Abstract
Breast cancer treatment currently requires the joint efforts of a multidisciplinary team to effectively combine chemotherapy, hormone therapy, biological agents, surgery and radiation therapy when needed. To develop such a treatment plan, it is important to know the benefits as well as the potential toxic effects of each therapy. Thus, many patients with early breast cancer complain of collateral adverse events such as fatigue, nausea, vomiting, loss of libido, hot flashes, night sweats or neuropathy due to the complex therapies they are receiving. To date, the treatment of such symptoms is an important issue that greatly affects the quality of life of these patients. In this review, we report the content of a multi-expert meeting where the incidence of and medical approach to some of the most common adverse events encountered during the treatment of patients with early breast cancer were analysed.
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References
Fan G, Filipczak L, Chow E (2007) Symptom clusters in cancer patients: a review of the literature. Curr Oncol 14:173–179
Soni MK, Cella D (2002) Quality of life and symptom measures in oncology: an overview. Am J Manag Care 8:S560–573
Parkin DM, Bray F, Ferlay J et al. (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Ellis M (2008) Febrile neutropenia. Ann N Y Acad Sci 1138:329–350
Lyman GH (2006) Risks and consequences of chemotherapy-induced neutropenia. Clin Cornerstone 8[Suppl 5]:S12–18
Pizzo PA (1993) Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 328:1323–1332
Crawford J, Dale DC, Lyman GH (2004) Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer 100:228–237
von Minckwitz G, Schwenkglenks M, Skacel T et al (2009) Febrile neutropenia and related complications in breast cancer patients receiving pegfilgrastim primary prophylaxis versus current practice neutropenia management: results from an integrated analysis. Eur J Cancer 45:608–617
Smith TJ, Khatcheressian J, Lyman GH et al (2006) 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol 24:3187–3205
Kuderer NM, Dale DC, Crawford J et al (2006) Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 106:2258–2266
Chirivella I, Bermejo B, Insa A et al (2008) Optimal delivery of anthracycline-based chemotherapy in the adjuvant setting improves outcome of breast cancer patients. Breast Cancer Res Treat 114:479–484
American Society of Clinical Oncology (1994) Recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. J Clin Oncol 12:2471–2508
Wong SF, Chan HO (2005) Effects of a formulary change from granulocyte colony-stimulating factor to granulocyte-macrophage colony-stimulating factor on outcomes in patients treated with myelosuppressive chemotherapy. Pharmacotherapy 25:372–378
Green MD, Koelbl H, Baselga J et al (2003) A randomized double-blind multicenter phase III study of fixed-dose single-administration pegfilgrastim versus daily filgrastim in patients receiving myelosuppressive chemotherapy. Ann Oncol 14:29–35
von Minckwitz G, Kummel S, du Bois A et al (2008) Pegfilgrastim +/− ciprofloxacin for primary prophylaxis with TAC (docetaxel/doxorubicin/cyclophosphamide) chemotherapy for breast cancer. Results from the GEPARTRIO study. Ann Oncol 19:292–298
Martin M, Lluch A, Segui MA et al (2006) Toxicity and health-related quality of life in breast cancer patients receiving adjuvant docetaxel, doxorubicin, cyclophosphamide (TAC) or 5-fluorouracil, doxorubicin and cyclophosphamide (FAC): impact of adding primary prophylactic granulocytecolony stimulating factor to the TAC regimen. Ann Oncol 17:1205–1212
Aapro MS, Cameron DA, Pettengell R et al (2006) EORTC guidelines for the use of granulocytecolony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphomas and solid tumours. Eur J Cancer 42:2433–2453
(2004) NCCN makes changes to its guidelines for treating fever and neutropenia. J Support Oncol 2:319, 355
Ozer H, Armitage JO, Bennett CL et al (2000) 2000 update of recommendations for the use of hematopoietic colony-stimulating factors: evidence-based, clinical practice guidelines. American Society of Clinical Oncology Growth Factors Expert Panel. J Clin Oncol 18:3558–3585
Gianni L, Cole BF, Panzini I et al (2008) Anemia during adjuvant non-taxane chemotherapy for early breast cancer: Incidence and risk factors from two trials of the International Breast Cancer Study Group. Support Care Cancer 16:67–74
Tas F, Eralp Y, Basaran M et al (2002) Anemia in oncology practice: relation to diseases and their therapies. Am J Clin Oncol 25:371–379
Pujade-Lauraine E, Gascon P (2004) The burden of anaemia in patients with cancer. Oncology 67[Suppl 1]:1–4
Mercadante S, Gebbia V, Marrazzo A et al (2000) Anaemia in cancer: pathophysiology and treatment. Cancer Treat Rev 26:303–311
Portenoy RK, Itri LM (1999) Cancer-related fatigue: guidelines for evaluation and management. Oncologist 4:1–10
Littlewood TJ, Bajetta E, Nortier JW et al (2001) Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double-blind, placebo-controlled trial. J Clin Oncol 19:2865–2874
Bohlius J, Langensiepen S, Schwarzer G et al (2005) Recombinant human erythropoietin and overall survival in cancer patients: results of a comprehensive meta-analysis. J Natl Cancer Inst 97:489–498
Leyland-Jones B (2003) Breast cancer trial with erythropoietin terminated unexpectedly. Lancet Oncol 4:459–460
Henke M, Laszig R, Rube C et al (2003) Erythropoietin to treat head and neck cancer patients with anaemia undergoing radiotherapy: randomised, double-blind, placebo-controlled trial. Lancet 362:1255–1260
Arcasoy MO, Amin K, Karayal AF et al (2002) Functional significance of erythropoietin receptor expression in breast cancer. Lab Invest 82:911–918
Henke M, Mattern D, Pepe M et al (2006) Do erythropoietin receptors on cancer cells explain unexpected clinical findings? J Clin Oncol 24:4708–4713
Khuri FR (2007) Weighing the hazards of erythropoiesis stimulation in patients with cancer. N Engl J Med 356:2445–2448
Selzer E, Wacheck V, Kodym R et al (2000) Erythropoietin receptor expression in human melanoma cells. Melanoma Res 10:421–426
Ludwig H (2004) rHuEPO and treatment outcomes: the preclinical experience. Oncologist 9[Suppl 5]:48–54
Fenner MH, Ganser A (2008) Erythropoietin in cancer-related anemia. Curr Opin Oncol 20:685–689
(2008) http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalproducts/ucm110249.htm. Accessed 2 October 2009
Rodgers GM (2006) Guidelines for the use of erythropoietic growth factors in patients with chemotherapy-induced anemia. Oncology (Williston Park) 20:12–15
Rizzo JD, Somerfield MR, Hagerty KL et al (2008) Use of epoetin and darbepoetin in patients with cancer: 2007 American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update. J Clin Oncol 26:132–149
Rizzo JD, Lichtin AE, Woolf SH et al (2002) Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. J Clin Oncol 20:4083–4107
Van Belle SJ, Cocquyt V (2003) Impact of haemoglobin levels on the outcome of cancers treated with chemotherapy. Crit Rev Oncol Hematol 47:1–11
Schwartzberg LS, Yee LK, Senecal FM et al (2004) A randomized comparison of every-2-week darbepoetin alfa and weekly epoetin alfa for the treatment of chemotherapy-induced anemia in patients with breast, lung, or gynecologic cancer. Oncologist 9:696–707
Auerbach M, Ballard H, Trout JR et al (2004) Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: a multicenter, open-label, randomized trial. J Clin Oncol 22:1301–1307
Henry DH (1998) Supplemental iron: a key to optimizing the response of cancer-related anemia to rHuEPO? Oncologist 3:275–278
Cazzola M, Mercuriali F, Brugnara C (1997) Use of recombinant human erythropoietin outside the setting of uremia. Blood 89:4248–4267
Molassiotis A, Saunders MP, Valle J et al (2008) A prospective observational study of chemotherapy-related nausea and vomiting in routine practice in a UK cancer centre. Support Care Cancer 16:201–208
Jordan K, Sippel C, Schmoll HJ (2007) Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations. Oncologist 12:1143–1150
Lachaine J, Laurier C, Langleben A et al (1999) Cost-effectiveness and quality of life evaluation of ondansetron and metoclopramide for moderately emetogenic chemotherapy regimens in breast cancer. Crit Rev Oncol Hematol 32:105–112
Gralla RJ, Osoba D, Kris MG et al (1999) Recommendations for the use of antiemetics: evidence-based, clinical practice guidelines. American Society of Clinical Oncology. J Clin Oncol 17:2971–2994
Guttuso T Jr, Vitticore P, Holloway RG (2005) Responsiveness of life-threatening refractory emesis to gabapentin-scopolamine therapy following posterior fossa surgery. Case report. J Neurosurg 102:547–549
Herrstedt J (2008) Antiemetics: an update and the MASCC guidelines applied in clinical practice. Nat Clin Pract Oncol 5:32–43
Grunberg SM, Osoba D, Hesketh PJ et al (2005) Evaluation of new antiemetic agents and definition of antineoplastic agent emetogenicity: an update. Support Care Cancer 13:80–84
Gralla RJ, Itri LM, Pisko SE et al (1981) Antiemetic efficacy of high-dose metoclopramide: randomized trials with placebo and prochlorperazine in patients with chemotherapy-induced nausea and vomiting. N Engl J Med 305:905–909
Grunberg SM, Hesketh PJ (1993) Control of chemotherapy-induced emesis. N Engl J Med 329:1790–1796
Schmoll HJ, Aapro MS, Poli-Bigelli S et al (2006) Comparison of an aprepitant regimen with a multiple-day ondansetron regimen, both with dexamethasone, for antiemetic efficacy in high-dose cisplatin treatment. Ann Oncol 17:1000–1006
de Wit R, Herrstedt J, Rapoport B et al (2004) The oral NK(1) antagonist, aprepitant, given with standard antiemetics provides protection against nausea and vomiting over multiple cycles of cisplatin-based chemotherapy: a combined analysis of two randomised, placebo-controlled phase III clinical trials. Eur J Cancer 40:403–410
Kris MG, Hesketh PJ, Somerfield MR et al (2006) American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 24:2932–2947
Roila F, Hesketh PJ, Herrstedt J (2006) Prevention of chemotherapy- and radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 17:20–28
(2004) Effective interventions for CINV: NCCN Antiemesis Clinical Practice Guidelines in Oncology. ONS News 19:17–18
Vassilopoulou-Sellin R (2003) Breast cancer and hormonal replacement therapy. Ann N Y Acad Sci 997:341–350
Cella D, Fallowfield LJ (2008) Recognition and management of treatment-related side effects for breast cancer patients receiving adjuvant endocrine therapy. Breast Cancer Res Treat 107:167–180
Jordan VC (2006) Tamoxifen (ICI46,474) as a targeted therapy to treat and prevent breast cancer. Br J Pharmacol 147[Suppl 1]:S269–276
Herold CI, Blackwell KL (2008) Aromatase inhibitors for breast cancer: proven efficacy across the spectrum of disease. Clin Breast Cancer 8:50–64
Howell A, Robertson JF, Quaresma Albano J et al (2002) Fulvestrant, formerly ICI 182,780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20:3396–3403
Gupta P, Sturdee DW, Palin SL et al (2006) Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric 9:49–58
Schover LR (1994) Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr (16):177–182
Wenzel LB, Fairclough DL, Brady MJ et al (1999) Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer 86:1768–1774
Loprinzi CL, Abu-Ghazaleh S, Sloan JA et al (1997) Phase III randomized double-blind study to evaluate the efficacy of a polycarbophil-based vaginal moisturizer in women with breast cancer. J Clin Oncol 15:969–973
Gardner EA, Johnston JA (1985) Bupropion: an antidepressant without sexual pathophysiological action. J Clin Psychopharmacol 5:24–29
Shadiack AM, Sharma SD, Earle DC et al (2007) Melanocortins in the treatment of male and female sexual dysfunction. Curr Top Med Chem 7:1137–1144
Le Veque FG, Hendrix S (2004) Oral pilocarpine to treat vaginal xerosis associated with chemotherapy-induced amenorrhea in pre-menopausal women. In: Journal of Clinical Oncology. ASCO Annual Meeting Proceedings, Detroit
Anllo LM (2000) Sexual life after breast cancer. J Sex Marital Ther 26:241–248
Collaborative Group on Hormonal Factors in Breast Cancer (1997) Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet 350:1047–1059
Dew JE, Wren BG, Eden JA (2003) A cohort study of topical vaginal estrogen therapy in women previously treated for breast cancer. Climacteric 6:45–52
Barton DL, Wender DB, Sloan JA et al (2007) Randomized controlled trial to evaluate transdermal testosterone in female cancer survivors with decreased libido; North Central Cancer Treatment Group protocol N02C3. J Natl Cancer Inst 99:672–679
Mom CH, Buijs C, Willemse PH et al (2006) Hot flushes in breast cancer patients. Crit Rev Oncol Hematol 57:63–77
Stearns V, Ullmer L, Lopez JF et al (2002) Hot flushes. Lancet 360:1851–1861
Kronenberg F (1990) Hot flashes: epidemiology and physiology. Ann N Y Acad Sci 592:52–86; discussion 123–133
Dalal S, Zhukovsky DS (2006) Pathophysiology and management of hot flashes. J Support Oncol 4:315–320, 325
Stevenson DW, Delprato DJ (1983) Multiple component self-control program for menopausal hot flashes. J Behav Ther Exp Psychiatry 14:137–140
Barton DL, Loprinzi CL, Quella SK et al (1998) Prospective evaluation of vitamin E for hot flashes in breast cancer survivors. J Clin Oncol 16:495–500
Goldberg RM, Loprinzi CL, O’Fallon JR et al (1994) Transdermal clonidine for ameliorating tamoxifen-induced hot flashes. J Clin Oncol 12:155–158
Loprinzi CL, Kugler JW, Sloan JA et al (2000) Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 356:2059–2063
Quella SK, Loprinzi CL, Barton DL et al (2000) Evaluation of soy phytoestrogens for the treatment of hot flashes in breast cancer survivors: a North Central Cancer Treatment Group Trial. J Clin Oncol 18:1068–1074
Shanafelt TD, Barton DL, Adjei AA et al (2002) Pathophysiology and treatment of hot flashes. Mayo Clin Proc 77:1207–1218
Jin Y, Desta Z, Stearns V et al (2005) CYP2D6 genotype, antidepressant use, and tamoxifen metabolism during adjuvant breast cancer treatment. J Natl Cancer Inst 97:30–39
Pandya KJ, Morrow GR, Roscoe JA et al (2005) Gabapentin for hot flashes in 420 women with breast cancer: a randomised double-blind placebo-controlled trial. Lancet 366:818–824
Filshie J, Bolton T, Browne D et al (2005) Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients: audit and treatment algorithm. Acupunct Med 23:171–180
Jacobson JS, Troxel AB, Evans J et al (2001) Randomized trial of black cohosh for the treatment of hot flashes among women with a history of breast cancer. J Clin Oncol 19:2739–2745
Liske E, Hanggi W, Henneicke-von Zepelin HH et al (2002) Physiological investigation of a unique extract of black cohosh (Cimicifugae racemosae rhizoma): a 6-month clinical study demonstrates no systemic estrogenic effect. J Womens Health Gend Based Med 11:163–174
Freedman RR, Woodward S (1992) Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring. Am J Obstet Gynecol 167:436–439
Ueda M (2004) A 12-week structured education and exercise program improved climacteric symptoms in middle-aged women. J Physiol Anthropol Appl Human Sci 23:143–148
Postma TJ, Heimans JJ (2000) Grading of chemotherapy-induced peripheral neuropathy. Ann Oncol 11:509–513
Cavaletti G, Zanna C (2002) Current status and future prospects for the treatment of chemotherapy-induced peripheral neurotoxicity. Eur J Cancer 38:1832–1837
Windebank AJ, Grisold W (2008) Chemotherapyinduced neuropathy. J Peripher Nerv Syst 13:27–46
Livi L, Paiar F, Santini R et al (2006) Alternating intravenous and oral vinorelbine plus epirubicin with pegfilgrastim as neoadjuvant treatment of locally advanced breast cancer. Anticancer Drugs 17:1081–1085
Chaudhry V, Rowinsky EK, Sartorius SE et al (1994) Peripheral neuropathy from taxol and cisplatin combination chemotherapy: clinical and electrophysiological studies. Ann Neurol 35:304–311
Forsyth PA, Balmaceda C, Peterson K et al (1997) Prospective study of paclitaxel-induced peripheral neuropathy with quantitative sensory testing. J Neurooncol 35:47–53
Chaudhry V, Chaudhry M, Crawford TO et al (2003) Toxic neuropathy in patients with preexisting neuropathy. Neurology 60:337–340
Cella D, Peterman A, Hudgens S et al (2003) Measuring the side effects of taxane therapy in oncology: the functional assesment of cancer therapy-taxane (FACT-taxane). Cancer 98:822–831
Miller AB, Hoogstraten B, Staquet M et al (1981) Reporting results of cancer treatment. Cancer 47:207–214
Hammack JE, Michalak JC, Loprinzi CL et al (2002) Phase III evaluation of nortriptyline for alleviation of symptoms of cis-platinum-induced peripheral neuropathy. Pain 98:195–203
Pace A, Savarese A, Picardo M et al (2003) Neuroprotective effect of vitamin E supplementation in patients treated with cisplatin chemotherapy. J Clin Oncol 21:927–931
Smets EM, Garssen B, Schuster-Uitterhoeve AL et al (1993) Fatigue in cancer patients. Br J Cancer 68:220–224
Irvine D, Vincent L, Graydon JE et al (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nurs17:367–378
Curt GA, Breitbart W, Cella D et al (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5:353–360
Mallinson T, Cella D, Cashy J et al (2006) Giving meaning to measure: linking self-reported fatigue and function to performance of everyday activities. J Pain Symptom Manage 31:229–241
Glaus A (1998) Fatigue in patients with cancer. Analysis and assessment. Recent Results Cancer Res 145:I–XI, 1–172
Mast ME (1998) Correlates of fatigue in survivors of breast cancer. Cancer Nurs 21:136–142
Woo B, Dibble SL, Piper BF et al (1998) Differences in fatigue by treatment methods in women with breast cancer. Oncol Nurs Forum 25:915–920
Andrykowski MA, Curran SL, Lightner R (1998) Off-treatment fatigue in breast cancer survivors: a controlled comparison. J Behav Med 21:1–18
Berglund G, Bolund C, Fornander T et al (1991) Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Eur J Cancer 27:1075–1081
Hann DM, Jacobsen PB, Azzarello LM et al (1998) Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Qual Life Res 7:301–310
Ferrell BR, Grant MM, Funk BM et al (1998) Quality of life in breast cancer survivors: implications for developing support services. Oncol Nurs Forum 25:887–895
Broeckel JA, Jacobsen PB, Horton J et al (1998) Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol 16:1689–1696
Dimeo F, Rumberger BG, Keul J (1998) Aerobic exercise as therapy for cancer fatigue. Med Sci Sports Exerc 30:475–478
McNeely ML, Campbell KL, Rowe BH et al (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 175:34–41
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García-Estévez, L., Tusquets, I., Álvarez, I. et al. Supportive care for patients with early breast cancer. Clin Transl Oncol 12, 32–42 (2010). https://doi.org/10.1007/s12094-010-0464-1
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DOI: https://doi.org/10.1007/s12094-010-0464-1