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Vol 20, No. 12, December 2016   |   Issue PDF view/purchase
Counter-Acting Chemotherapy’s Side Effects

We attended the press conference for the release of Akynzeo, the latest anti-nausea and anti-vomiting drug distributed by Mundipharma for chemotherapy patients, led by Dr Wong Seng Weng.

A comprehensive virtual reality program explaining the effects of the medication was presented with the Oculus Rift, giving a peek of the potential of technology in educating the public. Akynzeo was designed to prevent CINV (chemotherapy-induced nausea and vomiting) which has been reported to severely affect the patients’ quality of life.

At Mundipharma’s Singapore office in Asia Square Tower 2, a study carried out from 2005 was presented, showing what the most feared side effects of cancer treatment were from the patient’s point of view. As shown in the following graph “Patient perceptions of the most severe side effects of chemotherapy”, the scale extends from 0.00 to 1.00 with the lowest being the worst patient experience. Alarmingly, severe nausea and vomiting are ranked among the worst fears of patients; as Dr. Wong put it, “it is an experience in their minds almost as horrifying as death”. Medical estimates are often different, which leads us to believe that doctors and nurses very often underestimate what their patient is experiencing and may be unknowingly neglecting intense patient discomfort. We aren’t just treating a tumour or an X-ray, and attention must be given to how a patient feels if we want treatment to be productive, and best serve its patient.

If we look closer at the discomfort caused by nausea and vomiting from a medical point of view, it also in turn affects general health. Loss of fluid will cause dehydration, the salt balance in the body is destabilised which may affect brain and muscle function. This combines with cramps that exacerbate the muscle pain and cloud the mind, causing both physical and mental discomfort. These induced morbidities impair the health-related quality of life and unfortunately discourage patients from following through with treatment. As Dr. Wong presented, “patients delay chemotherapy cycles and contemplate refusing future treatments because of fear of further CINV”. Because of such fears, patients start making decisions that are detrimental to their own health.

A cancer patient of Dr. Wong’s was invited to speak about her experience. Wendy told us that the first thing friends and family told her after the news was that she would vomit a lot. However, this was never the case - now half-way through her treatment, she still hasn’t felt nausea nor experienced any scale of CINV symptoms. Of course, this isn’t the journey of every patient, there are many patient-related and treatment-related risk factors for CINV. One of them is prior CINV, in particular if the patient has previously been exposed to chemotherapy without CINV control. This is why support medication like Akynzeo is best administered from the start, and she trusted her doctor fully to prescribe the appropriate anti-nausea and anti-vomiting medication as he saw fit. Wendy experiences other side effects of chemotherapy, some of which are inevitable such as hair loss, but is able to live a normal life and continues to go to work.

Dr. Wong urges the public to be aware that adequate healthcare isn’t necessarily what it is feared to be: “it does not have to be this way”. Wendy’s experience is a tremendous relief to him as an example, because a lot of patients refuse chemotherapy saying they are going through a journey worse than death. “Patients hear all these horror stories and try to extrapolate them on themselves”. Other patients might have a tougher time than Wendy, but they aren’t doing themselves a favour by declining treatment based on misconceptions. Once the patient is aware that some degree of control over CINV may come with the treatment, a more proactive behaviour is adopted. Patients interact with healthcare professionals and reach a better decision with their doctors - in turn, doctors learn not to under manage the patient experience aspect of the treatment. Why not only seek to educate the doctors about this? Increasingly, doctor-patient relationship has been more flexible, the patient usually retains a degree of autonomy over the treatment and decisions are usually the product of a consensus reached between the doctor and the patient.

Writer’s Thought:

Treating Patients, Not Diseases

Many trends have evolved in the healthcare industry, such as personalised medicine or alternative medicine. One of the drives is the shift towards a patient-centric approach, serving the industry’s interest to cure diseases more efficiently, but also driven by individuals becoming more conscious about their well-being. New choices of treatments empower patients while scientific progress continues to provide doctors with better tools and drugs to offer. When it comes to making a decision about the best-suited treatment for a patient: what criteria are taken into account by the healthcare providers when they make treatment propositions, and are those criteria the same as the ones considered by the patients?

Indeed, among the modern tragedies lie the notorious cancers and the scary reputation of their treatment, chemotherapy, that causes some patients to decline treatment in order to avoid enduring its side effects. Without placing any judgement on such a choice, it is important to make sure the most informed decisions possible are made. In particular, we should strive to educate everyone about the available support medicine that improves patient experience, rather than focus only on which drugs can cure the disease in the most efficient and cost-optimised way. With all the exciting advances in medical sciences and technology, we must not forget that the primary goal is to treat people, not diseases.

What needs to be understood is that medication that improves patient experience does exist and should be taken into account when making potentially health-threatening decisions. They are sometimes left out for budget purposes or to save resources, because doctors or facilities are trying to save resources and cut corners. Since they usually prioritise the treatment outcome, one will seek to cut corners by limiting the support medication first. Public misconceptions must be tackled as well, it must be educated about the fact that nausea and vomiting can be controlled. For now, there is a tendency to magnify the side effects too much, which generates a fear that drives patients to hide from the problem, seek alternative medicine, pretend the disease is not here or hope they can just will it away.

Additionally, oncologists undergo a lot of pressure constantly and aren’t always able to provide the psychological support that the patients sometimes need. Shifting the medical aim to treat patient experience rather than relentlessly battle the sickness alone would help fuel a healthier doctor-patient relationship. While every cancer patient’s journey is different, it is important to talk about side effects and their impact on experience realistically, taking all options into account.

The social factor of fear should not affect the decision-making process regarding a patient’s treatment, and this is an issue that the media can play a role for in educating the general public. The same goes for the healthcare providers: awareness must be raised among doctors and nurses regarding patient experience, because lack of treatment that ends up in severe complications during the cancer’s later stage with need of hospitalisation isn’t doing the patient, nor the healthcare industry, any good.

Ideally, direct communication channels should be open between the governments and their healthcare system, to raise this issue and trigger a downstream education of the general public. Making support drugs more available, covering their cost with insurance in order to integrate them as part of the standard of care would help normalising the conversation about patient experience and the choice for treatment without having to severely compromise on quality of life would encourage the system to put suffering patients, and their health, first.

In an era of flourishing medical research, it would be unfortunate to put patients in the unnecessary position where they feel they have to choose between their health or their quality of life.


By Katya Guez Christiane
Katya Guez is currently pursuing her Life Sciences and Bioengineering degree at the Swiss Federal Institute of technology in Lausanne.

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