The difference in drug regimens used within the studies is of particular concern since the mechanism of nerve injury is theorized to differ between peripherally neurotoxic chemotherapies ( Shah et al. Implications for practice based on this review include providing patients with current data on the risk and benefit profile of peripheral cooling to protect against CIPN. Four out of six studies demonstrated benefit of peripheral cooling in reducing the severity of CIPN. The true level of tolerability of peripheral cooling has not been determined, and the range of tolerability reported in the studies reviewed here is in keeping with the range of tolerability reported in other studies that used cooling to prevent dermatologic toxicities.

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For the purpose of this review, studies were categorized as providing a relatively greater degree of cooling or a relatively lesser degree of cooling. A relatively greater degree of cooling is defined in this review to be between –20°C and –30°C of applied cooling temperature and was used in four studies ( Eckhoff et al.Factors influencing the effectiveness of scalp cooling in the prevention of chemotherapy-induced alopecia. No two studies used the same profile of measurement tool(s), although the CTCAE was used in two studies as was the PNQ ( Hanai et al. However, other differences in methods among those studies preclude a stronger comparison of their outcomes.

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This consideration is discussed further in the next section on implications for practice and further study.Outcomes were measured using the Neuropathic Pain Symptom Inventory (NPSI), the Brief Pain Inventory (BPI), and Quantitative Sensory Testing (QST) and were recorded at baseline, 2 weeks post treatment completion, and at first, fifth, ninth, and final weekly paclitaxel treatments ( Griffiths et al. Peripherally neurotoxic agents received by these patients included paclitaxel, albumin-bound paclitaxel, docetaxel, and platinum-based drugs, and were administered alone, in combination with other agents on this list, or with other nonperipherally neurotoxic chemotherapy agents (see summary of the included studies in Table 1). All but one of the studies also mentioned applying cooling for some period of time before and after the infusion, ranging from 15 to 60 minutes ( Eckhoff et al.