Adjusting Chemo to Mitigate Side Effects

But anyone who’s been through a round or two of chemo will tell you the treatment is not without its fair share of unpleasant side effects. Carboplatin or cisplatin with Taxol can cause symptoms that vary from patient to patient, ranging from mildly irritating to outright intolerable.

The most common chemo side effects include fatigue, anemia, nausea, heavier bleeding, increased risk of infection, and neuropathy, which is a tingling or loss of feeling that usually begins in the fingers or toes. Some women may find that these side effects become especially difficult to manage, and at a certain point, your quality of life can start to suffer. If these side effects (“toxicities,” in oncologist-speak) get bad enough, it might become necessary to adjust the chemotherapy dose. If, for example, your neuropathy is making it difficult to walk because you can’t feel the ground beneath your feet, or your blood cell counts have dropped too low for your body to fight potentially dangerous infections, your gynecologic oncologist may prescribe a chemo dose reduction or dose delay.

Dr. Leslie Boyd, a gynecologic oncologist at NYU Langone Health, says the idea of receiving a lower chemo dose often makes women anxious. Patients may fear that a lower dose won't be as effective, or that their cancers will be more likely to come back.

But Dr. Boyd says chemo dose adjustments are actually highly common, and that they shouldn't be a cause for worry.

That's because the listed dosethat is, the dose that oncologists usually prescribe at firstis based on testing in real patients under real circumstances. During clinical trials, women treated with chemotherapy also experienced side effects, and they too had to lower their doses.

"The results that are given are not just for the patients who got all the chemotherapy," Dr. Boyd says. "It's for everyone." The clinical trials that initially found these drugs effective in treating ovarian cancer included many women who did not end up getting 100 percent of the listed chemo dose. Many women in the clinical trials experienced side effects that required dose reductions or dose delays, and yet overall, the drugs still led to promising results.

"That's what we expect with treatment," Dr. Boyd says. "And it's not anything to be worried about.”

If the idea of lowering or delaying your chemo dose has you worried about results, it can help to remember that no two cancers are the same. Every woman is different, and it can sometimes take a few tries to find the exact dose that’s right for you. Studies have demonstrated the need for individualized treatment plans time and againand in one study published in Gynecologic Oncology, researchers found no difference in progression-free survival or overall survival between women who required chemotherapy dose adjustments and treatment delays and those who did not.

Chemo dose adjustment or no chemo dose adjustment, the best treatment plan for your specific ovarian cancer is the one that works for you. There are many factors that go into deciding on chemo doses, surgery plans, and other available treatments, and engaging in consistent discussions with your oncologist about your treatment plan can help ensure the best possible outcomes.

Learn more about SurvivorNet's rigorous medical review process.

---