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Using ice to fight a painful side effect of chemotherapy

headshot of Evelyn Fleider By Evelyn Fleider 513-5582996
5 minute read April 30, 2026

Alisha Bruner always knew she was meant to work with kids. What she didn't know was that oral cryotherapy, a simple, low-cost intervention, would become the centerpiece of her Doctor of Nursing Practice (DNP) project and a potential game changer for pediatric oncology patients battling one of chemotherapy's most painful side effects.

Bruner is a registered nurse in the hematology oncology unit at Akron Children's Hospital, a floor she first stepped onto as a nurse tech while still in college. But staying put professionally was never in her nature, so her choice was never whether to pursue an advanced degree, but how far to go.

When researching paths to becoming a nurse practitioner, the DNP seems to make the most sense for Bruner. “Nursing has more routes than most people realize and I wanted to be ready for all of them,” she explains. “The DNP will give me options if I ever decide to pivot away from clinical positions to leadership or administrative roles.”

Alisha Bruner

Alisha Bruner

There was also a personal dimension to her decision: the deliberate choice to finish the highest level of education she could before family life made it harder to do so. "I thought it would be nice to have all my education done so I could focus on whatever comes next, instead of trying to juggle everything years later."

Choosing the University of Cincinnati College of Nursing for her degree felt, in some ways, like coming home. Bruner grew up outside Cincinnati surrounded by a Bearcat family. So, when a friend mentioned she was going through a UC program, Bruner started looking. “The BSN-to-DNP track felt like it had been designed with me in mind, but I wasn’t sure about the online delivery since I’m an in-person learner,” she recalls.

What she found was that the flexibility of the online program suited her in ways she hadn't anticipated. She was able to continue working travel nursing assignments, rotating shifts, and was able to shape her study days around her workdays. "Having full control of my schedule was really nice," she says. "I wouldn't change anything."

Using cold therapy to protect chemotherapy patients

For Bruner's DNP project, she turned her attention to a problem she saw regularly on her floor: mucositis, a painful inflammatory condition caused by certain chemotherapy agents affecting the entire lining of the gastrointestinal tract, from the mouth all the way through. One of the most common and debilitating side effects of chemotherapy in pediatric oncology patients, the condition causes painful ulcerations that make it difficult to eat, drink, or swallow.

"These are patients who are already vulnerable," Bruner says. "Mucositis creates new complications."

Research has shown that oral cryotherapy, or the use of ice chips or cold liquids held in the mouth during chemotherapy infusion, can significantly reduce the incidence and severity of mucositis, as cold causes blood vessels in the mouth and throat to constrict, reducing the amount of chemotherapy that reaches the mucosal tissue and limiting the damage it can cause.

Alisha Bruner and her sister

Alisha Bruner (in red) and her sister

Working with her DNP project chair, Dr. Mandi Cafasso — director of the DNP program at UC and a nurse at Cincinnati Children's Hospital — and a bone marrow transplant NP colleague at Akron Children's, Bruner designed a structured educational plan to improve and sustain knowledge around mucositis and oral cryotherapy among chemotherapy-trained registered nurses aimed at increasing adherence to offering the intervention to patients.

"Even though Dr. Cafasso may not know the nitty-gritty of pediatric hematology oncology, she was constantly asking ‘what can we do to make this better not only for your project, but for the patients as well’,” she recalls. 

Bruner’s intervention improved staff knowledge and implementation of oral cryotherapy and sustained knowledge retention over time, exceeding expectations. "Oral cryotherapy is inexpensive, requires no specialized equipment, and involves no additional medications. Encouraging a patient to suck on ice chips during a chemotherapy infusion could mean fewer painful ulcers, fewer complications, and shorter hospital stays for some of the most vulnerable pediatric patients.”

As she prepares to graduate soon, her list of next steps is ready: expanding implementation to other institutions, evaluating long-term knowledge retention, assessing direct patient outcomes, incorporating digital tools for data collection and tracking. 

"Being a leader as a nurse and being a leader in the nursing profession are two different things," she says. "I thought I had a pretty good idea of what leadership looked like. But the DNP coursework showed me a bigger picture."

Want to learn more about our Doctor of Nursing Practice programs? Request information. 

Featured image: Alisha Bruner at Akron's Children's Hospital. / Photo provided

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