The experience of cancer might be described as a symptom continuum that begins at diagnosis, when cancer-related symptoms provide the first indication of disease, and continues throughout treatment to either death or survivorship. Morbidity from cancer-related symptoms is highly prevalent and has generally been managed by tumor eradication. Treatment of the malignancy, however, is associated with significant treatment-related symptoms and toxicities that can, in themselves, be disabling or life threatening. Typically, treatment toxicities have been managed by decreasing anticancer therapy doses or discontinuing the therapy altogether, but this approach is potentially detrimental to the patient's longevity. Now, decades after the first chemotherapies were administered, there is recognition of the need for balance between surviving the cancer and surviving the treatment.

Perhaps understandably, the primary focus in oncology drug development has been therapeutic drugs, with relatively less effort spent on supportive-care drugs. As a result, the number of approved high-impact agents for managing symptoms has not paralleled recent advances in cancer therapeutics, even though the evolution in anticancer treatments has engendered a spectrum of treatment-related toxicities. This chapter focuses on the development of specific drugs to reduce the toxicities and symptoms produced by cancer therapies. Issues in the assessment of symptoms and the measurement of response to treatment, as well as the design of symptom management trials, will be discussed.

Defining the problem

The rate of cancer survivorship in the United States is trending upward. In response to screening, early detection, and therapeutic advances, US cancer survivors numbered approximately 11 million in 2009.