Frozen Gloves and Socks May Relieve Chemotherapy-Induced Peripheral Neuropathy

Results of a small study exploring the use of frozen gloves and socks in women receiving paclitaxel chemotherapy for their breast cancer suggest the approach may hold promise for the relief of chemotherapy-induced peripheral neuropathy (CIPN).

Results of a small study exploring the use of frozen gloves and socks in women receiving paclitaxel chemotherapy for their breast cancer suggest the approach may hold promise for the relief of chemotherapy-induced peripheral neuropathy (CIPN).

CIPN can occur in approximately three-quarters of patients undergoing treatment with paclitaxel chemotherapy and can persist for a full year in up to 80% of those patients. Further, CIPN can cause dose delays, dose reductions, or treatment discontinuation in nearly 25% of patients.

“Paclitaxel is a key drug for breast cancer management. It is the standard chemotherapy for adjuvant and also the metastatic setting,” explained Hiroshi Ishiguro in an interview with Oncology Nursing News at the recent 2016 meeting of the American Society of Clinical Oncology (ASCO) where the study results were presented during a poster session.

“However, there is also a significant toxicity—peripheral neuropathy—which is very common, and when it occurs, it can sometimes last for many years.”

Ishiguro and his colleagues at Kyoto University in Japan, where he is senior lecturer with the Graduate School of Medicine, may have found a way to provide relief. With the addition of frozen gloves and socks during treatment, objectively assessed CIPN was reduced from 81% to 28% in the hands and 64% to 25% in the feet of patients with breast cancer.

The study involved 36 patients. Gloves and socks are stored inside a freezer set at -22 degrees Fahrenheit for more than 3 hours, typically overnight. A previous study by Ishiguro demonstrated that the degree of freezing does not alter the efficacy of the gloves in preventing chemotherapy-induced nail toxicity in patients with breast cancer.

Patients were included on the study if they were treated with weekly paclitaxel chemotherapy for at least 12 cycles. Gloves and socks were worn for 15 minutes during the pre-medication period, for the entirety of the 60-minute chemotherapy infusion, and then for 15 minutes post-medication for a total of 90 minutes. Frozen gloves and socks were replaced halfway through chemotherapy infusion.

One aspect of the trial was unique: Each of the patients wore a frozen glove and sock on their dominant hand and foot, and their non-dominant side acted as the control. No patients dropped out because of cold intolerance.

The research team was primarily interested in objective incidence of any-grade CIPN as assessed by the Semmes—Weinstein monofilament test, but also evaluated patient-reported symptoms using a questionnaire. Further, researchers monitored changes to small nerves using thermal threshold testing and “manipulative dexterity” using the “grooved pegboard test.”

Patients were evaluated before each of the 12 cycles of chemotherapy. The incidence of objectively assessed CIPN was significantly reduced from 81% to 28% in hands and 64% to 25% in feet. Incidence of patient-reported CIPN symptoms was also lower in hands (58% at baseline vs 8%) and feet (67% vs 19%).

Further, thermal threshold to hot was reduced significantly in both hands and feet, and though a reduction in thermal threshold to cold was also observed, the data were not statistically significant. In addition to the small study size, Ishiguro said limitations of the study were lack of blinding and randomization. Further, patients were not followed long-term after chemotherapy.

Despite these limitations, Ishiguro said he believes frozen gloves and socks are ready for standard use.

“This easy and safe strategy will be clinically applicable and improve the quality of life of cancer patients undergoing chemotherapy,” the research team noted in their poster.

Ishiguro said the gloves and socks cost about $80 each—he gets them at a discounted price—and that each patient uses 4 gloves and 4 socks. Though this adds up to $640 per patient, Ishiguro pointed out that the gloves and socks are reusable and called the method “very cost-effective.”

On their poster, Ishiguro and colleagues reviewed other methods of cryotherapy that have been previously studied and shown benefit: ice chips in the mouth to reduce fluorouracil-induced mucositis, scalp cooling to reduce hair loss caused by chemotherapy, and cold packs over the eyes to reduce 5-FU-induced ocular toxicity.

Notably, the DigniCap cooling cap system received FDA clearance in December 2015 for marketing in the United States for use in patients with breast cancer who are receiving chemotherapy.

One concern with the DigniCap system was that the cooled scalp would not absorb chemotherapy and would be susceptible to metastases. When asked if chemotherapy absorption was a concern with the frozen gloves and socks, Ishiguro said metastasis in hands and feet is extremely rare and that he has not seen it occur in his practice.

Additional questions do remain, according to Ishiguro.

“The only thing we couldn’t find out is who will get the neuropathy” despite using the frozen socks and gloves, Ishiguro said. “We don’t have data yet—[that] may be an area of future research.”