Focus on foot care
Given the serious impact of cancer therapies on feet, foot care in oncology demands more attention of patients as well as healthcare providers.
Foot problems related to cancer therapies may severely impact the quality of life of cancer patients, even long after their therapies have ended.
Systematic and evidence based foot care in oncology commands attention, given the wide range of agents resulting in adverse events that affect the feet. Moreover, complications may develop at a faster pace in cancer patients in the setting of immunosuppression and comorbidities.
Given the serious impact and potential development of complications, patients and healthcare providers must be informed as to how to prevent and address these untoward events.
The most common complications resulting from cancer treatments are:
Chemo induced polyneuropathy (CIPN)
Hand-foot-skin reaction (e.g. extreme callus formation)
Nail toxicity and infections
These complications may cause the patient to be unable to fit their shoes, stand, walk, work or perform self-care activities of daily living.
The OncoFoot Foundation aims to develop and establish the following actions worldwide:
Raise awareness amongst patients, caregivers and professionals (Education)
Publications in scientific journals and public campaigns
Knowledge transfer via intentional publications and conferences
Foot screening (Education)
Education program (already existing) (Research/Education)
Quality and safety label (Education)
Collect data from expert centres around the world and research (Research)
Initiate new research
Develop new care interventions (Research)
The foundation was established in august 2016 in Amsterdam and has a seat in Amsterdam and New York. The foundation functions under Dutch Law and the place of Arbitrage is the court of Amsterdam.
La Couture, Mario MD
Memorial Sloan Kettering Cancer Center NY, US (Accepted)
Beele, Hilde MD
University of Gent, Belgium
University of London and Ulster, UK
University of Freiburg and various others
Sibaud, Vincent MD
University of Toulouse, France
Mischa Nagel (1965) was forced to abandon his study of medicine at the age of 23 and became director of his family’s pharmaceutical company. Because of its inventive products, this company was taken over in 2003 by the largest pharmaceutical wholesaler in the Netherlands. The company still exists today under it’s original name.
As an extension of this, Mischa started Supplement in 1999.
Supplement is an 'information house' for healthcare. This organisation’s goal is to share knowledge about complementary treatments with doctors, therapists and patients. Supplement also produces the periodical De Medische Voet which focuses on medical foot care. Since 2008, in combination with the website and social media, this periodical has developed into the most important knowledge platform for medical foot health practitioners in the Netherlands and Belgium. The periodical is published in both Dutch and French. As an organisational body, De Medische Voet also organises several courses and conventions about medical foot care in the Netherlands and Belgium.
Under the supervision of Supplement another initiative was launched in 2015. OncoZorg (OncoCare) is rapidly becoming a source for patients and professionals about cancer care. As a speaker and panel member, Mischa has participated in various international congresses regarding health care and is a respected and highly-regarding foot health tutor in the Netherlands. Abroad, he is a requested speaker at congresses on the theme of 'Integrative Oncology'. In March 2012, he led a group of 30 doctors from the Netherlands around the Memorial Sloan Kettering cancer centre to show them how Integrative Oncology forms is part of patient care.
The Foundation offers two curricula in oncology foot care.
One is adapted from the existing program for podiatry students, and the other for established podiatry professionals.
Preventive evaluation and management strategies, such as those performed during de rigueur dental evaluations prior to head and neck radiotherapy or stem cell transplants, serve as a model for the podiatric evaluation of patients receiving agents that result in foot related adverse events.
Most patients, caregivers, podiatrists, other foot care therapists, and oncology professionals are not aware that cancer treatments may cause foot events. On the other hand, podiatrists and other foot care therapists may not be aware of the complications that their treatments can induce during or after cancer treatment.
Medical professionals, patients, and caregivers should be aware of potential foot complications and how to prevent and treat them.
A) Podiatry Students
Third or Fourth Year – 2 credit hours
So far there has been insufficient clinical or research focus on foot complications that result from cancer therapies. Foot conditions, however, are common and have a considerable negative impact on the patients’ ambulation, quality of life, and consistent dosing of antineoplastic agents.
Systematic and evidence-based foot care in oncology commands attention, given the wide range of agents resulting in adverse events that affect the feet. Moreover, complications may develop at a faster pace in cancer patients in the setting of immunosuppression and comorbidities. Given the serious impact and potential development of complications, patients and healthcare providers must be informed as to how to prevent and address these untoward events. The oncology team and caregivers need oncology-specific guidelines.
This course provides the student with the primary principles of safe cancer care (guidelines), learning about cancer and cancer treatments, onco pharmacology, side effects on foot and lower leg, podiatry interventions, communication with the oncology team and onco-psychology. The second part of this course provides the student with an inside in clinical practice; e.g. two-day internship at an oncological ward of a cancer centre.
The entire course syllabus is finalized. Students are required to purchase two books: one written by Professor Mario La Couture, Memorial Sloan Kettering Cancer Center and one written by Professor Vincent Sibaud, Université de Toulouse France.
B) Podiatry Professionals
2 day course
This course comprises the primary principles of safe cancer care (guidelines), cancer treatment and side-effects on foot and lower leg, screening & prevention and podiatry interventions.
A voluntary third day can be added to this program in which podiatrists will get updated on communication, principles of onco-psychology, patient communication and tools for intervision.
Accreditation for the two day program has to be obtained.
Preliminary data from the Foundation For Foot Oncology in The Netherlands from 291 patients treated by podologists revealed that foot care resulted significant benefits (see table below).
Today, there are no clinical or research programs on foot complications that result from cancer treatments. Consequently, there are no guidelines in the United States for screening or care of cancer treatment–related foot events. This is in contrast with foot care protocols for patients with diabetes and arthritis, where podiatric care is a critical component of disease control.
The incidence, clinical presentation, impact on quality of life, and effects on anticancer therapy dosing have not been systematically ascertained. This knowledge is critical in order to develop preventive and management guidelines to mitigate the impact of foot complications on patients’ ambulation, sense of well-being, and their ability to receive anticancer treatments, all of which would contribute to optimal cancer care.
Table: Patient reports after podology care (n=291); *P value <0.001
(0 = no complaints, zero impact on daily activities <> 10 = most severe complaints, heavy impact on daily activities)