Clinical Epidemiology Study Program, Master of Clinical Medicine Postgraduate Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Academic Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia.
PLoS One. 2024 Feb 23;19(2):e0298928. doi: 10.1371/journal.pone.0298928. eCollection 2024.
This study aims to characterize patient-reported chemotherapy-induced toxicity in patients with breast cancer, determine its association with treatment regimens and patient characteristics, identify toxicity symptom clusters within a specific chemotherapy timeframe and analyze the correlation between symptom clusters within and between the timeframe to understand the changes and influences across chemotherapy.
Forty-six patient-reported toxicities during neoadjuvant/adjuvant chemotherapy for breast cancer were evaluated using adapted CTCAE version 4.0. Chi-Square/Fisher's Exact test was performed to analyze the difference in the incidence of toxicity symptoms by chemotherapy regimens. Poisson regression performed to assess factors associated with patient's total chemotherapy toxicity. Exploratory factor analysis (EFA) conducted to identify symptom clusters at T1 (first half) and T2 (second half of planned cycle). Factor scores were generated and Spearman correlation performed to explore the factor scores correlation between symptom clusters.
A total of 142 patients with stage I-III breast cancer were included. The incidence of several toxicities differed significantly among three chemotherapy regimens. Subjects age ≥51 years are associated with lower number of reported toxicity (IRR/incidence rate ratio = 0.94, 95% confidence interval/CI 0.88 to 0.99, p = 0.042). Receiving more chemotherapy cycles are associated with higher number of reported toxicity (IRR = 1.06, 95% CI 1.03 to 1.10, p<0.001). Two symptom clusters identified at T1 (psychoneurological-pain/PNP-T1 and gastrointestinal-psychological/GIP-T1 cluster) and three at T2 (psychoneurological-pain/PNP-T2, epithelial/EPI-T2, and gastrointestinal cluster/GI-T2), with moderate-strong positive correlation between PNP-T1 and GIP-T2 (p<0.001), PNP-T1 and PNP-T2 (p<0.001), and GIP-T1 and PNP-T2 (p<0.001).
This study investigated 46 patient-reported toxicities prospectively during adjuvant/neoadjuvant chemotherapy for early breast cancer. Anthracycline-taxane combination regimen had higher proportions of toxicity incidence. Subject's age and number of chemotherapy cycles significantly associated with total number of toxicity symptoms. Two symptom clusters at T1 and three at T2 were identified, with significant correlation between symptom clusters within and between chemotherapy timeframe.
本研究旨在描述乳腺癌患者报告的化疗诱导毒性，确定其与治疗方案和患者特征的关系，确定特定化疗时间内的毒性症状群，并分析时间内和时间间症状群之间的相关性，以了解化疗过程中的变化和影响。
使用改编的 CTCAE 版本 4.0 评估 46 例接受新辅助/辅助化疗的乳腺癌患者报告的毒性。采用卡方检验/Fisher 精确检验分析不同化疗方案毒性症状发生率的差异。采用泊松回归分析评估与患者总化疗毒性相关的因素。采用探索性因子分析（EFA）确定 T1（前半部分）和 T2（计划周期后半部分）的症状群。生成因子得分并进行 Spearman 相关分析，以探讨症状群之间的因子得分相关性。
共纳入 142 例 I-III 期乳腺癌患者。三种化疗方案的几种毒性发生率存在显著差异。年龄≥51 岁的受试者报告的毒性数量较少（IRR/发病率比=0.94，95%置信区间/CI 0.88 至 0.99，p=0.042）。接受更多化疗周期与报告的毒性数量增加相关（IRR=1.06，95%CI 1.03 至 1.10，p<0.001）。在 T1 时确定了两个症状群（心理神经-疼痛/PNP-T1 和胃肠-心理/GIP-T1 群），在 T2 时确定了三个症状群（心理神经-疼痛/PNP-T2、上皮/EPI-T2 和胃肠群/GI-T2），PNP-T1 和 GIP-T2 之间存在中度至强正相关（p<0.001），PNP-T1 和 PNP-T2 之间（p<0.001），GIP-T1 和 PNP-T2 之间（p<0.001）。
本研究前瞻性调查了 46 例接受早期乳腺癌辅助/新辅助化疗的患者报告的毒性。蒽环类药物-紫杉烷联合方案毒性发生率较高。受试者年龄和化疗周期数与毒性总症状数显著相关。在 T1 时确定了两个症状群，在 T2 时确定了三个症状群，在化疗时间内和时间间的症状群之间存在显著相关性。
