Dr Montes de Oca on the Use of Cryocompression to Reduce Peripheral Neuropathy in Gynecologic Cancers

Mary Katherine Montes de Oca, MD, resident, Duke University Medical Center, discusses the use of cryocompression to reduce chemotherapy-induced peripheral neuropathy in gynecologic cancers. 

Peripheral neuropathy is one of the most common chemotherapy-related adverse effects (AEs), with an incidence rate between 30% and 40% within gynecologic cancers. Not only does this AE often lead to dose delays, reductions or discontinuations, but it can also interfere with a patient’s daily activities and decrease their quality of life.

To evaluate whether the mechanism of cryocompression would decrease both the incidence and degree of patient-reported peripheral neuropathy, investigators gave patients compression gloves or socks and a bag of surgical ice to be applied to either their dominant or non-dominant limb 15 minutes before the start of chemotherapy, Montes de Oca says. The study enrolled patients with a gynecologic cancer diagnosis who planned to receive at least 6 cycles of paclitaxel or 5 cycles of cisplatin, and had an ECOG performance status of 0 or 1. Key exclusion criteria included prior treatment with neurotoxic chemotherapy and evidence of baseline neuropathy.

Primary measures of this trial were subjective neuropathy according to a subjective patient neurotoxicity questionnaire (PNQ) and objective neuropathy according to a monofilament test, Montes de Oca continues. Monofilament testing involves the application of a small strand of nylon to a patient’s hand or foot to see whether potential nerve damage precludes them from perceiving the sensation, she explains. Secondary outcomes included a patient’s subjective FACT-NTX score, as well as reported tolerability and acceptability.

Although no significant differences in tactile sensitivity between sides were observed with the monofilament test, subjective sensory measures indicated that patients experienced less neuropathy on the side receiving cyrocompression vs the control side, Montes de Oca reports. According to the PNQ survey, cryocompression decreased the likelihood of patients reporting grade C or greater peripheral neuropathy at the final visit by 46%. Moreover, patients reported worse FACT-NTX4 scores on the control side at final visit vs the cryocompression side. Lastly, cryocompression was deemed somewhat or very tolerable by 95% of patients, and acceptable by 98% of patients, Montes de Oca states. This result is unexpected, as many patients do not report such a high degree of tolerability with cryotherapy alone according to previous research in this space, Montes de Oca explains.

Other objective measures of sensation, such as thermoception, could be utilized to confirm the degree of neuropathy with cryocompression in future research, Montes de Oca concludes.

Disclosures: Dr Montes de Oca reports no disclosures.