Written by: Jonas Congelli, RPh Hematology Oncology Associates of CNY
Download Here

To discuss prevention and management of Hand-Foot Syndrome.


Palmar‐plantar erythrodysesthesia, also known as hand‐foot syndrome (HFS) is a widely recognized dose‐limiting toxicity of certain chemotherapy agents, specifically capecitabine, infusional fluorouracil, liposomal doxorubicin, axitinib, sunitinib, sorafenib, pazopanib, cabozantinib, vemurafenib and regorafenib. Typically, HFS occurs within the first six weeks of starting targeted therapy and after two months for chemotherapy.

Symptoms of HFS include:

numbness, tingling,burning,itching, redness, swelling, tenderness, rash, cracked, flaking, or peeling skin, blisters or sores

PQI process: Upon receipt of a new prescription known to cause HFS:

  • Educate patient on signs and symptoms of HFS.
  • Provide or have Urea cream available for patients.
  • Preventative use of 10‐20% urea cream has been shown to reduce the severity and time to developing hand‐foot syndrome (HFS). Patients started on medications known to cause HFS will be educated on the importance of using 10‐20% urea cream to prevent HFS. Practices will stock 10‐20% urea cream in order to ensure that patients have the appropriate product to use.
  • Follow up with the patient within seven days of initial dispense and with every refill.

Patient Centered Activities

Counsel patient on non-medical interventional strategies including use of lotion within three minutes of bathing, use of cotton gloves or socks at bedtime or throughout the day, increased water intake and limiting diuretics and dehydrating agents (alcohol, caffeine)


  1. Hofheinz RD, Gencer D, Schulz H, et. Al Mapisal Versus Urea Cream as Prophylaxis for Capecitabine-Associated Hand-Foot Syndrome: A Randomized Phase III Trial of the AIO Quality of Life Working Group DOI: 10.1200/JCO.2014.60.4587 Journal of Clinical Oncology 33, no. 22 (August 01, 2015) 2444-2449.

Important notice: National Community Oncology Dispensing Association, Inc. (NCODA), has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional.  This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented.  NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.



Joshua has blogged 260 posts

View all PQI