPN. One study compared the efficacy of surgical gloves for compression therapy for the prevention of paclitaxel-induced peripheral neuropathy compared to bare hands.11 The study found that the occurrence rate of sensory and motor peripheral neuropathy was lower in the surgical glove hand compared to the control hand (sensory neuropathy 21.4 vs. 76.1%; motor neuropathy 26.2 vs. 57.1%).11
The survey data indicated that most participants initiate cryotherapy and compression therapy half an hour before chemotherapy administration and most continue for half an hour after the end of infusion. Most studies in the literature have initiated therapy 15 minutes before and continued 15 minutes after the end of infusion for cryotherapy.5–7, 9,10,12,13 Two studies investigating compression therapy both initiated half an hour before and continued half an hour after the end of infusion.10,11 The shorter administration time of cryotherapy compared to compression therapy can be attributed to the increased risk of adverse events including discomfort with cooling. Additional factors may include infusion center chair time for these modalities in addition to the chemotherapy infusion time. This increased chair time may result in a reduction of the number of patients that a center is able to accommodate. Hence, future studies should investigate the need for administration of these modalities prior to and post chemotherapy administration as well as the efficacy of shorter durations of administration.
The most identified adverse events associated with the use of cryotherapy among our participants included redness and irritation of skin. Overall, studies in the literature noted minimal adverse events associated with the use of these modalities including redness and irritation of skin.5,13,14 Although one-tenth of our participants indicated frostbite as an adverse event, current published studies in the literature have not reported such an adverse event.
While almost three-quarter of participants indicated awareness of cryotherapy for taxane-induced peripheral neuropathy, only one-quarter indicated recommendation in their practice setting. Insufficient evidence was the most identified barrier to implementation of cryotherapy and compression therapy. Current studies in the literature show mixed results regarding efficacy of cryotherapy. Additional phase III, randomized, controlled trials are needed to better validate safety and efficacy. Implementation studies are also needed to investigate the application of these modalities in clinical practice. The concept for such a trial has been approved by the United States National Cancer Institute; hopefully, this will clarify the benefits and risks of compression therapy versus cryo-compression therapy versus a control group.
This study had numerous strengths. This was a global survey of supportive care providers and included healthcare providers from various professions and practice settings. Although this study was not designed to assess the efficacy and safety of cryotherapy and compression therapy, it provides a novel perspective to the literature regarding the providers’ opinion of these modalities in clinical practice. This study was limited to MASCC members and response rate was low at 8.8% and, thus, may not represent views of all members. Higher awareness of cryotherapy and compression may also be a reflection of the increased knowledge and interest of MASCC members about cancer supportive care practices relative to non-members.