Chemo Complications: Underreported?

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Chemo Complications: Underreported?

 

http://www.webmd.com/content/Article/126/116352.htm

 

Researchers Say Estimates of Side Effects for Breast Cancer Chemotherapy Are Too

Low

By Salynn Boyles

WebMD Medical News Reviewed By Louise Chang, MD

on Tuesday, August 15, 2006

 

Aug. 15, 2006 -- The potentially serious side effects of chemotherapy appear to

be greater for younger breast cancerbreast cancer

patients than clinical trials suggest, according to findings from a new study.

 

Sixteen percent of the breast cancercancer patients in the study who had

chemotherapy experienced serious adverse

chemotherapy-related health events that resulted in hospitalization or an

emergency visit to the hospital.

 

More than 8% of chemotherapy patients were treated for infection or fever. Data

from clinical trials suggest that just 1% to 2% of

patients experience this chemotherapy side effect, researcher Michael J.

Hassett, MD, MPH, tells WebMD.

 

Underestimating the Risk

 

All of the women included in the study were aged 63 or younger when they were

diagnosed with breast cancer.

 

" All of our previous estimates of chemotherapy side effects among women of this

age group have come from clinical trials [designed

to assess new drugs], " Hassett says. " We hypothesized that the risk estimates

generated in these trials may be too low. "

 

More women have chemotherapy for breast cancer than for any other cancer, and

chemotherapy is a leading cause of serious and even

life-threatening adverse health events.

 

Only one previous study has examined the frequency of chemotherapy-related

serious side effects in the general population of women

treated for breast cancer, and that trial included only women over age 65.

 

Hassett and colleagues from Harvard Medical School's Dana-Farber Cancer

Institute sought to better understand the frequency of

chemotherapy-related hospitalizations and ER visits among younger women in their

latest study, published in the Aug. 16 issue of the

Journal of the National Cancer Institute.

 

Chemo Side Effects

 

Using a medical insurance claims database, the researchers compared outcomes

within the first year of treatment among 3,526 newly

diagnosed breast cancerbreast cancer patients 63 years or younger treated with

chemotherapy and an equal number of patients with

similar characteristics who did not receive chemotherapy.

 

Sixty-one percent of chemotherapy patients were hospitalized or were treated at

hospital ERs during their first year of treatment,

compared with 42% of the patients treated without chemotherapy.

 

In addition to the larger than previously reported treatment for fever and

infections, the researchers documented a higher than

previously reported incidence of other chemotherapy-related side effects,

including: low white blood cell or platelet counts (5.5%

of patients); dehydrationdehydration and other electrolyte (such as sodium and

potassium) disorders (2.5%); nausea, vomiting, or

diarrheadiarrhea (2.4%); general symptoms such as fatiguefatigue (2%); and

serious blood clots (1.2%).

 

Compared with chemotherapy patients who did not have treatment-related serious

adverse events, medical costs for those who did

averaged $13,000 more for hospital care, $406 more for emergency room visits,

$16,000 more for outpatient care, and $1,900 more for

prescription drugs.

 

'More Suffering, Higher Costs'

 

" Our results suggest that breast cancercancer chemotherapy may cause more

patients suffering and higher health care costs than

previously estimated, " the researchers wrote.

 

Hassett says the findings point to the importance of doing a better job of

assessing serious chemotherapy-related side effects so

that breast cancer patients and their doctors can better understand the risks

vs. benefits of this treatment.

 

John K. Erban, MD, who directs the breast cancer program at Tufts New England

Medical Center, agrees.

 

" It is not likely that this research will change practice in terms of whether

clinicians recommend chemotherapy to their patients, "

he tells WebMD. " But it can help us better advise our patients so that they will

be better prepared. "

 

In an editorial accompanying the study, Erban and Tufts colleague Joseph Lau,

MD, wrote that tracking the long-term side effects of

chemotherapy will become especially important as drug treatment for breast

cancer enters a new era of targeted therapy.

 

While in the short term the newer drugs have proven to be much less toxic than

traditional chemotherapy, the long-term side effects

of the treatment are not known.

 

" We don't know what the long-term implications of giving one of these therapies

followed by another and then maybe another will be, "

he says.