Breast cancer

More work required to avoid chemo adverse events in breast cancer

Docetaxel-containing chemotherapy protocols appear to increase the risk of hospitalisation for early and late adverse events in women with early-stage operable breast cancer.

A retrospective cohort study from the Cancer Institute NSW comprising 3,950 women between 2008 and 2012 found almost a third of women (30.6%) required emergency hospitalisation within six months of initiating chemotherapy.

Doxorubicin/cyclophosphamide (AC) and fluorouracil/epirubicin/cyclophosphamide followed by docetaxel (FEC-D) were the most commonly prescribed protocols, then docetaxel/cyclophosphamide (TC), docetaxel/doxorubicin/cyclophosphamide (TAC), doxorubicin/cyclophosphamide followed by paclitaxel (AC+PAC), FEC-100 and docetaxel/carboplatin/trastuzumab (TCH).

The most common adverse events were neutropenia, fever and infection and the average length of hospital stay was three days.

The study found an increased odds of hospitalisation in women on TCH (OR 1.71) and TC (OR 1.47) protocols, compared to women on AC. FEC protocols ranked in between.

The study reported 270 deaths within five years of chemotherapy initiation but only six during the first six months, suggesting treatment-related mortality was low. It found no difference between the different chemotherapy protocols and 5-year overall survival, after adjusting for age and clinical factors.

Overall 5‐year survival was high at 92.6% and similar in those women who were or were not hospitalised within six months of chemotherapy.

The researchers, including Cancer Institute NSW CEO Professor David Currow, said their findings were consistent with those from other overseas and local studies.

By only measuring hospitalisations, the study possibly underestimated the impact of chemotherapy-related toxicities on women, they commented.

“Nevertheless, unplanned hospital admissions have a negative impact on the quality of life for patients as well as economic implications.”

“Further work is needed to inform choice of chemotherapy regimen and to better understand the reasons for and drivers of these admissions to identify solutions, such as early prevention and management of toxicities and identifying patient groups that are most likely to experience adverse events.”

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