DISCUSSION


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Our aim in this study was to compare the impact on the foot health-related QoL between a group of women with breast cancer and a group of healthy women who present with normalized reference values. Foot health may be essential for the well-being and QoL of women with breast cancer. In a prior study on women’s QoL and breast cancer in Arab countries, the decrease in physical function in addition to psychological and social problems was demonstrated as affecting the QoL of women with breast cancer. Nevertheless, foot health-related QoL was not evaluated.2 In Iran, a sample of 119 women with a mean age of 48.27±11.42 years showed that chemotherapy had a negative impact on QoL and social relationship abilities, which was also a significant finding in our study.19 In 2007, Mitchell demonstrated that chemotherapy imposed drastic changes in social and emotional well-being, which supported our results that demonstrated significant changes in physical activity and social ability domains.20 For Ganz et al,21 chemotherapy was considered a concern as it may have a long-term impact on QoL. Moreover, Farrel et al22 highlighted the inability of women undergoing chemotherapy to perform tasks and reported that they practiced little or no physical activity. All of these contributions reinforced our study results.

The physical side effects of chemotherapy are well known, as is shown by chemotherapy’s impact on symptoms of the hand–foot syndrome.23,24 Patients with hand–foot syndrome usually present a spectrum of symptoms ranging from burning, tingling, and cutaneous erythema to pain, edema, and ulcerations in the extremities. Injuries may interfere considerably with even the simplest of daily activities such as walking. Thus, the impact on foot health and QoL supported our study results and may help to facilitate preventive actions or treatments for these symptoms.23

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Furthermore, another study reported new data about the incidence of all grades of hand–foot syndrome. In this study, 27.1% of all patients in whom the breast cancer had metastasized presented with this syndrome. In contrast to our study, the authors of this study strongly affirmed that hand–foot syndrome did not lead to a reduction in QoL and justified it by affirming that there was no available validated questionnaire for hand–foot syndrome. Moreover, these authors highlighted that the treatment stage may influence the health status of women with breast cancer.25 In addition, these same authors described the finding that only 11.9% of patients discontinued their therapies due to adverse events, which may have been secondary to metastatic breast cancer and no other type of cancer. Compared with other side effects, physicians may attach greater importance to dermatological or podiatric signs and symptoms in the feet than patients actually do.

Our study agrees with a study performed in 2015 in which recognition of the first signs and symptoms of hand–foot syndrome was found accelerate the use of management strategies.26 In addition, hand–foot syndrome lesions show a range of signs and symptoms from numbness to painful erosions. Therefore, this may have a significant impact on the QoL in affected patients. In agreement with our study, prior studies have tried to find ways to alleviate and prevent this syndrome. Thus, prior studies about preventive strategies have described the use of topically applied ointments with high content of radical protection factor or topical applications of antioxidants with high protection factors. Both of these have been demonstrated to be effective prevention strategies in these patients.12

The results of our study suggest that women with breast cancer undergoing chemotherapy present significantly different scores on the dimensions related to foot pain, foot function, physical activity, social ability, and vigor compared to healthy women. Therefore, it seems important to note that podiatric and medical care may be useful in women with breast cancer who have undergone or are undergoing chemotherapy in order to improve their QoL. Comparison of the impact of these results with other breast cancer and chemotherapy studies may be difficult due to differences in criteria and methodological variations. We have not been able to find many studies in the literature that used the FHSQ to relate QoL and foot health in this group of patients.

This study had important limitations that should be acknowledged. A larger and more diverse sample with individuals from various countries should be recruited in order to strengthen the results from the present study regarding chemotherapy and QoL. Also, additional evaluations of women with breast cancer again at 18 and 24 months after initiation of treatment would be helpful in order to consider the longer term effects of chemotherapy on general and foot health. Finally, women with breast cancer undergoing chemotherapy treatment were recruited, although data regarding the type of drugs or chemotherapy regimens were not collected. These important considerations should be addressed in future research studies in order to evaluate the relationship between foot symptoms and certain chemotherapy drugs. Furthermore, women with breast cancer undergoing no chemotherapy treatment (positive controls) were not recruited. Future studies should compare the foot-related QoL between breast cancer patients undergoing and not undergoing chemotherapy treatment.

CONCLUSION

In conclusion, measurable differences of association between women with breast cancer undergoing chemotherapy and those without breast cancer showed an impaired foot health-related QoL in breast cancer patients undergoing chemotherapy. Thus, this study provided evidence that chemotherapy and breast cancer may be associated with lower scores for dimensions related to foot pain, foot function, physical activity, social ability, and vigor. These items are indicative of a deterioration of specific foot-related QoL. Therefore, proper foot care and prevention may be extremely important to prevent the onset or development of lesions, pain, infections, and/or deformities throughout the chemotherapy process. Based on our research, a more exhaustive interventional study may be necessary to prevent or mitigate the negative effects after chemotherapy in this type of cancer, thereby improving foot and general QoL in these patients.