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Hand-Foot Syndrome Management — SCE Palliative Medicine MCQ

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ModeratePain ManagementHand-Foot Syndrome ManagementSCE Palliative Medicine

A 68‑year‑old woman with metastatic breast cancer on capecitabine develops grade 3 palmar‑plantar erythrodysaesthesia (painful blistering, swelling, redness on palms and soles, interfering with activities of daily living). What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Interrupt or reduce capecitabine dose, initiate urea‑based emollient, avoid friction/heat, and apply cooling measures

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

Grade 3 hand‑foot syndrome (painful blistering preventing normal activities) is a dose‑limiting toxicity of capecitabine. UK‑licensed prescribing guidance (SmPC) mandates interrupting treatment until resolution to grade 1, and then dose reduction on re‑challenge. St George’s Acute Oncology guidance concurs: stop medication, maintain skin care, withhold until resolution, and consider dose reduction. Supportive measures (emollients, cooling, avoiding friction/heat) are important, but alone are inadequate without dose modification. Direct ice (B) risks further skin injury; increasing the dose (C) is unsafe; steroids alone (D) do not address causation; paracetamol alone (E) is insufficient for this severity.

Reference: Capecitabine SmPC (emc, 2025) and St George’s Acute Oncology Service guidance on HFS (current), https://www.stgeorges.nhs.uk/aos/st-georges-healthcare-professional/guidance/ppe/