Are you worried whether you should have chemotherapy because of the side effects you have heard of?

Over the years, I’ve seen many patients who are fearful of chemotherapy side effects, often because of stories they have heard or seen in the media or elsewhere. While individuals being treated with chemotherapy can experience side effects it is important to realise that not everyone experiences side effects and that side effects can vary considerably with different people on the same chemotherapy and are different with different chemotherapies. I’ve seen patients who have undergone chemotherapy and continued to lead a productive and normal life with no significant side effects.

The importance of randomised clinical trials!

Our knowledge about the benefits and possible side effects of chemotherapy usually comes from the results of randomised clinical trials. These are studies where patients with the same cancer are randomly allocated to one treatment or another or sometimes the current “Gold Standard Treatment”. It is only in this way that decisions can be made about whether a treatment being offered works, what the size of the benefit is, how likely side effects are, and what they might be.

It is also important to consider whether your characteristics fit with the characteristics of the patients who were entered into the trials. There are often a large number of restrictions placed on who is selected for a clinical trial.  For example, a trial may have selected patients based on age and the number of other (or co-morbid or coexisting) diseases that they have. If treatment side effects have been found for people of a certain age range and you are younger or older than the range, it may not be possible to extrapolate the results to your situation. Discussions with your oncologist can help clarify these issues.

Tailoring chemotherapy where possible.

When prescribing chemotherapy, oncologists take into account a range of factors that may influence a patient’s response to treatment as well as any side effects. For example, a professional musician may be prescribed a form of chemotherapy that doesn’t have any possible neuropathic (nerve) effects so that playing a musical instrument for a living is not affected.  It may be that you need a particular chemotherapy, however, and there are no other options. In which case it is important to explore the implications of not using it because of side effects.

When do side effects need to be considered?

It is important to realise that not everyone gets side effects and for those who do, the degree to which they experience them can vary greatly. In terms of considering the relative benefits versus side effects that are possible, I find it helpful to think about side effects using the table below. There are two issues to consider. One of these is the side effects of treatment (Yes or No) and their severity. The other issue is response to treatment (Yes or No) and how much of a response you achieve. This response is measured with  scans (CT /MRI/PET/Ultrasound).

There are 4 possible outcomes with treatment and side effects:

1. NO RESPONSE, SIDE EFFECTS.
   If your chemotherapy/immunotherapy treatment is not working and you experience side effects, then it is time to stop the treatment and consider whether to change to a different treatment.
2. NO RESPONSE, NO SIDE EFFECTS.
   If there is no response to chemotherapy treatment and you are not experiencing side effects, you would cease the current treatment and consider other options.
   Immunotherapy can be different. How? There is a condition called “Pseudo progression” where the tumour looks on a scan as if  it is progressing, but later shrinks. Your oncologist will be aware of this and not stop your immunotherapy treatment early as with chemotherapy.
3. RESPONSE, NO SIDE EFFECTS.
   If you are responding to your treatment with no side effects, then, of course, you would continue.
4. RESPONSE, SIDE EFFECTS.

If you are having a response but you have side effects then, whether to continue treatment depends on the answers to the questions below.

• What degree of response are you getting? How well is the chemotherapy working?
• How large are the benefits of the treatment? Are they very large, modest or small?
• What side effects do you have and how unpleasant are they for you?
• Are there medications or methods that can reduce the side effects?
• Is the cancer curable with chemotherapy or is the treatment being offered to prolong life? If curable, you might be prepared to put up with more in the way of side effects.

Treating side effects

In many cases, side effects such as nausea and pain can be reduced with the use of appropriate medications and complementary methods (such as medical hypnosis and acupuncture). It is important to discuss these options with your doctor.

Research also shows that exercise can help to reduce side effects.  The Clinical Oncological Society of Australia (COSA) in the MJA  has called for exercise to be embedded as standard of care in cancer treatment and an adjunct that “helps counteract the adverse effects of cancer and its treatment”

If you are confused please contact me and we can discuss the options. It is often not as frightening if you have it explained to you either in person or by Skype.