Management of Chemotherapy Side Effects in Breast Cancer Patients
Danika Caruana, Lilian M. Azzopardi, Anthony Serracino-Inglott
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
email: danika.caruana.10@um.edu.mt
DEPARTMENT OF PHARM
ACY
UNIVERSI
TY OF MA
LTA
Department of Pharmacy
University of Malta
INTRODUCTION
AIMS
Despite its distressing side effects, chemotherapy has a substantial role in
To assess the incidence and management of FEC (a combination regimen
the management of breast cancer. Latest cancer statistics have shown a
of 5-fluorouracil, epirubicin and cyclophosphamide)–induced nausea and
marked increase in breast cancer incidence; worldwide 1 out of 4 women
vomiting (CINV), diarrhoea and oral mucositis and to evaluate patients’
diagnosed with cancer has breast cancer. 1
quality-of-life (QoL).
METHOD
Recruitment of patients
Identification of tools
University Research Ethics Committee approval was granted. Newly
diagnosed or relapsed breast cancer patients scheduled for FEC or FEC-T
Quality of Life
Assessment of side effects
were recruited from Sir Paul Boffa Oncology Hospital using non-probability
Assessment
Morrow Assessment of Nausea and
2
EORTC-QLQ-C30 V.3.0 was
Emesis (MANE)3 for CINV
assessment was identified.
chosen for quality of life (QoL)
assessment.
(usually 3 cycles FEC followed by 3 cycles docetaxel) chemotherapy regimen
convenience sampling (n=39). Informed consent was obtained from all
patients participating in the study.
Assessment tools for oral mucositis
and diarrhoea were developed and
Data Collection & Analysis
psychometrically evaluated.
Side effects assessment tools were addressed to patients following Cycle 1 and
Cycle 3 whilst EORTC-QLQ-C30 V.3.02 was addressed preceding Cycle 1
and following Cycle 3. All data collected was analysed using SPSS® v.22.
RESULTS
Assessment of QoL
A prominent decline in the patients’ daily functioning, mostly in social and
emotional functioning, in addition to a noteworthy increase in financial
burden, fatigue and insomnia was observed. These have all contributed to a
statistical decrease in the patients’ QoL (p= 0.000).
Reporting side effects
After both Cycle 1 and Cycle 3, nausea was the commonest side effect
(Cycle 1 = 26 patients; Cycle 3 = 27 patients), with an average duration of 3.81
days for Cycle 1 and 3.85 days for Cycle 3. Oral mucositis and vomiting were
Figure 1: Occurrence of side effects following Cycle 1 and Cycle 3 (n = 37)
also reported (Figure 1). No episodes of diarrhoea were reported.
Assessing Management of Nausea and Vomiting
A
discrepancy
in
the
dexamethasone
dosage
regimen
prescribed
post-chemotherapy was observed. For both Cycle 1 and Cycle 3, 13 patients
were prescribed 2mg t.d.s. while 24 patients were prescribed 4mg b.d.
(Figure 2). A Chi-square test was performed to determine whether a
relationship between the daily dose of dexamethasone prescribed and
occurrence of nausea and vomiting exists. The resultant p-value was greater
than 0.05 level of significance, hence the null hypothesis was accepted.
Figure 2: Dexamethasone dose and dosage regimen for both Cycle 1 and
Cycle 3 (n=37)
CONCLUSION
Chemotherapy side effects should never be underestimated. The high occurrence of breakthrough nausea sustains the vital need for healthcare providers to follow
recent clinical practice guidelines as well as evidence-based information. Many advances have been made in the prevention of CINV and clinical pharmacists
intervention should ensure individualised anti-emetic treatment.
Reference(s)
1. WHO International Agency for Research on Cancer. Latest world cancer statistics Press Release [Internet].Lyon: IARC;2009 [cited 2014 Jan 29]. Available from:
http://www.iarc.fr/en/mediacentre/pr/2013/pdfs/pr223_E.pdf
2. EORTC-QLQ-C30 [Internet]. Belgium: EORTC Quality of Life Department; [cited 2012 Dec 12]. Available from: http://groups.eortc.be/qol/eortc-qlq-c30
3. Morrow GR. A patient report measure for the quantification of chemotherapy induced nausea and emesis: psychometric properties of the Morrow assessment of nausea and
emesis (MANE). Br.J.Cancer.1992;66(19):S72-S74