According to an investigation published in the Journal of the National Cancer Institute, immunotherapies and targeted therapies (anti-neoplastic agents) specifically target signaling pathways in cancer cells. However, in about 20% to 50% of cancer patients they are linked to thyroid dysfunction which can result in adverse effects on patients’ quality of life.
New antineoplastic agents that prevent specific cellular processes to restrict the growth of cancer cells have been introduced over the past twenty years. However, a few of these agents can cause thyroid dysfunction, which, due to the complexity of the clinical picture in individuals with cancer, are often overlooked by physicians. Thyroid dysfunction symptoms, such as loss of memory, fatigue, weakness, cardiovascular effects and depression can be mistakenly associated to the primary disease. If thyroid dysfunction is under-diagnosed it can cause adverse effects on the quality of life of the individual.
Ole-Petter Riksfjord Hamnvik, M.D., of the Division of Endocrinology, Diabetes, and Hypertension at Brigham and Women’s Hospital in Boston, and team analyzed reports on thyroid dysfunction in individuals with cancer in order to get a better understanding of thyroid-related adverse effects of antineoplastic agents. They discovered that there are no known methods that stop patients who are receiving these agents from developing thyroid disease. In addition they found that potential measures to prevent thyroid disease may actually be more toxin than the disease itself. According to the investigators screening for the disease is most likely beneficial, but they noted that out of the reports they reviewed there were no screening recommendations for individuals who were asymptomatic. In this review however, researchers offer their own suggestions for patients depending on the abnormality pattern with each agent and also recommend to monitor thyroid functions tests in clinical trials of antineoplastic agents.
In addition they suggest that several areas need to be researched i.e., understanding the biological effects of the antineoplastic agents on the thyroid, in order for them to be able to identify potential strategies to prevent and improve the proposed screening strategies. In addition they suggest that large randomized clinical trials of screening and treatment of thyroid disease need to be conducted so that they can assess the improvements in fatigue and quality of life of the patients, and to assess the unexpected effects of cancer outcomes.
They explain: “Treatment for thyroid diseases is safe and likely to enhance patient quality of life, as well as potentially allow effective treatments for the underlying cancer to continue.” Noting that there are several levels of uncertainty and that the majority of the data are derived from small prospective studies, laboratory-based investigations, or case reports or case series. They suggest patients receiving these agents should be closely monitored. “This may allow early recognition and treatment of thyroid disease, allowing continued treatment of the underlying cancer, as well as improving the quality of life of the patient.”
Written by Grace Rattue