Dampak Penundaan Jadwal Kemoterapi Terhadap Rekurensi Pada Pasien Kanker payudara
Walit Uhkri Mukrinin(1*), Arief Nurrochmad(2), Fita Rahmawati(3)
(1) Program Pascasarjana Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada, Yogyakarta
(2) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(3) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(*) Corresponding Author
Abstract
Kemoterapi merupakan modalitas pengobatan utama pada kanker payudara bersama dengan operasi dan radioterapi. Kemoterapi memberikan manfaat dalam peningkatan ketahanan hidup pasien, namun manfaat tersebut dipengaruhi oleh kepatuhan terhadap jadwal kemoterapi. Dampak prognostik negatif dari keterlambatan dosis kemoterapi ini dapat berpengaruh pada hasil ketahanan hidup. Tujuan dari penelitian ini adalah untuk mengetahui gambaran penundaan jadwal kemoterapi (alasan dan durasi penundaan) serta dampaknya terhadap rekurensi. Penelitian ini menggunakan desain kohort retrospektif, melibatkan 138 pasien wanita kanker payudara stadium awal (stadium I-IIB) yang mendapatkan kemoterapi. Ekposur dalam penelitian adalah penundaan jadwal kemoterapi dan durasi penundaan, sedangkan luaran penelitian adalah rekurensi kanker payudara. Data penelitian diperoleh dari rekam medik pasien di RSUP Dr. Sardjito Yogyakarta. Analisis penelitian menggunakan metode Chi-square, Kaplan-Meier serta Cox-regression untuk mengetahui Hazard Ratio dengan tingkat kepercayaan 95%. Hasil penelitian menunjukkan bahwa penundaan jadwal kemoterapi pada pasien kanker payudara berhubungan dengan meningkatkan resiko rekurensi (HR 4,718; 95% Cl: 1,533-14,520, log rank tes p=0,003). Sementara durasi penundaan jadwal kemoterapi ≤7 hari dan >7 hari tidak berhubungan dengan peningkatan resiko rekurensi (HR 1,001; 95% Cl: 0.307-3,260, log rank tes p=0,999). Keterlibatan farmasi klinis sangat diperlukan untuk mencegah dan menyelesaikan masalah terkait efek samping obat serta monitoring pengobatan sehingga luaran pengobatan menjadi optimal.
Keywords
Full Text:
PDFReferences
Burstein, H.J., 2018. Adjuvant chemotherapy for HER2-negative breast cancer.
Caplan, L., 2014. Delay in breast cancer: Implications for stage at diagnosis and survival. Front. Public Heal. 2: 1–5.
Chen, Y., Shi, X.E., Tian, J.H., Yang, X.J., Wang, Y.F., Yang, K.H., 2018. Survival benefit of neoadjuvant chemotherapy for resectable breast cancer. Med. (United States) 97.
Chen, H.L., Zhou, M.Q., Tian, W., Meng, K.X., He, H.F., 2016. Effect of age on breast cancer patient prognoses: A population-based study using the SEER 18 database. PLoS One 11: 1–11.
Cianfrocca, M., Goldstein, L.J., 2004. Prognostic and Predictive Factors in Early-Stage Breast Cancer:The Oncologist 19: 606–616.
Denduluri, N., Lyman, G.H., Wang, Y., Morrow, P.K., Barron, R., Patt, D., Bhowmik, D., Li, X., Bhor, M., Fox, P., Dhanda, R., Saravanan, S., Jiao, X., Garcia, J., Crawford, J., 2018. Chemotherapy Dose Intensity and Overall Survival Among Patients With Advanced Breast or Ovarian Cancer. Clin. Breast Cancer 18: 380–386.
Gadisa, D.A., Assefa, M., Tefera, G.M., Yimer, G., 2020. Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study. J. Oncol. 2020: 1–12.
Gunasekaran, G.H., Hassali, M.A.B.A., Sabri, W.M.A.B.W., Rahman, M.T. Bin, 2020. Impact of chemotherapy schedule modification on breast cancer patients: a single-centre retrospective study. Int. J. Clin. Pharm. 42: 642–651.
John, P., Osani, M.C., Kodali, A., Buchsbaum, R., Bannuru, R.R., Erban, J.K., 2021. Comparative Effectiveness of Adjuvant Chemotherapy in Early-Stage Breast Cancer: A Network Meta-analysis. Clin. Breast Cancer 21: e22–e37.
Kogan, L.G., Davis, S.L., Brooks, G.A., 2019. Treatment delays during FOLFOX chemotherapy in patients with colorectal cancer: A multicenter retrospective analysis. J. Gastrointest. Oncol. 10: 841–846.
Liutkauskiene, S., Grizas, S., Jureniene, K., Suipyte, J., Statnickaite, A., Juozaityte, E., 2018. Retrospective analysis of the impact of anthracycline dose reduction and chemotherapy delays on the outcomes of early breast cancer molecular subtypes. BMC Cancer 18: 1–9.
Iyengar, N.M., Arthur, R., Manson, J.E., Chlebowski, R.T., Kroenke, C.H., Peterson, L., Cheng, T.Y.D., Feliciano, E.C., Lane, D., Luo, J., Nassir, R., Pan, K., Wassertheil-Smoller, S., Kamensky, V., Rohan, T.E., Dannenberg, A.J., 2019. Association of Body Fat and Risk of Breast Cancer in Postmenopausal Women with Normal Body Mass Index: A Secondary Analysis of a Randomized Clinical Trial and Observational Study. JAMA Oncol. 5: 155–163.
Lyman, G.H., Dale, D.C., Crawford, J., 2003. Incidence and predictors of low dose-intensity in adjuvant breast cancer chemotherapy: A nationwide study of community practices. J. Clin. Oncol. 21: 4524–4531.
Mavroudis, D., Matikas, A., Malamos, N., Papakotoulas, P., Kakolyris, S., Boukovinas, I., Athanasiadis, A., Kentepozidis, N., Ziras, N., Katsaounis, P., Saloustros, E., Georgoulias, V., 2016. Dose-dense FEC followed by docetaxel versus docetaxel plus cyclophosphamide as adjuvant chemotherapy in women with HER2-negative, axillary lymph node-positive early breast cancer: A multicenter randomized study by the Hellenic Oncology Research Group (HOR. Ann. Oncol. 27: 1873–1878.
Mayo Clinic, 2019. Recurrent breast cancer - Symptoms and causes [WWW Document]. Mayo Clinic. URL https://www.mayoclinic.org/diseases-conditions/recurrent-breastcancer/ symptoms-causes/syc-20377135 (accessed 26.4.22).
Motzer, R.J., Geller, N.L., George, J., 1990. The Efect of a 7-Day Delay in Chemotherapy Cycles on Complete Response and Event-Free Survival in Good-Risk Disseminated Germ Cell Tumor Patients. Cancer 66: 857–861.
Ntellas, P., Spathas, N., Agelaki, S., Zintzaras, E., 2019. Taxane & cyclophosphamide vs anthracycline & taxane-based chemotherapy as adjuvant treatment for breast cancer : a pooled analysis of randomized controlled trials by the Hellenic Academy of Oncology. Oncotarget 10: 1209–1216.
Qi, W., Wang, X., Gan, L., Li, Y., Li, H., Cheng, Q., 2020. The effect of reduced RDI of chemotherapy on the outcome of breast cancer patients. Sci. Rep. 10: 1–13.
Sinaga, E.S., Ahmad, R.A., Hutajulu, S.H., 2017. Analisis ketahanan hidup 5 tahun pada pasien kanker payudara di RS Sardjito provinsi Yogyakarta, Indonesia. Berita Kedokteran Masyarakat, 33 No.2.
Street, W., 2017. Breast Cancer Facts & Figures 2017-2018. American Cancer Society 44.
Sun, L., Zhu, Y., Qian, Q., Tang, L., 2018. Body mass index and prognosis of breast cancer. Med. (United States) 97.
West, J., Newton, P.K., 2018. therapies 77: 6717–6728.
Wong, F.Y., Tham, W.Y., Nei, W.L., Lim, C., Miao, H., 2018. Age exerts a continuous effect in the outcomes of Asian breast cancer patients treated with breast-conserving therapy. Cancer Commun. 38: 1–11.
World Health Organization. 2019, IARC Global Cancer Observatory Breast Cancer, France, WHO
Wu, Y., Aravind, S., Ranganathan, G., Martin, A., Nalysnyk, L., 2009. Anemia and thrombocytopenia in patients undergoing chemotherapy for solid tumors: A descriptive study of a large outpatient oncology practice database, 2000-2007. Clin. Ther. 31: 2416–2432.
Yu, K. Da, Liu, X.Y., Chen, L., Mo, M., Wu, J., Liu, G.Y., Di, G.H., Verschraegen, C., Stover, D.G., Zhuang, Z.G., Bertucci, F., Orlandi, A., Wang, J., Lippi, G., Wu, K.J., Osman, M.A., Fan, L., Shao, Z.M., 2021. Anthracycline-free or short-term regimen as adjuvant chemotherapy for operable breast cancer: A phase III randomized non-inferiority trial. Lancet Reg. Heal. - West. Pacific 11.
Zaheed, M., Wilcken, N., Willson, M.L., O’connell, D.L., Goodwin, A., 2019. Sequencing of anthracyclines and taxanes in neoadjuvant and adjuvant therapy for early breast cancer. Cochrane Database Syst. Rev. 2019.
Zheng, R., Han, S., Duan, C., Chen, K., You, Z., Jia, J., Lin, S., Liang, L., Liu, A., Long, H., Wang, S., 2015. Role of taxane and anthracycline combination regimens in the management of advanced breast cancer a meta-analysis of randomized trials. Med. (United States) 94: e803.
DOI: https://doi.org/10.22146/farmaseutik.v20i1.75491
Article Metrics
Abstract views : 1060 | views : 834Refbacks
- There are currently no refbacks.