Hand Cooling, Compression Nearly Halve Risk of Neuropathy From Chemotherapy

Hand Cooling, Compression Nearly Halve Risk of Neuropathy From Chemotherapy

Hand cooling and hand compression both worked well to reduce the risk of neuropathy in people receiving taxane chemotherapy for breast cancer.
Sep 16, 2022.
 

Hand cooling and hand compression both worked well to reduce the risk of neuropathy in people receiving taxane chemotherapy for breast cancer, according to a small German study.

The research “Chemotherapy-induced peripheral neuropathy (CIPN) prevention trial evaluating the efficacy of hand-cooling and compression in patients undergoing taxane-based (neo-)adjuvant chemotherapy for primary breast cancer: First results of the prospective, randomized POLAR trial” was presented at the European Society for Medical Oncology (ESMO) Congress 2022 on Sept. 11, 2022.

 

What is neuropathy?

Neuropathy is the general term for the pain, numbness, or tingling that you feel when your peripheral nerves are damaged. Your peripheral nerves bring signals from the brain and spinal cord to other — or peripheral — parts of the body, such as your hands and feet.

For people diagnosed with breast cancer, the most common cause of neuropathy is chemotherapy. Doctors call this chemotherapy-induced or chemotherapy-associated peripheral neuropathy.

Although there are some treatments to ease neuropathy, they’re not effective for everyone. Neuropathy is one of the most common reasons people:

  • receive a lower dose of chemotherapy

  • delay chemotherapy

  • stop chemotherapy

 

About the study

Very small earlier studies have suggested that cooling or compressing the hands could help prevent neuropathy.

In this study, the researchers wanted to do a larger, randomized trial.

Called the POLAR trial, the study included 122 people diagnosed with breast cancer. All the people were scheduled to receive weekly chemotherapy for 12 weeks to treat breast cancer:

  • 73% of the people received chemotherapy before surgery (called neoadjuvant chemotherapy)

  • 27% of the people received chemotherapy after surgery (called adjuvant chemotherapy)

  • 59% of the people received a chemotherapy regimen containing Abraxane (chemical name: albumin-bound or nab-paclitaxel)

  • 36% of the people received a chemotherapy regimen containing Taxol (chemical name: paclitaxel)

  • 5% of the people switched regimens (from Abraxane to Taxol or vice versa)

Some of the people also received carboplatin or Herceptin (chemical name: trastuzumab) as part of the chemotherapy regimen.

Both Abraxane and Taxol are taxanes. Taxanes work by making it difficult for cancer cells to divide.

The researchers randomly divided the people into two groups:

  • 61 people were in the cooling group; they wore a frozen Elasto-Gel therapy mitten on their dominant hand

  • 61 people were in the compression group; they wore two surgical gloves that were one size smaller than a tight-fitting size on their dominant hand

The number of people in each group who received Abraxane or Taxol were about the same.

In the cooling group:

  • 61% of the people received Abraxane

  • 38% of the people received Taxol

  • 2% switched regimens

In the compression group:

  • 57% of the people received Abraxane

  • 34% of the people received Taxol

  • 8% switched regimens

The people wore the frozen mitten or tight-fitting gloves for 30 minutes before, during, and 30 minutes after chemotherapy.

The researchers assessed neuropathy each week while the people were receiving chemotherapy, as well as one week, one month, and six months after they completed chemotherapy.

The researchers also wanted to compare cooling and compression to see if one was better at preventing neuropathy than the other.

Overall, both cooling and compression helped reduce the risk of neuropathy.

Among people who wore the frozen mitten:

  • 50% developed neuropathy in the hand that didn’t wear the mitten

  • 29% developed neuropathy in the hand that wore the mitten

Among people who wore the tight-fitting gloves:

  • 38% developed neuropathy in the hand that didn’t wear the gloves

  • 24% developed neuropathy in the hand that wore the gloves

Both of these differences were statistically significant, which means they were likely due to the cooling or the compression and not just because of chance.

The researchers found no difference between cooling and compression when seeing how effective each was at preventing neuropathy.

Still, the people tolerated compression better than cooling.

“We had six people drop out of the cooling arm because they couldn’t tolerate it,” said Laura Michel, MD, of the University Hospital and German Cancer Research Center in Heidelberg, Germany, who presented the research. “Only one person dropped out of the compression arm because they couldn’t tolerate the compression. Nine other people dropped out because they wanted to do the compression on their own.”

The researchers also wanted to see if there were any risk factors that could help predict who has a higher risk of neuropathy.

People who received Abraxane had a higher risk of neuropathy than people who received Taxol. Dr. Michel also noted that the higher overall dose of Abraxane a person received, the higher their risk of neuropathy.

“Interestingly, people who also received carboplatin had a lower risk of neuropathy,” she said. “But we realized this was because they received lower taxane doses.”

Age, smoking status, alcohol intake, and body mass index (BMI) did not affect the risk of neuropathy.

“Both interventions were highly effective and almost halved the risk of grade 2 or higher chemotherapy-induced peripheral neuropathy,” Dr. Michel concluded. “The efficacy of cooling and compression was similar. However, since compression is easily accessible, inexpensive, and better tolerated, it could play an increasing role in clinical practice and should be further investigated in clinical trials.”

 

What this means for you

Although very promising, this study is small. The researchers chairing the session where this research was presented said that a larger study is needed before cooling or compression is commonly recommended to prevent neuropathy.

Still, if taxane chemotherapy is part of your treatment plan, you may want to talk to your doctor about this study and whether wearing frozen mittens or compression gloves before, during, and after chemotherapy might make sense for you. Although these results need to be confirmed in a larger study, the side effects of wearing the frozen mittens or compression gloves are minimal for most people and may help.

It’s important to know that you likely have to take your own frozen mittens or compression gloves to your treatment center because it’s not clear how many centers offer these options.

Learn more about Neuropathy.

Written by; Jamie DePolo, senior editor

— Last updated on September 23, 2022, 6:34 PM

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