Hand and Foot Syndrome

[Gloria]

I have a question about Hand and foot syndrome, when I was on chemo, mine was mostly dry, peeling skin. I have a friend that's elderly Aunt has Esophageal cancer and she has Autism. She has gone through 5 weeks of chemo and radiation and now is on a 2nd round of chemo with 5FU continously, she goes every week and has the 5FU refilled and on the 3rd week get an infusion of Epirubicin (Ellence) and Cisplatin (Platinol) then another pump of 5FU . I read that the 5FU can cause hand and foot syndrome. She does a lot of walking, but my friend noticed today that she has blisters on her feet, toes, swelling. Could this be hand and foot syndrome? I advised her to call the oncall doctor and not wait until Monday to find out what she should do. Anyone have any thoughts?

[RixInPhx]

5-FU can cause Hand-Foot Syndrome, even when taken as a once-every-2 weeks infusion; taking it continuously is pretty much like taking Xeloda pills twicee daily.

BUT, HFS is caused by the drug leaking from very fine capllaries in the palsms and soles, and eventually killing the cells on those surfaces; and 'swelling' (I presume of the whole foot, possibly ankles, too) is NOT among the HFS symptoms.
Nor is swelling/blisters; see: http://www.chemocare.com/managing/handfoot_syndrome.asp

The fact that her toes are involved *might* be caused by that leaking drug being trapped in her shoes, I dunno.

In any case, she is certainly at risk of HFS as a patient receiving continuous 5FU, and she should follow all the precautions mentioned in that link.
Especially to limit the amount of walking.
Also, wearing socks significantly reduces the friction on the sole of the foot and on toes.
And if the pavement she walks on has gotten hot with the spring sunshine, that would further aggravate the condition.

This might just be 'normal' foot problems aggravated by the drugs and extensive walking, rather than true HFS.
Or she may have new shoes that don't fit properly, or is wearing them without socks or hose.
Depending on the extent of her autism and awareness of her world, she might even be walking around barefoot now that it's warmer.

Calling the oncall doc is certainly a good idea; staying off her feet would probably the number one recommendation, possibly along with Tylenol for pain relief.

[Gloria]

Thanks RX,
She always wears socks and good fitting shoes, but it is very warm here. She is what they would consider high functioning, there is what seems to be a disconnect when it comes to pain/nausea. The chemo or radiation has had any ill effects on her, no nausea, just a little tingling in her toes when she lays down, that could be from something else. They found her cancer when she had hip replacemet and got sick. My friend called the Oncologist he said to turn the pump off and to bring her in Monday. Limited walking and watch for fever.

[lauragb]

I presently have Hand/foot syndrome. I just have the typical symptoms though so it's good she will be going to the doctor to get swelling and blisters checked. In spite of everything I have read about this syndrome, I have found that wearing socks and shoes makes it worse for me. If I wear my cushiony teva flipflops all the time, I don't have the pain, burning or redness. I have had quite a bit of peeling. My hands, I just try to keep up with the lotion. The area around the nails is the worst.

So for my daily walk in the woods, I wear shoes and socks, then the rest of the time the Teva flipflops which has enabled me to remain on the high dosage of Xeloda. It is getting warmer where I live so the flipflops are okay, although I have worn them in the morning when it is still 30 degrees. I highly recommend anyone with feet issues try them.
Hope the problems are resolved soon. It sounds very uncomfortable for her.
Laura

[Bob_Weiss]

During the last days of my time on Xeloda, I developed foot swelling: Had difficulty getting into my shoes and was somewhat unsteady when walking. Swelling is not a typical symptom of H/F syndrome, but does develop in some of the more severe cases. Of course, there are many other causes for swelling; when in doubt about what is causing my problem I check with the oncologist.