As cancer therapies improve, patients are living longer. With these improvements in therapy comes a responsibility to optimize patients' quality of life during cancer therapy and beyond. This report reviews three timely and important topics.
The first section reviews the mechanism underlying chemotherapy-induced peripheral neuropathy and evaluates the evidence for interventions to prevent and treat peripheral neuropathy. It also provides a framework for approaching the diagnosis and management of this common and bothersome side effect.
The second section addresses the controversial but effective use of cannabinoids for cancer and chemotherapy symptoms. Although clinical trials are difficult to conduct because of the political and social stigma of this class of drugs, this review provides evidence of the efficacy of cannabinoids for treatment of pain and nausea. The last section addresses the mind-body connection, with a focus on the negative emotions patients with cancer often experience.
This section assesses the literature regarding mindfulness-based programs to improve cancer-related stress. These three topics may appear unrelated, but all address one common goal: treating the body and the mind to optimize quality of life during and after cancer therapy.
Chemotherapy-Induced Peripheral Neuropathy
The only thing good thing about CIPN is that it indicates maximal tolerance of the organism and might be good for outcomes; median overall survival of patients with pancreatic cancer in a nab-paclitaxel trial who developed grade III versus grade 0 CIPN was 15 months compared 6 months (HR 0.33; p < .0001).
First, take CIPN seriously. It occurs in 30% to 40% of people receiving platinums, taxanes, proteosome inhibitors, and an ever-increasing number of drugs. Sensory neuropathy may be worse in black or African-American women.
Only recently have we recognized the phenomena of “coasting,” wherein the damage may continue for months after the treatment ends, especially after treatment with oxaliplatin or cisplatin.
1. As our patients live longer, it is paramount that we seek ways to optimize quality of life through management of common side effects, such as chemotherapy-induced peripheral neuropathy, use of emerging and effective therapies, and recognizing the mind-body connection and integrating mindfulness-based programs with standard therapy.
2. Peripheral neuropathy is a common side effect of multiple cancer therapies but may be minimized or prevented by exercise, cold wraps, and emerging drugs that protect the mitochondria.
3. Drugs such as duloxetine, opioids, certain anticonvulsants, and menthol, as well as newer therapies such as neuromodulation, may treat existing chemotherapy-induced peripheral neuropathy.
4. Although commercially available dronabinol is not superior to other antiemetics and oromucosal nabiximols is not very effective for treating cancer pain, cannabis has been shown to be effective for treating pain and may help patients reduce opioid intake.
Mindfulness-based programs have been shown to decrease stress and anxiety in patients with cancer and to decrease cortisol and cytokine levels associated with stress.