Changing patient perceptions of the side effects of cancer chemotherapy

Abstract

BACKGROUND Quality‐of‐life (QoL) issues have become increasingly important as the number of newly diagnosed patients with cancer increases and survival improves. In 1983, Coates et al. reported a survey of patient perceptions of the side effects of cancer chemotherapy and showed the importance of including patient feedback for the accurate assessment of QoL (Eur J Cancer Clin Oncol. 1983;19:203–208.). The authors carried out a similar survey in 100 patients with cancer with the objectives of 1) investigating the changes in patient perceptions that have occurred and 2) evaluating the impact of new treatments on the profile of chemotherapy side effects among patients receiving anticancer drugs. METHODS One hundred patients attending the outpatient Medical Oncology Department of the Pitié Salpêtrière Hospital Group were surveyed between August 1998 and February 2000 by trained interviewers who were blinded to the patients' treatment. Patients identified all side effects associated with their treatment using a set of 45 cards that named physical side effects (Group A) and a set of 27 cards that named nonphysical side effects (Group B), and the patients ranked these side effects according to severity. The top 5 cards from each group were then combined, and the resulting 10 cards were rated again by severity, regardless of group. Results were analyzed for the entire cohort and for demographic, social, and clinical subgroups. RESULTS The participants included 65 women and 35 men; the most common malignancies were breast carcinoma (40 patients), gastrointestinal carcinoma (19 patients), lung carcinoma (7 patients), and ovarian carcinoma (9 patients). Patients rated affects my family or partner as the most severe side effect, alopecia was second, and fatigue was the third most severe. Effects on work or home responsibilities, effects on social activities, and loss of interest in sex were ranked fourth, fifth, and sixth, respectively. The results contrasted with those of Coates et al., in which affects my family or partner was ranked 10th, and fatigue was ranked 8th. CONCLUSIONS Patient perceptions of the side effects of cancer chemotherapy have changed markedly. In the current study, fatigue and psychosocial QoL concerns predominated, compared with emesis, nausea, and negative reactions to the treatment visit in the original survey. The current findings are consistent with the progress that has been made in reducing certain chemotherapy‐associated toxicities. Fatigue, however, although it often is related to anemia and is treatable with recombinant human erythropoietin, remains a major concern. The emotional, social, and sexual consequences of cancer treatment present continuing challenges in efforts to optimize QoL and to develop effective supportive care. Cancer 2002;95:155–63. © 2002 American Cancer Society. DOI 10.1002/cncr.10630

Chemotherapy‐induced alopecia and effects on quality of life among women with breast cancer: a literature review

“…However, the importance of hair loss from the patient's perspective has been infrequently reported. We found evidence that chemotherapyinduced alopecia is a problem considered important by cancer patients and frequently ranks among the top most distressing/troublesome side effects of chemotherapy [19,25,26,29,30,39]. Moreover, some women have refused chemotherapy because of the risk of alopecia [3].…”

“…Results of the search strategy and reasons for excluding articles In a population of mixed cancer patients where the majority had advanced cancer, three articles used the same methodology [16,22,30] to determine which chemotherapy side effects patients had experienced and their relative importance to the patient. Alopecia ranked 3rd in 1983 and 2nd in 2002 [16,30]. When data were reported in the subgroup of breast cancer patients, hair loss ranked 1st and 2nd in 1983 and 2002, respectively [16,30].…”

“…Alopecia ranked 3rd in 1983 and 2nd in 2002 [16,30]. When data were reported in the subgroup of breast cancer patients, hair loss ranked 1st and 2nd in 1983 and 2002, respectively [16,30]. Alopecia ranked 2nd in breast and lung cancer, two cancer types with chemotherapyassociated alopecia as a side effect [30].…”

“…When data were reported in the subgroup of breast cancer patients, hair loss ranked 1st and 2nd in 1983 and 2002, respectively [16,30]. Alopecia ranked 2nd in breast and lung cancer, two cancer types with chemotherapyassociated alopecia as a side effect [30]. When age was compared, alopecia ranked higher (more important) in older vs younger population [16,30].…”

“…Alopecia ranked 2nd in breast and lung cancer, two cancer types with chemotherapyassociated alopecia as a side effect [30]. When age was compared, alopecia ranked higher (more important) in older vs younger population [16,30]. There was no difference according to the marital status [30].…”