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Some chemotherapy drugs, such as paclitaxel, docetaxel, oxaliplatin, vincristine and bortezomib, can damage the nerves in the hands and feet, causing tingling, numbness or pain. Tell your team at every visit: the dose can be lowered or delayed before the damage lasts. No medicine is proven to prevent it; cooling or compressing the hands is being tested. Duloxetine can help painful nerve damage.
ASCO (2020) found that no agent is recommended to prevent CIPN and discourages acetyl-L-carnitine. Clinicians should consider dose delay, dose reduction, substitution or stopping the drug in people who develop intolerable neuropathy or loss of function; duloxetine is the only drug with appropriate evidence for established painful CIPN, and its benefit is limited. Assessment rests on asking at every cycle: an Australian Delphi consensus (2022) agreed on education before treatment, a history to find risk factors, closer monitoring or a baseline neurological assessment for people with existing neuropathy, screening with a short patient-reported questionnaire at every treatment cycle and at follow-up, and encouraging physical activity.
On prevention by cooling or compression, randomised evidence has grown since ASCO 2020. In POLAR (2025, 122 women on weekly paclitaxel or nab-paclitaxel, one hand treated and the other as control), a frozen glove or two surgical gloves one size too small, worn from 30 minutes before to 30 minutes after the infusion, each reduced grade 2 or higher sensory CIPN (cooling 29 against 50 per cent; compression 24 against 38 per cent). In CryoPac (2026, 268 randomised, frozen gloves and socks), cryotherapy did not significantly reduce CIPN at the end of treatment (74 against 84 per cent) but reduced patient-reported tingling and numbness, with 67 per cent compliance. No guideline read has yet graded these trials.
Why: Tingling and numbness are easy to dismiss; people who know to report them help the team act early.
“Patients should receive education about CIPN prior to treatment”
Why: Diabetes, existing neuropathy and some other conditions make nerve damage more likely or worse.
“Patients with preexisting peripheral neuropathy or who are at high risk should be considered for pretreatment neurological assessment or closer monitoring”
Why: Doctors' grading alone misses symptoms that the person notices; asking every cycle catches them early.
“Screening for CIPN should occur at every treatment cycle”
Why: Nerve damage can become permanent; changing the dose in time can prevent lasting harm.
“Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment.”
Why: No drug has been shown to prevent it, and ASCO specifically discourages acetyl-L-carnitine.
“The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged.”
Why: It is the only drug with good evidence for nerve pain after chemotherapy.
“Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited.”
Why: Staying active helps keep physical function; balance problems from nerve damage raise the risk of falls.
“All patients should be encouraged to be physically active during treatment to minimise impairments to physical function”
Why: Cooling or squeezing the hands during the drip is thought to reduce how much drug reaches the small nerves; in one randomised trial both lowered moderate or worse nerve damage.
“Cooling was performed with a frozen glove and compression was applied by 2 surgical gloves (1 size smaller than the tight-fitting size) 30 minutes before, after, and during taxane administration.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
ASCO 2020 remains the latest graded guideline read: no drug prevents CIPN, dose modification is the main tool, and duloxetine is the only treatment with adequate evidence for painful CIPN. Assessment at every cycle with patient-reported tools is consensus practice (Australian CIPN-path, 2022). On cooling and compression the evidence has moved since ASCO 2020 and is mixed: POLAR (2025) found that both a frozen glove and surgical-glove compression reduced grade 2 or higher sensory CIPN, while CryoPac (2026) found that frozen gloves and socks did not significantly reduce CIPN on its primary measure but reduced sensory symptoms. Offering them during weekly taxanes is reasonable where tolerated, and is not yet a guideline recommendation in any source read. The ESMO-EONS-EANO 2020 guideline could not be read.
ASCO, Journal of Clinical Oncology 2020 · Supportive Care in Cancer 2022 · JAMA Oncology 2025 · Annals of Oncology 2026 · ESMO, EONS and EANO, Annals of Oncology 2020
Where it differs: Cools both hands and feet during each taxane infusion, rather than one hand as in POLAR.
Evidence: Randomised trial of 268 people: CIPN at end of treatment 74 per cent with cryotherapy against 84 per cent with usual care, not significant (P = 0.071); fewer hand tingling and numbness and foot numbness on patient report; compliance 67 per cent; no effect on dose modifications. Read as an abstract.
Where it differs: Two surgical gloves one size smaller than a tight fit, worn from 30 minutes before to 30 minutes after the taxane infusion, with no cooling.
Evidence: In POLAR compression lowered grade 2 or higher sensory CIPN from 38 to 24 per cent in the compressed hand against the untreated hand (P = .008); cooling lowered it from 50 to 29 per cent (P = .002). The trial compared each method with the person's other hand, not the two methods with each other.
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.
Frozen gloves, tight gloves and cooling machines all aim to protect the nerves during taxane chemotherapy, but many patients take the cold ones off. Matching the method to what each person tolerates may matter as much as which method is best on paper.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Hand cooling reduced grade 2 or higher sensory CIPN in POLAR “Both interventions significantly reduced the incidence of grade 2 or higher CIPN (cooling: 15 participants experiencing high-grade CIPN in the cooling arm [29%] vs 26 in the control arm [50%]; P = .002;” | single randomised trial (within-patient control), P = .002 | JAMA Oncology 2025 |
| Frozen gloves and socks did not significantly reduce CIPN incidence at end of treatment in CryoPac “Cryotherapy did not significantly reduce CIPN incidence (TNS ≥ 2) at EoT but cryotherapy-treated patients reported fewer sensory symptoms and demonstrated reduced tactile disturbance.” | single randomised trial, P = 0.071 | Annals of Oncology 2026 |
Shares Peripheral neuropathy (chemotherapy-induced), Bortezomib, Oxaliplatin, Docetaxel and the tag supportive-care.
Shares American Society of Clinical Oncology (ASCO), Oxaliplatin and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.
Shares American Society of Clinical Oncology (ASCO) and the tags protocol, supportive-care.