Nail damage & chemotherapy: The troublesome side effect can now be prevented

The Princess of Wales like other men and women receiving cancer treatments are at risk of developing troublesome and painful nail damage. Although not life threatening, hence deemed inconsequential by some oncologists, it is yet another distressing side effect to cope with.

Fortunately, a topical plant-based therapy, developed by a team of oncologists and scientists based in Bedford and Addenbrooke's Cambridge University Hospitals, has put an end to the distress and pain of treatment associated nail damage, but it remains under utilised in many other oncology units.

We don't know what cancer or what chemotherapy the Princess is receiving but most chemotherapy agents can damage the nails to some degree. One of the most commonly uses agents called taxanes, often given for ovarian, breast and lung cancer are particularly notorious for their nail damaging properties, troubling over 40% of patients and even as many as 90% after six cycles of treatment.

On top of the visual trauma, the discomfort can lead to difficultly with routine daily tasks such as dressing, washing or shopping. Other sufferers report it adversely effects body image as it is a constant visual reminder of their cancer. The distorted nails can catch on clothing and many report trouble maintaining physical contact with their children and partners. All of these factors significantly impact on patients overall quality of life which is already impaired by the other common side effects of chemotherapy such as fatigue, nausea, mouth ulcers and brain fog, to mention but a few.

Paul Byrne who is currently receiving taxotere chemotherapy (one of the commonly prescribed taxanes) for prostate cancer explains: "This is one of the worse side effects of chemotherapy, people are always asking what's wrong with my nails and I have had to give up DIY and gardening."

The damage to both the finger and toenails can last many months after treatment has finished. The first symptoms are usually burning and pain, starting in the base of the nail then the physical changes appear. The severity ranges from mild ridges (Beau's lines) to troublesome damage and detachment called oncycholysis. Secondly infection can set in (called paronychia) particularly with some of the newer biological agents known as tyrosine kinase inhibitors (TKI's) such as glivec (imatinib) and sutent (dasatinib). Infection in the nail beds can cause breaks in treatment if it spreads into the hands, especially in patients with suppressed immunity.

A variety of anecdotal strategies have been used by patients desperate to help protect themselves from this nasty side effect. These include wearing dark nail varnish despite studies which refuted any benefits. Others use concentrated essential oils which can irritate, dry and inflame the nail beds making matters worse. Commercially available balms are marketed to people on chemotherapy but up to now, none have been scientifically evaluated for safety and effectiveness.

To address this information gap, a scientific committee was created with the aim of replacing speculation and hearsay with formal scientific data which will allow doctors and nurses to provide robust evidence based advice for patients. The team scrutinized the existing laboratory and clinic data from around the world, developed a topical therapy then evaluated its benefit in a formal double blind randomised controlled trial.

The best data came from plant based extracts, waxes and oils, rich in phenolic polyphenols which have natural antioxidant properties that act as a local antidote protecting the nail bed stem cells from chemotherapy. In addition these have moisturising and anti-inflammatory properties which prevent drying, splitting or cracking of the nail. African sage oil was added as it is known to have potent anti-microbial properties, helping to prevent secondary infection.

All the selected oils were cold pressed extracted which preservers the active phytochemicals. It contained no man-made chemicals such as perfumes, parabens, or colours which could act as irritants to the nail beds. The final formula contained cold extra virgin olive oil, organic beeswax, unrefined cocoa butter and unrefined organic shea butter gaultheria and essential oils; procumbens, lavandula officinalis, eucalyptus globulus and tarchonanthus camphoratus.

The study design

Sixty men and women receiving chemotherapy volunteered for the study. They were either randomised to apply a placebo based moisturising balm to their nail beds or the intervention now known as Polybalm. The health of the nails was measured by four independent validated tools. To ensure unbiased reliable data, none of the patients, doctors or research team knew which balm was assigned to which patient. Only when the final patient completed the study, the codes unblinded and the data analysed by the statistician, were the results available to interpret.

There were shouts of joy when the magnitude of the benefits were revealed. They beat all expectations - in all but 1 of the 30 patients in the Polybalm group, there was virtually no nail damage compared to more than half suffering significant distress in the placebo group. For all four measurements there was a 180 fold difference in damage which was highly statistically significant to a level which meant there was less than 1 in 10,000 probability that this affect could have happened by chance. In fact, nail related quality of life actually improved in the Polybalm group despite being on chemotherapy.

With such enormous benefits for a straight forward topical therapy you would think it would be snapped up by oncology units cross the World. The sad reality is that natural therapies are not recognised as drugs so cannot be prescribed in the NHS. Despite this robust data, licensing authorities demand to know which individual chemical had the therapeutic effect but a plant based therapy may have hundreds of separate phytochemicals which work together for the therapeutic effect.

What's more, the makers of Polybalm are not allowed to promote to patients starting chemotherapy as UK licensing rules ban marketing and advertising. As such, patients are left to find out about this therapy by word of mouth and then buy it themselves. Fortunately, in the original trials unit all patients are now given polybalm routinely before chemotherapy and immunotherapies but this is only possible from the grant received for the original study.

Across the country thousands people are missing out. One of the first women, Val from Glastonbury, who did find out about Polybalm and bought it before her intense chemotherapy had this to say: "I was the only patient on the cancer unit who still had perfect nails by the end of chemotherapy."

There was some good news announced this week. Polybalm has now been recognised in official NHS guidelines which can be followed by oncology units across the UK. It has been acquired by a UK organisation who are now campaigning to increase awareness for oncology staff and patients. They have also posted the NHS guideline on their website polybalm.com.