Cancer Patients Fear Chemotherapy as Much as Mortality.

ATLANTA--(BW HealthWire)--April 28, 1999--

New Research Suggests That Despite Medical Advances, Physical and

Psychological Side Effects of Treatment Can Still be Significant

People who are newly diagnosed with cancer fear chemotherapy treatment and side effects as much as their own mortality, according to findings released here today at the Oncology Nursing Society Annual Congress. In addition, the findings reveal that perceptions about chemotherapy -- and patients' actual physical and psychological experiences -- could be significantly improved if appropriate medications and psychological support resources were consistently made available.

Specifically, 40 percent of the 500 chemotherapy patients who responded to the randomized, national survey said that prior to starting treatment their biggest concern was "side effects/how I would feel physically" versus 32 percent who said their biggest concern was "whether I would survive cancer." Half of respondents said that "when I developed side effects" was a stressful time for them.

The survey, one of the largest of chemotherapy patients completed and published during the last decade, was conducted by research organization Roper Starch Worldwide on behalf of the Oncology Nursing Society (ONS) and Amgen. It evaluated patients' physical and emotional experiences during treatment, as well as the resources they found particularly valuable in managing these experiences.

"These findings highlight the absolute dread most Americans feel when they think of chemotherapy, despite advances in the last 10 years that have drastically reduced physical side effects," said Pearl Moore, executive director of ONS. "Our message today is that, yes, chemotherapy is still a very difficult experience for many people, but it can be much improved if patients are provided with the right tools and resources at the right times." -0-

Other key findings include:

--   Helping patients know what to expect from chemotherapy may help
     lessen their anxiety. From a list of five situations, the
     greatest percentage of patients said that "thinking about and
     preparing for my first chemotherapy session" was stressful. More
     than half of these patients attributed their feelings to "not
     knowing what to expect."
--   Preparing for chemotherapy appears to give patients a
     psychological and emotional advantage: Among patients who said
     they wanted to quit chemotherapy at any point during their first
     course, only 42 percent said they felt adequately prepared for
     the experience by their doctors. Seventy-five percent of
     respondents who did not want to quit said they felt adequately
     prepared.
--   Despite the availability of sophisticated information and support
     sources (e.g., the Internet), patients report that prayer is
     still their most valuable source of support prior to and during
     chemotherapy. Among those patients who prepared for chemotherapy,
     71 percent said they did so by praying, and 75 percent of these
     said praying was "extremely helpful" in getting them through
     treatment.
--   Nurses play an extremely important role in helping chemotherapy
     patients manage treatment. Patients said nurses were the most
     valuable source of information and support during chemotherapy,
     aside from their doctor. Sixty-five percent of the survey
     respondents who relied on a nurse for support during chemotherapy
     ranked their nurse as "extremely helpful."
--   Chemotherapy patients' experiences may be improved by ensuring
     they receive the right resources at the right times: Survey
     respondents highlighted periods during their chemotherapy when
     physical and emotional effects were most acute, as well as the
     types of resources they would liked to have had available. During
     the beginning of chemotherapy, feeling like "no one understood
     what I was going through" was cited as a major reason some
     patients felt like they wanted to quit chemotherapy. During the
     middle of chemotherapy, patients said that "feeling unable to
     handle day-to-day responsibilities" was a major reason they felt
     like they wanted to quit treatment.

-0-

The survey results also suggest that many patients might not be receiving the full benefit of newer medications that help manage the severe side effects of chemotherapy. For example, nearly 50 percent of survey respondents reported experiencing low white blood cell (LWBC) counts during chemotherapy, despite the availability of a blood cell growth factor that may help prevent this condition. In addition to potentially being life-threatening, LWBC can cause physicians to delay patients' chemotherapy sessions or reduce the amount of chemotherapy patients receive.(1) It has been particularly well documented in the breast cancer population that taken together, significant chemotherapy delays and dose reductions (the primary determinants of dose intensity) can reduce patients' long-term survival rates.(2)

According to the survey released today, delays in chemotherapy treatment can also carry a heavy emotional toll: Thirty-seven percent of patients who experienced LWBC-related delays found the delay to be "extremely" or "somewhat" stressful, and 31 percent of these patients said the delay made them want to quit chemotherapy. Two-thirds of those who found their delay to be stressful said it was because they were looking forward to finishing chemotherapy.

In addition to the impact of treatment delays, the survey highlighted other psychological and emotional challenges for chemotherapy patients -- and the continued need for targeted support services. For example, 41 percent of women in the survey reported that the impact of physical side effects was increased by accompanying "worry about how I would fulfill my family responsibilities." Thirty-three percent of patients said they wished they had been able to talk with someone else who had been through chemotherapy.

"While there has been some very promising news on the cancer front, the reality is that 50 percent of people who are newly diagnosed with the disease still receive chemotherapy," said Jimmie Holland, MD, chair of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center in New York City. "And the psychological effects of this treatment continue to be a serious, hidden problem. Our own research suggests that only about five percent of chemotherapy patients who are experiencing anxiety and distress receive some kind of support. This survey demonstrates that we could be intervening much more effectively to rescue patients who are suffering emotionally and psychologically."

Study Methodology and Demographics: The national Chemotherapy Experiences survey was conducted by research organization Roper Starch Worldwide, Inc. during the four weeks December 3, 1998-January 7, 1999. The survey comprised responses from 504 patients, the greatest percentages of whom reported having breast cancer (60 percent), prostate cancer (11 percent), and colon cancer (10 percent). Respondents were identified through random screening by NFO Research, Inc. and had all completed, or were completing, at least one course of chemotherapy at the time the survey was conducted. All results have been verified by Roper Starch Worldwide, Inc.

The Oncology Nursing Society is a national organization of more than 27,000 oncology nurses and other healthcare professionals committed to promoting excellence in oncology nursing and quality cancer care. ONS is the largest professional membership oncology association in the world.

Amgen is a global biotechnology company that discovers, develops, manufactures and markets cost-effective human therapeutics based on advances in cellular and molecular biology.

Note to Editors: Full prescribing information for NEUPOGEN(R) is available upon request.

1. Project ChemoInsight: A Quality Performance Tool developed by Amgen

2. Bonadonna G, Valagussa P. Adjuvant Cyclophosphamide, Methotrexate, and Fluorouracil in Node-Positive Breast Cancer: The Results of 20 Years of Follow Up, N Engl J Med 1995: 332:901-906