Tyrosine kinase inhibitors (TKI) side effects prevention

This information sheet is intended to provide supplementary guidance to your specific TKI product information. It is general advice and guidance; should you have particular concerns please do not hesitate to contact your clinical nurse specialist (CNS) or the acute oncology service (AOS) team.

Management and prevention of serious side effects relies on good communication with your oncology team and acting fast if problems occur. A treatment break is sometimes indicated to avoid problems worsening.

Skin changes, particularly to the hand and feet, are common with these drugs

Prevention tips:

• Use cooler water temperatures for washing yourself or when washing up. Use cotton gloves under rubber gloves to reduce sweat production.
• Pat skin dry rather than rub it.
• Use moisturisers liberally but with gentle application avoiding rubbing and pressure. Urea based ones can be helpful for feet particularly.
• Consider seeing a chiropodist for expert foot care.

Avoid:

• Saunas.
• Unprotected sun exposure.
• Sporting activities which cause rubbing.
• Tools which involve repeated pressure such as garden tools and screwdrivers.
• Tight fitting shoes or walking barefoot, soft socks or slippers should be worn.
• Chemicals such as detergents and cleaning products.

Management:

• Pain relief, anti-inflammatories as advised by your oncology team.
• Try using cool pack intermittently for sore areas.

Sore mouth

Prevention tips:

• Use a non-foaming toothpaste without whitening or tartar control additives and soft toothbrush.
• Maintain good oral hygiene brushing gently after meals (see your dentist six‑monthly).
• Salt water mouthwashes (made by boiling 900ml water, allowing it to cool somewhat then adding a teaspoon of salt). Rinse mouth with warm water after using.

Avoid:

• Spicy, hard/crunchy and acidic foods.
• Smoking & alcohol.

Paronychia – nail inflammation

Prevention tips:

• Keep feet and hands as dry as possible, take care when cutting nails to avoid trauma.
• Wear cotton gloves underneath washing up gloves to protect hands.
• Wear shoes that protect nails but are not restrictive.

Avoid:

• Soaking hands and feet in soapy water for a prolonged period of time without adequate protection.
• Skin irritants.

Management:

• Warm water or white vinegar soaks can be beneficial.
• The affected area should be soaked in warm water for approximately 15 minutes 3 to 4 times per day.
• White vinegar soaks (1:1 white vinegar: water) can be used for 15 minutes every day.

Diarrhoea:

• Antidiarrheal as prescribed.
• Keep diaries listing episodes, severity and foods that lead to them.
• Diet modification, avoid foods that aggravate such as spicy, fatty foods and possibly caffeine.
• Maintain good hydration.

Fatigue:

• Maintain a healthy balanced diet.
• Attempt a daily gentle walk outside (unless suffering with skin changes on feet).
• Try a stress-reduction technique such as yoga or mindful meditation.

High blood pressure:

• Daily home monitoring (take 3x readings after 15 minutes rest and record the lowest).
• Alert your medical team if above 140/90.

Contact information

Clinical nurse specialist (CNS) 01223 ............

Acute oncology service (AOS) 01223 274224

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.