Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study

Abstract

Background. e breast cancer chemotherapy leads to diverse aspects of noxious or unintended adverse drug reactions (ADRs) that cause the relative dose intensity (RDI) reduced to below optimal (i.e., if the percentage of actual dose received per unit time divided by planned dose per unit time is less than 85%). Hence, this prospective observational study was conducted to evaluate chemotherapy-induced ADRs and their impact on relative dose intensity among women with breast cancer in Ethiopia.Methods. e study was conducted with a cohort of 146 patients from January 1 to September 30, 2017, Gregorian Calendar (GC) at the only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. e ADRs of the chemotherapy were collected using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (version 4.03). e patients were personally interviewed for subjective toxicities, and laboratory results and supportive measures were recorded at each cycle. SPSS version 22 was used for analysis. Results. Grade 3 neutropenia (23 (15.8%)) was the most frequently reported ADR among grade 3 hematological toxicity on cycle 4. However, overall grade fatigue (136 (93.2%)) and grade 3 nausea (31 (21.2%)) were the most frequently reported nonhematological toxicities on cycle 1. e majority of ADRs were reported during the first four cycles except for peripheral neuropathy. Oral antibiotics and G-CSF use (17 (11.6%)) and treatment delay (31 (21.2%)) were frequently reported on cycle 3. Overall, 61 (41.8%) and 42 (28.8%) of study participants experienced dose delay and used G-CSF, respectively, at least once during their enrollment. Of the 933 interventions observed, 95 (10%) cycles were delayed due to toxicities in which neutropenia attributed to the delay of 89 cycles. Forty-four (30.1%) of the patients received overall RDI < 85%. Pretreatment hematological counts were significant predictors (P < 0.05) for the incidence of first cycle hematological toxicities such as neutropenia, anemia, and leukopenia and nonhematological toxicities like vomiting. Conclusion. Ethiopian women with breast cancer on anthracycline-based AC and AC-T chemotherapy predominantly experienced grade 1 to 3 hematological and nonhematological ADRs, particularly during the first four cycles. Neutropenia was the only toxicity that led to RDI < 85%. us, enhancing the utilization of G-CSF and other supportive measures will improve RDI to above 85%.

Chemotherapy-Induced Toxicities and Their Associations with Clinical and Non-Clinical Factors among Breast Cancer Patients in Vietnam

“…No significant differences were observed for hematological toxicities, whether they occurred during anthracycline treatment or during taxane administration post anthracycline treatment. Our findings are in line with the previous studies and support the evidence that adding taxane (e.g., paclitaxel) sequentially to the anthracycline-based regimens does not increase the overall incidence and severity of toxicity [ 27 , 28 ].…”

“…Another study revealed a positive association between severe chemotherapy-induced toxicities and decreased creatine clearance at baseline among older patients with cancer [ 44 ]. Inconsistent with our findings, lower pretreatment blood counts (e.g., WBC, ANC) and Hgb were previously suggested to be associated with chemotherapy-induced hematological toxicities [ 27 , 36 , 45 ]. Although not confirmed, we speculate that oncologists might have considered patients’ pre-existing hematological conditions in cancer treatment.…”

Incidence, Management and Predictors of Chemotherapy-Induced Neutropenia among Adult Solid Cancer Patients at the University of Gondar Comprehensive and Specialized Hospital: A Retrospective Follow-up Study

“…Doxorubicin-cyclophosphamide, doxorubicin-cyclophosphamide followed by paclitaxel regimen, cisplatin-paclitaxel regimen, and combination treatment modality of chemotherapy, radiotherapy, and surgery was signi cantly associated with the incidence of neutropenia. The result was consistent with the studies in Denmark, Belgium, and Korea [38][39][40]. This effect was also in line with the recommendation of the National Comprehensive Cancer Network (NCCN) guideline [41].…”

Chemotherapy-Associated Nausea and Vomiting

“…Previous studies report similar levels of vomiting. [ 22 23 ] As compared to nausea, vomiting was identified more frequently in the current study although literature shows that nausea is in fact more frequently occurring,[ 22 23 24 ] further supporting the hypothesis that nausea was under-reported.…”