Chemotherapy is a common and effective treatment for various cancers, targeting rapidly dividing cells. While life-saving, it often causes side effects by impacting healthy cells. Managing these side effects is important for patient comfort and to continue therapy. Addressing these challenges helps patients navigate their cancer journey.
Understanding Chemotherapy-Induced Peripheral Neuropathy
Chemotherapy-Induced Peripheral Neuropathy (CIPN) is a significant side effect of certain chemotherapy drugs, involving damage to peripheral nerves, those outside the brain and spinal cord. This nerve damage can lead to uncomfortable sensations like numbness, tingling, burning, or pain, commonly affecting the hands and feet. These symptoms can significantly impact daily activities, making fine motor tasks difficult or causing discomfort when walking.
A specific manifestation of CIPN is an extreme sensitivity to cold, known as cold dysesthesia or cold allodynia. Exposure to cold, whether from cold drinks, cold air, or even touching cold objects, can trigger or worsen these neuropathic symptoms. For example, drinking a cold beverage might cause a painful or uncomfortable sensation in the mouth, throat, or jaw, sometimes described as a tightness or burning. This acute sensitivity can occur soon after a chemotherapy infusion and may last for hours or days.
The underlying mechanism involves chemotherapy drugs affecting ion channels in sensory neurons, which are nerve cells responsible for transmitting sensations like temperature. Oxaliplatin can alter the expression of these ion channels, making neurons hypersensitive to cold stimuli. This means nerves that normally register cold as a mild sensation now perceive it as intense or painful, leading to considerable discomfort.
Additional Cold-Sensitive Side Effects
Beyond direct nerve damage, cold temperatures can aggravate other side effects of chemotherapy, particularly those affecting the mouth and throat. Oral mucositis, characterized by painful sores and inflammation, is common. While oral cryotherapy (ice chips) can sometimes reduce drug exposure during short infusions, cold can also exacerbate existing mouth sores, increasing pain and delaying healing. Similarly, pharyngitis, or throat inflammation, can be worsened by cold temperatures, causing increased pain and difficulty swallowing.
The body’s natural response to cold also plays a role. Exposure to cold temperatures can cause vasoconstriction, a narrowing of blood vessels. This response aims to conserve body heat by reducing blood flow to areas like the extremities or mouth and throat. While localized cooling (cryotherapy) is sometimes used to prevent hair loss or neuropathy, systemic exposure to cold can reduce blood flow to already compromised tissues. This reduced blood flow could hinder the healing process of irritated or damaged tissues, increasing discomfort and vulnerability.
Key Chemotherapy Drugs Causing Cold Sensitivity
Cold sensitivity is predominantly linked to certain classes of chemotherapy drugs known for their neurotoxic effects. Platinum-based drugs, particularly oxaliplatin, are a primary cause of this acute cold dysesthesia. Oxaliplatin is commonly used to treat various cancers. Almost all patients receiving oxaliplatin experience a degree of cold sensitivity, which can begin rapidly after an infusion.
Another group of drugs associated with cold sensitivity and peripheral neuropathy are taxanes, such as paclitaxel and docetaxel. While the cold sensitivity from taxanes may not always be as acute or universally present as with oxaliplatin, they can still contribute to nerve damage that makes patients more susceptible to cold-induced discomfort.
Strategies for Safe Hydration During Treatment
Maintaining adequate hydration is important during chemotherapy for overall health and to help manage various side effects. For those experiencing cold sensitivity, careful consideration of beverage temperature becomes necessary. It is recommended to opt for room temperature or warm beverages, such as warm water, herbal teas, or broths, to avoid triggering uncomfortable sensations. Small, frequent sips throughout the day can help ensure consistent fluid intake.
Patients should avoid ice cubes, chilled foods, and very cold drinks, as these can exacerbate cold sensitivity in the mouth and throat. Beyond beverages, it is advisable to minimize exposure to cold air or surfaces, for example, by wearing gloves when handling items from the refrigerator or freezer, or bundling up in cold weather. While staying hydrated is important, any dietary modifications or concerns about side effects should always be discussed with the oncology team or healthcare provider. They can offer personalized advice and strategies to ensure both effective treatment and comfort.