Management of hand-foot syndrome in patients treated with ...

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Introduction
Capecitabine (Xeloda s ) was specifically designed
for oral administration, to deliver 5-FU to the
tumour site and to avoid systemic 5-FU exposure
(Ishikawa et al., 1998; Miwa et al., 1998). As
discussed in article 1 in this Supplement (Sternberg
et al., 2004), the unique tumour-selective conversion
of capecitabine to active 5-FU is achieved by a
3-step enzymatic process. The final step of the
conversion is mediated by the enzyme thymidine
phosphorylase, which is found at higher levels in
cancer cells compared with normal tissues. As a
result, more of the active anticancer agent 5-FU is
produced where it is needed (i.e. within cancer
cells rather than in healthy tissues).
Oral capecitabine is being increasingly accepted
into clinical practice as it permits convenient
administration in a home-based setting. Capecitabine
tablets are taken orally twice daily approximately
12 h apart (after breakfast and after dinner)
for 2 weeks followed by a 1-week, treatment-free
period. After this 1-week ‘rest’ period, the patient
starts the next cycle. The normal recommended
dosage is 1250 mg/m 2 twice daily, unless dose
reduction is indicated because of adverse events.
At this dosage, capecitabine is generally well
tolerated, with a low incidence of grade 3/4
adverse events (see article 2 in this supplement).
One of the most common adverse events associated
with its use in clinical trials and in clinical practice
is hand-foot syndrome (HFS), which is rarely serious
and never life-threatening (Cassidy et al., 2002).
However, HFS can significantly interfere with the
activities of normal daily living.
The aim of the current paper is to describe the
occurrence of HFS in capecitabine-treated patients,
its nature, recognition, and severity, and
the role of the oncology nurse in managing HFS
optimally.
ARTICLE IN PRESS
Abschuppung, starke Schmerzen oder Geschwürbildung auftreten. Obwohl man HFS
behandeln kann, entwickelt es sich rapide, wenn man es ignoriert. Zeitweiliges
Absetzen oder eine Verminderung der Dosierung von Capecitabine führt jedoch
normalerweise zu einem raschen Abklingen der Anzeichen und Symptome ohne
langfristige Folgen. Das Pflegepersonal spielt eine führende Rolle dabei, die
Patienten darin zu unterweisen wie man HFS erkennt, wann man die Benandlung
unterbrechen sollte und wie man die Dosierung verändert, um eine wirksame
Behandlung mit Capecitabine langfristig aufrecht zu erhalten. Besonders wichtig ist
dabei, dass Patienten und Pflegepersonal wissen, dass die Unterbrechung oder
Minderung der Dosierung die langfristige turnorbekämpfende Wirksamkeit von
Capecitabine nicht beeintrǎchtigt.
r 2004 Elsevier Ltd. All rights reserved.
Hand-foot syndrome
HFS, which is also known as palmar-plantar
erythrodysesthesia (or PPE), was first described in
the literature in 1974 in patients receiving mitotane
therapy for hypernephroma (Burgdorf et al.,
1982; Baack and Burgdorf, 1991; Nagore et al.,
2000). In the early 1980s, it was referred to as
chemotherapy-induced acral erythema, and appeared
to be associated with continuous exposure
to various chemotherapy drugs (Baack and Burgdorf,
1991).
Description/classification
Y. Lassere, P. Hoff
In early reports, acral erythema was characterised
by erythema, numbness, tingling, dysesthesia,
and/or paraesthesia on the palms or soles; the
condition can also rarely affect the trunk, neck,
chest, scalp, and extremities (Baack and Burgdorf,
1991). In advanced cases, patients experience pain
with swelling of the skin, and even desquamation,
ulceration or blistering.
HFS has been defined more recently as a distinct
and specific presentation (Nagore et al., 2000).
Most patients present with dysesthesia, usually
with a tingling sensation of the palms and soles,
which can progress in 3–4 days to burning pain plus
well-defined symmetric swelling and erythema
(Fig. 1a). The hands tend to be more commonly
affected than the feet, and might even be the only
area affected in some patients. Erythema is
uncommon outside these areas, although occasionally
a mild erythema or morbiliform eruption on the
trunk, neck, chest and extremities can accompany
the acral response (Baack and Burgdorf, 1991; Kroll
et al., 1989). Blistering and desquamation (shedding
of scales or small sheets of skin) may also