Every medication carries the potential for side effects, and in the medical field, it’s often joked that if the FDA had existed during the development of aspirin, it might not have received approval due to its potential side effects. In the realm of oncology trials, we employ a severity rating system known as the Grade scale to assess toxicities. This scale helps us gauge whether a patient should modify or discontinue their treatment. The Grade scale consists of five points, ranging from mild toxicities to life-threatening ones.
I explain this grading system to patients using a two-fold approach:
Mild to Moderate Toxicities (Grade 1 or 2):
If, for example, I have a headache and I take Advil, which later upsets my stomach, but I’m willing to take another Advil later, we categorize this as a Grade 1 or 2 toxicity. It’s a real side effect, but it’s typically not severe enough to warrant discontinuing the medication. It might cause discomfort, but it won’t discourage me from using Advil again.
Severe Toxicities (Grade 3 or 4):
Conversely, if I take Advil for a headache and it leads to severe complications like stomach bleeding, requiring hospitalization and a blood transfusion, we classify this as a Grade 3 or 4 toxicity. Such an event would understandably make me wary of taking Advil at its full dose in the future.
Patients can gauge the severity of side effects based on the context:
If you’re at home, and my nurse reassures you that a side effect is expected and manageable, it’s likely a Grade 1 or 2.
However, if you end up in the hospital due to a severe side effect, that falls into the Grade 3 or 4 category.
The actual grading system is highly intricate, encompassing every organ system. Toxicity assessment may involve blood tests or imaging in addition to evaluating how a patient feels. This complexity is crucial because it guides us in managing toxicities and setting realistic expectations for other patients.
I always emphasize the importance of honesty from patients. Neglecting a Grade 1 or 2 toxicity can lead to rapid escalation to Grade 3 or 4. Timely reporting and intervention are vital in ensuring patient safety and treatment efficacy.
About the author
Dr. Daniel Landau is a distinguished board-certified hematologist/oncologist renowned for his exceptional contributions in the field. With an illustrious career spanning across esteemed institutions like the Orlando Health Cancer Institute and the Medical University of South Carolina, Dr. Landau’s expertise shines in both genitourinary oncology and hematology. His pioneering spirit extends beyond conventional care, as he has championed the integration of advanced technology into oncology, spearheading innovative telemedicine services to elevate the patient journey.
Engage with Dr. Landau’s expertise and ignite your curiosity on “Ask MedOnCMD” as he invites you to explore the vast landscape of oncology with a fresh outlook.