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Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, oncology, hospital admissions and readmissions, senior patients, and health policy.
Moffitt Cancer Center expert shares her thinking on managing chemotherapy-related side effects.
Nausea, vomiting, hair loss, loss of appetite, diarrhea, and fever are just some of the side effects of chemotherapy, according to the Mayo Clinic.
Managed Healthcare Executive (MHE) recently interviewed Karen Fields, MD, a medical oncologist specializing in breast cancer at Tampa, Florida-based Moffitt Cancer Center, for her insight on choosing chemotherapy treatments and what payers should keep in mind about managing the side effects of those treatments.
Fields: Side effects vary by the drug and the therapy-and they vary greatly. Certain drugs have high-toxicity profiles, and certain drugs have very low-toxicity profiles. When we make treatment recommendations for our patients, we try to define what are the most active drugs for treating the underlying disease. But we also try to look at the unique toxicity of those drugs, especially as they relate to the unique circumstances of that patient.
For example, does the patient have an underlying medical illness that’s more likely to impact the toxicity of a drug? Or do we need to have more dose intensity because they’ve got a more aggressive cancer?
We’re always weighing the risks and the benefits when we select a chemotherapy profile, but we also need to remember to personalize it around some of the predictable or projected toxicities.
At Moffitt, we have clinical pathways that help us make these decisions. When we make these decisions, first we look at efficacy, then we look at the unique toxicities-especially around the patient profile-and then we look at the cost to help us make our decisions.
Fields: Better management of chemotherapy side effects is going to improve quality for the patient. It’s also going to decrease costs because you’re prospectively anticipating what those side effects and toxicities might be-and then you’re coming up with strategies for managing them better. For example, more phone calls to and from the patient or better medicines-like better nausea medicines or growth factors that help stimulate the blood count during recovery.
If we try to anticipate the side effects and prevent them or intervene early for them then ultimately that’s going lead to better tolerance and more cost-effective care as well.
At Moffitt, we’ve worked really hard on better toxicity management by anticipating the chemotherapy-related side effects-and strategies to prevent them.
Fields: The number one side effect for chemotherapy to treat acute myeloid leukemia is the drugs decrease your good blood count, while they’re decreasing the “bad” blood count. That means increased chance of infections because the white blood cell count is lowered. There’s also an increased need for transfusion because the red blood cells are lowered. In addition, there’s an increased chance of bleeding because the platelet counts are lowered.
Some of the side effects of the acute leukemia drugs are nausea, mouth sores, and other gastrointestinal side effects that prohibit eating and can be associated with pain. That means we have to come up with strategies to make sure patients have nutrition and that we’re controlling their pain as well.
That becomes important because we can target those side effects in acute leukemias. But it also limits your ability to do outpatient chemotherapies with these patients. A lot of the acute leukemia drugs are inpatient-focused because patients are hospitalized after the therapies because of the side effects they have.