Unfortunately chemotherapy has side effects, well-known side effects, and we cannot exclude them. The most present ones are nausea, vomiting, loss of hair, diarrhoea, obstipation, skin alterations and a lot of side effects which we cannot measure but patients declare them as social problems affecting family, partner, work and so on. And fatigue is also a very often reported problem.
There have been improvements in the management of side effects, the gastrointestinal ones you mentioned, but the social ones persist.
Yes. Fortunately we have done some progress in supportive care for managing side effects. For example, nausea and vomiting which was very highly and often reported and is really a toxicity which was a major problem for patients is nowadays nearly no problem. According to that we are offering patients and giving supportive therapy in advance, not as in demand. These are some side effects we can deal very good with. On the other hand there are some side effects we cannot exclude, for example loss of hair. This is a permanent problem and there we are not so successful as we would like to be.
Then that leads into what can be done. You mentioned supportive care being involved in treatment throughout, rather than just on demand. What else can be done to help maximise quality of life and prevent these social limitations that you mentioned?
At the beginning it’s just simple but often forgotten to talk with the patient because not every patient has the same problem and has the same side effects. So the beginning is just to assess what are the problems and offer, especially for non-physical side effects, for social problems, offer them some access to, for instance, for psycho-oncologic needs and talk and so on. So from my point it’s much more important to talk with the patient to see where is the need, to evaluate this, and then to offer what kind of solution might be possible.
I think it was at ASCO this year that one of the big headlines from the first day was treating patients with behavioural therapy can improve their life expectancy, as well it improves progression free survival, so it does even bear out to clinical benefit.
Yes, this was a very interesting presentation and we doctors are much more aware of this kind of analysis and patient reported outcome is something which is integrated in all studies nowadays which was not done ten, fifteen years before. So reacting on that, what patients are reporting are much more becoming our focus because we know and we have data on this, especially in the last years, that there is a significant gap between reported outcomes and side effects by doctors and by patients. This is significantly different so at the end the question is what is much more important – does the doctor feel it better or does the patient feel it better and I would say it’s the patient who goes through this way.