Oral cryotherapy (ice chips) to prevent mucositis
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.
Overview
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.
How it works
Local vasoconstriction lowers drug delivery to the oral mucosa during the peak plasma phase of short-half-life cytotoxics.
- Cochrane and MASCC/ISOO recommendation
- Free and immediate
- Large effect for bolus 5-FU and melphalan
- Only for short-infusion drugs
- Avoid with oxaliplatin (cold-induced neuropathy)
- Discomfort
Latest papers
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