ED DU UC CA AT TI IO ON NA AL L C CO ON NF FE EREN NC CE E NURSING MANAGEMENT OF HAND-FOOT SYNDROME AND HAND-FOOT SKIN REACTION

Hand foot syndrome (HFS) and hand foot skin reaction (HFSR) are common side effects of a number of cancer treatments, including fluorouracil, capecitabine, doxorubicin, docetaxel, sunitnib and sorafenib. Hand foot syndrome is erythema of the palmar aspect of the hands and the plantar aspect of the feet accompanied by tingling, burning or painful sensation. This is primarily seen in patients receiving chemotherapy, such as doxorubicin, fluorouracil and docetaxel. The exact cause is unknown, but it is believed to be caused by concentrations of chemotherapy in the eccrine glands of affected patients. Hand foot skin reaction is similar to hand foot skin reaction with the exception, that the condition is complicated by hyperkeratosis. This condition is most commonly found in patients receiving multitargeted kinase inhibitors (MKI), such as sunitinib and sorafenib. Unlike the chemotherapeutic agents mentioned, the MKI are not found in the eccrine glands of affected patients. Because an overlap in targets for MKI such as sorafenib and sunitinib lies in vascular endothelial growth factor receptor (VEGFR) and platelet-derived growth factor receptor (PDGFR) inhibition, HFSR may be an indirect effect of this. Inhibition of VEGFR and PDGFR could prevent vascular repair mechanisms from functioning properly, thereby causing HFSR in high pressure areas, such as the palm of the hands and the soles of the feet. Both conditions can make it difficult or painful to carry out activities of daily living (ADL). For this reason, it is important for nurses to be diligent in managing and minimizing these side effects. Prior to the initiation of therapy, a comprehensive assessment of the patient should include a thorough examination of the skin’s condition. The nurse should also assess the likelihood of a patient developing HFS or HFSR based on patient social, work and home life. Patients whose jobs require a significant amount of walking or hand friction are at greater risk of developing HFS and HFSR. Caustic cleaning solutions and hot water are also contributors to the development of these skin toxicities. Educating the patients is an important step in management of HFS and HFSR. When nurses teach patients about the purpose and the side effects of antineoplastic agents and multikinase inhibitors, emphasis of HFS and HFSR and the need to be proactive upon initiation of therapy in taking measures to prevent or minimize them. Avoiding the use of hot water, contact with caustic chemicals, tight fitting shoes and rubber gloves, can reduce the risk of developing HFS and HFSR. Patients should also be taught to recognize the signs and symptoms of HFS and HFSR. HFS and HFSR are graded according to severity (Table I).