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CC BY 4.0 · Brazilian Journal of Oncology 2020; 16: e-20200003
DOI: 10.5935/2526-8732.20200003
Original Article
Clinical Oncology

Factors associated with chemotherapy toxicity in outpatients: a cohort study

Fatores associados à toxicidade à quimioterapia em pacientes ambulatoriais: um estudo de coorte

Inês de Oliveira Afonso Maia 
1   Instituto de Medicina Integral Professor Fernando Figueira, Clinical Oncology, Clinical Research - Recife - PE - Brazil
,
Jose Fernando do Prado Moura
1   Instituto de Medicina Integral Professor Fernando Figueira, Clinical Oncology, Clinical Research - Recife - PE - Brazil
,
José Iran Costa-Junior
1   Instituto de Medicina Integral Professor Fernando Figueira, Clinical Oncology, Clinical Research - Recife - PE - Brazil
,
Keityane Leacarla Bezerra da-Silva
1   Instituto de Medicina Integral Professor Fernando Figueira, Clinical Oncology, Clinical Research - Recife - PE - Brazil
,
Ariosto Afonso de-Morais
2   Universidade Católica de Pernambuco, Medicine Course - Recife - PE - Brazil
,
Jose Natal Figueiroa
3   Instituto de Medicina Integral Professor Fernando Figueira, Resarch Board - Recife - PE - Brazil
,
Maria de Fátima Costa Caminha
3   Instituto de Medicina Integral Professor Fernando Figueira, Resarch Board - Recife - PE - Brazil
› Author Affiliations Financial support: none to declare.
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ABSTRACT

Objectives: to identify the occurrence of toxicity associated with chemotherapy and predictors factors of hospitalization, delayed treatment, abandonment, treatment suspension or death. Methods: 126 patients with cancer were in a prospective cohort study, conducted between July/2012 and january/2013, they were interviewed before treatment and after completion of the 1st, 2nd and 3rd cycles, when clinical, demographic and laboratory data were collected. Results: 39,7% had toxicity grade = 3. The latter led to more hospitalization, suspension, delayed treatment and death ( p <0,05). Performance status 2 in cycles 1 ( p <0,001) and 2 ( p =0,025) were risk factors to the toxicity grade = 3. When studied variables prior to first chemotherapy cycle, the body surface area < 1,69 m2 was associated with the occurrence of toxicity grade = 3 ( p =0,023) and with anemia ( p =0,044) and thrombocytopenia ( p =0,006) of any grade. Creatinine clearance < 50mL/min was associated with anemia ( p =0,032), BMI < 18,5kg/m2 with thrombocytopenia ( p =0,012), lymphocytes < 1500/mm3 to leukopenia ( p =0,017), neutrophils < 3100/mm3 to neutropenia ( p =0,002) and leukopenia ( p <0,001), all of any toxicity grade. Conclusion: Approximately 40% of patients had toxicity grade = 3, motivating more hospitalization, suspension, delayed treatment and death. Performance status 2 and body surface area < 1,69 m2 were related toxicity grade = 3.

RESUMO

Objetivos: identificar a ocorrência de toxicidade associada à quimioterapia e fatores preditores de hospitalização, atraso no tratamento, abandono, suspensão do tratamento ou óbito. Métodos: 126 pacientes com câncer participaram de um estudo de coorte prospectivo, realizado entre julho/2012 e janeiro/2013, foram entrevistados antes do tratamento e após a conclusão do 1º, 2º e 3º ciclos, quando foram coletados dados clínicos, demográficos e laboratoriais. Resultados: 39,7% apresentaram grau de toxicidade = 3. Este último levou a mais hospitalização, suspensão, atraso no tratamento e óbito ( p <0,05). Performance status 2 nos ciclos 1 ( p <0,001) e 2 ( p =0,025) foram fatores de risco para o grau de toxicidade = 3. Quanto às variáveis estudadas antes do primeiro ciclo de quimioterapia, a área de superfície corporal < 1,69 m2 foi associada à ocorrência de grau de toxicidade = 3 ( p =0,023), anemia ( p =0,044) e trombocitopenia ( p =0,006) de qualquer grau. A depuração da creatinina < 50mL / min foi associada a anemia ( p =0,032), IMC < 18,5kg /m2 a trombocitopenia ( p =0,012), linfócitos < 1500/mm3 a leucopenia ( p =0,017), neutrófilos < 3100 / mm3 a neutropenia ( p =0,002) e leucopenia ( p <0,001), todas com qualquer grau de toxicidade. Conclusão: Aproximadamente 40% dos pacientes apresentaram grau de toxicidade = 3, motivando mais hospitalização, suspensão, atraso no tratamento e óbito. O performance status 2 e a superfície corporal < 1,69 m2 foram relacionados com grau de toxicidade = 3.

Keywords:

Drug-Related Side Effects and Adverse Reactions - Ambulatory Care - Antineoplastic Agents

Descritores:

Efeitos colaterais e reações adversas relacionados a medicamentos - Assistência ambulatorial - Agentes Antineoplásicos


Publication History

Received: 16 August 2019

Accepted: 13 October 2019

Article published online:
12 May 2020

© 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Bibliographical Record
Inês de Oliveira Afonso Maia, Jose Fernando do Prado Moura, José Iran Costa-Junior, Keityane Leacarla Bezerra da-Silva, Ariosto Afonso de-Morais, Jose Natal Figueiroa, Maria de Fátima Costa Caminha. Factors associated with chemotherapy toxicity in outpatients: a cohort study. Brazilian Journal of Oncology 2020; 16: e-20200003.
DOI: 10.5935/2526-8732.20200003
 

  • REFERENCES

  • BRASIL. Estimativa 2018: Incidência de Câncer no Brasil. Instituto Nacional do Câncer José de Alencar Gomes da Silva Coordenação de Prevenção e Vigilância; 2017
    Search in Google Scholar
  • Schein CF, Marques AR, Vargas CL, Kirsten VR. Efeitos colaterais da quimioterapia em pacientes oncológicos hospitalizados. Disciplinarum Scientia| Saúde 2016; 7 (01) 101-107
    Search in Google Scholar
  • Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J. et al Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer 2012; 118 (13) 3377-3386
    Search in Google Scholar
  • Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP. et al Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. Journal of Clinical Oncology 2011; 29 (25) 3457
    Search in Google Scholar
  • Jenkins P, Freeman S. Pretreatment haematological laboratory values predict for excessive myelosuppression in patients receiving adjuvant FEC chemotherapy for breast cancer. Annals of Oncology 2008; 20 (01) 34-40
    Search in Google Scholar
  • Hoff PMG, Katz A, Chammas R, Odone Filho V, Novis YS. et al Tratado de Oncologia. São Paulo: Editota Atheneu; 2013
    Search in Google Scholar
  • NCI. Common Terminology Criteria for Adverse Events (CTCAE). National Cancer Institute Department of health and human services National Cancer Institute Version 4.0 2009 U.S. May 28, 2009. (June 14, 2010); 4(3).
  • Pereira EEB, Santos NBd, Sarges EdSNF. Avaliação da capacidade funcional do paciente oncogeriátrico hospitalizado. Revista PanAmazônica de Saúde 2014; 5 (04) 37-44
    Search in Google Scholar
  • Extermann M, Boler I, Reich R, Lyman G, Brown R, DeFelice J. et al The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score: Design and validation. Journal of Clinical Oncology 2010; 28 (15_suppl) 9000
    Search in Google Scholar
  • Okino Sawada N, Nicolussi AC, Okino L, Coelho Cardozo FM, Fontão Zago MM.. Avaliação da qualidade de vida de pacientes com câncer submetidos à quimioterapia. . Revista da Escola de Enfermagem da USP. 2009;43(3)
  • Oliveira Gozzo Td, Panobianco MS, Clapis MJ, Almeida AMd. Toxicidade dermatológica em mulheres com câncer de mama submetidas à quimioterapia. Revista Latino-Americana de Enfermagem 2010; 18 (04) 681-687
    Search in Google Scholar
  • Schmidt Santos RC, Souza Dias R, Giordani AJ, Araújo Segreto R, Comodo Segreto HR. Mucosite em pacientes portadores de câncer de cabeça e pescoço submetidos à radioquimioterapia. . Revista da Escola de Enfermagem da USP. 2011;45(6)
  • Hespanhol FL, Tinoco EMB, Teixeira HGdC, Falabella MEV, Assis NMdSP. Manifestações bucais em pacientes submetidos à quimioterapia. Ciência & Saúde Coletiva 2010; 15: 1085-1094
    Search in Google Scholar
  • Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP.. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649655
    Search in Google Scholar
  • OMS. Organização Mundial de Saúde, Rede PanAmericana de Harmonização. Boas práticas de farmacovigilância para as Américas. 2011
    Search in Google Scholar
  • Oliveira Gozzo Td, Souza SGd, Panobianco MS, Moysés AMB, Almeida AMd. Ocorrência e manejo de náusea e vômito no tratamento quimioterápico em mulheres com câncer de mama. Revista Gaúcha de Enfermagem 2014; 35 (03) 117-123
    Search in Google Scholar
  • Martins AdCM, Caçador NP, Gaeti WP. Complicações bucais da quimioterapia antineoplásica. Acta Scientiarum Health Sciences 2002; 24: 663-670
    Search in Google Scholar
  • Schulmeister L. Extravasation management: clinical update. Seminars in oncology nursing. 2011. Elsevier;
    Search in Google Scholar
  • Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla J-P, Weaver C. et al Adjuvant docetaxel for node-positive breast cancer. New England Journal of Medicine 2005; 352 (22) 2302-2313
    Search in Google Scholar
  • Pozer MZ, Silva TAd, Regino PA, Fernandes Junior PC, Silva SRd. Sinais e sintomas de mielodepressão por quimioterapia no domicílio, entre portadoras de câncer ginecológico. Cienc Cuid Saude 2012; 11 (02) 336-342
    Search in Google Scholar
  • Belani CP, Fossella F. Elderly subgroup analysis of a randomized phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for first-line treatment of advanced non small cell lung carcinoma (TAX 326). Cancer 2005; 104 (12) 2766-2774
    Search in Google Scholar
  • Colorectal Cancer Collaborative Group, CRC Wessex Medical Oncology Unit, University of Southampton, Southampton General Hospital. SO16 6YD, UK Palliative chemotherapy for advanced colorectal cancer: systematic review and meta analysis. BMJ 2000; 321 (7260) 531-535
    Search in Google Scholar
  • Lamont EB, Herndon JE, JCW II, Henderson IC, Lilenbaum R, Schilsky RL. et al Measuring clinically significant chemotherapy-related toxicities using Medicare claims from Cancer and Leukemia Group B (CALGB) trial participants. Medical care 2008; 46 (03) 303
    Search in Google Scholar
  • Ellis GK, Barlow WE, Gralow JR, Hortobagyi GN, Russell CA, Royce ME. et al Phase III comparison of standard doxorubicin and cyclophosphamide versus weekly doxorubicin and daily oral cyclophosphamide plus granulocyte colonystimulating factor as neoadjuvant therapy for inflammatory and locally advanced breast cancer: SWOG 0012. Journal of clinical oncology 2011; 29 (08) 1014
    Search in Google Scholar
  • Alvarez-Cabellos R, Garcia-Carbonero R, GarciaLacalle C, Gomez P, Tercero A, Sanchez D. et al Fluorouracil-based chemotherapy in patients with gastrointestinal malignancies: influence of nutritional folate status on toxicity. Journal of Chemotherapy 2007; 19 (06) 744-749
    Search in Google Scholar
  • Ryan Aoife M., Power Derek G., Daly Louise, Cushen Samantha J., Bhuachalla E daoin Ní, Prado Carla M.. Cancer-associated malnutrition, cachexia and sarcopenia: the skeleton in the hospital closet 40 years later. Proceedings of the Nutrition Society 2016; 75: 199-211
    Search in Google Scholar
  • Hurria A, Hurria A, Brogan K, Panageas KS, Pearce C, Norton L. et al Effect of creatinine clearance on patterns of toxicity in older patients receiving adjuvant chemotherapy for breast cancer. Drugs & aging 2005; 22 (09) 785-791
    Search in Google Scholar
  • Pontes LdB, Chinaglia L, Karnakis T, Todaro J, Rodrigues HV, Souza PMRd. et al Quimioterapia em idosos: tradução do escore de toxicidade de hurria para o português. Geriatrics, Gerontology and Aging 2017; 11 (02) 76-79
    Search in Google Scholar