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Review
. 2024;20(21):1515-1530.
doi: 10.2217/fon-2023-0513. Epub 2024 Apr 8.

The impact of myelosuppression on quality of life of patients treated with chemotherapy

Jeffrey Crawford  1 , Dana Herndon  2 , Katerina Gmitter  3 , Jared Weiss  4
Affiliations
Review

The impact of myelosuppression on quality of life of patients treated with chemotherapy

Jeffrey Crawford et al. Future Oncol. 2024.

Abstract

Side effects from chemotherapy-induced myelosuppression can negatively affect patients' quality of life (QoL). Neutropenia increases infection risk, and anemia frequently results in debilitating fatigue. Additionally, the bleeding risk associated with thrombocytopenia can lead to fear and anxiety. However, traditional interventions for myelosuppression fall short of the ideal. Granulocyte colony-stimulating factors reduce the risk of severe neutropenia but commonly lead to bone pain. Erythropoiesis-stimulating agents are not always effective and may cause thromboembolic events, while transfusions to correct anemia/thrombocytopenia are associated with transfusion reactions and volume overload. Trilaciclib, which is approved for reducing myelosuppression in patients with extensive-stage small cell lung cancer, together with several investigational agents in development for managing myelosuppression have the potential to improve QoL for patients on chemotherapy.

Keywords: anemia; chemotherapy; myelosuppression; neutropenia; quality of life; thrombocytopenia; trilaciclib.

Plain language summary

Chemotherapy can cause side effects by killing blood-forming cells in the bone marrow. This is known as myelosuppression and leads to neutropenia (decreased neutrophils [white blood cells]), anemia (decreased red blood cells) and thrombocytopenia (decreased platelets). Neutropenia can increase the risk of getting an infection, and severe cases might result in patients being hospitalized. Both neutropenia and anemia can cause fatigue, which is often reported by patients as being the most draining symptom of chemotherapy. Thrombocytopenia increases the risk of bleeding and can cause patients with cancer to become even more scared and anxious. Myelosuppression due to chemotherapy is usually managed with delays or reductions in the amount of chemotherapy that patients receive, but this may worsen the disease. Other treatments, known as supportive care interventions, include growth factors, which stimulate the production of blood cells and red blood cell or platelet transfusions. However, having these treatments in addition to chemotherapy can be a burden to patients, and they can cause side effects such as bone pain and blood clots. A treatment called trilaciclib is approved by the US Food and Drug Administration for patients receiving certain types of chemotherapy for advanced small-cell lung cancer. Trilaciclib has been shown to reduce neutropenia, anemia and thrombocytopenia in these patients and improve their quality of life. Other drugs are also being assessed in clinical trials for preventing or treating myelosuppression in patients with different cancer types. In the future, these drugs may improve quality of life for patients on chemotherapy.

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Conflict of interest statement

J Crawford has participated as a scientific advisor for Actimed Therapeutics, Enzychem Lifesciences, Faraday Pharmaceuticals, Jazz Pharmaceuticals, Partner Therapeutics, and Pfizer; participated on publications committees for Amgen, Frensenius Kabi, G1 Therapeutics Inc., LUNGevity Foundation, Pfizer and Spectrum Pharmaceuticals; and participated on data safety monitoring boards for BioAtla, G1 Therapeutics, Inc and NiA Pharmaceuticals. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.

References

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    2. •• An online survey of 301 participants with breast, lung, or colorectal cancer describing the real-world impact of chemotherapy-induced myelosuppression. Participants reported that myelosuppression had a negative impact on their daily lives and that symptoms including fatigue, weakened immune system, bleeding and/or bruising and shortness of breath were as bothersome as other side chemotherapy effects (e.g., alopecia, neuropathy and nausea/vomiting).

    1. Epstein RS, Weerasinghe RK, Parrish ASet al. . Real-world burden of chemotherapy-induced myelosuppression in patients with small cell lung cancer: a retrospective analysis of electronic medical data from community cancer care providers. J. Med. Econ. 2022;25(1):108–118. doi: 10.1080/13696998.2021.2020570 - DOI - PubMed
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