Cancer care

First trial results support compression gloves for chemo-induced peripheral neuropathy

Compression gloves and cooling mittens have been shown to halve the rate of chemotherapy-induced peripheral neuropathy (CIPN) of the hand in cancer patients.

While both methods have been used for some time by cancer patients to prevent the troubling side effect of chemotherapy, there has been little evidence to support the practice until now, according to German researchers speaking at the recent ESMO 2022 meeting in Paris.

At the conference, Dr Laura Michel of the University Hospital and German Cancer Research Centre, Heidelberg, presented results from the POLAR study which she said was the first randomised trial to investigate the effectiveness of one-sided hand-cooling or compression for the prevention of CIPN

In the study, 122 breast cancer patients receiving weekly chemotherapy with paclitaxel or nab-paclitaxel were assigned to either cooling or compression of the dominant hand.

Hand cooling was done with a frozen glove (Elasto-Gel) while hand compression was achieved using two surgical gloves, 30 minutes before, during and 30 minutes after taxane therapy.

Dr Michel said the results in patients receiving 10-12 doses of chemotherapy showed that both cooling and compression were highly effective in preventing grade 2 CIPN, when the primary endpoint was evaluated by Common Terminology Criteria for Adverse Events v4.0 (CTCAE).

Rates of CIPN were 25% for cooling and 46% for control (p-value.0.0008). For  compression the rates were 23% for the intervention and 39% for control (p-value.0.0016).

These results showed similar efficacy for both cooling and compression, with no significant difference between interventions (p-value.0.7303).

Secondary outcomes such as patient self reported neuropathy scores and nerve conduction findings also showed protective effects for compression and cooling.

The reductions in CIPN were seen at one month, with the incidence being 10% in the cooling group and 19% with compression compared with 19% and 28% respectively in the control hands

Dr Michel noted that compression gloves were better tolerated, with only one out of 61 patients withdrawing compared to six of 61 withdrawing due to being unable to tolerate the freezing mitten intervention.

“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 trial,” she told the meeting.

During the discussion of the trial, some delegates questioned the study design. Noting that only the dominant hand had been subject to the intervention, which may lead to bias.

It was also noted that CIPN not only affects the hand, but is also a significant problem for the feet, which may lead to falls. Therefore interventions that can address neuropathy in the foot would also be of benefit to patients.

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