Cooling Therapy for Chemotherapy-Induced Nerve Damage: Does It Really Work?

Can Cryotherapy Prevent One of Chemotherapy's Most Difficult Side Effects?

Chemotherapy-induced peripheral neuropathy is one of the most troublesome and challenging side effects for patients undergoing cancer treatment. However, cryotherapy, or cold therapy, is emerging as an effective, low-risk approach to this nerve damage.

Recent research shows that, particularly in patients receiving taxane-based chemotherapy (docetaxel, paclitaxel), cryotherapy significantly reduces the risk of developing neuropathy . Despite promising findings, the approach is not yet accepted as standard treatment. Reasons include a lack of awareness, practical difficulties and the absence of standardized protocols.

How Does Cryotherapy Work?

Chemotherapy-induced peripheral neuropathy most often causes symptoms in the fingers and toes, including numbness, tingling, pain and sometimes loss of muscle strength . Patients frequently become hypersensitive to temperature and touch.

The risk varies with the chemotherapy used. Taxanes (paclitaxel and docetaxel) and platinum-based drugs (cisplatin and oxaliplatin) are associated with the highest risk of neuropathy.

Cryotherapy uses low temperatures ranging from -30 to 4 degrees on the hands and feet during chemotherapy infusions to constrict blood vessels. This constriction reduces the amount of chemotherapy drug reaching the fingers and toes and may help prevent nerve damage.

Some clinics are also testing cryocompression, which combines cooling with compression.

Does Scientific Evidence Support Cryotherapy?

New research demonstrates the effects of cryotherapy:

• A meta-analysis published in 2024examined more than 2800 patients with breast, gastrointestinal and gynecological cancers. Cryotherapy was found to reduce chemotherapy-induced peripheral neuropathy risk by 77% (RR: 0.23).

• Another meta-analysisfocused predominantly on patients with breast cancer. Its 11 studies involving 2250 patientsidentified the following effects of cryotherapy:

  • Sensory neuropathy risk decreased by 35% (RR: 0.65).

  • Motor neuropathy risk decreased by 82% (RR: 0.18).

Why Is It Not Widely Used?

Despite the scientific evidence, several factors have prevented cryotherapy from becoming routine practice:

1. Lack of Awareness: Among 184 oncologists and other clinicians participating in a survey, only 60% said they knew about cryotherapy as a treatment option , and just 25% routinely recommended it to their patients.

2. Lack of Standardized Protocols: There are no clear guidelines on issues such as cooling duration, optimal temperature and whether compression should be added.

3. Practical Difficulties: Clinics face practical problems such as changing ice packs and patients needing to remove gloves and boots.

4. Lack of Definitive Clinical Evidence: Most studies to date have been small, and some were retrospective. Phase 3 randomized controlled trials are still lacking.

5. Lack of Insurance Coverage: Many health insurance plans do not cover cryotherapy, limiting patient access.

Conclusion and Commentary

Cryotherapy is becoming more common at some chemotherapy centers. In addition, 800 patients are expected to participate in a large phase 3 clinical trial that is being planned.

The evidence is very promising, and cryotherapy is a low-risk approach. It is therefore worth considering.

Cryotherapy is a promising method for preventing chemotherapy-induced neuropathy. If larger clinical trials establish its efficacy, it could transform oncology care.