Neutropenia in breast cancer patients on chemotherapy in Tanzania.

Abstract

ABSTRACT Background: Breast cancer is the second most common female cancer following cancer of the cervix in Tanzania (1). Chemotherapy plays a role in curative and palliative treatment; however, it may lead to life threatening complications if rigorous preventive and management measures are not taken. Neutropenic fever is an oncologic emergency among other common side effects. It is critical to recognize neutropenia early and to initiate empiric antibacterial therapy promptly in order to avoid progression to sepsis syndrome and possibly death. This study was aimed at showing the prevalence of chemotherapy-associated febrile neutropenia for cancer patients treated at Ocean Road Cancer Institute. Aim: To determine the prevalence of chemotherapy associated febrile neutropenia and associated factors in breast cancer patients treated with chemotherapy at ORCI Material and Methods: A retrospective cohort study was conducted from March 2019 to April 2019. Breast cancer patients who had received at least one drug of chemotherapy that is known to cause neutropenia were eligible. Data collected included details on patient demographics and, hematological and clinical characteristics pre and post chemotherapy administration. Categorization was done into mild, moderate and severe neutropenia as follows: 1.1-2x109 /L, (mild), 0.5-1x109 /L (moderate) and less than 0.5 x109 /L (severe). Data were collected over three consecutive cycles. SPSS version 20 was used to analyze data using t-tests and linear regression analysis. Results This study involved 241 patients whose clinical data were abstracted from medical records. All patients were female, with mean age of 51 years and standard deviation of 13.7. The majority of patients were from coastal regions. Most (97.5%) had locally advanced breast cancer. Seventy-five percent of the study participants were prescribed chemotherapy as adjuvant treatment. Combination regimens including doxorubicin, cyclophosphamide, Fluorouracil were the most commonly administered chemotherapy regimens. Administered doses for this regimen were respectively as follows: 60:600:50 mg/m2 . The proportion of patients with neutropenia during the course of treatment was 27.4%. The pretreatment neutrophil count versus treatment neutrophil count for 3 cycles did not show significant association (2%). Among patients who had neutropenia before treatment (N=241), 16.6% were of advanced age, 51 years old and above. Pretreatment neutropenia was associated with having a neutropenia episode during the treatment with a p-value of 0.02. The average neutrophil count of each of three cycles were respectively 4.2%, 33.4%, and 62.2% meaning moderate and mild neutropenia respectively then normal neutrophil count. Pretreatment anemia was found to be associated with neutropenia during chemotherapy (p-value 0.06). Conclusion This study found that the prevalence of chemotherapy-associated neutropenia among breast cancer patients receiving chemotherapy at ORCI is high as compared to what is observed in developed countries in prospective studies; 37% versus 11.6% (2). Neutropenia in these patients is associated with low pretreatment hemoglobin, advanced age, and stage. Though strong clinical and treatment factors have been shown to be associated with neutropenia, specific chemotherapy drugs like taxanes, methotrexate and cyclophosphamide are the drugs most associated with neutropenia. Early identification of risk factors associated with neutropenia in history and physical exam before initiation of chemotherapy is necessary for better outcome