Oral Cryotherapy Aids in Reducing the Prevalence of Mucositis in Patients with Breast Cancer


Kara Morris, MSN, RN, OCN; and Christine Wylie, MSN, RN, OCN, discuss their research on oral cryotherapy as a mucositis mitigation strategy.

Oral Cryotherapy Aids in Reducing the Prevalence of Mucositis in Patients with Breast Cancer

Oral Cryotherapy Aids in Reducing the Prevalence of Mucositis in Patients with Breast Cancer

Cases of mucositis decreased in patients with breast cancer following administration of an oral cryotherapy intervention during the first 3 cycles of intravenous (IV) push doxorubicin, according to data presented at the 48th Annual Oncology Nursing Society (ONS) Congress.

Oral mucositis is an adverse event (AEs) commonly associated with chemotherapy and may lead to further AEs such as dehydration, pain, and malnutrition. Nurse investigators sought to assess the efficacy of cryotherapy in mitigating this symptom. The intervention was evaluated in patients with breast cancer (n = 21) for a total of 63 cycles. Oral mucositis ultimately occurred in 22% of patients. Compared with a previous retrospective clinical review, which showed that 67% of patients (n = 8 of 12) self-reported mucositis related to IV push doxorubicin, investigators determined that this intervention showed initial efficacy.

“Our evidenced based data demonstrates how a nurse driven project can positively impact a patient’s quality of life,” Christine Wylie, MSN, RN, OCN, of the Siteman Cancer Center/Washington University, said in an interview with Oncology Nursing News®.

“It’s our hope that our findings might inspire other nurses to do other projects and research to add to the data for oral cryotherapy because our findings [were] limited with specific drugs. We are excited to say that at our institution we have made this a standard of care option for patients with breast cancer—our nurses can offer this intervention to them to help reduce AEs.”

In an interview with Oncology Nursing News, Kara Morris MSN, RN, OCN, a nurse educator for a satellite location at the Washington University-Siteman Cancer Center, and co-author alongside Wylie, detailed implementing the intervention and results of the study.

Oncology Nursing News: What led to the initiation of this study?

Morris: Mucositis was a common AE that our nurses were seeing with doxorubicin IV push, [which] is in the treatment regimen that we give that is called AC [doxorubicin, hydrochloride (Adriamycin), and cyclophosphamide]. Our committee decided to dive into the literature and we found that cryotherapy was used with other medications that we administer, but we did not find literature to support use with doxorubicin IV push. We also reviewed charts of patients with breast cancer receiving IV push doxorubicin to help identify incidence of mucositis and discovered that 67% of those patients reported mucositis as an AE of their chemotherapy.

What was the intervention and how was it conducted?

Our intervention was cryotherapy during IV push doxorubicin. We decided on [oral cryotherapy with ice chips] 10 minutes before the infusion, during the treatment which is a 10-minute IV push infusion, and then 10 minutes after the infusion they would hold [the] ice chips in their mouth to keep their mouth cold and help prevent some of that mucositis from possibly occurring. This was based on literature with cryotherapy that was used during fluorouracil IV push, and we chose 10-10-and-10 for staff ease of remembering and the infusion time.

We tracked, by self-report, mucositis, from cycle 1 through 4. After cycle 4, patients started a new regimen, so at that point we did not track them. We used a tracking sheet for each of those patients and had IV pole reminders to help staff remember the ice during the infusion. We completed this project over a 1-year timeframe and there were 21 patients with breast cancer that agreed to the oral cryotherapy intervention with doxorubicin.

What were the study’s findings?

There were no patients that were unable to tolerate the cold; 78% of our patients had success and did not develop any mucositis and 22% reported mucositis, but they were small mouth sores that resolved without any further intervention.

We were surprised at the effectiveness of the cryotherapy intervention. We anticipated that it would decrease mucositis, but were pleasantly surprised at the outcome of 78%. Ice is available in our treatment room, and we were excited that this intervention was helpful in the prevention of mucositis which is a commonly experienced AE of these patients with breast cancer receiving doxorubicin.


Morris K, Wylie C, Bieg D, and Cipriano D. Oral cryotherapy to reduce mucositis in breast cancer patients receiving intravenous push, dose-dense doxorubicin. Poster presented at: 48th Annual Oncology Nursing Society Congress; April 26-30, 2023; San Antonio, TX. Accessed May 23, 2023. https://ons.confex.com/ons/2023/meetingapp.cgi/Paper/12706

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