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Nursing Practice: Hand-Foot Syndrome Management

Identification of Hand-Foot Disease (PPE) Caused by Chemotherapy/Targeted Therapy and Practical Management for Hong Kong Patients

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Hand–Foot Syndrome (HFS, also called Palmar–Plantar Erythrodysesthesia, PPE) is a type of cutaneous toxicity caused by chemotherapy or targeted therapy, commonly affecting the palms and soles. Symptoms include redness, swelling, tingling, burning sensation, and in severe cases blisters or ulcers, which can significantly impair daily life and mobility.
During Xeloda (Capecitabine) treatment, the incidence of ≥Grade 2 HFS ranges from about 11%–24%, highlighting its clinical significance (ctv.veeva.com; The ASCO Post; Breastcancer.org).

Symptom Recognition and Impact

Causative Drugs and Mechanism of Action

Common causative drugs include Capecitabine, 5-Fluorouracil, Liposomal Doxorubicin, Cytarabine, and targeted therapies such as Sorafenib and Sunitinib (eviQ).
The mechanism involves the high sweat gland density and thick stratum corneum of the hands and feet. Drugs accumulate in these tissues via sweat glands, and friction, heat, or pressure trigger local inflammatory responses leading to symptoms (Wikipedia).

Grading and Immediate Management Strategies

Grade
Symptom Description
Required Management
Grade 1
Redness and mild tingling without interference in daily activities.
Continue current medication with adequate moisturization and protection.
Grade 2
Noticeable pain and swelling that affect daily activities.
Initiate active care on the same day to prevent further progression.
Grade 3
Presence of ulcers or blisters, severe pain, and limited mobility.
Immediate treatment adjustment or suspension required until condition subsides.

Prevention and Mitigation Strategies (Hong Kong Patient–Focused Blueprint)

1.Cryotherapy (Cooling Strategy)

  • During chemotherapy infusion and early treatment phases, cold gloves/booties may be used to reduce peripheral drug penetration, lowering the risk of PPE (Wikipedia; NCODA).

2.Moisturization and Topical Care

  • Apply 10% urea cream three times daily. Studies show that during Xeloda treatment, urea cream is superior to Mapisal for prevention, reducing incidence to ~22% (vs. 39% with Mapisal) (Breastcancer.org).
  • Long-term urea cream use during Capecitabine cycles also trends toward symptom relief, though not significantly reducing severe cases (BMC Cancer).
 

3.Anti-inflammatory and Nutritional Support

  • COX-2 inhibitors (e.g., Celecoxib) have been found to reduce the severity of Capecitabine-induced HFS (Annals of Oncology).
  • Oral Vitamin B6 (Pyridoxine) has not demonstrated significant benefit in preventing ≥Grade 2 HFS (simul-europe.com).
 

4.Lifestyle Adjustments

  • Wear lightweight, breathable shoes and socks; avoid friction and heat pressure.
  • Reduce high-impact activities; bathe with cool or lukewarm water; pat dry gently.
  • Apply barrier creams to exposed areas, avoid vigorous rubbing.
  • Elevate hands/feet when possible; wear loose clothing to improve circulation and reduce inflammation.
 

5.Drug Adjustment in Severe Cases
For Grade 2–3 symptoms, patients should discuss with their physician:

  • Dose reduction or extended dosing intervals.
  • Temporary drug interruption until symptoms improve to Grade 1–2, then resume therapy.

Hand–Foot Syndrome is not an unsolvable obstacle but a manageable treatment challenge. With integrated nursing interventions and proactive patient engagement—from cryotherapy and moisturization to lifestyle adjustments and local care—Hong Kong patients can establish effective prevention and mitigation strategies. This ensures uninterrupted cancer treatment while preserving quality of life.

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References

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