The best sequencing of chemotherapy in metastatic breast cancer is unclear and the choice of chemotherapy agent is often influenced by side effect profile. A number of studies have examined patient preferences for chemotherapy toxicities but none have looked specifically at the preferences of prescribing oncologists. There is clear potential for the preferences of individual oncologists to bias discussions about chemotherapy and it is important to take into account any differences in the relative weighting of potential toxicities to help inform a more reasoned discussion with patients. The aim of this study was to survey the opinions of a group of consultant breast cancer oncologists asking what they deemed to be the most and least severe chemotherapy side effects, and to compare with similar patient opinion studies.
Consultant breast cancer oncologists at the UK Breast Cancer Meeting (UKBCM) 2014 were asked to vote using an electronic keypad voting system. A slide listed nine chemotherapy side effects: nausea/vomiting, hand-foot syndrome, sensory neuropathy, motor neuropathy, myalgia, mucositis, diarrhoea, fatigue and alopecia. Delegates were asked to vote on which was the worst side effect, assuming grade 3/4 toxicity. The vote was then repeated asking the question which was the most acceptable side effect.
106 electronic keypad voting responses were received to both questions. Sensory neuropathy (21.7%), nausea/vomiting (19.8%), motor neuropathy (17.9%) and fatigue (17.9%) were voted the most troublesome side effects. When asked about the most acceptable side effects, alopecia was the most popular response (40.6%) followed by fatigue (22.6%). Sensory (<1%) or motor (0%) neuropathies were not felt to be acceptable.
A previous study in breast cancer patients found that diarrhoea (34%), nausea/vomiting (15%) and hand-foot syndrome (13%) were considered the worst side effects. In contrast only 4.7% of oncologists ranked diarrhoea as the worst symptom. Both the patient and oncologist studies ranked alopecia as the most acceptable side effect (34% and 40.6% respectively).
The effect of fatigue in cancer treatment is often underestimated. Only 9% of patients recognised fatigue as the worst side effect compared with 17.9% of oncologists, although a similar proportion of oncologists (22.6%) felt it to be most acceptable - even professionals have a varying understanding of severe fatigue. Oncologists might underestimate the impact of diarrhoea caused by drugs such as capecitabine on quality of life, but tend to rank longer term toxicities such as neuropathy higher than patients. This is the first study to assess the concerns of oncologists with regard to chemotherapy side effects and as such gives some insight into how certain regimes might be chosen or presented to patients.
Citation Format: Beresford MJ, Makris A. Preferences for chemotherapy side effect profiles in breast cancer- The view of oncologists. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-11-01.