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Reducing the toxicity of cancer therapy: recognizing needs, taking action

Nature Reviews Clinical Oncology volume 9, pages 471–478 (2012)Cite this article

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Abstract

Our understanding of the biology of cancer and the application of this knowledge to cancer treatment has greatly outpaced what we know of the biology underlying the symptoms and toxic effects that therapies produce. These adverse effects of therapy cause substantial discomfort and distress to patients and their families, limit treatment tolerability and can persist indefinitely in post-treatment survivorship. Despite these concerns, little research effort is targeted at documenting the nature of these effects. Similarly, limited efforts are being made in the drug-development arena to identify or develop treatments that might prevent or reduce toxicities. A panel of clinicians and researchers as well as representatives from advocacy groups, federal agencies and the pharmaceutical industry was convened to identify gaps in cancer treatment toxicity research and to provide direction for future action. With an emphasis on coordinating multidisciplinary efforts, this panel has presented a strategy to increase funding for the field and develop a coherent research agenda.

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Acknowledgements

The authors thank Tim Ahles (American Association for Cancer Research Survivorship Task Force, New York, NY, USA), Ann O'Mara (National Cancer Institute [NCI], Bethesda, MD, USA), Jamie H. Von Roenn (ASCO, Chicago, IL, USA), Elaine B. Yu (Genentech, San Francisco, CA, USA) and Nora Janjan (National Center for Policy Analysis, Dallas, TX, USA) for their insightful comments during the drafting of this article. We also acknowledge Jeanie F. Woodruff for editorial assistance, and M. Catherine Rodgers for administrative assistance (both at The University of Texas MD Anderson Cancer Center, Houston, TX, USA). The authors wish to acknowledge the overall contribution of those who participated in and contributed to the March 2011 colloquium entitled Developing Strategies for Reducing Cancer Treatment-Related Toxicities and Symptoms in Houston, TX, USA: Lyndah K. Dreiling (Amgen, Thousand Oaks, CA, USA), Marilee Duffield (Alere Health, Marietta, GA, USA), Robert F. Gagel (The University of Texas MD Anderson Cancer Center, Houston, TX, USA), Mark Gorman (National Coalition for Cancer Survivorship, Silver Spring, MD, USA), Amy Guo (Novartis, East Hanover, NJ, USA), Carol A. Hahn (American Society for Therapeutic Radiation Oncology, Durham, NC, USA), Joan S. McClure (National Comprehensive Cancer Network, Fort Washington, PA, USA), Andrew Miller (Lance Armstrong Foundation, Austin, TX, USA), Scarlott K. Mueller (Oncology Nursing Society Foundation, Pittsburgh, PA, USA), Robert Z. Orlowski (The University of Texas MD Anderson Cancer Center, Houston, TX, USA), Lorna Patrick (NCI, Rockville, MD, USA), Ellen B. Smith (Texas Oncology, Austin, TX, USA), Mark Stephens (National Patient Advocate Foundation, Washington, DC, USA), Steve G. Waguespack (The University of Texas MD Anderson Cancer Center, Houston, TX, USA), Robert A. Warriner III (patient advocate and Diversified Clinical Services, Spring, TX, USA) and Armin D. Weinberg (Baylor College of Medicine, Houston, TX, USA). Funding support for the meeting was provided by the C. Stratton Hill Colloquium on Pain and Its Relief. The opinions expressed in this article are those of the panellists and do not constitute a policy position of the NIH, National Cancer Institute, US Department of Health and Human Services or the US government.

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Authors and Affiliations

  1. Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, 77030, TX, USA

    Charles S. Cleeland

  2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, 77030, TX, USA

    Zhongxing Liao

  3. Friends of Cancer Research, 2231 Crystal Drive, Suite 200, Arlington, 22202, VA, USA

    Jeff D. Allen & Samantha A. Roberts

  4. Symptom Management and Drug Development, Community Oncology and Prevention Trials Research Group, National Cancer Institute, 6130 Executive Boulevard, EPN 2013, Rockville, 20892, MD, USA

    Joanna M. Brell

  5. Adult Bone Marrow Transplant Service, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, Box 235, New York, 10065, NY, USA

    Sergio A. Giralt

  6. Research, Metabolic Disorders, Amgen, 1120 Veterans Boulevard, San Francisco, 94080, CA, USA

    Aarif Y. Khakoo

  7. Quality of Life and Survivorship, American Cancer Society, Inc., 901 East Street NW #500, Washington, 20004, DC, USA

    Rebecca A. Kirch

  8. Office of Hematology Oncology Products, Center for Drug Evaluation and Research, FDA, WO 22/Room 2212, 10903 New Hampshire Avenue, Silver Spring, 20993, MD, USA

    Virginia E. Kwitkowski

  9. Pfizer Medical Affairs, Pfizer Inc., 235 East 42nd Street, New York, 10017, NY, USA

    Jamey Skillings

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Contributions

All authors participated in the colloquium, contributed to the discussion of the article content and took part in the initial drafting of the article, after which C. S. Cleeland and S. A. Roberts wrote the full manuscript. All authors edited the manuscript before submission.

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Correspondence to Charles S. Cleeland.

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Competing interests

C. S. Cleeland has acted as a consultant or advisor for Abbott, Amgen, Bristol–Myers Squibb, Exelixis, Genentech and Pfizer and has received research funding from AstraZeneca. S. A. Giralt has acted as a consultant or advisor for Celgene, Novartis and Millennium and has received funding from Celgene. A. Y. Khakoo is employed by and owns stock in Amgen. J. Skillings is employed by Pfizer. The other authors declare no competing interests.

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Cleeland, C., Allen, J., Roberts, S. et al. Reducing the toxicity of cancer therapy: recognizing needs, taking action. Nat Rev Clin Oncol 9, 471–478 (2012). https://doi.org/10.1038/nrclinonc.2012.99

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