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Laryngopharyngeal dysaesthesia associated with oxaliplatin

This document is an evidence-based summary to complement treatment protocols and includes background and rationale for specific point of care actions. It is not intended to be a comprehensive literature review of all available evidence.

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Definition

The subjective sensations of difficulty swallowing or breathing without objective evidence of laryngopharyngeal dysfunction or respiratory distress, related to oxaliplatin treatment.

Pathophysiology

An acute sensory neurological toxicity, without evidence of cyanosis or hypoxia, laryngospasm or bronchospasm. Often occurs on exposure to cold and changes in temperature.

Incidence

Reactions of any grade reported to occur in 38.2% of patients, with grade 3 to 4 reactions in 1.5% of patients receiving oxaliplatin treatment. Must be differentiated from a platinum hypersensitivity reaction which can occur in up to 20% of patients treated with oxaliplatin and requires early and more intensive intervention.

Onset/duration

During or within 48 hours following oxaliplatin treatment.

Symptoms and signs

Clinical manifestations include:

  • difficulty in breathing or swallowing
  • sensation of discomfort or tightness in the back of the throat and the sensation of the inability to breathe
  • jaw pain.

The following table summarises some of the distinguishing features and management of laryngopharyngeal dysaesthesia and platinum hypersensitivity reaction.

Symptom Laryngopharyngeal dysaesthesia Platinum hypersensitivity
Dyspnoea Yes Yes
Anxiety Yes Yes
Difficulty swallowing Yes (loss of sensation) No
Oxygen saturation Normal Decreased
Bronchospasm No Yes
Laryngospasm No Yes
Pruritis No Yes
Blood pressure Normal or raised Normal or decreased
Cold induced symptoms Yes No
Management
  • stop infusion
  • notify physician
  • rapid resolution is typical
  • observations
  • consider anxiolytic
  • the infusion may be restarted cautiously at the physician's discretion
  • longer infusion time (6 hours) is recommended for subsequent cycles
  • stop infusion
  • notify physician
  • emergency measures per physician's orders (e.g. oxygen, steroid, adrenaline, bronchodilators etc.)
  • DO NOT restart the infusion

Grading

Grade Laryngopharyngeal dysaesthesia
1 Mild symptoms; no anxiety; intervention not indicated
2 Moderate symptoms; mild anxiety, but no dyspnoea; short duration of observation and or anxiolytic indicated; limiting instrumental ADL
3 Severe symptoms; dyspnoea and swallowing difficulty; limiting self care ADL
4 Life-threatening consequences

Common Terminology Criteria for Adverse Events (CTCAE) v5.0, November 27,2017 

Prevention

Avoid cold temperatures, cold drinks and ice cubes before oxaliplatin and for two days after (NO oral cryotherapy with fluorouracil infusion).

Treatment

If this occurs during the infusion:

  • STOP the infusion and monitor the patient
  • determine the exact nature of the reaction as this could be a platinum hypersensitivity reaction
  • check oxygen saturation levels and observations
  • consider giving subsequent doses of oxaliplatin over 2 to 6 hours.

Reassure patient that this acute neurotoxicity is frightening but not dangerous.

Educate patient to report any signs or symptoms of throat discomfort immediately.

Educate patient regarding self care measures:

  • advise patient to cup hands over mouth to warm and feel their breath, as reassurance that breathing is occurring despite the sensations they are experiencing
  • avoid exposure to cold during and after drug administration e.g. air conditioning
  • avoid drinking cold fluids/ice for at least 48 hours after drug administration.
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Bibliography

Sanofi-Aventis Australia Pty Ltd. Eloxatin Product Information. Date of TGA Approval or Last Amendment: 30 June 2015

Version 3

Date Summary of changes
20/09/2010 First approved on eviQ. Version 1.
30/06/2015 Reviewed and reformatted. Version 2.
31/05/2017 Transferred to new eviQ website. Version 3.
24/04/2018 CTCAE information updated to v5.0 published November 27, 2017.
10/12/2020 Document reviewed internally. Title changed to 'Laryngopharyngeal dysaesthesia associated with oxaliplatin'. Incidence data updated as per product information. Minor formatting and wording changes made. Next review in 2 years.
23/11/2022 Document reviewed internally. Moved to clinical resource section. No content changes. Next review in 2 years.

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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https://www.eviq.org.au/p/1735

10 Sep 2024