Nearly Half of Breast Cancer Patients Plagued with Severe Adverse Events

Nearly half of women with early-stage breast cancer experienced at least 1 severe or very severe adverse event (AE) from treatment, according to a study published in Cancer. The AEs led to additional visits to physicians’ offices, trips to the emergency department, a reduction of dosages, and delays in treatment.

“It's in patients' best interest to receive their treatments on time and on schedule, whenever possible, to give them the best possible outcome,” said study author Steven J. Katz, MD, MPH. “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.”

The investigators surveyed 1945 women with early-stage breast cancer an average of 7 months after diagnosis. Participants were asked to rate the severity of common AEs—– such as nausea/vomiting, diarrhea, constipation, arm swelling, breast skin irritation, constipation, and shortness of breath–– that resulted from breast cancer treatment.

The survey asked patients what type of help they sought for these AEs, such as emergency care, discussing it during routine visits, or scheduling additional appointments.

Overall, the results of the survey showed that 93% of women reported at least 1 of 7 AEs, with 45% rating it severe or very severe. The most frequent severe or very severe AEs were constipation, pain, and skin irritation.

A majority of participants sought help for AEs during routine physician visits, whereas, 9% scheduled an additional appointment and 5% went to an emergency department or hospital.

Women who underwent both chemotherapy and radiation were 30% more likely to experience severe AEs compared with women administered only 1 of the treatments. Women who had a double mastectomy were twice as likely to report severe or very severe pain compared with those who had a lumpectomy.

Latina women were 30% more likely to report severe or very severe AEs than white women, the study found.

“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, associate professor of medicine, 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.”

Dr Kurian stressed the importance of oncologists providing patients with the potential AEs, so that patients can better prepare what actions to take if nausea, pain, constipation, or other AEs occur. Furthermore, improved data on the severity of AEs should be collected and shared with patients to assist in their treatment decision-making, Dr Kurian noted.

Currently, investigators are developing tools to help women better understand how AEs vary by treatment. Additional studies will examine the optimal way to manage AEs, and how AEs vary across diverse chemotherapy practices.