Polyneuropathie (CIPN) / hand-foot syndrome (HFS)

Chemotherapy is the most-feared of the treatments available to cancer patients. There is a great deal of fear due to the typical side effects: nausea, vomiting, possible infections, hair loss and, last but not least, the development of painful nerve damage in the hands and feet (polyneuropathy - CIPN).  Whilst patients recover quickly from many side effects once chemotherapy has been completed; in the case of CIPN (chemotherapy-induced polyneuropathy) patients are often faced with a long-term complication that continues over several years, significantly impacting their quality of life.

CIPN particularly occurs in patients treated with taxane-containing drugs and platinum analogues. Other drugs, such as vinca alkaloids (incl. vincristine, or more rarely, vinblastine and vinorelbine), 5-fluoropyrimidines (5-FU, capecitabine), cyclophosphamide, cytarabine, doxorubicin, sorafenib and sunitinib may lead to these complications to a greater or lesser degree.

A medical problem​

• Up to 20% of patients develop severe HFS and polyneuropathy
   
• Patients are often forced to postpone therapy, or take a reduced dose (from just 2nd degree complications); some patients are even forced to stop treatment entirely.

• Complaints that can even persist years after therapy;

• it is not uncommon for symptoms to be irreversible.

Symptoms of polyneuropathy /
hand-foot syndrome

Polyneuropathy manifests itself as hypersensitivity to stimuli, pain, burning and/or tingling in the hands and feet, loss of sensitivity (numbness), in some cases with associated problems relating to coordination of movement and balance. Those affected are barely able to distinguish between hot and cold, or this ability may even be lost completely. The primary effects include paraesthesia (abnormal sensation in skin) and pains.

A special form of the disease, hand-foot syndrome, occurs when there is an associated inflammatory skin reaction in the hands and feet. Complaints are varied: painful areas of red skin, burning sensations (sometimes with skin abrasions), excess sensitivity to pain and at later stages, even numbness.

Where acute symptoms present during chemotherapy, the treatment intervals must often be extended, the dose reduced, and, in the most severe cases, the treatment discontinued entirely.

Grade 1: Tingling, painless swelling or erythema of the hands and/or feet, or complaints that do not impact on the patient's everyday activities.

Grade 2: Painful erythema and swelling of the hands and/or feet, and/or complaints that impact on the patient's everyday activities.

Grade 3: A moist peeling of the skin, ulceration, blistering and severe pain in the hands and/or feet, and/or severe symptoms which make it impossible for the patient to work or carry out the activities of daily life.