Hand Foot Syndrome Has the Strongest Impact on QOL in Skin Toxicities of Chemotherapy

Abstract

Background: Chemotherapy often results in dermatologic toxicities, which decrease quality of life (QOL) of cancer patients. These adverse skin reactions sometimes happen simultaneously. Though previous reports have demonstrated that skin reactions influence QOL, those reports were focused on only one kind of skin toxicity or on the most serious skin toxicity. The aim of this study is to demonstrate the contribution of each skin toxicity to QOL. Methods: This is a cross-sectional study at Kinki Central Hospital. Patients were enrolled who underwent skin toxic chemotherapy from April 1 to June 30, 2017. DLQI and Skindex29 were used to grade the QOL of patients. Also, the severity of skin toxicities was evaluated based on National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (NCI-CTCAE ver4.0). We investigated how QOL changed with patient demographic and clinical characteristics, the worst skin toxicity grade, and each skin toxicity using statistical analyses. Results: No significant differences were detected between QOL scores (total score of DLQI, emotions domain, symptoms domain, functioning domain and total score of Skindex29) and patient demographic and clinical characteristics (P values were 0.155, 0.086, 0.052, 0.312 and 0.114, respectively). There were statistically significant QOL differences among the grades of the worst skin toxicity (P values were <0.001). Xerosis, paronycia, pigmentation, and hand foot syndrome showed statistically significant associations with some QOL domains analyzed by multiple logistic regression analyses adjusted by demographic characteristics. When adjusted by both demographic characteristics and other skin toxicities, three of xerosis, paronycia, and pigmentation showed no statistically significant associations, but hand foot syndrome showed statistically significant associations in all subdomains and total score of Skindex29 (P values were <0.05). Conclusions: Hand foot syndrome was a stronger factor in decreasing QOL than xerosis, paronychia, pigmentation, or rash. Therefore, especially in hand foot syndrome, prevention, early detection, and daily medical care are necessary to maintain QOL.

Evaluating health related quality of life in outpatients receiving anti-cancer treatment: results from an observational, cross-sectional study

“…A study performed by Urakawa et al concluded that this AE had a stronger impact on HRQOL compared to other skin toxicities of chemotherapy [27]. Finally, alopecia can be related to conventional chemotherapy, targeted therapy or hormonotherapy and has a clearly negative emotional effect that was reported by Freites-Martinez et al [28].…”

Cutaneous adverse events and quality of life in outpatients receiving anticancer agents: results from an observational, cross-sectional study

“…Rosen et al 29 addressed this issue, and found that patients on targeted therapies experienced a significantly greater number of CAEs and worse QoL with regards to total Skindex-16 and the emotion subdomain compared with patients on non-targeted therapies. Lee et al 33 also reported that patients on targeted therapy experienced worse QoL by means of DLQI. However, Unger et al 35 did not find differences in QoL between targeted therapy alone and combined targeted therapy and chemotherapy.…”

“…In a clinical trial using EGFRI, Joshi et al 27 reported that skin toxicities, including rash, xerosis, paronychia, and pruritus, adversely affected QoL, and rash was associated with a greater QoL decrease. Lee et al 33 also evaluated the impact of skin problems on QoL in patients treated with anticancer agents and reported that palmo-plantar lesions, papulopustular eruption, and periungual inflammation had the highest impact. Similarly, Urakawa et al 34 found that hand–foot syndrome was a stronger factor in decreasing QoL compared to other skin toxicities of chemotherapy.…”

Skin disorder management in oral anticancer drugs by collaboration of hospital pharmacists and community pharmacists

“…As we previously reported, hand-foot syndrome was the strongest factor in decreasing QoL so that multi-kinase inhibitors, EGFR-TKI, and capecitabine require careful prevention, early detection, and daily medical care [ 22 ]. In the future, we will conduct a multicenter clinical study in order to verify the contribution of this approach to clinical benefits such as prevention of worsening and prolongation of PFS by targeting patients treated with multi-kinase inhibitors, EGFR-TKI, and capecitabine.…”