Anxious About Side Effects?

Michael Fisch’s patient seemed devastated to learn that her breast cancer had recurred—but not for the reasons he thought.

“Her reaction wasn’t about her survival or her prognosis but about what it meant to her hair,” recalls the chairman of the department of general oncology at MD Anderson Cancer Center in Houston. “When she had previously lost her hair due to treatment, her daughter would duck down in the car, so friends wouldn’t see her. This wasn’t about hair loss; it was about something much more profound.”

For many patients, anxiety about chemotherapy side effects, such as pain, fatigue or hair loss, can be worse than the side effects themselves. A 2008 survey by the National Coalition for Cancer Survivorship and Sanofi-Aventis highlighted this fact, indicating that 76 percent of people with cancer were most fearful of potential chemotherapy side effects. Of the 91 percent who experienced them, however, 87 percent said the effects were more manageable because of supportive care products.

How can patients best contend with these worries? Clear and frequent interactions between doctors and patients are crucial, according to Dawn Hershman, an associate professor of medicine and epidemiology at Herbert Irving Comprehensive Cancer Center at Columbia University in New York.

“The best thing is to communicate with your physician,” Hershman advises. “Some side effects can be prevented, and not everyone gets every side effect. Often patients’ concerns are disproportionate to what they’ve experienced, and usually a lot of it can be managed.”

Doctors can also do more to ask patients the right questions about their concerns, Fisch notes. “They can say, ‘Tell me more about what you’re scared about,’” he says. “Usually, missed opportunities are unspoken or unassessed. Symptom management is an assessment game—tricky but gratifying.”