Making the Grade: The Impact of Low-Grade Toxicities on Patient Preference for Treatment With Novel Agents

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Emily H Castellanos1, Sheau-chiann Chen1, Hillary Drexler1

  • 1From the Division of Hematology and Oncology, Vanderbilt University Medical Center; Division of Quantitative Sciences, Vanderbilt University Medical Center; and Vanderbilt University School of Medicine, Nashville, Tennessee.

Journal of the National Comprehensive Cancer Network : JNCCN
|December 15, 2015
PubMed
Abstract

Insights

Patient willingness to undergo targeted cancer therapy is negatively impacted by anticipated low-grade toxicities and treatment logistics. Understanding these factors is crucial for improving patient adherence and therapeutic outcomes in cancer treatment.

Area of Science:

  • Oncology
  • Clinical Pharmacology
  • Patient-Reported Outcomes

Background:

  • Targeted therapies offer clinical benefits for solid tumors but have distinct toxicity profiles compared to traditional chemotherapy.
  • Numerous studies report frequent grade 1 and 2 toxicities associated with targeted agents.
  • The impact of anticipating low-grade toxicities and treatment logistics on patient willingness to undergo therapy requires investigation.

Purpose of the Study:

  • To assess how anticipated low-grade toxicities (grade 1 and 2) and treatment logistics influence patient willingness to comply with targeted cancer therapy.
  • To compare patient willingness across different toxicity types, anticipated benefits, cancer types, and dosing convenience.

Main Methods:

  • A survey of 209 cancer patients (101 lung, 108 breast) at Vanderbilt-Ingram Cancer Center.
  • Patients reported willingness to comply based on efficacy, dosing convenience, and toxicity profiles (CTCAE v4.0 grade 1 and 2).
  • Statistical comparisons were made based on toxicity, benefit, cancer type, and convenience.

Main Results:

  • A significant percentage of patients (2.9%-48.8%) expressed unwillingness to undergo treatment due to anticipated grade 1 and 2 toxicities.
  • Gastrointestinal and constitutional toxicities more strongly deterred patients than dermatologic toxicities.
  • Lung cancer patients were more accepting of dermatologic and gastrointestinal toxicities than breast cancer patients.
  • Willingness to tolerate toxicities correlated with expected survival benefit and cure probability.
  • Long travel distances for treatment reduced patient willingness.

Conclusions:

  • Anticipation of low-grade toxicities and inconvenient dosing schedules negatively affects patient willingness to receive targeted cancer therapy, potentially impacting adherence and outcomes.
  • Long-term tolerability of novel agents is a critical factor to consider during their development and assessment.

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