Sunday, May 20, 2012

Their success is our problem

The doctor's successful treatment of us cancer people with chemotherapy and radiation is now our problem. Only now are doctors beginning to talk about the long term issues for people treated with chemotherapy. Well oncologists were more aware but other doctors not so much.

A recent study (because we needed another study) found that 6% of non cancer doctors knew about the long term side effects of chemotherapy drugs.

"While advances in cancer care have successfully kept more cancer patients alive, this new study finds there's room for improvement in their follow-up care. Primary care physicians and even cancer specialists need to be aware of the long-term effects of the drugs patients have taken to beat cancer.

Researchers at Harvard University, the National Institute of Nursing Research and the American Cancer Society surveyed nearly 1,100 primary care physicians and 1,100 oncologists or cancer specialists. They asked these doctors to identify the long-term side effects of four of the most widely used chemotherapy drugs used to treat breast and colorectal cancer, two of the most common cancers.

Overall, only 6% of primary care physicians and 65% of oncologists were aware of all the long-term side effects that the four drugs could cause.

When asked about the drug Doxorubicin, 55% of primary care physicians knew patients are at risk for cardiac dysfunction, compared to 95% of oncologists.

In the case of Cyclophosphamide, only 14% of primary care physicians knew women are likely to suffer premature menopause, compared to 71% of cancer specialists."

Doxorubicin is also know n as Adriamycin and Cyclophosphamide is known as Cytoxan. I was treated with these drugs during chemo. A friend of mine has impaired cardiac function as a result of chemo. All women are told that chemo was likely to put them into early menopause. But I do have another friend who was in her 20's when introduced. When she gets through hormonal treatment next year, they are going to start working on a baby.

I just checked on for details on side effects and Adriamycin is listed as having two long term side effects. It can interfere with the pumping of the heart and this can show up 7 or 8 years after treatment. And there is also a risk of developing leukemia years after treatment - I know two women who have had this.  Cyclophosphamide is only listed as possibly causing leukemia as well, nothing about premature menopause.

"... says that, in the past, medical training has not been focused on making sure physicians taking care of cancer survivors are adequately prepared to deal with long-term side effects.

In addition to chemotherapy drugs and radiation treatments affecting organs and tissues, ... also spoke about psychosocial problems patients can face, like fear of cancer recurrence. Problems with relationships also occur because patients are no longer functioning in crisis mode and reentry into a normal pattern is sometimes very difficult.

Experts agree that in the past, the emphasis has been to keep cancer patients alive, and that entire field of cancer survivorship is a pretty new one. But with the success of cancer care, more attention must be given to this area. ... points out that it's now recommended by professional societies for doctors to provide a survivorship care and treatment plan when patients complete their cancer therapy. Such a plan will inform the patient of issues they may face and they can share this information with their physician.

Not recognizing how a cancer survivor can develop treatment-related health problems is a concern. Link calls it a doctor-education problem and a patient-education problem, which he believes could be helped by better use of electronic medical records."

This means I need to educate my doctors. I do like my new primary care doctor but she is young and I will need to have a discussion with her about long term side effects. What didn't kill us may not have made us stronger in this case.

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