The changeable nature of patients' fears regarding chemotherapy: Implications for palliative care

The side effects of chemotherapy are feared by cancer patients as they begi n their treatment In this study, we investigated patients' anticipatory fea rs about chemotherapy. We then re-assessed these fears three to six months after the initial interview for patients who received chemotherapy during t hat time. We also examined symptom distress at these intervals. Hair loss, vomiting; infection, nausea, and weight loss were ranked as the most feared side effects of cancer treatment for the group as they began treatment. Pa tients beginning chemotherapy endorsed frequent or intense levels of fatigu e, worrying about the future, pain, and sleep problems. No differences were found in the reporting of symptoms based on gender, age, or educational le vel. While changes in symptom distress over the study period were unremarka ble, changes in fears about chemotherapy were of interest. The most feared symptoms were re-ordered following the treatment experience. The endorsemen t of nausea and vomiting; alopecia, and loss of appetite decreased signific antly. Thirty-five percent fewer chemotherapy patients reported vomiting as one of their most feared side effects; 45% fewer patients who received ant i-emetics reported vomiting as one of their most feared side effects. Effec tive treatments, such as those that have been developed to treat acute chem otherapy-related emesis, can relieve the fears of patients on treatment. We conclude that patients' fears about treatment are fluid and malleable. Pat ients' fears of suffering related to chemotherapy treatment change in respo nse to the provision of adequate management. We discuss the implications of these findings for palliative care education. (C) U.S. Cancer Pain Relief Committee, 2001.