Hand-Foot Syndrome in Cancer Patients on Capecitabine: Examining Prevalence, Impacts, and Associated Risk Factors at a Cancer Centre in Malaysia

Abstract Introduction Hand-foot syndrome (HFS) significantly impacts the quality of life in cancer patients undergoing capecitabine treatment. This study assessed capecitabine-associated HFS prevalence, its impacts on chemotherapy treatment, and identified risk factors in multiracial Malaysian patients. Methods We included adult cancer patients receiving capecitabine at Sarawak General Hospital for at least two cycles from April 1, 2021 to June 30, 2022. HFS rates, time to HFS, and proportions of HFS-related treatment modifications were determined. Characteristics between patients with and without HFS were compared and multivariable logistic regression was used to identify risk factors for all-grade HFS and grade ≥ 2. Results Among 369 patients, 185 (50.1%) developed HFS, with 14.6% experiencing grade ≥ 2. Notably, 21.6% of HFS cases underwent treatment modifications. Risk factors for all-grade HFS include older age (OR 1.04 95%CI 1.01, 1.06), prior chemotherapy (OR 2.12 95%CI 1.24, 3.61), higher capecitabine dose (OR 2.89 95%CI 1.69, 5.22), prolonged treatment (OR 1.34 95%CI 1.20, 1.49), and lower neutrophil count (OR 0.77 95%CI 0.66, 0.89). For HFS grade ≥ 2, older age (OR 1.04 95%CI 1.01, 1.08), female sex (OR 2.09 95%CI 1.05, 4.16), Chinese race (OR 2.07 95%CI 1.04, 4.10), and higher capecitabine dose (OR 2.61 95%CI 1.28, 5.32) are significant risk factors. Use of calcium channel blockers (OR 0.29, 95%CI 0.14, 0.59; OR 0.22 95%CI 0.66, 0.78) were associated with reduced risks of all-grade HFS and grade ≥ 2. Conclusion This study provides real-world data on capecitabine-induced HFS in Malaysian patients and identifies risk factors that may offer insights into its understanding and management.