Clinical Aspects of Foot Health and Their Influence on Quality of Life Among Breast Cancer Survivors: A Case-control Study

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Women with breast cancer present with lower foot health more frequently compared with healthy women, which can negatively impact their quality of life, according to a case-control study published in Cancer Management and Research.

Breast cancer is one of the leading causes of morbidity and mortality among women, with some estimates showing that there are 1.7 million new diagnoses annually, globally. Treatment for breast cancer may negatively impact psychosocial and health-related quality of life, including chemotherapy-related adverse events that affect the limbs such as hand-foot syndrome or palmoplantar erythrodysesthesia.

Hand-foot syndrome occurs when chemotherapeutic agents extravasate out of the capillaries around the hands and feet into the surrounding tissue, leading to numbness, tingling, burning/itching, redness, inflammation, discomfort, tenderness, and rash.

For this study, researchers assessed the foot and general health of women with breast cancer compared with women without, and investigated the most common podiatric pathologies that affect quality of life for this patient population.

Cancer Management and Research
Cancer Management and Research

Purpose: The aim of this study was to analyze and compare foot health and general health in a sample of women divided into two groups: 1) those with breast cancer and undergoing chemotherapy treatment and 2) healthy women without breast cancer and with normalized reference values.
Methods: A case–control observational study was performed. Two-hundred women with a mean age of 51.00±8.75 years were recruited from podiatric medicine and surgery clinics from the University of Extremadura (Plasencia, Spain) and the Hospital Infanta Cristina (Badajoz, Spain). The women were divided into case and control groups (undergoing chemotherapy treatment and healthy women, respectively). The Foot Health Status Questionnaire was used to assess foot health domain scores.
Results: Significant differences between both groups were seen for foot pain (P=0.003), foot function (P<0.001), physical activity (P<0.001), social capacity (P<0.001), and vigor (P=0.001). The remaining domains (footwear, general health, and foot health) did not show significant differences between the two groups (P≥0.01).
Conclusion: Women with breast cancer presented a lower foot health-related quality of life. Clinical aspects with emphasis on foot pain and disability were increased. Furthermore, physical activity, social capacity, and vigor were affected. Therefore, general health care and foot problem prevention for breast cancer survivors should be given more consideration.


Keywords: breast cancer, chemotherapy, foot injury, quality of life 

INTRODUCTION

Quality of life (QoL) is an important health indicator in cancer patients. Cancer is viewed as the main cause of death worldwide, and it also has a significant social impact on patients.1 Among QoL studies in cancer patients, breast cancer has received the most attention.2 This disease affects the QoL of these women.3 QoL measurements during cancer patients' treatment has become an important tool over the last several years as it provides information about physical, emotional, and/or social aspects in addition to disease-associated symptoms and their treatments.4 Cancer treatments such as chemotherapy may produce side effects and symptoms that negatively affect a patient's QoL, and treatments such as mastectomies can cause lower self-esteem.5 Other aspects such as psychosocial and medical factors (age, education, emotional, labor, and/or economic situations) can influence a patient's QoL.4 Based on these aspects, foot care and its follow-up should be considered for patients suffering from common foot problems.3

Breast cancer is the major cancer that is prevalent among women, especially in those aged >50 years.6,7 The World Health Organization has stated that breast cancer is the leading cause of cancer death worldwide, with varying incidences across countries. When considering developed countries, it has been shown that cancer-related mortality rates are declining.6,8–10 In 2012, a new global study detected approximately 1.67 million newly diagnosed breast cancer cases in women.3

Breast cancer-associated chemotherapy also leads to side effects, and certain chemotherapy regimens can cause, with regard to the limbs, handfoot syndrome or palmoplantar erythrodysesthesia, which has already been described in the scientific literature. Handfoot syndrome is a skin reaction that occurs when a small amount of medicine gets filtered out of the capillaries (small blood vessels) and into the skin, especially into the skin of the palms of the hands and soles of the feet. After the drug has filtered out of the capillaries into the skin, it can damage the surrounding tissues. The handfoot syndrome can be painful and may affect a patient's daily life; therefore, this study evaluated the symptoms that appeared in the feet of women with breast cancer who were undergoing chemotherapy. Thus, this could permit development of strategies to prevent these symptoms and improve the QoL of these women. Several signs and symptoms of the handfoot syndrome have been reported in the scientific literature: 1) numbness; 2) tingling; 3) burning or itching; 4) redness (similar to sunburn); 5) inflammation; 6) discomfort; 7) tenderness; and 8) rash.11,12

Foot conditions and deformities should be taken into consideration in these patients in an attempt to provide better QoL in addition to looking after the general and podiatric well-being of these women. Therefore, the main purpose of this study was to analyze and compare both foot health and general health in two groups of women: 1) those with breast cancer undergoing chemotherapy treatment and 2) those without breast cancer (healthy women with normal references values). The second aim of this study was to observe the most frequent podiatric pathologies that may appear in the population of women with breast cancer and influence foot and general health-related QoL. 

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