How to manage emotional side effects of Phesgo (pertuzumab and trastuzumab)

Managing Emotional Side Effects of Phesgo (Pertuzumab and Trastuzumab)

Emotional side effects of Phesgo should be addressed through empathic communication, acknowledgment of patient emotions, and supportive interventions, with consideration for referral to mental health services when symptoms are severe. 1

Understanding Emotional Side Effects of HER2-Targeted Therapy

Patients receiving Phesgo (fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection) may experience various emotional side effects as part of their treatment journey. While the clinical trials and drug information focus primarily on physical side effects, emotional distress is a common experience that requires proper management.

Common Emotional Side Effects

• Anxiety related to treatment administration
• Distress about diagnosis and prognosis
• Emotional reactions to physical side effects (fatigue, asthenia)
• Treatment-related mood changes
• Emotional burden of cancer diagnosis compounded by treatment effects

Management Approach

1. Empathic Communication

• Acknowledge and name emotions when patients display them through verbal or nonverbal behavior 1
• Use supportive statements such as "I know this treatment can be challenging" or "Help me understand how you're feeling about the treatment" 1
• Avoid providing complex information when patients are in a highly emotional state, as they may have difficulty processing it 1
• Ask patients about their specific concerns (e.g., "What worries you most about this treatment?") 1

2. Patient Education

• Provide clear, jargon-free information about expected side effects of Phesgo 1
• Use simple language tailored to the patient's educational level 1
• Check for understanding using "teach back" methods 1
• Reassure patients about availability to answer questions in the future 1

3. Supportive Interventions

Psychoeducational Approaches

• Provide education regarding stress management and healthy living (nutrition, exercise) 1
• Offer specific information about managing emotional responses to treatment 1

Psychotherapy Options

• Consider supportive psychotherapy to flexibly meet patients' changing needs 1
• Supportive-expressive group therapy has been shown to improve mood in patients with metastatic breast cancer 1
• Meaning-centered group psychotherapy can reduce psychological distress in patients with advanced cancer 1

4. Special Considerations for Older Adults

Since more than 70% of all cancers are diagnosed in adults aged 65 years or older 1, special attention should be paid to this population:

• Older adults (≥65 years) receiving pertuzumab and trastuzumab may experience more frequent side effects including fatigue, decreased appetite, and asthenia compared to younger patients 1
• These physical symptoms can contribute to emotional distress and should be addressed proactively
• Dose adjustments may be needed more frequently in older adults, which can help manage both physical and emotional side effects 1

When to Consider Additional Support

Referral to Mental Health Services

Consider referral to mental health professionals when:

• Emotional distress persists despite supportive interventions
• Patient shows signs of clinical depression or anxiety
• Emotional symptoms interfere with treatment adherence
• Patient expresses interest in additional psychological support

Family and Couples Therapy

• Cancer diagnosis causes distress in partners and family members as well as the patient 1
• Family or couples therapy may be beneficial when the emotional impact affects relationships 1
• Training in constructive communication can be an effective intervention for couples 1

Monitoring Approach

• Regular assessment of emotional well-being at each visit
• Use open-ended questions to encourage expression of feelings
• Monitor for changes in mood, sleep patterns, and social functioning
• Assess impact of emotional side effects on treatment adherence and quality of life

Practical Tips for Clinicians

• Allow adequate time for patients to express emotions during appointments
• Be cautious about providing new information when patients are in a highly emotional state 1
• Create a private, comfortable environment for discussions about emotional concerns
• Document emotional side effects and responses to interventions to track patterns over time
• Consider the timing of discussions about emotional side effects (early in the appointment rather than at the end)

By implementing these strategies, healthcare providers can effectively manage the emotional side effects of Phesgo, improving patient quality of life and potentially enhancing treatment adherence and outcomes.