Pojavnost nevtropenije pri citostatskem zdravljenju raka dojk v onkološki ambulanti Splošne bolnišnice Slovenj Gradec

Muš, Jasmina (author), Vovk, Tomaž (mentor), Kikec, Zdenko (comentor)

Rak je skupno ime za skupino bolezni, pri katerih se celice nenadzorovano delijo. Nastanejo spremenjene celice, ki nimajo fiziološkega pomena za telo. Citostatiki so zdravila, ki ustavijo delitev rakavih celic. Zaradi neselektivnosti okvarijo tudi zdrave hitro deleče se celice v telesu in pogosto povzročijo neželene učinke. Neželeni učinki zdravila so nenamerna in škodljiva reakcija, do katere lahko pride pri terapevtskih odmerkih. Nevtropenija je zmanjšanje absolutnega števila nevtrofilcev v krvi pod 2,0 x 109/L in sodi med najpogostejše in najnevarnejše hematološke neželene učinke. Granulocitne kolonije stimulirajoči dejavniki so rastni dejavniki, ki se predpisujejo z namenom preprečitve nevtropenije ali zdravljenja le-te. Namen raziskave je pridobiti informacije o pojavnosti nevtropenije pri citostatskem zdravljenju raka dojk in o načinu preprečevanja in zdravljenja nevtropenije pri bolnicah, zdravljenih v onkološki ambulanti Splošne bolnišnice Slovenj Gradec. V raziskavo smo zajeli 50 bolnic z rakom dojk, ki so bile zdravljene s citostatiki. Podatke smo pridobili iz laboratorijskih izvidov in zdravstvene dokumentacije bolnic. Posvetili smo se prejetim shemam zdravljenja, laboratorijskim vrednostim nevtrofilcev, ravnanju ob pojavu nevtropenije ter predpisani podporni terapiji ob nevtropeniji. Nevtropenija se je pojavila pri 32 bolnicah (64,0 %). Najpogosteje se je pojavila blaga nevtropenija (54,0 %), nato zmerna (24,0 %) in najredkeje huda nevtropenija (6,0 %). Pri vseh bolnicah, zdravljenih po shemah 6 x EC, 4 x AC ali 12 x PAKLI, se je pojavila nevtropenija. Pri 62,5 % bolnic so bili ob pojavu nevtropenije sprejeti ukrepi. Najpogosteje izbran ukrep je bil zamik kemoterapije. Ukrepi ob pojavu nevtropenije so bili v 78,7 % skladni s priporočili smernic zdravljenja. G-CSF so bili predpisani pri 46,9 % bolnic s pojavom nevtropenije. Najpogosteje apliciran G-CSF je bil pegfilgastrim, pri katerem je tudi najredkeje prišlo do ponovne pojavnosti nevtropenije pri naslednjem ciklu kemoterapije. 86,7 % apliciranih odmerkov G-CSF se je skladalo s priporočili, najpogosteje je to bil filgrastim (100,0 %). Pojavnost nevtropenije je bila pogostejša, ko so bili v shemi prisotni antraciklini ali taksani. Pojavnost hude in febrilne nevtropenije je bila, v primerjavi s podobnimi študijami, v naši raziskavi manj pogosta. G-CSF so ustrezna podporna terapija, saj po večini aplikacij G-CSF ni prišlo do ponovne pojavnosti nevtropenije.

• Language: Slovenian
• Keywords: pojavnost nevtropenije pri citostatskem zdravljenju, stopnje nevtropenije, rak dojk, sheme zdravljenja, G-CSF
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-117189
• Publication date in RUL: 01.07.2020

Secondary language

• Language: English
• Title: Incidence of chemotherapy-induced neutropeniain patients with breast cancer at the oncology clinic Splošna bolnišnica Slovenj Gradec

Abstract

Cancer is a common name for a group of diseases in which cells divide uncontrollably. Altered cells are formed that have no physiological significance for the body. Cytostatics are drugs that stop the division of cancer cells. Due to non-selectivity, they also damage healthy rapidly dividing cells in the body and often cause side effects. Adverse drug reactions are an unintentional and harmful reaction that may occur at therapeutic doses. Neutropenia is a decrease in the absolute number of neutrophils in the blood below 2,0 x 109/L and is one of the most common and dangerous haematological side effects. Granulocyte colony stimulating factors are growth factors that are prescribed for the purpose of preventing or treating neutropenia. The purpose of the study is to obtain information on the incidence of neutropenia in the cytostatic treatment of breast cancer and on the method of prevention and treatment of neutropenia in patients treated in the oncology clinic of the General Hospital Slovenj Gradec. 50 patients with breast cancer who were treated with cytostatics, were included in the study. Data were obtained from laboratory results and medical records of patients. We focused on the received treatment regimens, laboratory values of neutrophils, treatment in case of neutropenia and prescribed supportive therapy in case of neutropenia. Neutropenia occurred in 32 patients (64,0 %). Mild neutropenia occurred most frequently (54,0 %), followed by the moderate (24,0 %) and severe neutropenia (6,0 %). In all patients treated according to the schemes 6 x EC, 4 x AC or 12 x PAKLI, neutropenia occurred. For 62,5 % of patients, interventions were taken when neutropenia occurred. The most chosen intervention was delay of the next chemotherapy. Interventions in the case of neutropenia were in 78,7% in line with the recommendations. G-CSF were prescribed to 46,9 % of patients with neutropenia. Most often applied G-CSF was pegfilgrastrim, which also had the least recurrence of neutropenia in the next cycle of chemotherapy. 86,7 % applied doses of G-CSF were in line with the recommendations, most commonly it was filgrastim (100,0 %). The results of the study show that the incidence of neutropenia is more common when anthracyclines or taxanes are present in the scheme. The incidence of severe and febrile neutropenia is less common compared to similar studies. G-CSF has been shown to be an appropriate supportive therapy, as neutropenia has not recurred after most G-CSF applications.

• Keywords: the incidence of neutropenia in cytostatic treatment, degrees of neutropenia, breast cancer, treatment protocols, G-CSF