Think about the long-term consequences of cancer treatment.
In this issue, we cover an important topic that often takes a back seat to the discussions and decisions about cancer treatment: the collateral damage these treatments can cause—the same treatments that over the years are continuing to improve the outlook for many cancer patients.
Even though therapies are becoming more focused on cancer cells (and not healthy tissue) through the advent of a new generation of targeted agents, we still rely on chemotherapy, the most commonly used class of drugs for many types of cancer. Even biologically targeted "magic bullet" drugs can be off target or can share targets with healthy cells. Most damaged normal cells and tissues repair themselves through natural healing, regeneration and recovery, but some effects from treatment can be long-standing—even permanent. You will read about several aspects of these long-standing or permanent effects that are part of what is termed "survivorship" concerns. Although permanent effects tend to be rare compared with the more common and well-known short-term side effects, the permanent effects need to be understood by both the care team and the patient.
Although permanent effects tend to be rare compared with the more common and well-known short-term side effects, the permanent effects need to be understood by both the care team and the patient.
One not-so-rare permanent side effect is infertility, and this is relevant for the nearly 10 percent of people in the U.S. who receive a cancer diagnosis under the age of 45 (Read "Preserving Fertility"). Another side effect that is not fully understood is cardiac toxicity, a spectrum of disorders that can affect the heart in different ways and can be transient or permanent depending on the treatment and patient factors. Both of these topics are discussed in detail in thought-provoking articles (Read "Cardiac Toxicity: Heart of the Matter"). The "thought-provoking" aspect is important because every cancer patient needs to be fully aware of possible consequences of treatment to make a more informed, value-based decision and know what to monitor and report to the care team. The encouraging trend is that, in many cases, new methods are available to prevent these side effects, to detect and treat them, and to determine who might be more at risk for experiencing them.
Debu Tripathy, MD
Professor of Medicine, University of Southern California
Co-Leader, Women’s Cancer Program at the USC/Norris Comprehensive Cancer Center