Relationship between hand-foot skin reaction and external force on patients with hepatocellular carcinoma: A cohort study.

Purpose: Hand-foot skin reaction (HFSR), a side effect of tyrosine kinase inhibitor (TKI) treatment, makes it difficult to walk and perform daily activities because of pain in the limbs. HFSR occurs predominantly in the sites where external forces (pressure and shear stress) are applied. This study aimed to determine whether pressure or shear stress induces the occurrence of HFSR.
Methods: This cohort study was conducted in patients who received TKI treatment for hepatocellular carcinoma. The external forces applied to the sole of the patients' foot while walking was measured, and its association with the occurrence of HFSR was examined. The degree of HFSR was assessed by the patient's response during the examination and by photographs of their feet. The patients' feet were divided into low (grade <2) or high (grade ≥2) HFSR foot group, and the differences in external forces between the groups were analyzed using t-test and Cox hazard analysis.
Results: Analysis of the feet of 55 study participants (n = 110) showed no significant difference between the groups on t-test (p ≥ 0.05), however, Cox hazard analysis showed an increased risk of HFSR with higher peak shear stress values at the fifth metatarsal head (hazard ratio = 1.01, p = 0.047; 95% confidence interval = 1.00-1.02).
Conclusion: Shear stress is possibly related to HFSR occurrence. Nurses should assess whether patients' shoes fit their feet before initiating TKI treatment. They should instruct patients to wear shoes that are fit of both diameter and width for their feet.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yukie Tahara reports financial support was provided by Yamaji Fumiko Nursing Research Fund. Sadahisa Ogasawara reports a relationship with Bayer Corporation that includes: funding grants and speaking and lecture fees. Sadahisa Ogasawara reports a relationship with Eisai Inc that includes: funding grants and speaking and lecture fees. Sadahisa Ogasawara reports a relationship with Eli Lilly that includes: consulting or advisory, funding grants, and speaking and lecture fees. Sadahisa Ogasawara reports a relationship with Chugai Pharmaceutical Co Ltd that includes: consulting or advisory and speaking and lecture fees. Sadahisa Ogasawara reports a relationship with AstraZeneca Pharmaceuticals LP that includes: consulting or advisory, funding grants, and speaking and lecture fees. Sadahisa Ogasawara reports a relationship with Takeda Pharmaceutical Company Limited that includes: speaking and lecture fees. Sadahisa Ogasawara reports a relationship with AbbVie Inc that includes: speaking and lecture fees. Sadahisa Ogasawara reports a relationship with Gilead Sciences that includes: funding grants and speaking and lecture fees. Sadahisa Ogasawara reports a relationship with Merck & Co Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Naoya Kato reports a relationship with Bayer Corporation that includes: funding grants and speaking and lecture fees. Naoya Kato reports a relationship with Eisai Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Naoya Kato reports a relationship with Sumitomo Dainippon Pharma Oncology, Inc. that includes: speaking and lecture fees. Naoya Kato reports a relationship with Merck & Co Inc that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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