At the International Kidney Cancer Symposium (IKCS) in the USA last week, there were a couple of interesting talks about side effect management for kidney cancer treatments by two kidney cancer patients.
Kiran Virdee discussed daily living with side-effects. Discussing the side effect profile of the different treatments available for kidney cancer, and educating patients about potential side effects is important. She listed some of the more common side effects from kidney cancer treatments, as follows:
- TKIs: hypertension, diarrhoea, dermatitis, sore mouth, fatigue, and nausea
- Immunotherapy: colitis, dermatitis, itchy skin, inflammation of the lungs, problems with hormones, and inflammation of the heart
- Radiation therapy: fatigue, blood problems, dermatitis, oedema, and nausea
- Surgery: pain, wound care, and fatigue.
She also gave some tips on how to manage specific side effects, for example:
- Hypertension: accurate blood pressure monitoring, recording a daily log of readings, and understanding blood pressure parameters
- Diarrhoea: understanding your bowel movement habits, incorporating diet modification, obtaining stool samples, and taking anti-diarrhoea medication
- Dermatitis: having daily skin checks, using emollient-based creams, using topical steroids, and having a dermatology referral
- Sore mouth: review of mouth care, using steroid rinses, and understanding diet modification
- Fatigue: prioritise activities, continue doing light activity, eat a well-balanced diet, limit naps, and do relaxing activities
- Decreased appetite: have small frequent meals, schedule meals and snacks, drink fluids with calories, and having a nutrition referral.
Laura Esfeller discussed the patient perspective on side-effects and care. She started by highlighting her own patient journey, when she was diagnosed with stage 4 papillary renal cell carcinoma in 2016 at 29 years of age. Her kidney cancer was related to hereditary leiomyomatosis and renal cell cancer (HLRCC). She had a radical nephrectomy, followed by cabozantinib in a clinical trial. Her cancer was successfully treated and she has been cancer free since August 2017. Cabozantinib was stopped in April 2020 and she is now has 6-month scans.
Ms Esfeller highlighted the importance of palliative care early on and to determine what is most important to patients when dealing with side effects from treatment. Can they tolerate side effects? Also, it is important to discover barriers to successful treatment and help patients address things such as home health, work habits, and/or supportive services from social workers or therapists. Patients should be encouraged to bring a carer to all appointments, or record appointments and to refer back to the recordings later (which is less stressful than writing notes). It is crucial to create an environment of trust with the patient. The oncologist, the staff, the patient, and the carer are a team. The more the patient trusts their doctor, the more open they will be with their side effects and other quality of life outcomes.
Her take home messages were:
- A patient who feels well equipped and knowledgeable about their care is worth their weight in gold
- How you approach these sensitive conversations can be positively or negatively life-changing for them
- Make it positive!