Efficacy of herbal medicine in managing hand–foot syndrome: A systematic review and meta-analysis

Introduction: Hand–foot syndrome (HFS) is a frequent complication of fluoropyrimidine chemotherapy, and increasing evidence suggests that herbal medicine may provide effective management. Objective: This study aims to assess the effectiveness of herbal medicine in treating fluoropyrimidine-induced HFS. Methods: This review was pre-registered with the International Prospective Register of Systematic Reviews under the registration number CRD42025643171. A comprehensive literature search was conducted across six databases, including Embase, PubMed, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and China Science and Technology Journal Database. The primary outcomes were the incidence of HFS and the treatment efficacy. Results: A total of 34 studies were included, and their outcomes were analyzed using four key indicators: the incidence of HFS, treatment efficacy, pain relief, and improvements in the quality of life (QoL). Patients receiving herbal medicine had a significantly lower overall incidence of HFS (odds ratio [OR] = 0.30, p<0.00001) and a reduced incidence of severe HFS (≥grade 2) (OR = 0.32, p<0.00001) compared to those without herbal treatment. Furthermore, herbal medicine was associated with a higher overall response rate (OR = 7.17, p<0.00001), better recovery rate (OR = 4.70, p<0.00001), greater pain relief (mean differences [MD] = 1.64, p=0.001), and improved QoL (MD = 9.75, p<0.0001). In addition, two subgroup analyses were performed: A comparison of herbal medicine with Western medicine and a comparison of external versus internal administration of herbal medicine. Conclusion: According to these results, herbal therapy may be used alone or in conjunction with Western medicine to treat fluoropyrimidine-induced HFS.