# Oral cryotherapy (ice chips) to prevent mucositis

Source: https://onco.cc/technologies/oral-cryotherapy-mucositis/  
OnCo record `oral-cryotherapy-mucositis` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Sucking ice chips for half an hour around a bolus dose of fluorouracil or high-dose melphalan roughly halves the risk of painful mouth ulcers. It costs nothing and is recommended in international mucositis guidelines.

## Summary

Cooling the mouth constricts mucosal blood vessels during the short window when a bolus cytotoxic is at peak concentration, reducing the dose delivered to the oral epithelium. A 2015 Cochrane review of 14 randomised trials found that oral cryotherapy reduces the incidence of oral mucositis of any severity and of moderate to severe mucositis in adults receiving fluorouracil-based chemotherapy for solid cancers, and probably reduces it with high-dose melphalan before stem cell transplant. The 2020 MASCC/ISOO guidelines recommend 30 minutes of oral cryotherapy for patients receiving bolus 5-fluorouracil and for high-dose melphalan conditioning. It does not help with infusional 5-FU or capecitabine, whose exposure is prolonged. It is uncomfortable for some and unsuitable with oxaliplatin because cold triggers acute neuropathy.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-10
- Tags: complementary; supportive-care; evidence:strong
- Principle: Local vasoconstriction lowers drug delivery to the oral mucosa during the peak plasma phase of short-half-life cytotoxics.
- Strengths: Cochrane and MASCC/ISOO recommendation; Free and immediate; Large effect for bolus 5-FU and melphalan
- Limitations: Only for short-infusion drugs; Avoid with oxaliplatin (cold-induced neuropathy); Discomfort

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Oral_mucositis
- Cochrane: oral cryotherapy for preventing oral mucositis in patients receiving cancer treatment (2015): https://doi.org/10.1002/14651858.CD011552.pub2
- MASCC/ISOO clinical practice guidelines for mucositis (Cancer 2020): https://doi.org/10.1002/cncr.33100

## Connected records

- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Dry mouth, teeth and taste after head and neck radiotherapy](https://onco.cc/technologies/dry-mouth-teeth-after-head-neck-radiotherapy/), [Honey for radiation mucositis](https://onco.cc/technologies/honey-radiation-mucositis/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/)
- drugs: [Fluorouracil (5-FU)](https://onco.cc/drugs/fluorouracil/), [Melphalan (including hepatic delivery system)](https://onco.cc/drugs/melphalan/)
- institutions: [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/)
- terms: [Mucositis and stomatitis](https://onco.cc/terms/mucositis/)
- bottlenecks: [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Interventions for preventing oral mucositis in patients with cancer receiving treatment: oral cryotherapy](https://onco.cc/key-papers/paper-riley-cochrane-database-syst-rev/), [MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy](https://onco.cc/key-papers/paper-elad-cancer/)

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