PCPs Highly Unaware of Long-Term Chemotherapy Side Effects

Larissa Nekhlyudov, MD, MPH

Many primary care providers (PCPs) and some oncologists are unaware of the long-term effects of four chemotherapy drugs used to treat two of the most common forms of cancer, a large survey has demonstrated. That gap in knowledge highlights the need for more education and communication among PCPs, oncologists, and cancer survivors, according to investigators who analyzed the findings.

The American Society of Clinical Oncology (ASCO) released the results today in advance of its annual meeting in Chicago June 1-5, during which the survey and a range of other developments in cancer research and treatment will be discussed.

The analysis of the survey’s results, titled Oncologists’ and Primary Care Providers’ Awareness of Late Effects of Cancer Treatment: Implications for Survivorship Care, addresses the needs of America’s 12 million cancer survivors, who in many cases experience long-term effects of chemotherapy and get their follow-up care from PCPs.

“Much of our focus has been on the treatment of cancer patients,” said the study’s lead author, Larissa Nekhlyudov, MD, MPH, assistant professor of population medicine at Harvard Medical School and internist at Harvard Vanguard Medical Associates. “Only recently have we become more aware of the importance of survivorship and the potential for late effects.”

In their analysis, Nekhlyudov and her co-authors examined the results of the 2009 survey to determine how much practitioners know about the most common late effects of chemotherapy treatments for breast and colorectal cancers.

SPARCCS, or the National Cancer Institute/American Cancer Society Survey of Physician Attitudes Regarding the Care of Cancer Survivors, asked 1072 primary care physicians and 1130 oncologists about the long-term effects of doxorubicin (Adriamycin), paclitaxel (Taxol), oxaliplatin (Eloxatin), and cyclophosphamide (Cytoxan). For each drug, the doctors were asked to choose, from a list, the five late side effects they had most frequently observed in patients or seen reported in literature.

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Of the PCPs surveyed, 55.1% recognized heart dysfunction as a long-term effect of doxorubicin. Peripheral neuropathy was cited by 26.9% PCPs as a potential late side effect of paclitaxel, and by 21.8% of PCPs as being associated with oxaliplatin. Two typical long-term side effects of cyclophosphamide, premature menopause and second cancers, were identified by 14.8% and 17.2% of PCPs, respectively.

More than 95% of the oncologists associated cardiac dysfunction with doxorubicin and peripheral neuropathy with paclitaxel and oxaliplatin, but they were less able to identify the late side effects of cyclophosphamide, with 71.4% and 62%, respectively, associating premature menopause and secondary malignancies with long-term use of the drug.

Nekhlyudov expects oncologists to “become more equipped” with information about late chemotherapy effects as the survivor population grows. She added that the Commisson on Cancer of the American College of Surgeons wants accredited hospital oncology programs to provide patients, after cancer treatment, with a summary of the care they received and a follow-up plan.

“While we encourage patients to be aware of the drugs they receive and their side effects, it is vitally important that oncologists relay this information to patients’ PCPs so their risks can be appropriately managed,” Nekhlyudov said. “Our findings (also) underscore the need for ongoing education among all physicians who care for cancer survivors, including oncologists, about the potential late effects of treatment.”

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