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machado: will 'symptom science' make it easier to live with cancer?

understanding what causes side effects, who is most likely to develop them and how severe they will be can make a huge difference in the quality of life of people living with cancer.

it's a sad irony that ripples through all cancer types: people on life-saving therapies that have such negative impacts on their lives that they would rather die. getty
when a prince edward island man living with a rare blood cancer sent a note last year to say he had decided to stop taking his medication — the medication that was keeping his cancer in check — because he couldn’t live with the side effects anymore, there were many people in the leukemia community who were shocked. “we are so lucky to have a medication that has saved our lives, why would you choose to die?” was one facebook post from someone who had been living with blood cancer for more than a decade.
certainly on the surface, such a decision — one surely not made easily — seems bananas. choosing death, an agonizing one at that, instead of life? but when the man described in detail the things that plagued him everyday, including, bone pain, anxiety, nausea, diarrhea, vomiting, muscle spasms that made it impossible to type on his phone, brain fog, headaches and fatigue (especially the fatigue! he had written in big letters) — all things that had turned a very social social life into one that was darkly reclusive and lonely — it’s not so difficult to see how extending life would suddenly lose its appeal.
it really stinks, actually. there you are going along in your life when you and your body come under siege by a brutal, unforgiving disease offering worrying clues, determined to take you down with painfully unrelenting symptoms. then, you experience the joy and relief of finding out that there is a medicine to chokeslam it. except that while said battle is raging inside you then — and for a long time afterwards — many of the awful symptoms that led you to the treatment in the first place don’t disappear. in fact, they get worse, piggybacking on a whole slew of other unpleasant things that make living through it, and with it, seem impossible, or worse, unwanted.
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it’s a sad irony that ripples through all cancer types — people with access to life-saving therapies that have such negative and life-changing impacts on their lives that they would rather die. in fact, it’s so pervasive that researchers at oregon health & science university (ohsu) have created a symptom science research group, running clinical trials to study what causes these symptoms and side effects and identify biomarkers that predict treatment toxicity to improve quality of life for people with cancer. 
“it’s easy for an oncologist to stand at a podium and say that an exciting new drug was ‘well-tolerated,’ but i can tell you that people experiencing even low-grade symptoms over time would not agree,” medical oncologist dr. eric roeland, an associate professor of medicine in the ohsu school of medicine, told ohsu news. he added that while new cancer therapies are urgently needed, so is figuring out how to make them easier to live with. 
it’s something that has long been left in the laps of patients who grapple with being torn between gratitude for treatment and the grief of all that the side effects steal from them. and while doctors often try to ease symptoms like diarrhea, vomiting, pain and nausea with additional medication, management and prevention of these and many other life-affecting side effects is largely a big unknown.
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the ohsu group is taking on some of the big ones, like chemo-induced peripheral neuropathy (a nerve disorder that can cause weakness, numbness, pain, and tingling or a “pins and needles” feeling in hands and feet) and cachexia, which is severe weight loss and muscle wasting, hoping to figure out what determines who experiences what and to what degree. for example, is a man more likely to experience neuropathy than a woman? they also want to know how side effects change over time so that doctors can intervene before they get worse. but perhaps even more promising is that instead of using clinician feedback, which is typical, the researchers are documenting real-life insights from patients on how they are feeling, their symptoms and the effect of those symptoms on quality of life.
hallelluja. imagine, asking patients about their side effects directly — the ones who have the most intimate knowledge of them — instead of relying on a clinician’s perspectives, observations and best guesses. it’s brilliant, really. (eyeroll.)
the ohsu project comes at the same time as former premier of queensland, australia anna bligh is speaking out about how cancer-related fatigue impacted her life after being diagnosed with non-hodgkin lymphoma in 2013. bligh, recently named national ambassador of the leukaemia foundation, has spoken publicly about how fatigue was not a side effect or symptom that was spoken about during her diagnosis or treatment, and that she was unaware of the huge impact it would have on her life, even after she reached remission. certainly, if i had a dollar for every time i heard a doctor say to a room full of cancer patients that the cure for fatigue was to get more sleep … well, you get the idea.
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that cancer-related fatigue as being nothing even close to a “healthy” person’s tiredness, what with its tendency to weigh down limbs, make thinking coherently a monumental task and getting dressed an accomplishment, has made it into the press is a small victory for patients who struggle each day with these very things. it also highlights the value of symptom science so that we can not only figure out the why and how of side effects and symptoms, but also learn how to manage — even eliminate —  them so that every person with cancer gets the quality of life they deserve.
hopefully, we can make this happen in time to change the mind of the man in prince edward island.
lisa machado is executive producer of healthing’s advocacy & better health. she can be reached at lmachado@postmedia.com.
lisa machado
lisa machado

lisa machado began her journalism career as a financial reporter with investor's digest and then rogers media. after a few years editing and writing for a financial magazine, she tried her hand at custom publishing and then left to launch a canadian women's magazine with a colleague. after being diagnosed with a rare blood cancer, lisa founded the canadian cml network and shifted her focus to healthcare advocacy and education.

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