Lynne I. Wagner, PhD

Cognitive impairment, including memory loss, inability to concentrate, and difficulty multitasking, has become a widely recognized possible late effect of chemotherapy and cancer treatment.

Dermatologic toxicities associated with EGFR inhibitors can have a profound impact on patients' health-related quality of life (HRQL) and may interfere with treatment adherence. We interviewed 20 patients and 12 expert clinicians to identify the most bothersome aspects of dermatologic toxicities to better understand the impact on patients' HRQL. Patients and expert clinicians reported that dermatologic toxicities have an impact on patients' physical, functional, emotional, and social well-being. Patients identified the physical discomfort as having the most impact on their HRQL, specifically the sensations of pain, burning, and skin sensitivity. Patients experienced worry, frustration, and depression because of their dermatologic symptoms and reported withdrawing from social activities. Cognitive behavioral strategies such as guided imagery and symptom reframing (eg, rash means treatment is working) may provide patients with valuable skills for the management of this physical discomfort. Cognitive behavioral strategies may also be useful in helping patients manage anxiety and depression associated with any changes in their social function caused by skin rash, as well as distress associated with having a cancer diagnosis.

Fatigue, the most common symptomreported by people withcancer, is associated with functionalimpairments and decrements inquality of life. As Drs. Lipman andLawrence have pointed out, researchon the etiology of cancer-related fatigueis scant. Morrow et al[1] conducteda detailed review of theevidence to support four hypothesesfor cancer-related fatigue and highlightedindependent findings that implicatecytokines, 5-HT, and thehypothalamic-pituitary axis in the developmentof cancer-related fatigue.Additional research is needed in thisarea to articulate the pathophysiologyof fatigue and the associated clinicalimplications.