Prospective Observational Study on the Risk Factors of Chemotherapy-Induced Myelosuppression and Its Management in a Tertiary Care Hospital

Abstract

Abstract Introduction  Myelosuppression is a commonly observed dose-limiting side effect of majority of chemotherapeutic drugs, characterized by a decrease in blood cell production. They cause neutropenia, thrombocytopenia, and anemia and can be life threatening in few susceptible individuals. Attempts to lessen chemotherapy-induced myelosuppression have been minimally effective. Managing myelosuppression has been a challenge to medical practitioners and pharmacist. Identifying their risk factors and the management strategies can help prevent the debilitating effects on chemotherapy patients. Objectives  The aim of this study was to determine the risk factors for chemotherapy-induced myelosuppression and identify its management in a tertiary care hospital. We also observed the cycle it predominantly occurs and its prevalence rate in the region. Materials and Methods  The study is a prospective observational cohort study conducted in a tertiary care hospital in Coimbatore, Tamil Nadu. The sample size was calculated using RAO software for a study duration of 4 months from 73 patients who were prescribed the inclusion criteria drugs paclitaxel, carboplatin, 5-fluorouracil, doxorubicin, and cyclophosphamide. The complete blood count was obtained and followed up to find myelosuppression occurrence on day 8 of first three cycles. The National Cancer Institute grading system was used to assess the severity of myelosuppression. It was done from May 2022 to August 2022. Chi-squared tests and percentages were adopted by using the SPSS software. Result  The result for primary objective is that among the total 73 patients employed, 30 patients were found to be myelosuppressive (41%) and the prevalence rate was 41%. Risk factors such as age, gender, and diagnosis showed statistically significant association (confidence interval: 95% and p -value <0.005). The drugs paclitaxel, carboplatin, 5-fluorouracil, cyclophosphamide, and adriamycin proved to be highly myelosuppressive with a p -value of 0.049. The results for secondary objectives were that cycle 1 was reported to be highly myelosuppressive with 27%. The treatment options that was highly used was granulocyte-colony stimulating factor (90%), followed by packed red blood cell transfusion (7%). Conclusion  The incidence of chemotherapy-induced myelosuppression from this study showed that it was important to monitor the complete blood count levels in patients undergoing chemotherapy. Early assessment of risk for developing myelosuppression may prevent or reduce its severity.