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Mitigating acute chemotherapy-associated adverse events in patients with cancer

Nature Reviews Clinical Oncology volume 19, pages 681–697 (2022)Cite this article

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Abstract

Despite the enthusiasm surrounding novel targeted agents and immunotherapies, chemotherapy remains the mainstay treatment for most human malignancies, either alone or in combination. Yet, the burden of chemotherapy-associated adverse events (CAAEs) remains high and, importantly, is associated with considerable morbidity, mortality and costs that affect patients across multiple dimensions, including physical, emotional and social functioning. CAAEs can directly affect patient outcomes and indirectly increase the risk of cancer recurrence by compromising treatment intensity and continuity. Systematic efforts to identify and critically summarize the evidence on management approaches for CAAEs remain limited. Herein, we review the most common acute CAAEs having a major effect on survival, quality of life, function and/or continuation of optimal therapy. We focus on selected acute toxicities that occur during treatment, summarizing their underlying pathophysiology, multifactorial aetiologies, evidenced-based treatments, prevention strategies and management recommendations. We also summarize the available evidence on risk factors, validated risk assessment tools and other efforts to optimize symptom control in patients most likely to benefit in order to personalize the prevention and treatment of acute CAAEs. Finally, we discuss innovative symptom monitoring and supportive care interventions that are under development to further improve the outcomes of patients with cancer.

Key points

  • The burden of chemotherapy-associated adverse events (CAAEs) remains high and is associated with considerable morbidity, mortality and costs.

  • CAAEs are frequently multifactorial in nature and often adversely affect multiple dimensions, including physical, emotional and social functioning domains.

  • CAAEs have a direct effect on patient symptoms, quality of life, and both physical and psychosocial functioning and can also compromise treatment intensity and continuity, potentially increasing the risk of cancer recurrence.

  • Continuing research into the underlying pathophysiology, emerging biomarkers, supportive care therapies and advances in patient risk stratification will further enable the personalized management of CAAEs.

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Fig. 1: Acute and chronic/late chemotherapy-associated adverse events in patients with cancer.
Fig. 2: Febrile neutropenia.
Fig. 3: Venous thromboembolism.
Fig. 4: Chemotherapy-induced nausea and vomiting.
Fig. 5: Chemotherapy-associated mucositis and oesophagitis.
Fig. 6: Tumour lysis syndrome.

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Acknowledgements

The authors want to thank the peer reviewers for their thoughtful and constructive comments.

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Authors and Affiliations

  1. Advanced Cancer Research Group, Kirkland, WA, USA

    Nicole M. Kuderer

  2. Department of Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA

    Aakash Desai

  3. Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Aakash Desai

  4. Department of Medicine, Yale University School of Medicine, New Haven, CT, USA

    Maryam B. Lustberg

  5. Division of Medical Oncology, Yale Cancer Centre, New Haven, CT, USA

    Maryam B. Lustberg

  6. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Gary H. Lyman

  7. Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, USA

    Gary H. Lyman

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  1. Nicole M. Kuderer
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  2. Aakash Desai
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  3. Maryam B. Lustberg
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  4. Gary H. Lyman
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All the authors contributed equally to all aspects of the preparation of the article.

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Correspondence to Nicole M. Kuderer or Gary H. Lyman.

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Competing interests

N.M.K. reports personal fees from BeyondSpring, BMS, G1 Therapeutics, Invitae, Sandoz, Seattle Genetics, Spectrum and Total Health, all outside the submitted work. M.B.L. is on the physician advisory board for Infinite Strength, Project Life, and The Right Dose and has been a consultant for AstraZeneca, Biotheranostics, Novartis, and Pfizer outside of the current subject. G.H.L. reports institutional research funding from Amgen, honoraria for lectures from Merck, Partners Healthcare, ER Squibb, Samsung, Sandoz, Seattle Genetics and TEVA, and honoraria for consulting from BeyondSpring, G1 Therapeutics and Jazz Pharm. A.D. declares no competing interests.

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Nature Reviews Clinical Oncology thanks P. Gascon, M. Shayne and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Kuderer, N.M., Desai, A., Lustberg, M.B. et al. Mitigating acute chemotherapy-associated adverse events in patients with cancer. Nat Rev Clin Oncol 19, 681–697 (2022). https://doi.org/10.1038/s41571-022-00685-3

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