Lack of Awareness of Late Drug Effects in Cancer Survivors

Zosia Chustecka

May 17, 2012

May 17, 2012 — With so many cancer patients now surviving and returning to primary care for their long-term medical care, there is an urgent need to raise awareness among primary care physicians (PCP) about the long-term adverse effects from chemotherapy. A new study shows that very few PCPs were able to correctly identify the main complications associated with 4 chemotherapies used in the 2 most common cancers — breast and colon.

"There is clearly a lot of work to be done," said Nicholas J. Vogelzang, MD, chair of the Cancer Communications Committee at the American Society of Clinical Oncology (ASCO).

"This is a problem created by our successes," he said; there are now more than 12 million cancer survivors living in the United States.

Results from the study, highlighted at a press briefing held in advance of the ASCO annual meeting, where they will be formally presented, "should give us pause," Dr. Vogelzang said. The education of PCPs is essential to meet the needs of these cancers survivors, so that "the ball does not get dropped."

The study was reported at the briefing by Larissa Nekhlyudov, MD, MPH, assistant professor of population medicine at Harvard Medical School in Boston, Massachusetts.

"While we strongly encourage patients to be aware of the chemotherapy drugs they receive and their side effects, it is vitally important that oncologists relay this information to patients' primary care providers so that their risks can be appropriately managed throughout their lives," she told journalists.

Large Survey

These results are the latest to come out of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors (SPARCCS), which surveyed 1130 oncologists and 1072 PCPs by mail in 2009.

Previous results have shown that many PCPs feel they lack the general knowledge and confidence to care for people who have been treated with cancer.

The analysis specifically examined the long-term adverse effects of 4 widely used chemotherapies — doxorubicin (Adriamycin), paclitaxel (Taxol), oxaliplatin (Eloxatin), and cyclophosphamide (Cytoxan).

Most oncologists participating in the survey (62% to 97%) were able to correctly identify late adverse effects from all 4 drugs, although the researchers note that there is a need for improvement even among these specialists.

Overall, 65% of oncologists identified all 4 main late effects of the 4 chemotherapies.

In contrast, only 6% of all the PCPs were able to do so.

The most widely recognized late adverse effect was heart dysfunction with doxorubicin — identified by 55% of PCPs and 95% of oncologists.

Nearly all oncologists (97%) also recognized that peripheral neuropathy is associated with paclitaxel and with oxaliplatin, but only 26.9% and 21.8%, respectively, of PCPs also knew about this late effect.

Both sets of physicians showed the lowest awareness of the 2 late complications from cyclophosphamide therapy: premature menopause and secondary cancers. Among oncologists, 71% knew about premature menopause and 62% about the secondary malignancies, but among PCPs, only 15% and 17%, respectively, were aware of these 2 long-term complications.

Dr. Nekhlyudov emphasized the need to inform PCPs about the late effects of chemotherapy "so that they are better prepared to recognize and address these among the cancer survivors in their care."

"At the same time, our findings underscore the need for ongoing education among all physicians who care for cancer survivors, including oncologists, about the potential late effects of treatment," she added.

2012 Annual Meeting of the American Society of Clinical Oncology: Abstract 6008. To be presented June 2, 2012.