Management practice of Hematologic Toxicities and its Determinants among Breast Cancer Patients Treated with Doxorubicin-Cyclophosphamide Followed by Paclitaxel Regimen in Cancer Centers, Northwest Ethiopia, 2022

Abstract

Abstract Background:Chemotherapy induced neutropenia, febrile neutropenia, thrombocytopenia and anemia were the common toxicities among breast cancer patients treated with doxorubicincyclophosphamide

followed by paclitaxel regimen. Those toxicities may lead to chemotherapy dose adjustment, delay and discontinuation that may compromise therapeutic outcomes. Objective:The aim of this study is to assess hematologic toxicities and its determinants among breast cancer patients treated with doxorubicin-cyclophosphamide followed by paclitaxel regimen in cancer centres, Northwest Ethiopia; 2022. Method:Retrospective cohort study was conducted on a total of 422 breast cancer patients from July,1 to August 1, 2022 and the data were collected using a systematic random sampling technique. Descriptive analysis was done. Binary and multivariable logistic regression analysis were used to assess the association between different variables. P<0.05 was used to declare the association. Paired T test was done to determine the mean difference of hemoglobin, absolute nuitrophil and platelet count before and after paclitaxel treatment. The appropriateness of toxicity management practice of neutropenia and febrile neutropenia were evaluated as per the Ethiopian standartd treatment guidline 2021 and infectious disease society of America 2010 guideline and anemia and thrombocytopenia were evaluated as per the national comprehensive cancer network 2018 and American society of clinical oncology 2017 guideline recommendation respectively. Results:Among the total 422 patients included in the study, the magnitude of neutropenia, febrile neutropenia, anemia and thrombocytopenia were 61.8%, 10%, 44.1% and 16.4% respectively. Age >43years(P=0.011) and rural residence(P=0.008) were significantly associated with neutropenia. Stage III and IV cancer(P=0.017) was significantely associated with febrile neutropenia. Mixed type histology(P=0.011), lobular type histology(P=0.014), stage III and IV cancer(P=0.010) and disease comorbidity(P=0.039) were significantly associated with anemia. Rular residence(P=0.046), age >43years(p=0.044) and stage III and IV cancer(P=0.008) were significantly associated with thrombocytopenia. There was a significant mean difference in participants absolute neutrophil, hemoglobin and platelete count before and after paclitaxel treatment. A total of 74.2% and 58% of neutropenic and febrile nutropenic patients were got inappropriate treatment as per the standard guideline set by Ethiopian standartd treatment guidline 2021 and infectious disease society of America 2010 guideline and 13% thrombocytopenic patients were received inappropriate treatment as per American society of clinical oncology 2017 guideline. Conclusion: The magnitude of neutropenia, febrile neutropenia, anemia and thrombocytopenia were relatively high. Age, rular residence, stage of cancer, comorbidity, mixed and lobular type histology were factors associated with chemotherapy induced hematologic toxicities.There was a significant mean difference in participants absolute neutrophil, hemoglobin and platelete count before and after paclitaxel treatment. Inappropriate toxicity management practice of neutropenia, neutropenic fever and thrombocytopenia were high. Clinicians should segment the patients based on their risk status and manage accordingly. Keyword: Hematologic toxicity, AC-T regimen, Breast cancer, Northwest Ethiopia