Skip to main content
Top
Published in: Supportive Care in Cancer 3/2008

01-03-2008 | Original Article

Chemotherapy-induced dermatological toxicity: frequencies and impact on quality of life in women’s cancers. Results of a prospective study

Authors: Mark Hackbarth, Norbert Haas, Christina Fotopoulou, Werner Lichtenegger, Jalid Sehouli

Published in: Supportive Care in Cancer | Issue 3/2008

Login to get access

Abstract

Purpose

The study aimed to determine the prevalence of dermatological side effects and its impact on quality of life in patients receiving systemic chemotherapy for women’s cancers.

Materials and methods

A prospective study was conducted on patients with histologically confirmed advanced women’s cancers who were deemed candidates for adjuvant or palliative chemotherapy. Patients were systemically examined for skin, hair, and nail side effects. The impact of those side effects on their quality of life was assessed using the health-related quality of life score (HRQL).

Results

Between April 2001 and October 2001, 91 patients received 1 to 17 (median 4) courses of chemotherapy. Malignancies included breast cancer (n = 39, 43%), ovarian cancer (n = 32, 35%), cervical cancer (n = 12, 13%), endometrial cancer (n = 5, 6%), fallopian tube cancer (n = 2, 2%), and vaginal cancer (n = 1, 1%). Chemotherapy agents included taxanes (n = 42, 46%), PEG doxorubicin (n = 17, 7%), other anthracyclines (epirubicin and doxorubicin; n = 6, 19%), topotecan (n = 13, 14%), and other agents (n = 13, 14%). Overall incidence of skin, nail, and hair side effects was 86.8% (n = 79). Seventeen patients (18.7%) developed a palmo-plantar erythrodysesthesia (PPE), and nine of those (53%) were of grade 3 in common toxicity criteria scale (NCI). Twenty-one patients (23.1%) developed nail changes such as subungual hematomas, onycholysis, and leukonychias or nail loss, while 69 (75.8%) developed hair loss. There was a higher incidence of PPE in patients receiving chemotherapy for palliation rather than cure (percent over percent, p < 0.001, Fisher’s exact test). Using the HRQL score, skin changes were the most frequently reported unpleasant side effect (34.1%), and of those patients who developed PPE, this was reported by n = 8 (47%) as the most unpleasant.

Conclusions

Dermatological chemotherapy side effects are frequent after treatment of women’s cancers and have a major impact on quality of life as assessed by HRQL. Counseling of patients with women’s cancers and the profile of side effects of chemotherapeutic agents should be considered before considering an adjuvant or palliative chemotherapy regimen.
Literature
1.
go back to reference Anonymous (1998) Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors. Meta-Analysis Group in Cancer. J Clin Oncol 16(11):3537–3541 Anonymous (1998) Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors. Meta-Analysis Group in Cancer. J Clin Oncol 16(11):3537–3541
2.
go back to reference Chiara S, Nobile MT, Barzacchi C, Sanguineti O, Vincenti M, Di Somma C, Meszaros P, Rosso R (1997) Hand–foot syndrome induced by high-dose, short-term, continuous 5-fluorouracil infusion. Eur J Cancer 33(6):967–969PubMedCrossRef Chiara S, Nobile MT, Barzacchi C, Sanguineti O, Vincenti M, Di Somma C, Meszaros P, Rosso R (1997) Hand–foot syndrome induced by high-dose, short-term, continuous 5-fluorouracil infusion. Eur J Cancer 33(6):967–969PubMedCrossRef
3.
go back to reference Chiewchanvit S, Noppakun K, Kanchanarattanakorn K (2004) Mucocutaneous complications of chemotherapy in 74 patients from Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thail 87(5):508–514 Chiewchanvit S, Noppakun K, Kanchanarattanakorn K (2004) Mucocutaneous complications of chemotherapy in 74 patients from Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thail 87(5):508–514
4.
go back to reference Chu CY, Yang CH, Yang CY, Hsiao GH, Chiu HC (2000) Fixed erythrodysaesthesia plaque due to intravenous injection of docetaxel. Br J Dermatol 142(4):808–811PubMedCrossRef Chu CY, Yang CH, Yang CY, Hsiao GH, Chiu HC (2000) Fixed erythrodysaesthesia plaque due to intravenous injection of docetaxel. Br J Dermatol 142(4):808–811PubMedCrossRef
5.
go back to reference Comandone A, Bretti S, La Grotta G, Manzoni S, Bonardi G, Berardo R, Bumma C (1993) Palmar–plantar erythrodysestasia syndrome associated with 5-fluorouracil treatment. Anticancer Res 13(5C):1781–1783PubMed Comandone A, Bretti S, La Grotta G, Manzoni S, Bonardi G, Berardo R, Bumma C (1993) Palmar–plantar erythrodysestasia syndrome associated with 5-fluorouracil treatment. Anticancer Res 13(5C):1781–1783PubMed
6.
go back to reference DeSpain JD (1992) Dermatologic toxicity of chemotherapy. Semin Oncol 19(5):501–507PubMed DeSpain JD (1992) Dermatologic toxicity of chemotherapy. Semin Oncol 19(5):501–507PubMed
7.
go back to reference Drake RD, Lin WM, King M, Farrar D, Miller DS, Coleman RL (2004) Oral dexamethasone attenuates doxil-induced palmar–plantar erythrodysesthesias in patients with recurrent gynecologic malignancies. Gynecol Oncol 94(2):320–324PubMedCrossRef Drake RD, Lin WM, King M, Farrar D, Miller DS, Coleman RL (2004) Oral dexamethasone attenuates doxil-induced palmar–plantar erythrodysesthesias in patients with recurrent gynecologic malignancies. Gynecol Oncol 94(2):320–324PubMedCrossRef
8.
go back to reference EORTC (2006) EORTC QLQ-C30 Questionnaire V3.0 EORTC (2006) EORTC QLQ-C30 Questionnaire V3.0
9.
go back to reference Essex (2000) Caelyx, Wissenschaftliche Produktinformationen Essex (2000) Caelyx, Wissenschaftliche Produktinformationen
10.
go back to reference Fitzpatrick JE (1993) The cutaneous histopathology of chemotherapeutic reactions. J Cutan Pathol 20(1):1–14PubMedCrossRef Fitzpatrick JE (1993) The cutaneous histopathology of chemotherapeutic reactions. J Cutan Pathol 20(1):1–14PubMedCrossRef
11.
go back to reference Flory SM, Solimando DA Jr, Webster GF, Dunton CJ, Neufeld JM, Haffey MB (1999) Onycholysis associated with weekly administration of paclitaxel. Ann Pharmacother 33(5):584–586PubMedCrossRef Flory SM, Solimando DA Jr, Webster GF, Dunton CJ, Neufeld JM, Haffey MB (1999) Onycholysis associated with weekly administration of paclitaxel. Ann Pharmacother 33(5):584–586PubMedCrossRef
12.
go back to reference Gabizon AA (2001) Pegylated liposomal doxorubicin: metamorphosis of an old drug into a new form of chemotherapy. Cancer Invest 19(4):424–436PubMedCrossRef Gabizon AA (2001) Pegylated liposomal doxorubicin: metamorphosis of an old drug into a new form of chemotherapy. Cancer Invest 19(4):424–436PubMedCrossRef
13.
go back to reference Gordon AN, Fleagle JT, Guthrie D, Parkin DE, Gore ME, Lacave AJ (2001) Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol 19(14):3312–3322PubMed Gordon AN, Fleagle JT, Guthrie D, Parkin DE, Gore ME, Lacave AJ (2001) Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol 19(14):3312–3322PubMed
14.
go back to reference Gordon AN, Granai CO, Rose PG, Hainsworth J, Lopez A, Weissman C, Rosales R, Sharpington T (2000) Phase II study of liposomal doxorubicin in platinum- and paclitaxel-refractory epithelial ovarian cancer. J Clin Oncol 18(17):3093–3100PubMed Gordon AN, Granai CO, Rose PG, Hainsworth J, Lopez A, Weissman C, Rosales R, Sharpington T (2000) Phase II study of liposomal doxorubicin in platinum- and paclitaxel-refractory epithelial ovarian cancer. J Clin Oncol 18(17):3093–3100PubMed
15.
go back to reference Gordon KB, Tajuddin A, Guitart J, Kuzel TM, Eramo LR, VonRoenn J (1995) Hand–foot syndrome associated with liposome-encapsulated doxorubicin therapy. Cancer 75(8):2169–2173PubMedCrossRef Gordon KB, Tajuddin A, Guitart J, Kuzel TM, Eramo LR, VonRoenn J (1995) Hand–foot syndrome associated with liposome-encapsulated doxorubicin therapy. Cancer 75(8):2169–2173PubMedCrossRef
16.
go back to reference Halford S, Yip D, Karapetis CS, Strickland AH, Steger A, Khawaja HT, Harper PG (2001) A phase II study evaluating the tolerability and efficacy of CAELYX (liposomal doxorubicin, doxil) in the treatment of unresectable pancreatic carcinoma. Ann Oncol 12(10):1399–1402PubMedCrossRef Halford S, Yip D, Karapetis CS, Strickland AH, Steger A, Khawaja HT, Harper PG (2001) A phase II study evaluating the tolerability and efficacy of CAELYX (liposomal doxorubicin, doxil) in the treatment of unresectable pancreatic carcinoma. Ann Oncol 12(10):1399–1402PubMedCrossRef
17.
go back to reference Heo YS, Chang HM, Kim TW, Ryu MH, Ahn JH, Kim SB, Lee JS, Kim WK, Cho HK, Kang YK (2004) Hand–foot syndrome in patients treated with capecitabine-containing combination chemotherapy. J Clin Pharmacol 44(10):1166–1172PubMedCrossRef Heo YS, Chang HM, Kim TW, Ryu MH, Ahn JH, Kim SB, Lee JS, Kim WK, Cho HK, Kang YK (2004) Hand–foot syndrome in patients treated with capecitabine-containing combination chemotherapy. J Clin Pharmacol 44(10):1166–1172PubMedCrossRef
18.
go back to reference Hussain S, Anderson DN, Salvatti ME, Adamson B, McManus M, Braverman AS (2000) Onycholysis as a complication of systemic chemotherapy: report of five cases associated with prolonged weekly paclitaxel therapy and review of the literature. Cancer 88(10):2367–2371PubMedCrossRef Hussain S, Anderson DN, Salvatti ME, Adamson B, McManus M, Braverman AS (2000) Onycholysis as a complication of systemic chemotherapy: report of five cases associated with prolonged weekly paclitaxel therapy and review of the literature. Cancer 88(10):2367–2371PubMedCrossRef
19.
go back to reference Israel VP, Garcia A, Roman L, Muderspach L (1999) Phase II study of liposomal doxorubicin in advanced gynecologic cancers. Gynecol Oncol 78:143–147CrossRef Israel VP, Garcia A, Roman L, Muderspach L (1999) Phase II study of liposomal doxorubicin in advanced gynecologic cancers. Gynecol Oncol 78:143–147CrossRef
20.
go back to reference Korac B, Buzadzic B (2001) Doxorubicin toxicity to the skin: possibility of protection with antioxidants enriched yeast. J Dermatol Sci 25(1):45–52PubMedCrossRef Korac B, Buzadzic B (2001) Doxorubicin toxicity to the skin: possibility of protection with antioxidants enriched yeast. J Dermatol Sci 25(1):45–52PubMedCrossRef
21.
go back to reference Link CJ Jr, Sarosy GA, Kohn EC, Christian MC, Davis P, Adamo DO, Reed E (1995) Cutaneous manifestations of Taxol therapy. Invest New Drugs 13(3):261–263PubMedCrossRef Link CJ Jr, Sarosy GA, Kohn EC, Christian MC, Davis P, Adamo DO, Reed E (1995) Cutaneous manifestations of Taxol therapy. Invest New Drugs 13(3):261–263PubMedCrossRef
22.
go back to reference Lopez AM, Wallace L, Dorr RT, Koff M, Hersh EM, Alberts DS (1999) Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar–plantar erythrodysesthesia. Cancer Chemother Pharmacol 44(4):303–306PubMedCrossRef Lopez AM, Wallace L, Dorr RT, Koff M, Hersh EM, Alberts DS (1999) Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar–plantar erythrodysesthesia. Cancer Chemother Pharmacol 44(4):303–306PubMedCrossRef
23.
go back to reference Lotem M, Hubert A, Lyass O, Goldenhersh MA, Ingber A, Peretz T, Gabizon A (2000) Skin toxic effects of polyethylene glycol-coated liposomal doxorubicin. Arch Dermatol 136(12):1475–1480PubMedCrossRef Lotem M, Hubert A, Lyass O, Goldenhersh MA, Ingber A, Peretz T, Gabizon A (2000) Skin toxic effects of polyethylene glycol-coated liposomal doxorubicin. Arch Dermatol 136(12):1475–1480PubMedCrossRef
24.
go back to reference Makris A, Mortimer P, Powles TJ (1996) Chemotherapy-induced onycholysis. Eur J Cancer 32A(2):374–375PubMedCrossRef Makris A, Mortimer P, Powles TJ (1996) Chemotherapy-induced onycholysis. Eur J Cancer 32A(2):374–375PubMedCrossRef
25.
go back to reference Molpus KL, Anderson LB, Craig CL, Puleo JG (2004) The effect of regional cooling on toxicity associated with intravenous infusion of pegylated liposomal doxorubicin in recurrent ovarian carcinoma. Gynecol Oncol 93(2):513–516PubMedCrossRef Molpus KL, Anderson LB, Craig CL, Puleo JG (2004) The effect of regional cooling on toxicity associated with intravenous infusion of pegylated liposomal doxorubicin in recurrent ovarian carcinoma. Gynecol Oncol 93(2):513–516PubMedCrossRef
26.
go back to reference Muggia FM, Hainsworth JD, Jeffers S, Miller P, Groshen S, Tan M, Roman L, Uziely B, Muderspach L, Garcia A, Burnett A, Greco FA, Morrow CP, Paradiso LJ, Liang LJ (1997) Phase II study of liposomal doxorubicin in refractory ovarian cancer: antitumor activity and toxicity modification by liposomal encapsulation. J Clin Oncol 15(3):987–993PubMed Muggia FM, Hainsworth JD, Jeffers S, Miller P, Groshen S, Tan M, Roman L, Uziely B, Muderspach L, Garcia A, Burnett A, Greco FA, Morrow CP, Paradiso LJ, Liang LJ (1997) Phase II study of liposomal doxorubicin in refractory ovarian cancer: antitumor activity and toxicity modification by liposomal encapsulation. J Clin Oncol 15(3):987–993PubMed
28.
go back to reference Obermair A, Binder M, Barrada M, Bancher-Todesca D, Asseryanis E, Kubista E (1998) Onycholysis in patients treated with docetaxel. Ann Oncol 9(2):230–231PubMedCrossRef Obermair A, Binder M, Barrada M, Bancher-Todesca D, Asseryanis E, Kubista E (1998) Onycholysis in patients treated with docetaxel. Ann Oncol 9(2):230–231PubMedCrossRef
29.
go back to reference Oskay-Oezcelik G, Lehmacher W, Könsgen D, Christ H, Kaufmann M, Lichtenegger W, Sehouli J (2007) Breast cancer patients’ expectations in respect of the physician–patient relationship and treatment management results of a survey of 617 patients. Ann Oncol 18(3):479–484CrossRef Oskay-Oezcelik G, Lehmacher W, Könsgen D, Christ H, Kaufmann M, Lichtenegger W, Sehouli J (2007) Breast cancer patients’ expectations in respect of the physician–patient relationship and treatment management results of a survey of 617 patients. Ann Oncol 18(3):479–484CrossRef
30.
go back to reference Park YH, Ryoo BY, Lee HJ, Kim SA, Chung JH (2003) High incidence of severe hand–foot syndrome during capecitabine–docetaxel combination chemotherapy. Ann Oncol 14(11):1691–1692PubMedCrossRef Park YH, Ryoo BY, Lee HJ, Kim SA, Chung JH (2003) High incidence of severe hand–foot syndrome during capecitabine–docetaxel combination chemotherapy. Ann Oncol 14(11):1691–1692PubMedCrossRef
31.
go back to reference Rose PG, Maxson JH, Fusco N, Mossbruger K, Rodriguez M (2001) Liposomal doxorubicin in ovarian, peritoneal, and tubal carcinoma: a retrospective comparative study of single-agent dosages. Gynecol Oncol 82(2):323–328PubMedCrossRef Rose PG, Maxson JH, Fusco N, Mossbruger K, Rodriguez M (2001) Liposomal doxorubicin in ovarian, peritoneal, and tubal carcinoma: a retrospective comparative study of single-agent dosages. Gynecol Oncol 82(2):323–328PubMedCrossRef
32.
go back to reference Salzberg M, Herrmann R (2000) Hand–foot syndrome (palmar–plantar erythrodysesthesia). Schweiz Med Wochenschr 130(40):1413–1416PubMed Salzberg M, Herrmann R (2000) Hand–foot syndrome (palmar–plantar erythrodysesthesia). Schweiz Med Wochenschr 130(40):1413–1416PubMed
33.
go back to reference Sehouli J, Oskay-Oezcelik G (2004) Biweekly schedule of pegylated liposomal doxorubicin (PLD) induces low rates of skin toxicities: results of a phase-II trial in heavily preteated patients with relapsed ovarian cancer. ASCO 2004 Sehouli J, Oskay-Oezcelik G (2004) Biweekly schedule of pegylated liposomal doxorubicin (PLD) induces low rates of skin toxicities: results of a phase-II trial in heavily preteated patients with relapsed ovarian cancer. ASCO 2004
34.
go back to reference Smorenburg CH, Bontenbal M, Seynaeve C, van Zuylen C, de Heus G, Verweij J, de Wit R (2001) Phase II study of weekly gemcitabine in patients with metastatic breast cancer relapsing or failing both an anthracycline and a taxane. Breast Cancer Res Treat 66(1):83–87PubMedCrossRef Smorenburg CH, Bontenbal M, Seynaeve C, van Zuylen C, de Heus G, Verweij J, de Wit R (2001) Phase II study of weekly gemcitabine in patients with metastatic breast cancer relapsing or failing both an anthracycline and a taxane. Breast Cancer Res Treat 66(1):83–87PubMedCrossRef
35.
go back to reference Susser WS, Whitaker-Worth DL, Grant-Kels JM (1999) Mucocutaneous reactions to chemotherapy. J Am Acad Dermatol 40(3):367–398 (quiz 399–400)PubMedCrossRef Susser WS, Whitaker-Worth DL, Grant-Kels JM (1999) Mucocutaneous reactions to chemotherapy. J Am Acad Dermatol 40(3):367–398 (quiz 399–400)PubMedCrossRef
36.
go back to reference Tejada-Berges T, Granai CO, Gordinier M, Gajewski W (2002) Caelyx/doxil for the treatment of metastatic ovarian and breast cancer. Expert Rev Anticancer Ther 2(2):143–150PubMedCrossRef Tejada-Berges T, Granai CO, Gordinier M, Gajewski W (2002) Caelyx/doxil for the treatment of metastatic ovarian and breast cancer. Expert Rev Anticancer Ther 2(2):143–150PubMedCrossRef
Metadata
Title
Chemotherapy-induced dermatological toxicity: frequencies and impact on quality of life in women’s cancers. Results of a prospective study
Authors
Mark Hackbarth
Norbert Haas
Christina Fotopoulou
Werner Lichtenegger
Jalid Sehouli
Publication date
01-03-2008
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 3/2008
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-007-0318-8

Other articles of this Issue 3/2008

Supportive Care in Cancer 3/2008 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine