Drug Holiday: A Double-Edged Sword?

Adverse effects or toxicities are an inherent aspect of many cancer treatment modalities, notably chemotherapy and immunotherapy. The severity of these side effects can vary significantly from one individual to another. Despite this variability, patients typically undergo cycles of treatment accompanied by tumor response assessments. These assessments inform healthcare professionals' decisions regarding the subsequent course of action, which may entail a drug holiday, maintenance therapy, or initiation of second or third-line treatments. 

Following an initial treatment phase, patients whose condition exhibits stability may be granted a temporary respite, commonly known as a "holiday." Conversely, individuals requiring ongoing medical attention to bolster their chances of survival may be recommended maintenance therapy. It is imperative to recognize that discontinuing certain medications or treatments can pose risks, and opting for a treatment break, while potentially enhancing quality of life, may carry its own set of potential hazards.

Engaging in open dialogue with one's cancer care team is paramount. Patients are encouraged to candidly discuss their reasons for considering a drug holiday, as well as any associated concerns or apprehensions. In turn, healthcare professionals will leverage their expertise and insights into the patient's unique circumstances to provide tailored recommendations and guidance.

Maintenance therapy, whether immune- or chemotherapy-based, serves as a seamless extension of initial treatment to delay cancer progression. Throughout maintenance therapy, patients benefit from ongoing monitoring by their cancer care team, ensuring prompt detection of any signs of disease advancement.

In contrast, patients opting for treatment holidays risk overlooking symptoms of disease progression, potentially delaying the initiation of second-line therapy. Additional research underscores that patients adhering to maintenance therapy enjoy prolonged periods of progression-free survival compared to those taking drug holidays.

Related: Maintenance Therapy in Lung Cancer: Who, What, Why, When, How

When considering a treatment holiday, it is essential to approach the decision thoughtfully and keep several factors in mind. While a treatment hiatus can offer much-needed respite for both body and mind, remaining vigilant and mindful of potential risks is paramount. Your cancer care team will play a crucial role in evaluating whether a treatment break is appropriate and guiding you on how to navigate it safely and effectively. Below are some questions to discuss with your doctors. Remember, taking the time to make informed decisions can significantly impact your outcomes.

• How long can I safely pause medication?
• What methods can I employ to monitor for cancer recurrence?
• How will the stability of my disease or cancer progression be monitored?
• Are the benefits of a treatment holiday worth the associated risks?
• When should I schedule follow-up tests or visits to assess disease progression?
• What symptoms should I be alert to that may signal a recurrence or progression?
• What is the plan for resuming treatment?

It is important to note that a treatment holiday may not be suitable for all cancer patients. The decision should be based on individual factors, including

• the type of cancer,
• long-term treatment objectives
• disease stability, patient's performance status
• treatment history, and patient preferences.

Close communication between you and your cancer care team throughout this process is vital to ensuring the best possible outcome. Additionally, involving your caregivers in discussions about the risks and benefits of treatment holidays can provide valuable support and perspective.

Read next: Monitoring Therapy Response and Progression Of Lung Cancer