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Half of women with early-stage breast cancer experience severe treatment-associated toxicity
Nearly half of women with early-stage invasive breast cancer reported at least one clinically burdensome toxicity during treatment, according to results from the iCanCare study.
These burdens were also associated with poorer physical health and an increase in health care service use.
“Clinicians constantly weigh the anticipated benefits of anticancer treatments against the risks for treatment-associated toxicities,” Christopher R. Friese, PhD, RN, professor in the department of systems, populations and leadership at University of Michigan School of Nursing, and colleagues wrote.
“Toxicities may lead to treatment discontinuation, costly health care service use and premature death. Toxicities place physical, emotional and financial burdens on patients and families. Toxicity management also consumes clinician and practice resources.”
Few data sources accurately and reliably report toxicities; most data come from clinical trials and health care claims.
“As an oncologist, I knew from my clinical practice that more women were suffering than is generally reported in clinical trials,” Allison W. Kurian, MD, MSc, associate professor of medicine at Stanford University, said in a press release.
The researchers analyzed data from a population-based mailed survey of women with early-stage invasive breast cancer to determine the frequency, severity and burden of toxicities associated with treatment.
Measured toxicities included nausea or vomiting, diarrhea, constipation, pain, arm edema, dyspnea and breast skin irritation.
Seventy-one percent of the identified patient population responded to the survey.
Overall, 1,810 women (93%) reported at least one toxicity, and 866 (45%) of these women rated at least one toxicity as severe or very severe.
Among the seven toxicities, pain was most frequently reported as severe or very severe (23%), followed by constipation (14%) and breast skin irritation (13%).
Of the women who experienced at least one toxicity, 9% reported unscheduled clinic visits for toxicity management and 5% visited an ED or hospital.
“It’s in patients’ best interest to receive their treatments on time and on schedule, whenever possible, to give them the best possible outcome,” Steven J. Katz, MD, MPH, professor of medicine at University of Michigan, said in a press release. “Unscheduled care for toxicities — including clinic visits, ED visits and hospital stays — are expensive, inconvenient and disruptive to both doctors and patients. We need to avoid them whenever possible.”
Patients reported a mean physical functioning score on the PROMIS measure of 14.5, “reflecting substantial deficits from the optimal score of 50,” the researchers wrote.
A multivariable logistic regression model found three toxicities that were associated with more severe ratings:
- pain (OR = 4.7; 95% CI, 4.2-5.3);
- skin irritation (OR = 2.1; 95% CI, 1.8-2.5); and
- constipation (OR = 1.5; 95% CI, 1.4-1.7).
Toxicity was more severe in patients who had received chemotherapy (OR = 2.2; 95% CI, 2-2.5) or both chemotherapy and radiotherapy (OR = 1.3; 95% CI, 1-1.7). Researchers also observed greater odds of severe toxicity in patients who were of Latina ethnicity (OR vs. white patients = 1.3; 95% CI, 1.1-1.5).
Women who underwent bilateral mastectomy demonstrated a nonsignificant increase in at least one severe or very severe toxicity report (OR = 1.2; 95% CI, 1-1.4).
“The value of cancer care may improve if toxicities can be managed proactively, before they worsen,” the researchers wrote. “The results of the current study underscore the need for further research that examines novel strategies with which to reduce preventable treatment toxicities.”
The researchers also noted a need for additional studies to help distinguish the duration of treatment-associated toxicities and their impact on therapy completion.
“The data from the current study speak to the need for culturally tailored interventions coupled with management protocols to improve quality of life for patients at risk for burdensome toxicities,” they wrote. – by Kristie L. Kahl
Disclosure: Friese reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.