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When Ann developed Palmar-plantar syndrome as a side effect of capecitabine, she couldn’t find any support. She gives her top tips on how to manage symptoms.
I was diagnosed with breast cancer in 2006 and took part in a clinical trial. The oral chemotherapy drug capecitabine was part of my treatment. I initially tolerated the capecitabine well, but after four months I started getting a side effect called hand-foot or Palmar-plantar (PP) syndrome. PP usually affects the palms of your hands and the soles of your feet, causing them to become red, painful and sore, which in turn can affect your quality of life.
In 2006 I reluctantly had to finish my capecitabine because of the effects of PP.
I developed secondary breast cancer in my bones and in 2015 was offered the capecitabine again. I looked online for information on how to manage, prevent or tolerate the effects of capecitaine more effectively, but I couldn't find any. So I set about finding ways which worked for me.
Your hands and feet may firstly start to feel hot. Friction can cause this, for example when ironing or cleaning. I found that wearing cotton gloves helped to stop the friction when hoovering or driving, for example. I bought cotton gloves from eBay in packs of 12 as they get grubby quite quickly and need to be washed frequently.
Find a cream that suits your hands and feet. Cream soothes the skin and provides a protective coating on the skin. Your doctor can advise on the creams they think would be suitable. Or you can choose your own that you feel happy with such as E45, Aveeno, Diprobase or Body Shop.
Ideally you should bathe or shower in the morning. This is because bathing at night and then getting under a warm duvet will raise the temperature of your feet and hands. If you prefer to bathe at night, put a pillow under the duvet near your feet. This raises the duvet up, so it is not touching your feet, and allows the feet to cool slightly.
Keep your feet uncovered as much as possible to keep them cool and wear sandals to allow the air to circulate. However, do not go barefoot in the house. If you go barefoot, you may irritate your feet or stand on something. Carpet and rugs are an irritant to your feet.
Try and rest with your feet up when watching TV. Raise your feet on a stool and keep them uncovered. Your feet may swell slightly, so you may need to go up a shoe size. I went from a size 6 to a 7. Try to buy comfy, flat shoes with Velcro fastenings, or slip-on shoes. This saves irritating your hands with fiddly laces or buckles.
Ice packs wrapped in a tea towel will help to cool both hands and feet. Small gel packs cost about £1 from bargain shops. These can be popped into your gloves to cool your hands down. But do not walk if you use them in your socks! Use them when your feet are up and resting
Accept help from family and friends. It can be quite frustrating to be slowed down by PP. Do an online shop so you don’t have to walk around the supermarket. Buy ready meals to pop in the microwave when your hands are too hot or sore to cook.
Cream on your hands and feet will make them very smooth. So be careful when picking up milk bottles and glasses. These have literally slid through my fingers and landed on the floor. It’s good to buy milk in a plastic carton with a handle, which you can grip securely.
Take care when standing in the bath and use a bath mat. Be careful when standing on tiled or marble floors when barefoot. In the bathroom, stand on a bath rug or towel to stop your feet from slipping.
Not everyone will experience PP as a side effect of capecitabine. Always remember to discuss side effects with your consultant or GP. You may need a break from capecitabine or go on a reduced dosage to effectively your manage PP.
Finally, good luck with your treatment!
Find more information on hand-foot (Palmar-plantar) syndrome.