Treatment with TKIs can cause a widespread range of adverse events (AEs) such as rash, nausea, fatigue, headache, myelosuppression, cardiac AEs, and elevated liver enzymes.1
- It is important to monitor tolerance to treatment, as well as response, since AEs cannot only impact a patient’s wellbeing but also their motivation to adhere to treatment.2
- Patients who self-report lower adherence, could prevent achievement of an optimal response to treatment.3
- Despite managing AEs with dose reductions/interruptions, supportive care and concomitant medications, many patients treated with TKIs experience intolerance to treatment.4,5
Real-world data shows that >1 in 5 patients discontinue TKIs due to intolerance6
44% patients required ≥1 TKI switch7
21% switched more than once7
Even minor AEs can have major impacts
Although severe AEs may lead to drug discontinuation, hospitalisation, or death, even mild events can have a significant impact on patients’ quality of life.4,5 For example:
A PERSISTENT GRADE 2 DIARRHOEA COULD CAUSE SERIOUS DISRUPTION TO A PATIENT’S EVERYDAY LIFE.8
AES SUCH AS FATIGUE CAN SEVERELY IMPACT QUALITY OF LIFE OF PATIENTS.5
From the patient’s perspective
- It is crucial you take your patient’s perspective when assessing symptom burden and overall quality of life, especially for those at later lines of treatment.
- Clinicians and patients can see the way symptoms are reported quite differently.1
- Clinicians can sometimes miss some of patients’ symptomatic AEs that may be less visible.
- Widely used symptom-assessment questionnaires cannot capture the full impact of certain events, such as fatigue and overall symptom burden.
- Patients may be suffering in silence, as these AEs limit activities central to daily life,8 such as personal care, performance at work, socialising with family and friends, or tackling household chores.8,9
- A good start is to proactively ask patients about AEs arising from treatment and their impact on their daily routine (work, exercise, social and sexual activities).
See downloadable resources:
Encouraging Open Discussion with Your Patients About Symptoms
References:
- DeAngelo DJ, et al. Blood Cancer J. 2012 Oct;2(10):e95.
- Galinsky I, et al. J Adv Pract Oncol. 2012;3(4):225–236.
- Boons CCLM, et al. Eur J Haematol. 2018;101:643–653.
- Efficace F, et al. Hematology Am Soc Hematol Educ Program. 2016;2016(1):170–179.
- Cortes J, et al. J Hematol Oncol. 2021;14(1):44.
- Geelen IGP, et al. Haematologica. 2017;102:1842–1849.
- Milojkovic D, et al. Br J Haematol. 2021;192:62–74.
- Flynn KE, et al. Curr Hematol Malig Rep. 2016;11(2):80–85.
- Leukaemia Care. https://media.leukaemiacare.org.uk/wp-content/uploads/Living-Well-with-C.... Accessed June 25, 2021.