Cancer is one of the leading causes of death and illness worldwide, including The Bahamas. There are many people in The Bahamas receiving chemotherapy for treatment of various types of cancer including breast, prostate, colon and more. The recent improvements in chemo therapies have resulted in more cancer survivors and people living longer. Despite these advances, the majority of patients may experience some adverse events from anti-cancer (chemo) therapies. Chemotherapy works by attacking fast growing cells of the cancer but it can also affect fast growing good cells of the body such as those in the hair, skin and nails.
How chemotherapy affects the feet
Nail toxicities, hand foot syndrome, swelling, dry skin, hard skin and calluses, and neuropathy are common among cancer patients. These effects negatively impact the patient's quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments.
Peripheral neuropathy
Chemotherapy medications can damage the nerves in the feet that affect feeling and movement. The most common effects of chemotherapy on the foot care in cancer patients and survivors is chemotherapy-induced peripheral neuropathy. A 2014 study of 90 people receiving chemotherapy found that about half had neuropathy, and 6.7 percent said it was overlooked by their doctors. Doctors are unsure why some people have neuropathy, and others do not. The risk depends on the chemotherapy drug a person takes, which could cause damage to the nerves, but the risk may be higher in patients who have other risk factors, such as diabetes mellitus and obesity.
The drugs mostly to cause CIPN include paclitaxel, cisplatin, oxaliplatin, epothilones, thalidomide, docetaxel, bortezomib, vincristine, etc.
Numbness and tingling in the hands and feet are the main symptoms of neuropathy. Some people have weakness and find it difficult to hold small objects as well. These symptoms can be severe and significantly impact a person's quality of life. Neuropathy can be extremely painful, but it is not usually permanent. For most people, symptoms go away after they stop chemotherapy but it can take months to fade. A 2014 study found that 30 percent of people still had symptoms of CIPN six months or longer after stopping chemotherapy. In some cases, neuropathy can be permanent, but there is no way to predict it and symptoms almost always improve over time.
Some simple remedies that may help the neuropathy are topical creams and lotions, low impact exercise, like swimming or yoga, a healthful diet high in fruits and vegetables, lean proteins, and whole grains, and lots of water and massage. Vitamins may also help, but always consult your doctor before taking vitamins or any other medications.
Nails
Some chemotherapy drugs have effects on the toenails. It can cause change in the curvature, color, thickening, loss of the entire nail, infection and foul odor from the toenails. The toenail becomes loose and become prone to a fungal infection known as onychomycosis. This fungus can also cause discoloration as well as pain in the toes. Around 35 percent of patients undergoing anticancer therapies may suffer some type of nail effects.
Swelling
Certain chemotherapy drugs can cause swelling to the ankles, feet and legs. This happens when fluid builds up in the body's tissues from the effects of the medications. Care must be taken to prevent cuts and bruises on the skin.
Hand-foot syndrome
Hand-foot syndrome is a side effect of certain types of chemotherapy medications that can cause redness, swelling and blistering on the palms of the hands and soles of the feet. It can resemble a sunburn and its also known as palmar-plantar erythrodysesthesia. Several drugs may cause hand-foot syndrome, most commonly seen in patients taking 5-fluorouracil (5-FU) and capecitabine (Xeloda®), but also seen in those taking docetaxel (Taxotere), cytarabine (Cytosar), doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil). Because these drugs can be used to treat many different cancers, hand-foot syndrome is more common in patients with certain types of disease, especially gastrointestinal cancers seen in the stomach, esophagus, pancreatic, liver, colon, etc. – but also in breast and ovarian cancer.
Hand-foot syndrome tends to appear within the first two to three months of treatment. It often begins as redness in the hands and feet, but it's more common in the palms than the soles. The redness looks similar to a sunburn, with the soles and/or palms turning completely red, unlike a rash, which appears in small, patchy areas. There can also be swelling, pain or a burning sensation. In severe cases, patients may notice dryness, or cracking or peeling skin. The skin might also look tight or thin and feel tender to the touch.
Hand-foot syndrome treatment is largely based on symptoms and is determined by the oncologist (cancer treatment doctor) to relieve symptoms or adjust the chemotherapy. Moisturizers are recommended for dryness. Sometimes medicated creams, like urea cream, can help get rid of rough dry skin. Using thick, unscented creams at least twice a day to moisturize the hands and feet may help. Avoid scented lotions that may contain alcohol which can be drying. Avoid exposure to heat or high temperatures that could dry out the skin, wear gloves to wash dishes, take showers in lukewarm water, and stay out of direct sunlight. Avoid wearing tight-fitting gloves, socks or shoes, or even holding tools or standing in one position for very long, because pressure and repetitive friction can make hand-foot syndrome worse. Avoid picking at dry skin, breaking any blisters, or soaking the hands in hot water. And when moisturizing, be gentle; don't vigorously rub the creams in. Call the doctor immediately if you develop a fever or chills, if symptoms worsen, if there's any bleeding or drainage from the sores and cracks, or if your hands and/or feet become increasingly painful, or inhibit your ability to complete regular daily tasks.
If you are having any effects for the chemotherapy drugs, inform your doctor as soon as possible and always talk to them before going to see another doctor.
When to see
your podiatrist
If advised to do so by your cancer doctor, over-the-counter medication can be used to treat mild discomfort on the feet and nails. If these do not work or if your toenails are inflamed or painful, it is time to see your podiatrist. Your podiatrist in consultation with your oncologist can treat the toenail and feet locally and with medications for infection and to relieve pain and swelling.
Everyone deserves to be as comfortable as possible while undergoing cancer treatment, so do not hesitate to contact a podiatrist with any questions or concerns you have about the effect of chemotherapy on your feet.
• For more information email info@familyfootcentre.com or visit www.foothealthfacts.org or www.footlogix.com. To see a podiatrist visit Family Foot Centre on #45 Daffodil Avenue, Independence Highway or call 605-3668; Bahamas Surgical Associates Centre at Hill Top Medical, telephone 603-1814/5. In Grand Bahama visit Lucayan Medical Center on East Sunrise Highway or call 373-7400.
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