Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer
Open Access
- 14 December 2018
- journal article
- research article
- Published by Oxford University Press (OUP) in The Oncologist
- Vol. 24 (6), 762-771
- https://doi.org/10.1634/theoncologist.2018-0590
Abstract
Background This study explores the incidence of patient-reported major toxicity—symptoms rated “moderate,” “severe,” or “very severe”—for chemotherapy regimens commonly used in early breast cancer. Patients and Methods Female patients aged 21 years or older completed a validated Patient-Reported Symptom Monitoring instrument and rated 17 symptoms throughout adjuvant or neoadjuvant chemotherapy. Fisher's exact tests compared differences in percentages in symptom ratings, and general linear regression was used to model the incidence of patient-reported major toxicity. Results In 152 patients, the mean age was 54 years (range, 24–77), and 112 (74%) were white; 51% received an anthracycline-based regimen. The proportion of patients rating fatigue, constipation, myalgia, diarrhea, nausea, peripheral neuropathy, and swelling of arms or legs as a major toxicity at any time during chemotherapy varied significantly among four chemotherapy regimens (p < .05). The mean (SD) number of symptoms rated major toxicities was 6.3 (3.6) for anthracycline-based and 4.4 (3.5) for non-anthracycline-based regimens (p = .001; possible range, 0–17 symptoms). Baseline higher body mass index (p = .03), patient-reported Karnofsky performance status ≤80 (p = .0003), and anthracycline-based regimens (p = .0003) were associated with greater total number of symptoms rated major toxicities (alternative model: chemotherapy duration, p < .0001). Twenty-six percent of dose reductions (26 of 40), 75% of hospitalizations (15 of 20), and 94% of treatment discontinuations (15 of 16) were in anthracycline-based regimens. Conclusion Capturing multiple toxicity outcomes throughout chemotherapy enables oncologists and patients to understand the range of side effects as they discuss treatment efficacies. Continuous symptom monitoring may aid in the timely development of interventions that minimize toxicity and improve outcomes. Implications for Practice This study investigated patient-reported toxicities for 17 symptoms recorded prospectively during adjuvant and neoadjuvant chemotherapy regimens for early breast cancer. An analysis of four commonly used chemotherapy regimens identified significant differences among regimens in both individual symptoms and total number of symptoms rated moderate, severe, or very severe. Longer chemotherapy regimens, such as anthracycline-based regimens followed by paclitaxel, had higher proportions of symptoms rated major toxicities. The inclusion of patient perspectives on multiple toxicity outcomes at the same time at multiple time points during chemotherapy has the potential for improving patient-provider communication regarding symptom management, patient satisfaction, and long-term clinical outcomes.Keywords
This publication has 54 references indexed in Scilit:
- Feasibility of Long-Term Patient Self-Reporting of Toxicities From Home via the Internet During Routine ChemotherapyJournal of Clinical Oncology, 2013
- A literature synthesis of symptom prevalence and severity in persons receiving active cancer treatmentSupportive Care in Cancer, 2013
- Electronic Toxicity Monitoring and Patient-Reported OutcomesThe Cancer Journal, 2011
- Adverse Symptom Event Reporting by Patients vs Clinicians: Relationships With Clinical OutcomesJNCI Journal of the National Cancer Institute, 2009
- Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal womenEuropean Journal of Oncology Nursing, 2008
- Toxicity of Older and Younger Patients Treated With Adjuvant Chemotherapy for Node-Positive Breast Cancer: The Cancer and Leukemia Group B ExperienceJournal of Clinical Oncology, 2007
- Evaluation of an Online Platform for Cancer Patient Self-reporting of Chemotherapy ToxicitiesJournal of the American Medical Informatics Association, 2007
- Patient Online Self-Reporting of Toxicity Symptoms During ChemotherapyJournal of Clinical Oncology, 2005
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- Fatigue in Women Receiving Adjuvant Chemotherapy for Breast CancerJournal of Pain and Symptom Management, 1999