Chemotoxicity in Carcinoma Breast Patients - Its Incidence and Trends in Severity - An Observational Study

Abstract

BACKGROUND Chemotherapy has improved the survival of the carcinoma breast patients. But the use of cytotoxic drugs causes multiple chemotoxicities such as nausea, vomiting, weight changes and leucopenia reducing the quality of life of the patients, thereby making the patients defaulters and thus, increasing the chances of recurrence. Very few studies were done in India where patients have different physical, mental, social & cultural characteristics that affect the response & outcomes of treatment differently. We wanted to assess the prevalence & severity of chemotoxicity in carcinoma breast patients receiving chemotherapy along with its comparison amongst commonly used regimens of chemotherapy. METHODS Fifty female patients diagnosed with carcinoma breast (excluding the ones having poor performance status, receiving chemotherapy with different regimes) were included in this single centre study. Prevalence and trends of different chemotoxicities like hair loss, nausea, vomiting, fatigue, leucopenia, thrombocytopenia, weight changes were observed using Common Terminology Criteria for Adverse Events version 4 (CTCAE V4.0) guidelines and were compared at the end of 1st, 3rd& 6th cycle of chemotherapy. Categorical variables were presented in numbers and percentages (%) and continuous variables were presented as mean ± SD and median. Qualitative variables were correlated using chi-square test / Fisher’s exact test. A P value of < 0.05 was considered statistically significant. The data was analysed using Statistical Package for Social Sciences (SPSS) version 21.0. RESULTS Hair loss was detected in 98 % of patients with increasing trend of severity; nausea & vomiting were experienced by 100 % & 54 % respectively, with decreasing trend of severity. One patient suffered with extravasation of chemotherapeutic drug, 52 % of patients had nail changes with non-significant trend in severity, 24 % patients experienced weight gain while rest had weight loss. All of the patients experienced varying grades of fatigue with increasing trend of severity. Leukopenia was seen single or multiple times (21 times) amongst 16 patients during chemotherapy, while thrombocytopenia was observed 22 times among 15 patients. There was no prevalence of neuropathy, cardiotoxicity, and oral ulcers; also, there was minimal prevalence of severe grades of chemotoxicity with no life-threatening event. CONCLUSIONS Hair loss and nausea were seen with increasing and decreasing tendency respectively. No particular regimen was found to be more toxic or safer than the other. With the prevalence and severity trends, patients can be counselled properly regarding chemotoxicity and prepared for these adverse effects. This would have lesser impact on the quality of life. KEY WORDS Chemotherapy, Chemotoxicity, Alopecia, Nausea, Vomiting, Fatigue, Leukocytopenia, Thrombocytopenia, Carcinoma Breast