Side effects and emotional distress during cancer chemotherapy

Abstract

Chemotherapy side effects, patient distress, and patient-practitioner communication were evaluated in an inception sample of 238 patients with breast cancer or malignant lymphoma. Participants were interviewed at five points during their first six cycles of therapy, and a subsample kept brief daily symptom diaries. Nausea, hair loss, and tiredness were each experienced by more than 80% of patients. By cycle 6, 46% of patients had thoughts about quitting therapy, but only a few had told medical staff. Patients' ratings of the objective difficulty of treatment increased over time, varied by treatment regimen, and were predicted by the experience of side effects, with the number of different side effects serving as the best predictor. In contrast, emotional distress was less sensitive to the directly assessable characteristics of treatment. Communication between patient and practitioner was found to be inadequate in a number of respects (i.e., patients did not fully anticipate the toxicities of treatment and did not report their concerns to medical staff). Communication may be impeded by inaccuracies in a patient's recall of treatment difficulties and by a patient's inability or unwillingness to attend to all presented information. More frequent opportunities for patient-practitioner discussion are necessary.

Discordance between physicians' estimations and breast cancer patients' self-assessment of side-effects of chemotherapy: an issue for quality of care

“…Figure 1 compares the frequency of declaration of each symptom, during the 180 cycles of chemotherapy of these 30 patients, to those noted by clinicians in their medical records. Concordance between patient's self-assessment and clinical reports is moderately correct (Kappa coefficient between 0.45 and Figure 1 Comparison of chemotherapy side-effects evaluated by patients with those reported by physicians in medical records (n = 30,180 cycles of chemotherapy), *, Patient; physician; (,Cohen's Kappa coefficient; *P < 0.05; **P<10-2; ***P < 10-3; NS, not significant 0.75; Landis and Koch, 1977) (Love et al, 1989;Portenoy et al, 1994a) that the number of disturbing physical symptoms experienced by cancer patients is strongly associated with their overall quality of life during chemotherapy treatment. Our study, carried out in a group of female patients with standard risk breast cancer, also found similar frequencies of symptoms, such as nausea and vomiting, associated with NCF chemotherapy as in other groups of patients (metastatic breast cancers) receiving the same regimen (Bennett et al, 1988).…”

“…It is well established that somatic symptoms condition cancer patients' acceptability of treatments and that side-effects of chemotherapy may create barriers to patients' acceptance and compliance with effective adjuvant therapies before and during treatment (Love et al, 1989;Cooper and Georgiou, 1992;Fallowfield, 1992). Oncologists' attention has, however, been mainly focused on toxicity of chemotherapy and on some of its most noticeable associated side-effects (hair loss, nausea and vomiting) (Coates et al, 1983;Griffin et al, 1996;Morrow, 1996).…”

Fatigue and radiotherapy: (A) experience in patients undergoing treatment

“…These patients max then be informed accordingly. Results have indicated that patients do not always expect fatigue to be a side-effect of treatment (Cassileth et al 1985: Love et al 1989: Tierney et al 1991. Preparatory information on what to expect in terms of fatigue during and after treatment could enhance the possibility of patients to cope with this symptom.…”

Interpretation of MR Imaging of Spinal Metastasis: Focus on the Understanding of Its Pathophysiology and the Next Step toward a Further Clinical Approach Using MRI Findings

“…However, successful chemotherapy can help to shrink the tumor burden and to decrease pain (2,22). Finally, epidural steroid injection, vertebroplasty or kyphoplasty are useful options for spinal metastases and metastatic pathologic fractures of the spine in order to control back pain (23).…”