Patient-Reported Toxicities During Chemotherapy Regimens in Current Clinical Practice for Early Breast Cancer

Kirsten A. Nyrop*, Allison M. Deal, Shlomit S. Shachar, Ethan Basch, Bryce B. Reeve, Seul Ki Choi, Jordan T. Lee, William A. Wood, Carey K. Anders, Lisa A. Carey, Elizabeth C. Dees, Trevor A. Jolly, Katherine E. Reeder-Hayes, Gretchen G. Kimmick, Meghan S. Karuturi, Raquel E. Reinbolt, Jo Ellen C. Speca, Hyman B. Muss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

Background: This study explores the incidence of patient-reported major toxicity—symptoms rated “moderate,” “severe,” or “very severe”—for chemotherapy regimens commonly used in early breast cancer. Patients and Methods: Female patients aged 21 years or older completed a validated Patient-Reported Symptom Monitoring instrument and rated 17 symptoms throughout adjuvant or neoadjuvant chemotherapy. Fisher's exact tests compared differences in percentages in symptom ratings, and general linear regression was used to model the incidence of patient-reported major toxicity. Results: In 152 patients, the mean age was 54 years (range, 24–77), and 112 (74%) were white; 51% received an anthracycline-based regimen. The proportion of patients rating fatigue, constipation, myalgia, diarrhea, nausea, peripheral neuropathy, and swelling of arms or legs as a major toxicity at any time during chemotherapy varied significantly among four chemotherapy regimens (p <.05). The mean (SD) number of symptoms rated major toxicities was 6.3 (3.6) for anthracycline-based and 4.4 (3.5) for non-anthracycline-based regimens (p =.001; possible range, 0–17 symptoms). Baseline higher body mass index (p =.03), patient-reported Karnofsky performance status ≤80 (p =.0003), and anthracycline-based regimens (p =.0003) were associated with greater total number of symptoms rated major toxicities (alternative model: chemotherapy duration, p <.0001). Twenty-six percent of dose reductions (26 of 40), 75% of hospitalizations (15 of 20), and 94% of treatment discontinuations (15 of 16) were in anthracycline-based regimens. Conclusion: Capturing multiple toxicity outcomes throughout chemotherapy enables oncologists and patients to understand the range of side effects as they discuss treatment efficacies. Continuous symptom monitoring may aid in the timely development of interventions that minimize toxicity and improve outcomes. Implications for Practice: This study investigated patient-reported toxicities for 17 symptoms recorded prospectively during adjuvant and neoadjuvant chemotherapy regimens for early breast cancer. An analysis of four commonly used chemotherapy regimens identified significant differences among regimens in both individual symptoms and total number of symptoms rated moderate, severe, or very severe. Longer chemotherapy regimens, such as anthracycline-based regimens followed by paclitaxel, had higher proportions of symptoms rated major toxicities. The inclusion of patient perspectives on multiple toxicity outcomes at the same time at multiple time points during chemotherapy has the potential for improving patient-provider communication regarding symptom management, patient satisfaction, and long-term clinical outcomes.

Original languageEnglish
Pages (from-to)762-771
Number of pages10
JournalOncologist
Volume24
Issue number6
DOIs
StatePublished - Jun 2019
Externally publishedYes

Funding

FundersFunder number
Kay Yow Cancer Fund
UNC Cancer Center
UNC Line-berger Comprehensive Cancer Center/University Cancer Research Fund
UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund
Breast Cancer Research Foundation
Duke University
University of North Carolina
University of Texas MD Anderson Cancer Center
Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute

    Keywords

    • Breast cancer
    • Chemotherapy
    • Patient-reported symptoms

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