{"entity":{"id":"idea-upgrade-hand-foot-cooling-compression-during-taxanes","kind":"idea","name":"Frozen gloves or tight surgical gloves offered during every weekly taxane infusion","aka":[],"tldr":"Cooling the hands and feet, or squeezing them in tight surgical gloves, during paclitaxel infusions narrows blood vessels while the drug level peaks. In one randomised trial, moderate or worse nerve damage in the treated hand fell from 50 to 29 per cent with cooling; a larger trial of frozen gloves and socks missed its main target but found less numbness.","summary":"The positive trial. POLAR randomised 122 women with early breast cancer receiving weekly paclitaxel or nab-paclitaxel to cooling (a frozen glove) or compression (two surgical gloves one size smaller than a tight fit) of the dominant hand, 30 minutes before, during and after each infusion, with the other hand left untreated as the control; 101 were analysed. Grade 2 or higher sensory neuropathy occurred in 29 per cent of cooled hands against 50 per cent of untreated hands, and in 24 per cent of compressed hands against 38 per cent. Neuropathy was the main reason for stopping treatment in 16 of the 24 who stopped.\n\nThe trial that did not reach its target. CryoPac randomised 268 patients receiving taxanes to frozen gloves and socks at every infusion or to usual care; 217 were analysed. Neuropathy on the Total Neuropathy Score at the end of treatment was 74 per cent with cryotherapy and 84 per cent with usual care (P = .071), so the primary endpoint was not met. Patient-reported tingling and numbness in the hands, numbness in the feet and trouble handling small objects were all lower with cryotherapy, there was no difference in grade 2 or higher neuropathy by the clinician scale, and compliance with the gloves and socks was 67 per cent. A smaller self-controlled study (Hanai, 2018) also favoured frozen gloves and socks on the treated side.\n\nWhere guidance stands. The 2020 ASCO guideline on chemotherapy nerve damage states that no agents are recommended for prevention; it was written before both randomised trials above. Adoption has not been measured. The harms reported are discomfort and the risk of cold injury with prolonged contact, and the trials enrolled patients on taxanes only, so the result does not transfer to other drugs that damage nerves.","asOf":"2026-10-20","links":[{"label":"Michel et al., Efficacy of Hand Cooling and Compression in Preventing Taxane-Induced Neuropathy: the POLAR randomized clinical trial (JAMA Oncol 2025)","url":"https://doi.org/10.1001/jamaoncol.2025.0001"},{"label":"Lendorf et al., Efficacy of Cryotherapy in Preventing Taxane-Induced Neuropathy: the CryoPac randomised controlled trial (Ann Oncol 2026)","url":"https://doi.org/10.1016/j.annonc.2026.09.014"},{"label":"Hanai et al., Effects of Cryotherapy on Objective and Subjective Symptoms of Paclitaxel-Induced Neuropathy (J Natl Cancer Inst 2018)","url":"https://doi.org/10.1093/jnci/djx178"},{"label":"Loprinzi et al., Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update (J Clin Oncol 2020)","url":"https://doi.org/10.1200/JCO.20.01399"}],"tags":["protocol-upgrade","upgrade:promising","evidence:moderate"],"related":["idea-moon-neuropathy-prevention-programme"],"cancers":["breast-hr-positive"],"sections":["supportive-care","chemotherapy"],"technologies":["frozen-gloves-compression-taxane"],"targets":[],"drugs":["paclitaxel","docetaxel"],"companies":[],"institutions":[],"pathways":[],"terms":["peripheral-neuropathy"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol"],"keyPapers":["paper-hanai-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Offering every patient starting weekly paclitaxel a choice of cooling or compression of hands and feet reduces patient-reported neuropathy six months after the last dose by a clinically meaningful margin, without lowering the dose of taxane delivered.","rationale":"Neuropathy from taxanes is common, can last for years and is a leading reason for stopping treatment early. Both interventions use equipment that costs a few pounds and add no drug, so a modest benefit would justify routine use if it holds up; the split between the two trials is the reason it is graded promising rather than proven.","test":"A multicentre randomised trial in patients starting weekly paclitaxel comparing usual care with cooling or compression of both hands and feet, with patient-reported neuropathy (EORTC QLQ-CIPN20) six months after the last dose as the primary endpoint, because persistence is what matters to the person and neither published trial was powered for it; delivered taxane dose and adherence to the gloves as secondary endpoints.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-upgrade-hand-foot-cooling-compression-during-taxanes/","neighbours":{"idea":[{"id":"idea-moon-neuropathy-prevention-programme","kind":"idea","name":"A prevention programme for chemotherapy nerve damage: SARM1 inhibitors, cooling and compression","route":"/ideas/idea-moon-neuropathy-prevention-programme/"}],"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"frozen-gloves-compression-taxane","kind":"technology","name":"Frozen gloves, socks and compression for taxane nail and nerve damage","route":"/technologies/frozen-gloves-compression-taxane/"}],"drug":[{"id":"docetaxel","kind":"drug","name":"Docetaxel","route":"/drugs/docetaxel/"},{"id":"paclitaxel","kind":"drug","name":"Paclitaxel / nab-paclitaxel","route":"/drugs/paclitaxel/"}],"term":[{"id":"peripheral-neuropathy","kind":"term","name":"Peripheral neuropathy (chemotherapy-induced)","route":"/terms/peripheral-neuropathy/"}],"bottleneck":[{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-hanai-j-natl-cancer-inst","kind":"paper","name":"Effects of Cryotherapy on Objective and Subjective Symptoms of Paclitaxel-Induced Neuropathy: Prospective Self-Controlled Trial","route":"/key-papers/paper-hanai-j-natl-cancer-inst/"}]}}