Obviously, interrupting adjuvant therapy causes a lot of worry. The decision to start this therapy was difficult; once the decision had been taken, the patient was anxious to begin; hundreds of questions were asked: What does it involve? When can we start? How long will it last? What are the side-effects? The tension was high. All of this was tolerated in order to obtain that 3% or 7% or 10% or 25% increase in the chance of being cured. But now the doctors say, “Stop, that’s it; we can’t carry on”. The frustration is great.
The decision to discontinue treatment is taken by the doctor, and it is always taken for one reason alone: reassessment of the balance between benefit and toxicity in the light of how the therapy is being tolerated by that individual patient (ADJUVANT THERAPY).
Indeed, the therapy may have caused a severe allergic reaction. Or a serious infection might have arisen because the therapy has lowered the level of white blood cells excessively and for too long. Or again, the patient might have suffered some serious event, such as a heart attack or stroke, while on therapy. In this last case, it is very unlikely that this serious event has been caused by the adjuvant therapy itself. Nevertheless, the patient’s general condition has changed, which exposes him/her to risks that are no longer proportional to the expected benefits.
There are precise international guidelines on the conditions that make it necessary to discontinue adjuvant therapy. These must be respected, even if the patient wants to carry on with the treatment.
Sometimes, however, it is the patient who wants to interrupt the therapy. The doctor sees no dangerous side-effects and the various examinations have all gone well, but after a couple of months, the patient insists on discontinuing the therapy. This happens because relatively modest side-effects of the therapy, such as vomiting, diarrhea or inflammation of the mucosa inside the mouth, may be seen by the patient as intolerable.
In the book entitled “Il male addosso”, the Italian writer Sandra Verda provides a masterful description of her experience of cancer, the treatments administered, and all the disorders she suffered during her courses of chemotherapy and radiotherapy. No oncology textbook provides such acute insight into the plight of the cancer patient.
Interrupting adjuvant therapy does not necessarily mean that no benefit has been obtained. Of course, if the therapy is discontinued during the first course, we can’t expect it to have had much effect. If, on the other hand, it is interrupted after 2 or 3 courses, it may be almost as effective as the complete program (or perhaps only slightly less so), even if only half or a third of the planned doses have been administered.