Patient Perceptions on Importance of Chemo Side Effects Have Shifted

The relative importance of common chemotherapy side effects has shifted substantially over the last few decades, and it also shifts from before to after treatment, according to a new study. In general, psychosocial effects have become more important while physical effects seem less significant to patients than in the past.

The new study (abstract 1472P_PR) is an extension of a survey last conducted in 2002. “Living conditions have changed, and so have the accompanying therapies linked to chemotherapy,” said the study’s lead author Beyhan Ataseven, MD, of Kliniken Essen-Mitte in Essen, Germany. “As doctors, we want to know what our patients care about.”

Ataseven presented results of the study at the European Society for Medical Oncology (ESMO) 2017 Congress, held September 8–11 in Madrid. Unlike past versions, it included only breast and ovarian cancer patients, as well as a longitudinal interview carried out before, during, and after chemotherapy was completed. It included 141 patients, 113 of whom completed all 3 interviews.

The most significant chemotherapy side effect (CSE) in the new cohort was “difficulty sleeping.” In the 2002 version of this study, “affects my family or partner” was the top-ranked CSE; in 1993 it was nausea, and in 1983 it was vomiting.

The concern over effects on family or partner was second in the new version, followed by loss of hair, numbness in limbs, and shortness of breath. Loss of hair has consistently been a high-ranked side effect for patients undergoing chemotherapy, ranking second or third in each of the previous versions.

Patient rankings of CSEs did shift over the three interviews as well. “Affects my family or partner” was the primary concern before starting therapy, but “difficulty sleeping” became the primary concern during and after chemotherapy. Loss of hair ranked third on patients’ list of concerns before initiation, but dropped to fourth during therapy and was not in the top five afterward. Numbness in limbs was not ranked initially, but was ranked at the intermediate and post-chemotherapy interviews.

“As doctors, these findings might lead us to consider possible improvements to the accompanying therapies we offer our patients,” Ataseven said. “For instance, sleeping tablets were not until now a part of the routine regimen. There is also a clear case for providing stronger psychological support to address patients’ social anxieties and family-related concerns.”

Karin Jordan, MD, of the University of Heidelberg in Germany, commented on the study. “The results show that there might be a gap between what doctors think is important or disturbing for patients, and what patients really think,” she said. “Going forward, similar studies also need to be done for other types of cancer, including analyses of how an optimal management of side effects influences the disease trajectory.”