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 For the study, researchers surveyed 1,945 women diagnosed with
early-stage breast cancer about the severity of seven treatment side
effects: nausea and vomiting, diarrhea, constipation, pain, arm
swelling, shortness of breath and breast skin irritation.
Overall, 45 percent of participants reported severe or very severe
forms of at least one of these side effects. When women got
chemotherapy, the odds of severe side effects were twice as high,
though the side effects were just 30 percent more likely when chemo
was paired with radiation.
“We did know that some of these side effects were associated with
these treatments, but we did not know how severe or how common these
side effects were,” said study co-author Dr. Allison Kurian, a
researcher at Stanford University School of Medicine in California.
“I found it striking that nearly half of all women treated for
early-stage breast cancer reported suffering toxicity that they
considered severe or very severe,” Kurian added by email. “This
emphasizes the prevalence and seriousness of the problem.”
Early-stage breast cancer is the most common type of invasive breast
cancer diagnosed in the U.S, and it involves smaller tumors that may
have spread to nearby lymph nodes but not other parts of the body.
Most early-stage breast cancer patients have surgery – either a
lumpectomy that removes malignant tissue while sparing the rest of
the breast or a mastectomy that removes the entire breast. After
surgery, they may also get chemotherapy or radiation to destroy any
remaining abnormal cells and reduce the risk of cancer coming back.
Overall, 93 percent of the women in the study experienced at least
one of the seven side effects, researchers report in the journal
Cancer.
Nearly one in 10 women surveyed said they made at least one
unscheduled clinic visit because of side effects, and 5 percent said
they went to an emergency department or hospital.
Severe swelling in the arm or skin irritation were the most common
reasons for unscheduled clinic visits. Severe breathing
difficulties, arm swelling, pain or diarrhea were the most common
side effects that brought women to the hospital.
Most patients in the study got some type of surgery and about half
of them had radiation. There were 736 women who had chemotherapy,
including 217 who received this in addition to radiation.
About 29 percent of chemotherapy patients reported severe or very
severe pain, compared with 19 percent of women who didn’t receive
chemo.
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Women who had both chemotherapy and radiation treatment were 30
percent more likely to report a severe side effect, compared to
women who had only one of those treatments.
Women who had double mastectomy were twice as likely as those who
had lumpectomy to report severe or very severe pain.
Severe side effects were also more common for Latina women, who were
30 percent more likely than white women to report a severe or very
severe side effect.
The study wasn’t a controlled experiment designed to prove that
certain treatments directly cause specific severe side effects, the
authors note. Researchers also lacked data on the timing or dosing
of chemotherapy and radiation, both of which can influence the
severity of side effects.
“It is intuitive that patients who have worse disease, and who
therefore require more therapy, experience worse toxicity,” said Dr.
Anees Chagpar, a researcher at Yale University in New Haven,
Connecticut, who wasn’t involved in the study.
Still, the results should encourage doctors to consider when
patients' treatment regimens might be able to achieve the same
survival benefit with fewer side effects, Chagpar added by email.
“The treatments we have for cancer are very effective, but there is
a growing recognition of the ‘collateral damage’ that can accompany
these treatments,” said Dr. Shelley Hwang, a researcher at Duke
University in Durham, North Carolina, who wasn’t involved in the
study.
“Patients should recognize two things: first, that cancer treatments
involve trade-offs; second, that some toxicities can be
long-lasting,” Hwang added by email.
SOURCE: http://bit.ly/2ku8CO6 Cancer, online January 24, 2017.
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