While the adverse events associated with chemotherapy are often reported in clinical trial publications, there is little evidence about the incidence and management of adverse events in the clinical practice setting.
To investigate the frequency and severity of chemotherapy adverse events in a population receiving standard care.
The Elements of Cancer Care (EoCC) study collected both primary and secondary data from a prospective cohort of individuals with breast, colorectal or lung cancer undergoing chemotherapy in 12 cancer centres in New South Wales, Australia. Occurrences of adverse events were identified through blood test results and self-report at monthly interviews. The adverse event interview questions were designed to elicit information about both the experience and grade of 11 adverse events according to the NCI Common Toxicity Criteria. Rates of adverse advents were calculated at any grade, worst grade and by cumulative incidence.
There were 482 individuals in the EoCC study, 54% with breast cancer, 33% with colorectal cancer and 13% with non-small cell lung cancer. The sample was predominantly female (74%) and 51% were aged 60 or over. 86% of participants reported at least one adverse event during the study period, and 27% of individuals reported a grade IV event. Fatigue was most the common self-reported event (85%), followed by diarrhoea (74%), constipation (74%), dyspnoea (71%) and mucositis (71%). Blood tests indicate that 75% of individuals were anaemic during the study period.
This work produces the first Australian estimates of the incidence of chemotherapy adverse events in a standard-practice setting. Adverse events are common in this cohort, indicating that adverse events may occur more often in clinical practice than reported in clinical trials. This study highlights the value in investigating the patient experience of chemotherapy outside the clinical trial setting.