Hematologic Toxicities and its Determinants among Breast Cancer Patients Treated with Doxorubicin-Cyclophosphamide Followed by Paclitaxel Regimen in Cancer Centers: Retrospective Cohort Study

Abstract

Background Clinically, chemotherapy induced neutropenia, febrile neutropenia, thrombocytopenia and anemia were the common toxicities among breast cancer patients treated with doxorubicin-cyclophosphamide followed by paclitaxel regimen. Those toxicities may lead to chemotherapy dose modification, delay and discontinuation that may substantially compromise therapeutic outcomes. Objective To assess hematologic toxicities and its determinants among breast cancer patients treated with doxorubicin-cyclophosphamide followed by paclitaxel regimen in cancer centers, Northwest Ethiopia. Method Retrospective cohort study design was used to collect data among 422 breast cancer patients from Felege-Hiwot Comprehesnsive and Specialized Hospital and University Of Gondar Comprehensive and Specialized Hospital using a structured data abstraction format by employing systematic random sampling technique. The collected data were entered into EPI-data version 3.1 and analysed using IBM SPSS version 26. Association between dependent and independent variables was determined by using bivariate and multivariate logistic regression analysis where p < 0.05 was considered to be statistically significant. Results Among the study participants, more than half (76.1%) and (51.4%) patients had ductal type histology and stage III cancer, respectively, and almost all (98.9%) breast cancer patients performed modified radical mastectomy. Besides, nearly half of patients (46%) had poor ECOG PS. In the current study, the occurrence of neutropenia, anemia, thrombocytopenia and febrile neutropenia were 61.8%, 44.1%, 16.4% and 10%, respectively. Significant association with neutropenia was seen in patients; age ≥ 43years [AOR = 1.68, 95%CI (1.13,2.52)] and rular residency [AOR = 1.76,95%CI (1.16,2.67)]. Whereas stage III and IV cancer [AOR = 2.40,95%CI (1.17,4.94)] was significantly associated with febrile neutropenia. Furthermore, association with anemia was also seen in patients with mixed type histology [AOR = 4.71, 95%CI (1.43,15.53)], lobular type histology [AOR = 0.51,95%CI (0.29,0.87)], stage III and IV cancer [AOR = 1.73,95%CI (1.14,2.63) and disease comorbidity [AOR = 2.11,95%CI (1.04,4.30)]. Likewise, rular residency [AOR = 1.72,95%CI (1.01,2.91)], age ≥ 43years [AOR = 1.75,95%CI (1.02,3.02)] and stage III and IV cancer [AOR = 2.13,95%CI (1.22,3.74) were significantly associated with thrombocytopenia. Conclusion The magnitude of hematologic toxicities in patients treated with doxorubicin-cyclophosphamide followed by paclitaxel was high in the study setting. Age, rular residence, stage of cancer, disease comorbidity, mixed and lobular type histology were factors associated with chemotherapy induced hematologic toxicities.