Mary Katherine Montes de Oca on Cryocompression Therapy For Peripheral Neuropathy in Gynecologic Cancers

Cryocompression therapy can significantly decrease chemotherapy-induced peripheral neuropathy in patients with gynecologic cancer, according to Mary Katherine Montes de Oca, MD.

Montes de Oca, who is an Duke Ob/Gyn resident at Duke University Medical Center, recently presented on the use of cryocompression to reduce peripheral neuropathy in gynecologic cancer during the Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer. In an interview with Oncology Nursing News®, she described the rationale for the study, as well as the main takeaways for providers.

Montes de Oca explained that chemotherapy, particularly those used for the treatment of gynecologic cancers, can cause neuropathy. This adverse event often lasts throughout treatment and can be long-term for survivors. One prevention strategy used in many institutions is cryotherapy or exposing the hands and feet to cold temperatures during chemotherapy. However, this strategy is not applicable for all patients, such as the elderly or those with frailer conditions who cannot tolerate the cold. Consequently, there have been studies assessing a combination of compression therapy and cryotherapy.

Montes do Oca, therefore, sought to assess that combination at her institution by conducting a randomized controlled trial to see if cryocompression could prevent neuropathy.

A total of 91 patients with gynecologic cancer were included in the study. As part of their treatment plan, nearly all patients received 6 cycles of paclitaxel (n = 90), with 1 patient receiving 5 cycles of cisplatin. Each patient served as their own control, as they were randomly assigned to receive cryocompression on either their dominant or nondominant hand or foot. The opposite hand and foot received no intervention.

The intervention consisted of a combination of compression socks and gloves along with bags of ice. Cryocompression began approximately 15 minutes before their chemotherapy, and continued throughout the 3-hour infusion, and 15 minutes posttreatment.

Investigators used a patient neurotoxicity questionnaire to assess the efficacy of the treatment. By the final visit (n = 69), cryocompression had reduced the rate of moderate to severe sensory peripheral neuropathy (PNQ grade ≥ C) by 46% (odds ratio, 0.54; 0.31-0.94; P = .03). Moreover, there was no significant difference in tactile sensitivity based on the monofilament test between study arms, and participants had significantly worse Functional Assessment of Cancer Therapy – Taxane scores on their control side compared with their cryocompression side (P = .036).

In addition, 75% of patients described the intervention as very tolerable; 20% of patients deemed it somewhat tolerable, 3% called it somewhat intolerable, and 2% described it as very intolerable. Similarly, 78% of patients strongly agree with a statement describing the intervention as acceptable; 20% agreed with the statement, and 2% strongly disagreed.

“The primary goal of this study was to improve patient’s quality of life,” Montes de Oca said. “We’re often focused on the different treatments or the different surgeries [to improve survival], but we also have to think about if we are helping our patients survive longer, that [we ensure] they have a good quality of life. Neuropathy is one of the most common [adverse] effects that our patients experience, so being able to prevent that is really important.”

Reference

Montes de Oca MK, Unnithan S, Erkanli AAE, et al. Use of cryocompression to reduce peripheral neuropathy in gynecologic cancer: A randomized controlled trial. Presented at: 2023 Society of Gynecologic Cancer Annual Meeting on Women’s Cancers; March 25-28, 2023; Tampa, FL.