The Time Has Come

Dawn L. Hershman, MD, MS1

Adjuvant chemotherapy reduces the 10-year relative risk of death from breast cancer by approximately 35%.1 Efforts have been made to define the subset of women who derive the most benefit from this treatment so patients who are cured without chemotherapy can avoid the toxic adverse effects, and patients who would benefit most from chemotherapy would receive it.2 Despite these efforts, a substantial number of women are still advised to undergo chemotherapy but choose not to receive treatment because of concerns about adverse effects.3,4 Therefore, an intervention that could reduce the adverse effects of chemotherapy may lead to improvements in the initiation and completion of therapy, in quality of life, and in survival outcomes. Substantial improvements in supportive care have led to significant improvements in the management of several chemotherapy-induced toxic effects such as nausea and vomiting, fever related to neutropenia, anemia, menopausal symptoms, and infertility.5 Reassuring patients that symptoms can be controlled may help persuade them to initiate treatment despite their apprehension and distress about doing so.

JAMA