Mitigating long-term and delayed adverse events associated with cancer treatment: implications for survivorship

Abstract

Despite the importance of chemotherapy-associated adverse events in oncology practice and the broad range of interventions available to mitigate them, limited systematic efforts have been made to identify, critically appraise and summarize the totality of evidence on the effectiveness of these interventions. Herein, we review the most common long-term (continued beyond treatment) and late or delayed (following treatment) adverse events associated with chemotherapy and other anticancer treatments that pose major threats in terms of survival, quality of life and continuation of optimal therapy. These adverse effects often emerge during and continue beyond the course of therapy or arise among survivors in the months and years following treatment. For each of these adverse effects, we discuss and critically evaluate their underlying biological mechanisms, the most commonly used pharmacological and non-pharmacological treatment strategies, and evidence-based clinical practice guidelines for their appropriate management. Furthermore, we discuss risk factors and validated risk-assessment tools for identifying patients most likely to be harmed by chemotherapy and potentially benefit from effective interventions. Finally, we highlight promising emerging supportive-care opportunities for the ever-increasing number of cancer survivors at continuing risk of adverse treatment effects.

Fig. 1. Long-term treatment-related adverse events in patients with cancer.

a, Fatigue is the most common symptom reported by patients with cancer receiving chemotherapy and it has multiple risk factors. b, Cancer-induced peripheral neuropathy most commonly manifests as either positive or negative sensory symptoms and pain, although autonomic and motor symptoms can also appear in patients with severe cancer-induced peripheral neuropathy^,. c, Chemotherapy-related cognitive impairment is caused by various pathophysiological mechanisms activated by certain therapeutic agents. Importantly, fatigue, depression and sleep disturbances can contribute to chemotherapy-related cognitive impairment. These and other adverse events can compromise patient quality of life and their willingness to continue effective therapy. Part a is adapted with permission from ref. , Taylor & Francis. Part b is adapted from ref. , CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Part c is adapted with permission from ref. , Elsevier.

Fig. 2. Addressing psychosocial needs in cancer survivors.

Guidelines recommend the use of validated screening tools to identify common unmet psychosocial oncology needs, determine the severity of the associated symptoms and guide treatment planning. ASCO, American Society of Clinical Oncology; NCCN, National Comprehensive Cancer Network.