Patients’ Chemotherapy-Related Side-Effect Concerns Have Evolved, But Hair Loss Remains Significant

TON - November 2017, Vol 10, No 6

Madrid, Spain—Patients’ perceptions of worrisome chemotherapy-related side effects have evolved since the 1980s and 1990s, according to a recent survey of women with breast and ovarian cancers that was reported at the 2017 European Society for Medical Oncology Congress.

Hair loss has been a constant issue over time; difficulty sleeping and the effects of adverse events on family members are also important concerns for patients. However, nausea and vomiting no longer take center stage as concerns the way they did in the 1980s and 1990s.

Patient assessments about the impact of chemotherapy-related side effects have been carried out since the early 1980s, explained lead investigator Beyhan Ataseven, MD, Senior Physician, Department of Gynecology and Gynecological Oncology, Evangelische Huyssens-Stiftung, Kliniken Essen-Mitte, Germany.

“With the most recent analysis dating back to 2002, we felt it was time to collect new data and update the interview format. Living conditions have changed, and so have the accompanying chemotherapies, as well as supportive measures to manage side effects. As doctors, it is important to know what our patients care about,” she told the audience.

According to Dr Ataseven, the survey differed from previous surveys on the same topic by focusing exclusively on patients with breast (N = 95) and ovarian (N = 46) cancers. Furthermore, the investigators added a longitudinal analysis by conducting 3 separate interviews with patients—before, during, and after completion of chemotherapy.

At each interview, 141 patients who were scheduled for or undergoing chemotherapy were presented with 2 groups of cards featuring physical and nonphysical side effects. Patients selected the 5 most burdensome symptoms in each group and ranked them according to importance. Of the 10 side effects each patient chose, they were then asked to select the 5 most significant and rank those as well.

“We found that on the one hand, side effects like nausea and vomiting are no longer a major concern for patients. We can explain this by effective modern supportive care for these symptoms. On the other hand, hair loss remains a persistent unresolved issue that is particularly difficult for patients at the start of treatment. As time passes, patients seem to get used to hair loss and other side effects take precedence,” Dr Ataseven said.

“Over their entire course of chemotherapy, sleep disorders are the most difficult side effect they deal with, and this becomes increasingly concerning over time. Anxiety about the effects of their illness on their partner or family remains a top issue throughout the course of treatment,” she stated.

Dr Ataseven explained that these findings can provide physicians with important insights that can translate into better care for patients.

“They should lead us to consider ways to improve on our therapies. For example, prescribing a sleeping tablet can alleviate sleep disturbance. Until now, this has not been part of routine care. In addition, the findings suggest that more psychological support is needed to address patients’ social anxieties and family-related matters,” Dr Ataseven said.

She also noted that, although 2 different scalp-cooling devices are FDA approved for hair loss in the United States, this is not a “global solution.”

“We must clearly discuss treatment-related side effects with our patients in advance; in particular, difficulty sleeping and the impact of side effects on family or partners,” Dr Ataseven concluded.

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