Understanding the Benefits and Risks of Chemotherapy

Besides hair loss and nausea, side effects include fatigue, vomiting, mouth sores and pain

THURSDAY, Oct. 16, 2008 (HealthDay News) -- Women starting chemotherapy for breast cancer often expect unpleasant side effects, from hair loss to nausea.

What they may not appreciate is just how debilitating the side effects of treatment can be.

A recent study in the Journal of the National Cancer Institute identified eight serious chemotherapy-related adverse effects that may be more common than reported by large clinical trials.

Fever and infection were the most common causes of hospitalization or emergency room visits. Other serious side effects included low white-blood cell or platelet count, and dehydration or electrolyte disorders.

"Women should be aware that chemotherapy can cause side effects, but should not make a decision regarding whether or not to receive chemotherapy solely based on the results of our study, said lead author Dr. Michael Hassett, an instructor in medicine at Harvard Medical School and a medical oncologist at the Dana-Farber Cancer Institute in Boston.

Hassett's study was not a "randomized controlled trial," the rigorous type of investigation typically needed to change clinical practice guidelines. However, several ongoing trials of this sort are looking into the side effects associated with chemotherapy, he noted.

Meanwhile, there are continuing efforts to improve the treatment of patients on chemotherapy.

"Physicians have increasingly worked to prevent some of the most common side effects of chemotherapy, particularly nausea," said Dr. Jennifer J. Griggs, associate professor in the department of internal medicine and director of the Breast Cancer Survivorship Program at the University of Michigan Health System in Ann Arbor.

In addition, doctors are more routinely administering "colony stimulating factors," Griggs said. These injections boost the supply of a patient's infection-fighting white blood cells, and that "has most likely decreased the risk of admissions to the hospital for fever and other infections," she said.

Chemotherapy is a "systemic" treatment, meaning that it works throughout the body to kill cancer cells, according to the American Society of Clinical Oncology. It may be given before surgery or radiation to shrink a tumor and afterward to kill any cancer cells left behind.

While very effective against rapidly growing cancer cells, chemotherapy can also affect healthy cells that divide quickly, and that damage can cause side effects. Besides hair loss and nausea, common side effects include fatigue, vomiting, decreased blood cell counts, mouth sores and pain, says the U.S. National Cancer Institute.

Hassett and his colleagues set out to quantify the number, nature and cost of serious side effects among younger women receiving chemotherapy for breast cancer. The researchers culled 4,075 chemotherapy patients from a database of more than 12,000 women, 63 years of age or younger, with newly diagnosed breast cancer.

The chances of landing in the hospital or emergency room for any reason was 61 percent for women who received chemotherapy, compared with 42 percent for those who didn't get the drug cocktail.

Women receiving chemotherapy also incurred additional costs of $1,271, on average, per year, for chemotherapy-related side effects and $17,617 per year more for ambulatory-care services than women who weren't given chemotherapy.

Patients should weigh the potential benefits and risks of chemotherapy in conjunction with a cancer specialist, like an oncologist, said Hassett, whose team is working on a study that will examine whether chemotherapy leads women to retire or go on long-term disability.

But are patients getting enough information? Griggs says it's hard to know how much information to share. "We usually prepare them for the most common side effects, such as hair loss, fatigue, and nausea, but we try not to tell patients that they definitely will get nauseated" because one of the biggest predictors of nausea is thinking you'll get it, she explained.

"I do think that we need to continue to enhance our support of our patients when they call our offices with questions or symptoms," Griggs added. "So many physician offices are increasingly busy with more patients and more complex chemotherapy and other treatment regimens that some offices may have a difficult time providing support to patients who call us with questions."

More information

For more on chemotherapy, visit the U.S. National Cancer Institute.

SOURCES: Michael Hassett, M.D., M.P.H., instructor in medicine, Harvard Medical School, and medical oncologist, Dana-Farber Cancer Institute, Boston; Jennifer J. Griggs, M.D., M.P.H., associate professor, Department of Internal Medicine, and director, Breast Cancer Survivorship Program, University of Michigan Health System, Ann Arbor; Journal of the National Cancer Institute; American Society of Clinical Oncology, Alexandria, Va.; U.S. National Cancer Institute
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