The advantages of compression over cryotherapy in the prevention of chemotherapy-induced peripheral neuropathy (CIPN) – a randomized clinical trial
Cryotherapy vs. compression vs. placebo: Which one is the best intervention with CIPN?
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of taxane therapy: A severe dose-limiting toxicity of neurotoxic chemotherapy such as paclitaxel and docetaxel, which are used to treat many cancers. Up to 81% of patients treated with paclitaxel have reported CIPN symptoms (tingling, pain, feel like burning, decreased sensity, etc.) that can persist for years after treatment and can impact quality of life and limit daily functioning.
There are no effective therapies for CIPN prevention. A decrease of the chemotherapy with the aim to lower CIPN symptoms can result in an inadequate treatement of the cancer, with potential life threatening consequences; however, both cryotherapy and compression therapy have shown some benefit in small trials. Both techniques result in vasoconstriction which limits blood flow to the extremities and are hypothesized to reduce exposure of peripheral nerves to chemotherapeutic agents.
The authors conducted this trial comparing three treatment modalities (cryotherapy vs compression vs placebo) in patients
with early-stage breast cancer (BC) starting taxane chemotherapy treatment, with the primary goal to select the best intervention.
Method: Patients were randomized to three treatment groups
Baseline – week 12 n=4 discontinued (2 died, 2 withdrew consent)
Week 12 – week 24 n=2 discontinued (1 died, 1 withdrew consent)
Results: Treatment success was defined as > 5-point decrease in the Functional Assessment of Cancer Therapy Neurotoxicity (FACT-NTX) scale at week 12
- Adherence to intervention was lower with cryotherapy (35.0%) when compared to compression (72.7%) and placebo (76.2%)
- 91% of participants in the compression arm were satisfied with their garment vs only 75% in the cryotherapy arm
- 21.4% of participants in the cryotherapy arm reported diminished pressure sensation at week 12 vs no participant in the compression arm
Conclusion: Compression more effective
Compression therapy was the most effective intervention and well tolerated in this randomized clinical trial that had the goal to prevent CIPN. Adherence to and patient-reported satisfaction with the study garments were also higher in the compression arm compared to patients treated with cryotherapy. The authors conclude that compression therapy for the prevention of CIPN should be evaluated in a phase III study.
Take-home message
Compression therapy seems to be an effective and well tolerated intervention for the prevention of chemotherapy-induced peripheral neuropathy (CIPN). Patients reported a higher satisfaction with compression treatment than with cryotherapy and the adherence to compression therapy was higher than to cryotherapy.
Reference
Breast Cancer Research and Treatment (2024) 204:49–59: Randomized adaptive selection trial of cryotherapy, compression therapy, and placebo to prevent taxane-induced peripheral neuropathy in patients with breast cancer.
https://link.springer.com/article/10.1007/s10549-023-07172-y