ABSTRACT
Objective:Chemotherapy is the main treatment for lung cancer. However, chemotherapy-related toxicity has a high incidence, which brings adverse experiences to patients and seriously affects treatment plans and quality of life. Low skeletal muscle mass (SMM), malnutrition, and cachexia are related to a higher incidence of chemotherapy toxicity in cancer patients. The main purpose of this study is to evaluate the relationship between baseline body composition, nutritional status, cachexia, and lung cancer chemotherapy toxicity and dose-limiting toxicity (DLT).Methods:This is a single-center prospective study of lung cancer patients receiving chemotherapy for the first time. Body composition was measured using multi-frequency bioelectrical impedance, and the skeletal muscle index (SMI) was calculated. Grip strength and gait speed were used to assess muscle strength and function. The Asian Working Group on Sarcopenia (2019) criteria were used to evaluate the presence of sarcopenia. Cachexia was defined based on muscle mass and weight loss, while nutritional risk and malnutrition were evaluated based on the Nutritional Risk Screening 2002 and Global Leadership Initiative on Malnutrition criteria, respectively. Chemotherapy toxicity and DLT were defined according to the Common Terminology Criteria for Adverse Events and were divided into hematological, non-hematological, and DLT. The association between muscle condition, nutritional status, cachexia, and toxicity was evaluated by univariate and multivariate regression models.Results:The study included and analyzed 126 patients, with a median follow-up of 17.9 months (12-25 months). During chemotherapy, 27.8% of patients experienced grade 3/4 hematological toxicity, 14.8% experienced any ≥2 grade non-hematological toxicity, and 26.1% had any DLT. Old age and multiple comorbidities were risk factors for hematological, non-hematological toxicity, and DLT. Insufficient muscle strength and function could increase the incidence of hematological toxicity [ OR 1.121, 95% CI 1.048~2.865, P=0.031], and high SMI was a protective factor for DLT [ OR 0.638, 95% CI 0.242~0.083, P=0.021]. Conclusions:Lung patients with low SMI, low muscle strength and function have an increased risk of DLT and grade 3/4 hematological toxicity during chemotherapy. At the same time, elderly age and multiple comorbidities are also risk factors for chemotherapy toxicity and DLT. In clinical work, assessments should be conducted to identify high-risk populations for chemotherapy toxicity and preventive measures should be taken. Future research could consider adjusting chemotherapy plans based on different muscle statuses.
ABSTRACT
Contexte et Objectif. Déterminer l'infl uence des toxicités hématologiques induites par la chimiothérapie sur l'adhésion à une chimiothérapie anticancéreuse chez des patients traités pour un cancer à l'hôpital universitaire Yalgado Ouédraogo (Ouagadougou, Burkina Faso). Méthodes. Il s'est agi d'une étude rétrospective ayant analysé les dossiers médicaux des patients cancéreux suivis par le service de cancérologie du CHU-YO. Tous les adultes ayant reçu six séances d'une première ligne de chimiothérapie ont été inclus. Pour chaque patient, nous avons analysé toutes les numérations formule sanguines effectuées environ 16 à 18 jours après la cure de chimiothérapie précédente et 3 à 5 jours avant la suivante. Ont été considérés comme observants, les patients ayant respecté tous les intervalles inter-cures. Résultats. Vingt-six patients (27,6%) ont présenté au moins un épisode d'anémie, 46 patients (48,9%) ont au moins un épisode de neutropénie et 9 patients (9,6%) ont au moins un épisode de thrombopénie. Les neutropénies de grade 3 et 4 représentaient de 67,9% à 87% des cas de neutropénie. Aucun cas de thrombopénie de grade 3 ou 4 n'a été observé. Vingt-deux patients ont respecté tous les intervalles intercures. Après ajustement sur les autres toxicités hématologiques en analyse multivariée, la neutropénie était associée de manière signifi cative au non-respect de la chimiothérapie (OR: 0,43). Conclusion. L'amélioration de la disponibilité et de l'accessibilité des moyens de prévention et de traitement des toxicités hématologiques pourraient permettre une amélioration de l'observance de la chimiothérapie anticancéreuse.
Aim and Objective. This study aims to identify the infl uence of chemotherapy induced haematological toxicities on adherence to anti-cancer chemotherapy in patients treated for cancer at Yalgado Ouédraogo University Hospital (Ouagadougou, Burkina Faso). Methods. This study was grounded on the analysis of the medical fi les of the patients, and the consultation and hospitalisation registers for the cancer patients who were monitored by the oncology department of CHU-YO. All adults having received six treatment sessions as fi rst-line chemotherapy were taken into account. For each patient, we analysed all the blood counts carried out approximately 16 to 18 days after the previous treatment session, and 3 to 5 days before the following one. Were considered adherent patients, the patients who complied with every intertreatment interval. Results. 26 patients (27.6%) presented with at least one episode of anaemia, 46 patients (48.9%) with at least one episode of neutropenia, and 9 patients (9.6%) with at least one episode of thrombocytopenia. Grade 3 and grade 4 neutropenia represented from 67.9% to 87% of neutropenia cases. No case of grade 3 and grade 4 thrombocytopenia was noticed. Twenty-two patients respected all the inter-treatment intervals. Adjusted on the other haematological toxicities as a multivariate analysis, neutropenia was significantly associated to non-adherence to chemotherapy (OR: 0.43). Conclusion. Improving availability and access to prevention and treatment for haematological toxicities could lead to improving adherence to anti-cancer chemotherapy
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Toxicity Tests , HematologyABSTRACT
Oral mucositis (OM) is a common and dose-limiting side effect of cancer treatment, including 5-fluorouracil (5-FU) and radiotherapy. The efficacy of the therapeutic measures to prevent OM is limited and disease prevention is not fully observable. Amifostine is a cytoprotective agent with a described anti-inflammatory potential. It is clinically used to reduce radiotherapy and chemotherapy-associated xerostomia. This study investigated the protective effect of amifostine on an experimental model of OM. Hamsters were divided into six groups: saline control group (5 mL/kg), mechanical trauma (scratches) of the right cheek pouch; 5-FU (60 and 40 mg/kg, ip, respectively, administered on days 1 and 2); amifostine (12.5, 25, or 50 mg/kg) + 5-FU + scratches. Salivation rate was assessed and the animals were euthanized on day 10 for the analysis of macroscopic and microscopic injury by scores. Tissue samples were harvested for the measurement of neutrophil infiltration and detection of inflammatory markers by ELISA and immunohistochemistry. 5-FU induced pronounced hyposalivation, which was prevented by amifostine (P<0.05). In addition, 5-FU injection caused pronounced tissue injury accompanied by increased neutrophil accumulation, tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) tissue levels, and positive immunostaining for TNF-α, IL-1β, and inducible nitric oxide synthase (iNOS). Interestingly, amifostine prevented the inflammatory reaction and consequently improved macroscopic and microscopic damage (P<0.05 vs 5-FU group). Amifostine reduced inflammation and protected against 5-FU-associated oral mucositis and hyposalivation.
Subject(s)
Animals , Male , Stomatitis/prevention & control , Xerostomia/prevention & control , Amifostine/therapeutic use , Protective Agents/therapeutic use , Fluorouracil/adverse effects , Inflammation/prevention & control , Stomatitis/chemically induced , Stomatitis/pathology , Xerostomia/chemically induced , Xerostomia/pathology , Cricetinae , Disease Models, Animal , Inflammation/chemically induced , Inflammation/pathologyABSTRACT
Objetivo: Traduzir e realizar a adaptação transcultural para a Língua Portuguesa do escore de toxicidade de Hurria, instrumento utilizado para avaliação de toxicidade à quimioterapia em idosos. Métodos: Realizada a tradução e adaptação transcultural do escore, seguindo a técnica proposta por Guilemin de tradução/retrotradução. Resultados: A tradução foi realizada por dois brasileiros fluentes em inglês, sendo um médico e um tradutor profissional. Sequencialmente, realizou-se a retrotradução do escore por dois profissionais independentes ao estudo, ligados a um serviço especializado de tradução linguística. Finalmente, um comitê formado por especialistas em Oncologia, Geriatria e Hematologia checou a consistência da tradução/retrotradução, chegando a um modelo final na Língua Portuguesa. Posteriormente, esse modelo sofreu avaliação prática em uma amostra de prontuários de um ambulatório de Oncogeriatria, com versão em português do instrumento atingindo alto grau de confiabilidade pelo teste estatístico de Kappa. Conclusão: A versão final do escore de toxicidade de Hurria em português mostrou-se clara, simples e de rápida aplicação, estando adequada para o uso na prática clínica.
Objective: To describe the translation and transcultural adaptation of Hurria's chemotherapy toxicity score, a prediction tool to estimate chemotherapy toxicity in the elderly. Methods: The original English version of the score was translated to Portuguese using the forward and backward translation technique, as described by Guilemin. Results: The translation was performed by two Brazilians (a physician and a professional translator), both fluent in English. Two professionals from a specialized linguistic service, not related to the study, then carried out the backward translation. Finally, a medical committee composed of oncologists, geriatricians, and hematologists discussed the consistency of the score, choosing a final version of the instrument in Portuguese. This version was piloted-tested in medical charts in an Oncogeriatric service, with high reliability as tested by Kappa statistic test. Conclusion: The final version of Hurria's chemotherapy toxicity score in Portuguese proved to be an easy, clear, and quick tool, suitable for use in clinical practice.
Subject(s)
Humans , Male , Female , Aged , Aged , Drug Therapy , Geriatrics , Medical Oncology , Drug-Related Side Effects and Adverse ReactionsABSTRACT
OBJECTIVE: Amifostine (Ethyol(R)), an organic thiophosphate, has shown the ability to protect normal, but not neoplastic, tissues from the damaging effects of chemotherapy and radiotherapy in various kinds of cancers. This study was designed to determine ifostine could reduce the serious hematologic and nephrologic toxicities associated with cisplatin based combination chemotherapy in gynecologic cancer patients. PATIENTS AND METHODS: Forty patients who received cisplatin-based combination chemotherapy were randomized into two groups. They received chemotherapy with or without pretreatment of amifostine before each course. The occurrence of hematologic and renal toxicities were evaluated. Stastical analysis was done by independent t-test and Chi-square test. RESULTS: Hematologic toxicity was evaluated with nadir count of neutrophil and platelet. The nadir count of neutrophil was 2034.2+/-1199.20/microliter in group with pretreatment using amifostine vs 1070.85+/-472.66/microliter in control group (p<0.01). Platelet count was not statistically different. (p<0.16) Grade 3 neutropenia was observed in nine (45%) patients in pretreatment group vs four (20%) patients with control group (p<0.09). Grade 4 neutropenia occurred in one patient only in control group. Renal toxicity was evaluated by serum creatinine and creatinine clearance. Protracted serum creatinine elevation was not significant in both groups. (p<0.14) Reduction of creatinine clearance was less in patients with pretreatment (p<0.01). There were no significant side reactions in subjects using amifostine. CONCLUSION: Pretreatment with amifostine reduces the neutropenia and nephrotoxicity associated with cisplatin-based combination chemotherapy with gynecologic cancer patients.
Subject(s)
Humans , Amifostine , Blood Platelets , Cisplatin , Creatinine , Drug Therapy , Drug Therapy, Combination , Neutropenia , Neutrophils , Platelet Count , RadiotherapyABSTRACT
OBJECTIVE: Amifostine (Ethyol(R)), an organic thiophosphate, has shown the ability to protect normal, but not neoplastic, tissues from the damaging effects of chemotherapy and radiotherapy in various kinds of cancers. This study was designed to determine ifostine could reduce the serious hematologic and nephrologic toxicities associated with cisplatin based combination chemotherapy in gynecologic cancer patients. PATIENTS AND METHODS: Forty patients who received cisplatin-based combination chemotherapy were randomized into two groups. They received chemotherapy with or without pretreatment of amifostine before each course. The occurrence of hematologic and renal toxicities were evaluated. Stastical analysis was done by independent t-test and Chi-square test. RESULTS: Hematologic toxicity was evaluated with nadir count of neutrophil and platelet. The nadir count of neutrophil was 2034.2+/-1199.20/microliter in group with pretreatment using amifostine vs 1070.85+/-472.66/microliter in control group (p<0.01). Platelet count was not statistically different. (p<0.16) Grade 3 neutropenia was observed in nine (45%) patients in pretreatment group vs four (20%) patients with control group (p<0.09). Grade 4 neutropenia occurred in one patient only in control group. Renal toxicity was evaluated by serum creatinine and creatinine clearance. Protracted serum creatinine elevation was not significant in both groups. (p<0.14) Reduction of creatinine clearance was less in patients with pretreatment (p<0.01). There were no significant side reactions in subjects using amifostine. CONCLUSION: Pretreatment with amifostine reduces the neutropenia and nephrotoxicity associated with cisplatin-based combination chemotherapy with gynecologic cancer patients.