Edwards, S.J. (2003). Prevention and treatment of adverse effects related to chemotherapy for recurrent ovarian cancer. Seminars in Oncology Nursing, 19(3, Suppl. 1), 19–39.

Guidelines & Recommendations

  • The author described the pathophysiology of palmar-plantar erythrodysesthesia (PPE) and strategies to prevent or minimize PPE.
    • Pegylated liposomal doxorubicin leaks out of abnormally formed (i.e., tumor-related), damaged, or dilated blood vessels.
    • Because the hands and feet contain a high concentration of blood vessels, they are particularly susceptible to PPE.
    • Patients should avoid any undue pressure to their skin caused by running, gardening, crossing their legs, leaning on their elbows, or wearing shoes or clothing that is too tight or rubs the skin.
    • In addition, patients should avoid activities that dilate the blood vessels, such as sitting in the sun, ingesting hot fluids or food, and taking hot showers or baths.
  • The author provided a nursing algorithm for the management of hand-foot syndrome.
    • Provide patient education prior to chemotherapy.
    • Review causes and symptoms of PPE.
    • Avoid undue pressure to the skin (i.e., wear loose clothing and shoes).
    • Avoid dilation of blood vessels (e.g., hot showers, sun).
    • Report all symptoms.
  • Manage symptoms of PPE as required.
    • Advise patients to use cold packs.
    • Advise patients to elevate extremities to reduce edema.
    • Suggest topical emollients (e.g., lanolin creams, Bag Balm®).
    • Suggest burn ointments (e.g., silver sulfadiazine).
    • Initiate administration of oral pyridoxine (100–300 mg per day).
    • Prescribe systemic pain medications, as required.
    • Teach wound care to prevent infection.
    • Reinforce patient education, emphasizing prevention.

Nursing Implications

Multiple interventions can be implemented to prevent or minimize PPE. Patient education is an integral component to promote self-care. Key teaching points include strategies for patients to avoid pressure and friction on their skin because those behaviors may increase uptake of the affecting drug into the blood vessels of the hands and feet.

Routine assessment for PPE should include examination of the palms and soles for redness, swelling, flaking, blisters, rash, sores, cracks, and fissures. Based on nursing assessment, dose modifications may be needed.