Abstract

The last decade has seen major changes in attitudes towards the management of toxicities relating to cancer treatments. This change has partly been brought about by a realisation of the importance of survivorship as more and more of our patients are either cured or live with their cancer for prolonged periods of time. In addition, some unanticipated late toxicities have emerged. A further important change relates to the treatments themselves in that many are now delivered weekly in order to reduce toxicities or by mouth daily, and these schedules can bring their own challenges. More fundamentally, the introduction of novel targeted therapies which often have to be delivered for life, has altered our perception of the importance of particular toxicities such as fatigue and the relevance of lower grades of toxicity. The last decade has also been associated with increasing efforts to specifically research individual toxicities both in terms of their biology and management. It is no longer acceptable for cancer doctors and nurses to simply encourage their patients to bear their toxicities bravely; understanding the mechanisms of toxicities and studying interventions to alleviate them is of increasing importance. We need to re-double our efforts to find ways of reducing the impact of our treatments particularly those that are delivered for prolonged periods of time. The goal of chronic therapies should be to maintain the quality of life of our patients while controlling their disease and thus allowing our patients to live normal and fulfilled lives both at home and in the workplace.