delayed emotional recovery after taxane-based chemotherapy. Comments?

[Lani]

Cancer. 2008 Jun 2. [Epub ahead of print] Links
Delayed emotional recovery after taxane-based chemotherapy.

Thornton LM, Carson WE 3rd, Shapiro CL, Farrar WB, Andersen BL.
Department of Psychology, Ohio State University, Columbus, Ohio.
BACKGROUND: There are few patient-reported data regarding quality of life after taxane-based adjuvant chemotherapy and none regarding mental health outcomes. METHODS: This was a naturalistic, longitudinal study that used a case-control design. Data were derived from a randomized clinical trial in patients who had stage II/III breast cancer (N = 227). Paclitaxel (Taxol) was approved for use midway during the accrual period (1994-1999). Patients who received taxanes as part of their adjuvant chemotherapy (the taxane group; n = 55) were matched with patients receiving regimens without taxanes (the no-taxane group; n = 83) on trial arm, lymph node status, surgery type, menopausal status, and partner status. Mixed-effects models tested for group differences in nurse evaluations of patients' symptoms and Karnofsky performance status and in patient-reported quality of life (the 36-item Medical Outcomes Study Short Form) and emotional distress (Profile of Mood States; Center for Epidemiological Studies Depression scale). RESULTS: As expected, patients in the taxane group experienced significantly higher rates of selected toxicities, including arthralgia/myalgia (45% vs 26%) and ataxia (20% vs 5%). Patients in the taxane group also had significantly worse emotional distress and mental quality of life throughout adjuvant treatment. Rates of probable clinical depression also were high. In contrast, these outcomes were improving for patients in the no-taxane group (all P < .023). Emotional recovery for patients in the taxane group required 2 years on average versus 6 to 12 months for patients in the no-taxane group. During Years 3 through 5, the groups had similar outcomes. CONCLUSIONS: These data suggested that taxane-based chemotherapies confer risk for significant psychological symptoms. Depression, in particular, should be monitored. Cancer 2008. (c) 2008 American Cancer Society.
PMID: 18521922 [PubMed - as supplied by publisher

[StephN]

This is interesting.

I assume that the taxane was for 4 rounds in adjuvent.

What about those of us, like me, who have to take much more for our mets. I had 27 weekly treatments. But I also had the "lift" of knowing that the treatment was working against my mets, and that I might nor die after all!

But some long term after effects are still with me. One is that I have no deep tendon reflexes left and have lots of cramping of hands, legs, feet as nerves try to repair.

As for emotional consequences, it is more like a double-edged sword. The underside of the sword being another recurrence. Hard to say what is due to the taxanes and what is due to the toll of "life in general."

[Donna]

Interesting question - I got very depressed and weepy during the last part of my Taxol treatment - had been very upbeat and positive until then, my Dr. was very alarmed by the change in my attitude. I have been on Effexor ever since and that handled it, but I wonder if it was the Taxol that darkened my mood?????

Provocative for sure.

Donna

[DonnaD]

Many of us will find comfort in this article. It may help explain the down times we have/had or is it as Steph says "life in general"?

[TSund]

Steph, does anything help the cramping? I've seen Ruth's fingers/hands suddenly lock, and she's gotten charlie horses in her legs/feet for the first time in her life. I suspect this is related?

On the postive side, evidence keeps showing that the taxanes are an important element of treatment.

[Alice]

This is very interesting. I am 2 1/2 years out of therapy with Taxol and I feel just recently that my mood is getting better. I just thought I might be crazy for feeling this way after making it through. I also have a lot of trouble with arms, hands, legs and feet. My neurologist said after this amount of time it is what I can expect to stay. Small price for a future in my opinion.

[fauxgypsy]

I, too, am having problems with cramping. At first they attributed it to low potassium levels, but even when my potassium and magnesium levels are normal, I have times when my legs, feet, and sometimes my hands cramp so much and so often. My oncologist does not even attempt to explan it.

As far as mood, I have times that I am so down. But I always have, so it is hard for me to tell if this is something different or not. I do think that it is worse. I just put it down to "life in general". Femara, and to a lesser extent, Arimidex do affect my moods. I had to quit taking Femara. I am looking forward to being through with the Herceptin. I feel worn down after a year and a half of chemo, surgery, and Herceptin. I am hoping that I will start to bounce back soon. My immune sytem is weak and I keep getting one thing after another.

It is good to think that some of the depression is caused by the Taxol, because that means there is more light at the end of the tunnel and it is not a train. ;)

Leslie

[Sheila]

I too am very interested in this, seeing as how I just had 10 months of Taxol, took 2 months off and am back on it again....maybe this will explain my mood swings that my husband just doesn't understand. I can cry at the drop of a hat

[Paris]

I was on taxotere and had really bad mood swings when I finished it. I would burst into tears several times a day at the littlest thing. I thought it was hormones but reading this study maybe it wasn't? I took zoloft which definitely "leveled" me out and I got off of it this past January.

I definitely feel arthritic. My left hand hurts when I try to pick things up and hold them, I creek in the morning and I have on and off nerve pain in my arm. My onc. says it's typical and hopefully by this time next year I will be feeling better. I sure hope so. I'm too young to feel old!

I pray for the day when there is a drug that wipes out cancer permanently with no side effects.

[Mary Anne in TX]

Kinda like being a rusty ol' robot with attitude! ma

[LAURIE]

I know anxiety and depression go hand and hand. I have a super increased anxiety level, after finishing Taxol.

[tricia keegan]

I too have had a lot of physical effects including neuropathy which my onc feels is from the taxol.
I had it weekly for twelve weeks and definatly noticed a depression and change of mood from about the sixth week onwards.
Thankfully the depression cleared over the months after I finished and did'nt last but just wish the physical side effects had done the same!

[jones7676]

I have been having a terrible time with depression the last two - 3 months.....perhaps I've found an explanation. I was blaming it on winter, cancer etc. I have not been this down and out in years... I also have a lot of odd nerve problems (my should likes to go numb when I sit in the recliner too long, hand goes numb if I lay my head on it too long etc.) All I know is I was beginning to think I'm going crazy. Perhaps there is a scientific explanation!

[westswon]

Wow.. that explains alot.. yesterday I told the radiologist that I wanted a support group named: Lopsided--Tired of Pink--and Pissed. I thought it was the Herceptin but since Taxotere damn near killed me I now understand the moods better. Also, I find that during the second week after Herceptin my arches and calves cramp like crazy... thanks for the info! westswon

[chicagoetc]

Thanks, Lani. The info helps. I am a few weeks out from Taxol...and it helps to think that being depressed at this point is a normal response [along with the assorted other symtoms/responses]. Maybe anxiety too? Two years sounds like a long time...or maybe not in the long run. Melanie

[harrie]

Towards the end of my taxotere txs, I remember having these fleeting feelings of what could have been a mild case of depression. Was hard to put my finger on being that I never really experienced depression before....crabbiness, irritability...oh yes, I've had THAT before chemo, but depression I can't really say I had. The feeling I had post chemo was different and it may have been some depression. I think maybe it came and went for a few wks post chemo.
Now I am just back to my normal crabby self every so often with no signs of depression!

[NanaKaren]

How nice to have a reason for all the emotions. Seems like I cried even if the wind blew. My husband would try to comfort me and say, "Honey look what you have just been through". It did comfort me, but sometimes didn't help. I am just a little over 2 years out and I can say, thanks Lani. The article explains alot. Thanks, NanaKaren