Ice chips may help some people undergoing chemotherapy eat better, according to a new study.
Oxaliplatin (Eloxatin) is a chemotherapy drug used mainly to treat gastrointestinal cancers.
The drug can cause oral side effects that include trouble eating and drinking, particularly cold items.
Researchers say that patients who kept ice chips in their mouths during the infusion had less trouble eating and drinking than those who didn’t.
The study authors think the ice may cool the mouth’s internal temperature just enough to constrict blood vessels inside the mucous membranes.
That may decrease the amount of the drug that gets delivered directly to the mouth and throat.
“Our study highlights a low-tech, no-cost intervention that has the potential to improve quality of life for patients undergoing treatment with oxaliplatin-based therapy,” Dr. Kim A. Reiss Binder, a researcher and assistant professor of medicine at the Hospital of the University of Pennsylvania, said in a statement.
“Patients being treated with chemotherapy often have reduced appetites and may have trouble finding foods or beverages that appeal to them,” she added. “Not being able to tolerate anything cold can further limit their ability to eat and drink, which certainly lowers quality of life. Our findings suggest that it might make sense to educate patients about this strategy during standard chemotherapy teaching.”
The study is published in the Journal of the National Comprehensive Cancer Network.
The study included 50 patients who weren’t having oral symptoms. They were divided into two groups.
People in group A were asked to hold ice chips in their mouths as much as possible during chemotherapy.
People in group B were asked to avoid putting anything cooler than room temperature in their mouths during infusions.
The researchers defined oral symptoms as prickling, burning, tingling, or “pins and needles.” Symptoms were scored on a scale of one to five.
After one treatment cycle, 32 percent of people in group A had oral symptoms. That compared with 72 percent of those in group B.
By the second treatment cycle, people in group A had significantly fewer oral symptoms. They also had less trouble eating and drinking overall. In addition, they had less trouble with colder items than people in group B.
For people in group A, holding the ice in their mouths longer increased this effect.
The study only involved the first two cycles of treatment. More research is needed to learn if this effect would continue through ongoing chemotherapy.
In addition to oral symptoms, some patients also reported a reduction in peripheral neuropathy symptoms. This includes numbness, weakness, and pain, particularly in the hands and feet.
The researchers don’t know if that was a placebo effect or if the ice lowered the core body temperature.
Dr. Stavroula Otis, a hematologist and medical oncologist at St. Joseph Hospital in California, told Healthline she’s impressed with the study.
She noted it was a randomized prospective study, and there was no way to test it blindly.
“The outcome is subjective because there’s no measuring or qualitative outcome. But the difference between what patients in group A and group B said is pretty dramatic,” she explained.
While there can be some placebo effect, Otis doesn’t believe that’s the case here.
“These oral symptoms are quite intense. I do not think that’s a placebo effect. I think they’ve hit on something,” she said.
Marlon Saria, PhD, RN, is an advanced practice nurse researcher at the John Wayne Cancer Institute at Providence Saint John’s Health Center in California.
Saria told Healthline it’s important to note why oxaliplatin was specifically selected for this study.
“The mechanism behind cold-induced oral dysesthesia with oxaliplatin is unique and not seen in other chemotherapy agents,” he said.
“Peripheral neuropathy is a different story altogether and as the investigators acknowledged, it was an ‘incidental’ finding from this study. Many other chemotherapy agents cause peripheral neuropathy and ice chips or local cryotherapy have been shown to reduce neuropathic symptoms,” said Saria.
The package insert for oxaliplatin specifically instructs patients to avoid cold drinks and use of ice.
Otis explained that’s because once tissues and nerves are damaged, touching something cold can cause a dramatic reaction.
“It feels a lot colder and causes pain and spasms to the throat and esophagus. So, outside of preventing damage in the first place, we tell patients to try to avoid cold stuff because these are triggers for the symptoms,” Otis said.
Whether to use ice chips or avoid cold items isn’t an either-or proposition.
Otis said you can recommend ice chips during infusion to minimize exposure to tissues. Later, you can also recommend avoiding cold items to minimize symptoms.
“I don’t think the two are incongruent,” she continued.
During cancer treatment and chemotherapy, ice chips can become important.
Saria recalled a patient who had already had multiple abdominal surgeries due to colorectal cancer. He was unable to eat, and the only thing he could have was ice chips.
“Then we started the oxaliplatin and had to take the ice chips away. He hated me and his whole family for taking the ice chips away. But we did become friends after,” said Saria.
“It was just ice chips. But for him, it was the world. That’s why these studies are important. You don’t know what ice chips mean for the quality of life for an individual,” he continued.
“I will continue to recommend anything that would help minimize side effects so patients can continue receiving treatment as long as they have been shown to be effective and safe. This is integrating evidence into practice or as the Oncology Nursing Society affectionately calls it, Putting Evidence into Practice (PEP),” said Saria.
When considering interventions, doctors must weigh potential risks against potential benefits, said Otis.
“The potential risks of the ice chips are minimal and transient. You can fix them by quickly taking the ice chips out. For the potential benefit of decreasing pain and cold sensations, it’s sort of a no-brainer. I’m inclined to recommend it to patients,” she said.
Otis said it’s too soon to know if this would have any effect on long-term outcomes.
“It’s more supportive care, not necessarily having any bearing on cancer response. We want to make it more tolerable, getting them through the treatment process as well and as normally as they can,” said Otis.