A number of symptoms may be experienced in the hands and feet with continuous treatment for secondary breast cancer. The following information may help you to manage these symptoms.
In this section
Soreness of the hands & feet
Soreness of the hands and feet experienced as a result of cancer treatment is referred to as hand-foot syndrome or, to use its medical term, Palmar-Plantar Erythrodysesthesia (PPE).
Causes of Palmar-Plantar Erythrodyesthesia (PPE)
PPE happens when small amounts of cancer treatment leak out of the small blood vessels (capillaries) which deliver blood to the skin. In secondary breast cancer, it is most likely to occur with chemotherapy such as Docetaxel or Capecitabine, or when the targeted therapy lapatinib is given alongside Capecitabine, though this is not always the case and it can depend on the amount of treatment (dose) given.
Signs & symptoms
This condition affects the palms of the hands, fingers and soles of the feet, which may become red, sore, swollen, cracked and blistered. The skin may feel tight and stiff and begin to peel. Some people may also develop a rash and increased sensitivity to sunlight. The nails may also be affected and become dry, brittle, discoloured or even fall out.
PPE can also cause numbness, tingling and burning sensations in the hands and feet, making it difficult to walk, to carry out normal day to day activities or even to sleep at night. As a result, this condition can have a huge impact on a person’s quality of life.
If you develop a raised temperature it is important for you to contact your hospital immediately as this could be a sign of infection.
Whilst there are no treatments to completely cure this condition, there are lots of things you can do to help ease the symptoms of PPE. It is also important for you to let your doctor or nurse know if you develop sore hands are feet so that they are aware. If these symptoms become severe, it could be that the chemotherapy dose is too strong for you and your doctor may recommend delaying or reducing the dose to give your hands and feet a chance to heal.
Some women worry that any changes to treatment could worsen their cancer but this is a normal part of delivering chemotherapy safely. Everyone reacts differently and so it is important to find the dose that is right for you. Making changes or delaying treatment can actually reduce the risk of having to stop taking that particular treatment altogether.
There are some treatments to help relieve the symptoms of PPE. Your doctor may prescribe gels or creams to moisturise, relieve pain or reduce inflammation. Creams containing 10% urea may also be prescribed to help prevent moisture loss.
Tips for coping with PPE
Whilst it is quite rare for severe symptoms of PPE to develop, even mild symptoms can make it difficult to go about your day to day life. The following tips can help you to better cope with and ease these symptoms;
- Wear comfortable and loose fitting clothes, socks and shoes to avoid any rubbing or friction.
- Try to avoid unnecessary pressure or friction to the skin, for example certain sports or using household items or tools which create pressure or friction on your hands or feet.
- Take cool baths and showers and pat dry, rather than rub, your hands and feet with a towel.
- Keep skin well moisturised by gently and regularly applying unscented moisturisers such as E45.
- Try to stay out of the sun. If you are in the sun, be sure to cover up your skin and apply a high factor (no less than 30) sun block.
- Avoid being barefoot. Always wear soft, comfortable socks and/or slippers.
- Avoid using saunas.
- Try to avoid carrying very hot and cold drinks.
- If you need to cool your hands, don’t apply ice directly to your skin. Instead, try putting your hands and feet under cool running water or using a cold compress for 10-15 mins.
- Try to avoid contact with harsh chemicals such as bleach, cleaning products or chlorine in swimming pools.
Breast Cancer Now have also published some top tips shared by a woman undergoing treatment for breast cancer who has suffered with PPE.
Numbness & tingling
Treatments for cancer can cause damage to the nerves carrying signals to and from the brain, spinal cord and the rest of the body. This is referred to as ‘peripheral neuropathy’ and can cause a range of symptoms such as numbness, tingling, pins & needles, burning and a feeling of weakness in the hands and feet, usually the fingers and toes. As this condition affects the sensations in your hands and feet, this also makes people more prone to injuries since they may not necessarily feel the pain that comes with bumps, cuts & grazes and burns.
As well as feeling painful and unpleasant, peripheral neuropathy can also affect your ability to go about day to day activities, such as getting dressed, using a computer or mobile phone, cooking or even holding a pen. Driving may also become more challenging. Importantly, you are required by law to inform the DVLA if you have developed peripheral neuropathy, even if you do not think this is affecting your ability to drive. Please visit the government website gov.uk for further information and to find out how to inform the DVLA.
These day to day limitations be very frustrating and difficult to cope with alongside secondary breast cancer and the other symptoms which come along with it.
If you do experience numbness or any of these other symptoms in your hands and feet, please tell your doctor or breast cancer nurse. It is important not to wait until these symptoms become too severe or painful as they may be able to modify your treatment earlier on to reduce further damage or problems.
Whilst there are no treatments to completely cure this condition, there are lots of things you can do to prevent further damage or injury;
Tips for coping with peripheral neuropathy
- Don’t struggle alone. Ask your family and loved ones for help with tasks which you are finding difficult.
- Be patient with yourself. Accept that some things may take a little longer and give yourself plenty of time.
- Be aware of potential causes of injury. Take extra care in situations where they may a risk of cuts, burns etc.
- Test the temperature of water with your elbow before stepping into the bath or shower or doing the washing up.
- Wear comfortable shoes and avoid walking barefoot as this risks injuring your feet.
- Wear gloves when using your hands for household tasks such as washing up, gardening and DIY. Use oven gloves and be careful when handling hot pans.
- Protect your hands from the cold by wearing gloves outside in cold weather and when taking items out of the fridge and freezer.
- Wear warm socks to protect your feet from the cold.
- Keep your home clear or any potential trip hazards and put the light on if you get up during the night.
- Check your hands and feet for any sign of injury every day. You may need to use a mirror to see all angles, or ask someone for assistance.
Whilst the most effective treatment is to try and prevent further damage, you may be given some medication to help with nerve pain (‘neuropathic’ pain). Common painkillers such as paracetamol are not effective in treating this type of pain. Instead, it can be treated using drugs which are usually used to treat conditions such as depression or epilepsy, since they also reduce pain caused by damaged nerves.
Speak to your doctor or breast cancer nurse about your options for pain relief. Your doctor may also refer you for some physiotherapy to help with your symptoms.
Some people also find acupuncture can help to relieve the symptoms associated with peripheral neuropathy. See our section on Complementary therapies for further information.
Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.
Page last updated: April 2020