Utility of cooling patches to prevent hand-foot syndrome caused by pegylated liposomal doxorubicin in breast cancer patients

Abstract

BACKGROUND Pegylated liposomal doxorubicin (PLD) uses the hydrophilic layer of liposomes to reach the sweat on the skin surface or accumulate in the sweat glands, producing toxic free radicals and oxidative damage, resulting in hand-foot syndrome (HFS). Regional cooling can induce vasoconstriction to reduce the release of drugs in the limbs and reduce the accumulation of drugs in sweat glands; thus, decreasing the incidence and severity of HFS. AIM To study the efficacy of cooling patches to prevent HFS caused by PLD in the short-term. METHODS This is a retrospective cohort study. Female breast cancer patients ( n = 101) who were treated with PLD in two breast wards at our department from February 2020 to February 2021 were enrolled in the study and were randomly divided into the cooling group (51 patients) and the control group (50 patients). Patients in the control group only received routine care, while the patients in the cooling group applied cooling patches, based on routine care, to the palm and back of the hands 15 min before chemotherapy infusion for 10 h. All patients took a corresponding dose of dexamethasone orally one day before chemotherapy, on the day of chemotherapy, and one day after chemotherapy. SPSS23.0 version was used to analyze the data in this study. The occurrence and severity of HFS was analyzed by the Mann-Whitney U test, and scores were analyzed by the Student’s t test or Wilcoxon rank-sum test. A P value < 0.05 was regarded as statistically significant. RESULTS In this study, neither group of patients developed Grade 3 HFS. In the control group, the incidence of Grade 1 HFS and Grade 2 HFS was 38% and 2%, respectively. However, in the cooling group, only one person developed Grade 1 HFS (2%), and none of the patients developed Grade 2 HFS. These findings showed that cooling patches can effectively reduce the frequency and severity of HFS ( P < 0.0001) in the short-term. Before the fourth chemotherapy cycle, although general self-efficacy scale scores in the cooling group were low, they were still significantly higher than those in the control group (17.22 ± 5.16 vs 19.63 ± 6.42, P = 0.041). Compared with the control group, the mean Hand-Foot Skin Reaction and Quality of Life Questionnaire score in the cooling group was significantly lower (18.08 ± 7.01 vs 14.20 ± 7.39, P = 0.008). CONCLUSION Cooling patches can effectively reduce the frequency and severity of HFS caused by PLD in the short-term. In addition, it may help delay the decline in patients’ self-efficacy.

CE: HIV-Associated Kaposi Sarcoma in the Combination Antiretroviral Therapy Era

“…56 Emollients have been used to treat this, but limited studies have shown that cooling patches and henna are effective treatments. 56,57 Patients treated with paclitaxel, a taxane, should be monitored for peripheral neuropathy. 58 Some patients undergoing chemotherapy may feel unwell and present in primary care, ambulatory biopsy of a lymph node is preferred.…”

“…Hand-foot syndrome, or palmar–plantar erythrodysesthesia, is another adverse effect that patients receiving liposomal doxorubicin may report. Hand-foot syndrome causes erythema, swelling, blisters, and paresthesia in the hands and feet 56. Emollients have been used to treat this, but limited studies have shown that cooling patches and henna are effective treatments 56, 57.…”

“…Hand-foot syndrome causes erythema, swelling, blisters, and paresthesia in the hands and feet 56. Emollients have been used to treat this, but limited studies have shown that cooling patches and henna are effective treatments 56, 57. Patients treated with paclitaxel, a taxane, should be monitored for peripheral neuropathy 58…”

Efficacy of cooling + oral dexamethasone as primary prevention for hand-foot syndrome associated with liposomal doxorubicin

“…Then, ROS attack keratinocytes and trigger release of in ammatory cytokines that lead to the onset of HFS [21]. Regional cooling has been the most common strategy for the primary prevention of HFS [22][23][24][25]. Cooling of the wrists and ankles during PLD administration constricts blood vessels, thus reducing blood ow to the hands and feet.…”

“…As a result, the distribution of PLD to the hands or feet is decreased and HFS can be prevented. However, the e cacy of cooling for prevention of HFS associated with PLD is controversial; up to 30% and 17% of patients received cooling reportedly developed HFS ≥ Grade 2 and ≥ Grade3, respectively [22][23][24][25], indicating that cooling alone is insu cient in preventing HFS associated with PLD. Meanwhile, oral steroid therapy has been recommended as a secondary preventive therapy [26].…”