Nursing Research Unit,
`Department of Nursing
`Studies, University of
`Edinburgh, Edinburgh
`EH8 9JT
`A J Tierney, PHD, unit
`director
`S J Closs, MPHIL, research
`associate
`
`Department of Clinical
`Oncology, Western
`General Hospital,
`Edinburgh
`R C F Leonard, FRCPED,
`senior lecturer
`A Rodger, FRCR, consultant
`radiation oncologist
`
`Breast Unit, Longmore
`Hospital, Edinburgh
`J Taylor, RGN, ward sister
`U Chetty, FRCSED, consultant
`surgeon
`
`Correspondence to:
`Dr Tierney.
`
`BMJ 1991;302:272
`
`Side effects expected and
`experienced by women receiving
`chemotherapy for breast cancer
`
`A J Tierney, R C F Leonard, J Taylor,
`S J Closs, U Chetty, A Rodger
`
`An in depth descriptive study of women receiving
`chemotherapy for breast cancer showed discrepancies
`between the side effects that they had expected would
`be the most difficult to cope with and those that they
`had actually found to be the most difficult.'
`
`Patients, methods, and results
`The patients comprised 60 consecutive women
`with breast cancer aged from 24 to 66 years (mean
`43-3). Chemotherapy combinations were based on
`doxorubicin for locally advanced cancer and cyclo-
`phosphamide for adjuvant treatment of local disease.
`Before treatment data were collected on the women's
`knowledge and expectations of chemotherapy. During
`treatment their experiences of side effects were re-
`ported. These data were collected mainly by interview.
`Reflections on chemotherapy, including views on
`information and support provided, were reported
`at follow up three weeks after treatment by postal
`questionnaire, which was returned by 51 women.
`The women's knowledge about their forthcoming
`treatment was limited. Eleven had no knowledge of the
`drugs used and some of them did not even appreciate
`that chemotherapy took different forms. All women
`reported being warned about possible side effects,
`most commonly those of hair loss and sickness (table).
`These two problems were the ones most often expected
`to be the most difficult. Though hair loss was expected
`to be the worst side effect by 35 women, fewer (13)
`eventually reported it as such despite the fact that 37
`women eventually had alopecia. Similarly, sickness
`was reported as the most difficult side effect by fewer
`women than had expected this (four v 11).
`In general the side effects actually experienced by
`the women were rather different and more diverse than
`they had expected. More side effects were experienced
`than they had been warned to expect; the women
`experienced a mean of 5-4 side effects after the first
`treatment and 6-7 after the last compared with the 3 7
`they had been warned about. A total of 36 different side
`effects were reported. Those most often reported were
`tiredness, nausea, loss of appetite, mouth soreness,
`pain, sickness, and sore eyes. Unforewarned side
`effects included weight change, hot flushes or night
`
`Side effects that women reported having been warned about in
`advance
`
`Side effect
`
`No of women
`
`Hair loss
`Sickness
`Tiredness
`Nausea
`Mouth soreness/ulcers
`Infections/lowered resistance to infection
`Flu-like symptoms
`General unwellness
`Diarrhoea and/or constipation
`Loss of appetite
`Depression
`Skin or nail problems
`Sore/itchy eyes
`
`Total
`Mean
`
`15
`
`60
`45
`30
`21
`16
`
`14
`6
`5
`3
`2
`2
`2
`
`221
`3-7
`
`sweats, heartburn, paraesthesia, and taste change.
`That tiredness would be the single most often
`reported side effect was completely unexpected. It was
`reported by no less than 87 5% of the sample at any
`stage oftreatment. Having to "give in" to tiredness and
`to offload domestic and work responsibilities was a
`source of considerable anxiety for some women. Only
`two women had expected tiredness to be potentially so
`problematic and only 30 had been forewarned of this
`(table). Tiredness was reported by 11 women as the
`most difficult side effect.
`After reflecting on their treatment most women (35
`of the 51 who replied to the follow up questionnaire)
`reported that they had felt adequately prepared for
`chemotherapy. Others complained that they had not
`been warned that there could be so many different side
`effects and that they had been given little practical
`advice on coping with them.
`
`Comment
`The dilemma of how to prepare patients for chemo-
`therapy without inducing unnecessary fear and anxiety
`is well recognised. These findings suggest, however,
`that preparation needs to consider that the side effects
`of chemotherapy may be more diverse, and the
`reactions of patients more individualistic, than tends to
`be acknowledged. Problems such as tiredness, even if
`not hazardous, will continue to be underrated if they
`are not asked about, and we recommend a more open
`minded approach to the routine monitoring ofpatients'
`problems during chemotherapy.
`
`1 Tiemey AJ, Taylor J, Closs SJ. A study to inform nursing support ofpatients coping
`with chemotherapy for breast cancer. Edinburgh: Nursing Research Unit,
`University of Edinburgh, 1989.
`
`(Accepted 17 October 1990)
`
`Effects of withdrawing
`erythropoietin
`
`J E Taylor, I S Henderson, R A Mactier,
`W K Stewart
`
`Recombinant human erythropoietin is an effective
`treatment for the anaemia of chronic renal failure.'
`Exercise tolerance and quality of life are dramatically
`improved.2 Most side effects are not life threatening,
`so only a small proportion of patients are completely
`unsuitable for treatment.3 Until recently patients in the
`United Kingdom have received erythropoietin freely
`as part of clinical trials. Now that the drug has been
`
`granted a product licence, many units are being faced
`with the prospect of reducing the numbers of patients
`receiving erythropoietin owing to financial constraints.
`We report our findings from 12 patients treated with
`and withdrawn from erythropoietin.
`
`Patients, methods, and results
`Twelve patients who were undergoing haemo-
`dialysis (mean age 49 years, range 21-72 years) with
`haemoglobin concentrations of less than 85 g/l were
`treated with erythropoietin (Recormon, Boehringer
`Mannheim UK Pharmaceuticals), starting at a dose of
`120 IU/kg/week. Five patients received the erythro-
`poietin intravenously and seven subcutaneously. After
`the first six weeks the dosage was increased at a
`minimum of fortnightly intervals to achieve a target
`
`BMJ VOLUME 302
`
`2 FEBRUARY 1991
`
`Renal Unit, Ninewells
`Hospital and Medical
`School, Dundee DD1 9SY
`J E Taylor, MRCP, registrar
`I S Henderson, FRCP,
`consultant nephrologist
`R A Mactier, MRCP, senior
`registrar
`W K Stewart, FRCP, reader in
`medicine
`
`Correspondence to:
`Dr Taylor.
`
`BMJ 1991;302:272-3
`
`272
`
`IMMUNOGEN 2185, pg. 1
`Phigenix v. Immunogen
`IPR2014-00676
`
`