Almost half women with early stage, invasive breast cancer report severe or very severe side effects from their treatment, leading to more visits to doctors and emergency rooms as well as delays in treatment and reduced doses, research shows.
This includes women who did not receive chemotherapy as part of their treatment plan. Nearly 30 percent of them experienced severe side effects.
The study, “Treatment-Associated Toxicities Reported by Patients With Early-Stage Invasive Breast Cancer,” was published in the journal Cancer.
The ratio of therapeutic effect, or benefits, over toxicity in cancer treatments is often small. Toxicities can lead to treatment discontinuation, use of costly health care services, and premature death. They can also place physical, emotional, and financial burdens on patients and families.
That means doctors constantly weigh the anticipated benefits of anticancer treatments against the risks of treatment: toxicities, or adverse side effects.
“It’s in patients’ best interest to receive their treatments on time and on schedule, whenever possible, to give them the best possible outcome. Unscheduled care for toxicities — including clinic visits, emergency department visits and hospital stays — are expensive, inconvenient and disruptive to both doctors and patients. We need to avoid them whenever possible,” Steven J. Katz, MD, MPH, a professor of medicine and of health management and policy at the University of Michigan, said in a news release.
Katz and his colleagues surveyed a population-based sample of 1,945 women from the iCanCare study. They lived in Los Angeles County and Georgia, and had early stage, invasive breast cancer seven months after their diagnosis.
They were asked about the frequency and severity of toxicities, including pain, nausea or vomiting, constipation, diarrhea, arm swelling, breast skin irritation, and shortness of breath.
The survey also asked them about the kind of help they had sought for their side effects: either routine clinic visits and additional doctor’s appointments, or emergency-department visits or hospitalizations.
Ninety-three percent said they had experienced at least one of the seven side effects, with 45 percent reporting severe or very severe side effects, particularly pain, skin irritation and constipation.
Nine percent said they have scheduled additional clinic visits due to side effects from their treatment, and 5 percent said they had visited an emergency department or hospital.
Women who underwent both chemotherapy and radiotherapy were 30 percent more likely to have experienced a severe side effect than women who had only one of those treatments.
Study participants who underwent bilateral mastectomy, or removal of both breasts, were twice as likely as those who underwent lumpectomy, or removal of tumor and surrounding tissue, to experience severe or very severe pain.
Latina women were 30 percent more likely to report severe or very severe side effects than white women.
Patient-reported side effects help doctors evaluate breast cancer treatments, but most available data comes from clinical trials and health care claims, which may be biased.
“As an oncologist, I knew from my clinical practice that more women were suffering than is generally reported in clinical trials,” said Allison Kurian, MD, MSc, an associate professor of medicine and health research and policy at Stanford University. “Often, women suffer in silence, afraid to tell their providers about how bad things really are for fear that their treatments may be halted. We need to change that.”
Kurian said oncologists should talk with their patients about the potential side effects of treatments to prepare them for what they will experience. Additional studies on the severity of side effects can provide doctors with information on their impact, which they can share with patients to help them make treatment decisions.
Katz and his colleagues are developing resources to help women understand how side effects vary by treatment. Other studies are looking at how side effects vary across diverse chemotherapy regimens, as well as the best strategies for managing side effects.