Yonsei Med J.  2009 Dec;50(6):796-802. 10.3349/ymj.2009.50.6.796.

Compliance and Effective Management of the Hand-Foot Syndrome in Colon Cancer Patients Receiving Capecitabine as Adjuvant Chemotherapy

• Son HS
• Lee WY
• Lee WS
• Yun SH
• Chun HK

• KMID: 1777093
• DOI: http://doi.org/10.3349/ymj.2009.50.6.796

Abstract

PURPOSE
Physicians and oncology nurses must continue to update their knowledge on treatment and treatment-related side effects, while searching for effective methods to prevent or manage side effects. The objective of our study was to describe the incidence and response to treatment of the hand-foot syndrome (HFS) and the compliance with treatment of patients with stage IIB, IIIA, IIIB, and IIIC colon cancer that were treated with capecitabine alone as adjuvant therapy.
MATERIALS AND METHODS
Between September 2005 and September 2006, 84 patients fulfilled the inclusion criteria and were included in this retrospective analysis of prospectively collected data.
RESULTS
The treatment compliance rate was 90.5% (76 out of the 84 patients). The HFS developed in 65 patients (77.4%). Thirty-three patients (50.7%) had grade 1 HFS, 22 patients (33.8%) had grade 2 HFS and 10 patients (15.5%) had grade 3 HFS, as their most severe episode. For Grade 1 patients, the dose was maintained, and skin barrier cream and moist exposed burn ointment (MEBO) were applied. For Grade 2 patients, either the dose was maintained or 25% of the dose was reduced; MEBO and supportive care were provided. For Grade 3 patients, one cycle of chemotherapy was interrupted followed by dose adjustment; MEBO and supportive care were provided.
CONCLUSIONS
HFS is manageable if both patients and oncology care teams are educated about HFS associated with capecitabine. The HFS is treated by patient education, preventive management, ointment application, conservative management, dose reduction, and interruption of chemotherapy administration.

Keyword

Colon neoplasm; capecitabine; compliance; side effects; hand erythema; foot erythema

MeSH Terms

Adult
Aged
Antimetabolites, Antineoplastic/adverse effects/*therapeutic use
Chemotherapy, Adjuvant/adverse effects
Colonic Neoplasms/*drug therapy
Deoxycytidine/adverse effects/*analogs & derivatives/therapeutic use
Female
Fluorouracil/adverse effects/*analogs & derivatives/therapeutic use
Foot Dermatoses/*chemically induced
Hand Dermatoses/*chemically induced
Humans
Male
Middle Aged
Retrospective Studies
Syndrome

Figure

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  Fig. 1 Management system of hand-foot syndrome.

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  Fig. 2 Clinical manifestations of hand-foot syndrome (HFS). (A) Grade 1 HFS. (B) Characteristic erythema associated with moderate HFS, grade 2. (C) Grade 3 HFS associated with progressed moist desquamation with the patient in an extremely painful and debilitated condition.

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  Fig. 3 Response to the treatment of hand-foot syndrome.

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  Fig. 4 Management of hand-foot syndrome. (A) Grade 2 HFS; Painful erythema, swelling/ discomfort that affects activity of daily living occurred, and the original dose was maintained with application of MEBO for 1 cycle (3 weeks). (B) After management, Grade 1 HFS; numbness, tingling, painless erythema / discomfort, able to perform activities of daily living. (C) Grade 3 HFS; Pain moist desquamation, ulceration, blistering, and severe pain / unable to perform daily living activities occurred, and the drug administration was interrupted for one cycle (3 weeks). The patient was treated with MEBO. (D) After management, Grade 2 HFS; Painless erythema / discomfort, able to perform daily living activities.

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