# Integration of Ayurveda in managing chemotherapy-induced hand–foot–skin reaction—an exploratory quasi experimental study

## TL;DR

This study explores using Ayurveda treatments alongside standard care to manage chemotherapy-induced hand-foot-skin reactions, showing improved quality of life and reduced pain.

## Contribution

The novel contribution is the integration of Ayurveda as an add-on therapy for chemotherapy-induced hand-foot-skin reactions, with promising results in a quasi-experimental design.

## Key findings

- The study group showed significant reduction in pain (VAS) compared to the control group.
- Quality of life (HF-QoL) improved in patients receiving Ayurveda treatment alongside standard care.
- Integrated therapy was found feasible for managing chemotherapy-induced hand-foot-skin reactions.

## Abstract

Hand–foot–skin reaction (HFSR) is one of the major mucocutaneous adverse events of multi-kinase inhibitors (MKIs). Its overall incidence is 35.0%. It negatively impacts the quality of life of the patient and compliance with chemotherapy. Present management of HFSR is largely anecdotal, and the common treatment is dose regulation or discontinuation of chemotherapy. In Ayurveda, the clinical presentation of HFSR may be understood as pitta rakta-pradhana agantuja vraṇa in hasta and pada caused by MKIs. The present study aimed to evaluate the Ayurveda treatment protocol as an add-on to the standard of care.

This is a double-arm-controlled interventional study with a quasi-experimental design, registered in the Clinical Trial Registry of India under CTRI/2022/03/040929, with 22 participants from the Medical Oncology Department and Integrative Medicine, Amrita Institute of Medical Sciences, Kochi. The study group received an add-on treatment to the standard of care (SOC). This included Yasṭimadhu Kashaya pariseka (from days 1 to 30), followed by Satadhauta ghrita Lepana (from days 6 to 30) twice daily immediately after pariseka. A gap of 1 h was maintained between the Ayurveda treatment and SOC as prescribed by the oncologist.

The study group demonstrated a significant reduction in pain (VAS) and improvement in quality of life (HF-QoL) compared to the control group. Yasṭimadhu is vrana sandhaneeya, varnya, daha prashamana, shothahara, and shonitasthapana. Ghrita is Vata pittahara, sheeta veerya, and dahaprashamana, and it facilitates ropana. HF-QoL improved due to effective management of symptoms. The pilot study suggested that an integrated therapy is feasible in HFSR patients, which can possibly support improving the quality of life for cancer patients undergoing chemotherapy.

CTRI/2022/03/040929, https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NjMwMTE=&Enc=&userName=.