Palliative care for patients on FOLFOX
Preventing the Cold Sensitivity Side Effect of Oxaliplatin with Ice
Ice may help prevent cold sensitivity side effect caused by oxaliplatin in the FOLFOX treatment for colorectal cancer patients.
The side effect is due to a short-term nerve damage that occurs in the mouth and throat, making it difficult to eat or drink anything cold in the days after treatment. Additionally, FOLFOX often leads to chemotherapy induced peripheral neuropathy (CIPN). CIPN is a progressive and sometimes irreversible condition of the hands and feet. Patients often describe it as feeling numb, tingling, and painful, and it also leads to a sensitivity to cold.
(I would personally describe it as electric shock on the hands, like when you reach inside an uncovered light-switch, or as swallowing a jellyfish, like having piercing knives all the way down the throat in strands. It's awful!)
Preventing it with Ice
Sucking on ice and wearing ice bags can prevent this side effect.
An April 2019 study published in the Journal of the National Comprehensive Cancer Network, showed that gastrointestinal cancer patients who kept ice chips in their mouth during their oxaliplatin infusion (called “icing” by some) developed less cold sensitivity in their mouths compared to patients who did not keep ice in their mouths during treatment. The benefit of this is that those patients could eat and drink with less discomfort.
Maybe it's because the ice restricts blood vessels and prevents the chemo from reaching those nerves.
Applying ice to the hands, feet, and orally, constricts the blood vessels and decreases the amount of oxaliplatin that reaches the nerves in those regions. My decision is based on previous studies with positive findings that cold therapy has had in alleviating.
- hair loss for breast cancer patients (P. Katsimbri, 2000) (Corina J. van den Hurk, 2012 - https://www.sciencedirect.com/science/article/abs/pii/S0959804900000125)
- in preventing oral mucositis (Peterson, 2013 - https://link.springer.com/article/10.1007/s00520-012-1562- 0#Sec4) and
- in preventing oral thermal hyperalgesia (Brittany Bauman, 2019 - https://jnccn.org/view/journals/jnccn/17/4/article-p358.xml?rskey=EgOyxH&result=1).
My decision is also based on the positive feedback from the Live Wire group. Those that are voluntarily icing are reporting no cold sensitivity. No tingling, burning or numbness in their hands or feet. No problems eating or swallowing cold food. No severe reactions like laryngospasms"
COLONTOWN suggests this protocol:
- 1. Start icing prior to starting oxaliplatin infusion
- a. Request a 10 minute warning prior to starting oxaliplatin to allow time to get your cold packs applied.
- a. Rest the hands and feet directly on the cold packs or secure with tape or ace type bandages. Socks and thin gloves can be worn during icing or you can wrap the cold packs in cloth.
- b. Types of cold packs.
- Small bags of ice – have replacement ice ready, as your body heat will melt the ice fairly quickly.
- Freezer packs (gel or blue ice) – might need replacements if they start to get warm
- Commercial cold therapy mittens and socks
- Frozen water bottles
- c. Wrists and Ankles
- If cold sensitivity is present in the hands and feet, icing of the wrists and ankles can be used as an alternative.
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- Oral Icing
- a. Find a cold substance that you can consume during infusion by sucking on it or chewing it.
- b. Types of cold substances
- Ice chips
- Frozen ice treats like Popsicles
- Slushy type drinks
- Ice water
- c. You may experience some slurring of words as your mouth and tongue become numb
- 7. Feel free to cover the non-icing portions of your body with a blanket during the icing protocol. Do not let your body get so cold that you begin to shiver.
Disclaimer: Icing is most effective at reducing cold sensitivity (hands, feet, and drinking cold liquids) and the symptoms of Chemotherapy-Induced Peripheral Neuropathy in the hands and feet (pain, tingling, and numbness) when started at the first infusion. It is less effective for the other side effects from oxaliplatin like the sensation of throat closing (without itching or hives) and first-bite pain. The throat closing with itching, hives etc., which can come on suddenly, indicate an allergic reaction. Muscle soreness or cramping is not a sign of Chemotherapy-Induced Peripheral Neuropathy.
(https://fightcolorectalcancer.org/blog/chemo-oxaliplatin-cold-sensitivity/, https://fightcolorectalcancer.org/wp-content/uploads/2021/06/Icing-Letter-Procedure-Infusion-Centers-Supplies.pdf, https://jnccn.org/view/journals/jnccn/17/4/article-p358.xml)
My Experience
I tried it halfheartedly (seems crazy!), but sucking on ice chips the whole time during infusion helped. The cold sensitivity was becoming unmanageable, so this tip came just in time. After my 4th treatment, even lukewarm water shocked my mouth, and nearly everything felt like swallowing a jellyfish's shocking tentacles all the way down. Even plastic utensils locked up my hands too much to eat. With ice chips, my 5th treatment allows me to wash my hands with cold water (no more waiting for the faucet to heat up!). I tried a popsicle the next morning, and I could taste it (usually cold foods just taste like pain). It lightly shocked my lips, and afterwards, my tongue and cheeks were a little numb but never painful. Such a boost to my quality of life!
I tried it again for treatment 6, and it was less effective. First day, swallowing ice water was like swallowing nails. I could hold the cold drink, walk into cold breezes, and wash with cold water just fine, though. The next day, my hands locked up a lot after going to the cold downstairs, but they worked fine after warming up upstairs. Day 3, first swallow of ice water was nails, but I could drink afterward fine. My lips tingle a little, though, when they touched the ice.
Treatment 10, still barely have any electric shock after only sucking on ice.