How do you balance the benefits of chemotherapy with the side effects?

People are very worried about the side effects of chemotherapy. In fact, often they're more focused on the side effects than the potential benefits. The side effects traditionally included hair loss, nausea and vomiting, risk of infection, fatigue.

But the last 10 years have been exciting, not only because of better therapies, but also because of better ways of treating the side effects and supporting people through their therapy. We have much better anti-nausea medicines, for example, so vomiting has now become relatively rare. One of the things we still struggle with is fatigue. We don't have a direct way to deal with the fatigue that's common with chemotherapy. And we don't have a way to deal with the hair loss that occurs.

Then there are the life-threatening side effects that are long term, such as leukemia or heart failure. They are, thankfully, very rare. They are in many cases associated with specific drugs, and we may reserve the use of those drugs for very high-risk situations where the benefits of therapy dramatically outweigh those risks.

In the last few years, we've developed chemotherapy regimens that have fewer of these side effects and are, in many cases, shorter than traditional therapy, so the duration of these side effects can be shortened, as well.