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Adverse ReactionsMonash University researchers are investigating the adverse drug reactions caused by cancer treatments in the hope some can be prevented. PENNY FANNIN reports. There is not much Darren McNamee wants to remember of the time two years ago he spent nine months in and out of hospital receiving treatment for non-Hodgkin's lymphoma. Mr McNamee was admitted to Melbourne's Peter MacCallum Cancer Institute a week after being taken by his wife to the Angliss Hospital. He had been receiving treatment for lower back pain, but after three litres of fluid were extracted from a collapsed lung and biopsies were taken, he was diagnosed with non-Hodgkin's lymphoma, a cancer of the lymphatic system. On his first day at the Peter Mac, Mr McNamee met Ms Phyllis Lau, a pharmacist undertaking her PhD research at the institute in conjunction with Monash University's Department of Pharmacy Practice. Ms Lau was working with Mr Michael Dooley - director of pharmacy at Peter Mac - and Dr Kay Stewart, both of whom are senior lecturers in the Department of Pharmacy Practice, to investigate the common side effects of cancer treatments. "Cancer is a common disease and a major health problem in Australia. There is a perception that side-effects and adverse drug reactions are part and parcel of living with cancer and its treatments," Ms Lau says. "The quality of life for patients is very important, but there is not a lot of evidence about the impact of adverse drug reactions on cancer patients. We wanted to see what patients were experiencing and what could be learned from that - what were the adverse drug reactions, what caused them, could you predict or prevent them and what was their impact on patients?" Although many cancer patients receive chemotherapy, they are also treated with opiates for pain and antiemetics to treat sickness. All these treatments have side effects. "A very common adverse reaction a person with cancer experiences is constipation due to strong pain killers," Ms Lau says. "Clinicians do not necessarily see it as an important event, yet patients rate constipation due to opiates as having a huge impact on their wellbeing." After interviewing 170 patients, including Mr McNamee, about the side effects they experienced from their treatment and analysing a further 503 patients' medical histories, Ms Lau found many patients rated constipation as the adverse reaction that most affected their wellbeing. Nausea and vomiting were rated second, fatigue third and hair loss fourth. "Most of the constipation could not be prevented, however the early use of simple gentle laxatives could have resulted in it being less severe," she says. "A lot of times, things like constipation are not adequately tackled until they happen." Other adverse events that patients rated as having a big impact on their wellbeing were drowsiness, anorexia, rashes, diarrhoea and mouth ulcers. Mr McNamee can still recall his litany of side effects: excruciating headaches, brittle teeth, memory loss, blood nose, constipation, diarrhoea and vomiting. "With the morphine I had hallucinations. I used to have dreams and they were so intense that I would wake up and it was as though I had really been there," he says. "And for about two weeks I was seeing coloured spots - green, yellow and black spots - before my eyes. When I had the chemotherapy treatment, I remember the side effects of that well - loss of appetite, everything tasted like cardboard, I had to force myself to eat. I lost my hair." Many of these events were caused by drugs and could have been predicted and prevented, according to the Monash researchers. Ms Lau will now use the data from this study to identify strategies specifically targeted at preventing adverse drug reactions in patients. The results of the study are already being used to improve the care of patients at the Peter Mac, she says. "We know that many of the adverse drug reactions will occur, and now that we know how they affect patients, we can look at ways of preventing them." Action box |
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