Diferencias en la percepción de la toxicidad del tratamiento quimioterápico en cáncer de mama y su influencia en la calidad de vida relacionada con la salud

Abstract

Introduction Breast cancer is the most common malignant tumour among women worldwide. In Spain some 26,000 cases are diagnosed annually, accounting for almost 30% of all tumours found in women in our country. The overall 5-year survival rate for breast cancer patients in Spain has increased from 82.8% to 87% in recent years, above the European average. Several studies have shown the superior efficiency of the docetaxel, adriamycin and cyclophosphamide (TAC) based treatment, over other chemotherapy therapies commonly used to treat breast cancer, and in particular the cyclophosphamide, fluorouracil and adriamycin (FAC) based therapy. However, in general clinical practice, epirubicin is used instead of adriamycin as similar response rates with adriamycin 60 mg/m2 epirubicin 90 mg/m2 have been observed, although the latter shows less cardiotoxicity. The amount of dosage adjustments required due to adverse reactions may be reduced by oncologists underestimating these adverse reactions. This can result in repeated, or increased complications experienced during the previous cycle which leads to increased morbidity, avoidable hospitalisations and premature suspension of the chemotherapy treatment. The study "Health Related Quality of Life" (HRQOL) is currently considered a fundamental tool to assess the treatment and monitoring of patients with breast cancer. Method Cross-sectional study conducted at Huelva University Hospital between May 2012 and August 2014. The sample consisted of 110 women with breast cancer under neoadjuvant or adjuvant, chemotherapy therapy, with the TEC scheme (docetaxel 75 mg/m2 + epirubicin 75 mg/m2 + cyclophosphamide 500 mg/m2 + colony-stimulating factor: filgrastim or pegfilgrastim] + dexamethasone triple antiemetic therapy, aprepitant and ondansetron) with a minimum of one cycle of the treatment already performed. Res y Its There is a clear discrepancy between the frequency of toxicities estimated by oncologists and the results obtained during medical consultations. The toxicity experienced by the patient is, in these cases, underestimated by oncologist. There is a great disparity in the level of understanding of the toxicities associated with the TEC scheme between oncologists. Furthermore, the presence of adverse reactions, related to ECT treatment, significantly reduces the health related quality of life of patients. In particular, nausea, loss of appetite, dysgeusia, peripheral neuropathy, myalgia and peripheral edema are those toxicities where this difference has been more significant. Finally, this study has analysed a network of complex relationships amongst the various constructs tested (sense of coherence, doctor-patient relationships, patient optimism and pessimism factors) together with adverse reactions, in order to explain the factors determining the health related quality of life of patients. Thus, the study has proven the importance of analysing psychosocial aspects in patients with breast cancer, as well as to try to alleviate the adverse symptoms and fostering a good doctor-patient relationship, which would contribute to improved levels of quality of life. Conclusion In general, the results of this study showed that there is room for improvement in the area of cancer patient care (more specifically breast cancer patients). These improvements include the need for greater awareness of non- haematological adverse reactions. The need to implement information systems for patients in order to document more accurately the symptoms associated with the prescribed treatment.