Adherence to a topical moisturizing preparation for regorafenib-related hand-foot skin reaction

Abstract

Objective Application of topical moisturizing preparations is important for the prevention and palliation of hand-foot skin reaction induced by multi-kinase inhibitor. Application adherence of topical moisturizing preparations in clinical practice has rarely been reported. This study investigated the factors affecting adherence to the application of topical moisturizing preparations in patients administered regorafenib. Methods The subjects were patients administered regorafenib ( n = 118). Consumption of a urea-based moisturizing ointment, hand-foot skin reaction grade (CTC-AE ver 3.0), treatment duration, and dose of regorafenib, factors that might affect the onset of symptoms and adherence, including age, sex, presence of a key person, working status, performance status, past use of capecitabine or epidermal growth factor receptor antibodies, and relative dose intensity were retrospectively investigated. The adherence to the topical moisturizing ointment (<21 g per week) was judged as poor. The data were analyzed by logistic regression analysis. Results Working status was associated with poor adherence, showing a positive correlation (odds ratio; 3.024, p = 0.023). In contrast, symptom grade of hand-foot skin reaction and regorafenib relative dose intensity showed negative correlation with poor adherence (odds ratio; 0.971, p = 0.012, and 0.485, p < 0.001, respectively). Conclusions The results suggest that adherence decreases in patients with working. The relative dose intensity of regorafenib decreased when adherence to topical moisturizing ointments decreased. Severe hand-foot skin reaction could be associated with adherence. Patients consciously might not apply the ointment when hand-foot skin reaction did not become severe. It will be problematic for medical personnel to motivate patients for improving adherence to the use of moisturizing ointments.

Effectiveness of a pharmaceutical instruction video for adherence to dermatopathy treatment in patients with cancer receiving the anti-epidermal growth factor receptor antibody

“…Previously, we retrospectively investigated adherence to topical moisturizer in patients receiving regorafenib. 10 In that study, 36% of the patients had poor adherence, and used <6 FTU/day (3 g/day), when topical moisturizer was prescribed to cover both hands and feet. Kobayashi et al also reported that topical moisturizer use in patients receiving sorafenib greatly varied.…”

“…Employment status was found to affect adherence in our previous survey. 10 However, we did not analyze the employment status of our study patients. Future studies are required to verify the effectiveness of pharmaceutical instructional video for adherence to topical moisturizer use in a randomized manner or after adjusting for patient background.…”

“…In our preliminary survey, adherence to urea ointment for the prevention of HFSR among patients receiving regorafenib was investigated. 10 When the daily dose of the topical preparation was prescribed as 6 finger-tip units (6 FTU as the optimal dose for application on both the hands and feet), 36% of patients showed poor adherence. Based on these findings, patient compliance instruction appears to be important for adherence to topical preparation for chemotherapy-associated dermatopathy.…”

Effect of Urea Cream on Hand-Foot Syndrome in Patients Receiving Chemotherapy

“…The 7 trials were published between 2010 and 2020 and had sample sizes ranging from 32 to 871, with a total of 1387 participants. Among the 7 trials, 4 were RCTs, 10,11,18,20 1 was a prospective cohort study, 18 and 2 were retrospective cohort studies 17,21 . All trials recruited patients with cancer.…”

“…All trials recruited patients with cancer. Four trials enrolled patients newly starting with chemotherapy, 10,11,19,20 1 trial enrolled patients who were already receiving chemotherapy and had developed first-grade HFS, 18 and 2 trials enrolled patients receiving chemotherapy retrospectively 17,21 . All included trials used urea cream as the prevention or treatment strategy for HFS.…”