Evaluation sheet for the efficacy of Uridine ointment

Evaluation sheet for the efficacy of Uridine ointment

Barth - ESOP
Evaluation sheet for the efficacy of Uridine ointment for the treatment of the hand-foot-syndrome induced by 5-Fluorouracil (5-FU) or the oral
derivates Capecitabin (C) or Uracil/Tegafur (UFT).
Patient
(Initials +
Age)
Gender
!
Male
(M)
Causing agent Tox. grade Time of
Affected
1
(5-FU/C/UFT) (CTC )
treatment with (H, F, H+F?2)
5-FU/C/UFT
(cumulative
dose)
Female
(F)
CTC Version 2, revised4/30/99: adverse event ! Dermatology/Skin ! Hand-foot skin reaction
Grade
0
None
1
skin changes or dermatitis without pain (e.g. erythema, peeling)
2
skin changes with pain, not interfering with function
3
skin changes with pain, interfering with function
4
not defined
2
H = Hand, F = Foot, H+F = both
1
Seite 1 von 1
Duration of treatment
[weeks] until distinct
onset of relief
Inpatient (I) or
Outpatient (O)
treatment
Frequency of
use per day
(min. q3d)