Chemotherapy In Cancer Patients Research Articles

A Review Article: The Relationship of Nutrient Status with Chemotherapy Frequency in Cancer Sufferers

Cancer is a disease caused by an irregular hormonal pathway that results in the growth of flesh in normal body tissues, often known as malignant tumors. In addition, these symptoms are also known as malignant neoplasms. They are often characterized by characteristic cell cycle abnormalities that give rise to the ability of cells to grow uncontrollably, invading nearby biological tissues. These cells migrate to other body tissues through the blood circulation or lymphatic system, called metastasis. This study aimed to analyse the relationship between nutritional status and the frequency of chemotherapy in cancer patients. This study uses a literature review method based on references from ten national journals sourced from Google Scholar for the last five years. It uses the keywords frequency of chemotherapy, cancer patients, and nutritional status. From this study, the frequency of chemotherapy given to cancer patients is quite influential on the nutritional status of chemotherapy patients depending on the patient's immune system. Many patients are malnourished due to decreased appetite while energy needs in the body increase.

Recent Updates on Folate Targeted Drug Delivery Systems in Cancer: A Mini Review

Abstract:Targeted drug delivery systems that selectively deliver anticancer drugs to tumour cells have always been a field of interest in reducing side effects associated with chemotherapy in cancer patients. Cancer cells require nutrients for their multiplication; folic acid is one such nutrient. The expression of folate receptors is negligible in normal cells, whereas they are overexpressed in a variety of cancer cells. A number of studies have shown that selective targeting of folate receptors in cancer is a beneficial approach, as folate targeted anticancer conjugates are selective towards cancer cells, thereby sparing non-cancerous cells. In this review, we have discussed folate receptor, folic acid as a cancer targeting moiety, different folate targeted anticancer drug conjugates, and different folate conjugated nanodelivery systems. This summarized information may turn out to be valuable for researchers to design novel folate targeted anticancer drug delivery systems that can potentially reduce the drawbacks associated with conventional cancer therapeutics.

Development and validation of a comprehensive needs assessment tool to assess the burden of cancer chemotherapy patients attending a tertiary care hospital.

In India in 2020, there were an estimated 1.39 million cancers present in the country. Chemotherapy patients experience several problems such as ADRs (adverse drug reactions), and because of this, many dropouts have been happening. Also, there is a lack of communication between the patient and care providers (doctors). Development and validation of a comprehensive needs assessment tool to assess the burden of chemotherapy on patients attending tertiary level health care facilities. Development and validation of comprehensive needs assessment in cancer chemotherapy involve several steps, including problem statement and literature review regarding the problem, domain generation, development of the preliminary questionnaire, face validation, statistical validation, and final draft of the tool. A total of 10 experts are involved in face validation. The majority (80%) of the experts agreed with the grammar, clarity, and content of the tool. A few experts (20%) disagreed regarding the construction of the questionnaire, the appropriate level of understanding for the participants, and the content of the tool and suggested changes in the physical and psychological domains. The questionnaire has been re-structured according to the expert's suggestion before going for statistical validation. Internal consistency of the CNAT-CC was optimal, with a satisfactory Cronbach's alpha of 0.7 for the total scale. The current study was focused on the development and validation of needs assessment in cancer chemotherapy patients. The CNAT-CC promises to be a comprehensive needs assessment tool that applies to a comparatively vast majority of patients undergoing cancer chemotherapy.

The Effects of Laughter Yoga on Perceived Stress, Positive Psychological Capital, and Exercise Capacity in Lung Cancer Chemotherapy Patients: A Pilot Randomized Trial

Background: Lung cancer is the malignant tumor with the highest morbidity and mortality rate in China. Although chemotherapy is effective in improving clinical symptoms, it causes a variety of acute and chronic side effects, seriously aggravating the psychological stress of patients. Laughter Yoga as a new type of aerobic exercise can effectively reduce stress levels and increase positive mood in patients. This study aimed to examine the effects of laughter yoga on perceived stress, positive psychological capital, and exercise capacity in lung cancer patients. Methods: This study was a randomized, single-blind, parallel-group trial. The study enrolled 84 lung cancer chemotherapy patients from a general hospital in central China. These patients were randomly allocated to control and intervention groups (n = 42 per group) after baseline assessments. Patients in the control group received routine care and those in the intervention group received laughter yoga intervention. Perceived stress, positive psychological capital, and exercise capacity were assessed at baseline, immediately post-intervention. Results: During the implementation of the study, there were 2 dropouts in each of the intervention and control groups. Ultimately, 80 patients in the control and intervention groups completed the trial. Patients who received laughter yoga intervention had significantly higher scores in positive psychological capital ( P < .01, Cohen’s d = 0.692) and exercise capacity ( P < .01, Cohen’s d = 0.659). Discernible differences were also observed in perceived stress ( P < .01, Cohen’s d = 1.087) between the 2 groups. Conclusions: The results of this study suggest that laughter yoga is an effective way and may produce beneficial effects on perceived stress, positive psychological capital and exercise capacity.

Az onkokardiológia kialakulása

In our days, the worldwide leading cause of mortality is cardiovascular, and the second place is held by cancer diseases. Actually, we achieved a significant breakthrough in cancer treatment through multi-disciplinary cooperation but parallel there were emerging cardiac side effects. Several hundred years earlier all cancer patients were considered uncurable, and they were labelled this way through many centuries. Some people are thinking the same way even in our days. The first therapeutic initiatives were surgical operations aiming to remove cancer tissues. These therapeutic approach flourished in the surgeons’ century by spreading of general anaesthesia. At the end of the 19th century, a new diagnostic and therapeutic approach used the X-ray technique which spread fast throughout the world. In the middle of the 20th century, scientist started to investigate the chemical weapons of warfare and discovered, that these lessened the progression of some cancer types. Thanks to these discoveries, there was introduced the first anti-cancer drug aminoptein that opened the era of chemotherapy. However, after a few years, it was realized that some patients treated by pharmaceuticals of the antraciklin groups developed heart failure. This phenomenon instigated more scientists to investigate heart-related side effects. Later, there were observed similar side effects as developing high blood pressure and ECG anomalies in patients treated with further chemicals such as HER-2 blocking herceptin and multi-kinase inhibitors. These researcher outcomes were more and more noticed in the practical cardiology in patients treated previously by chemotherapy. Finally, in 2016 the European Society of Cardiology issued the first guideline about the side effects of cancer chemotherapy patients, which started the era of on-cardiology. Since 2016, the once-cardiology become a new medical discipline that concerns the prevention of complications, and the recognition and treatment of heart-related side effects. In the same year was founded the Hungarian Onko-cardiology Society which is translating, spreading and exposing the actual guidelines and holds annual conferences for postgraduate training.

Taxanes induced hypersensitivity reactions in cancer chemotherapy patients reported at adverse drug reaction monitoring centre at a tertiary care hospital

Background: Cancer chemotherapy involves highly complex regimens using antineoplastic agents like taxanes (paclitaxel, docetaxel) etc. Taxanes cause hypersensitivity reactions (HSRs) like redness, rashes, dyspnoea, severe anaphylaxis and death. In this study, adverse drug reactions (ADRs) associated with taxanes are described & analysed on their severity and preventability. The present study aims to analyse and determine the prevalence of ADRs, especially HSRs in patients treated with taxanes.Methods: After getting IEC approval, the present study is done retrospectively by assessing the HSRs in suspected ADR reporting forms from December 2019 to February 2022 in ADR monitoring centre (AMC) in the Department of Pharmacology at Kurnool Medical College, Kurnool. Descriptive statistics used to analyse patient demography, frequency, various carcinomas under treatment & organ involved, causality assessment using WHO-UMC Scale and Naranjo's Algorithm, severity assessment using modified Hartwig & Siegel’s scale and preventability by modified Schumock & Thornton scale.Results: A total of 258 ADRs were recorded, of which 30 cases reported HSRs with taxanes-paclitaxel (22) and docetaxel (8). The most commonly occurred HSR is shortness of breath. Naranjo’s algorithm showed 52.5% possible (score 1-4) HSRs. WHO-UMC causality assessment scale showed 56.4% as probable HSRs. Modified Hartwig & Siegel severity scale showed 46.6% moderate (level 3). Modified Schumock and Thornton scale showed 76.9% as not preventable.Conclusions: Chemotherapy-related ADRs among cancer patients urges the oncologists to be actively involved in ADR reporting, in the need of the hour in order to mitigate, avoid their occurrence and reducing morbidity and mortality, when practiced with diligence.

Application of Box-Behnken design for optimization of A RP-HPLC method for determination of palonosetron and netupitant in their combined dosage form in presence of their impurities

The use of (Netupitant and Palonosetron) combination to treat nausea and vomiting in cancer chemotherapy patients has been authorized by the Food and Drug Administration. For the simultaneous determination of Netupitant (NET) and palonosetron (PAL) in the presence of two of their related substances and in their dosage form, a sensitive and selective RP-HPLC method has been developed and validated. The aforementioned medications were separated and quantified with the help of experimental design. The Box-Behnken design was used in the experiment to optimize the chromatographic method’s analytical parameters. It employed RP-HPLC with a UV detector. Waters ODS-C18 column (3.5 µm, 75 × 4.6 mm) with a mobile phase composed of acetonitrile: 25 mM phosphate buffer (pH = 3.5) in a gradient mode at 254 nm was employed to separate the cited drugs and their impurities. Palonosetron was linear over the concentration range (1–50 µg/mL) and Netupitant (10–100 µg/mL). According to ICH guidelines, the new method underwent thorough validation. Between the proposed method’s results and those from the reported method, there was no significant difference. It is easy to apply the technique to the analysis of the specified drugs in their combination dosage form for quality control considerations.

Comparative Safety and Effectiveness of Direct Oral Anticoagulants and Warfarin during Chemotherapy in Cancer Patients with Venous Thromboembolism Aged 75 Years or Older: A Nationwide Inpatient Database Study

Introduction: Venous thromboembolism (VTE) is a life-threatening complication occurring in cancer patients. Direct oral anticoagulants (DOACs) or warfarin are widely prescribed for treating cancer-associated VTE. However, data are sparse as to the effectiveness and bleeding complications associated with these medications in elderly patients. The purpose of this study was to compare effectiveness and safety profiles between DOACs and warfarin in elderly cancer patients undergoing chemotherapy. Methods: Using the Diagnosis Procedure Combination inpatient database, we retrospectively identified cancer patients aged ≥75 years who developed VTE during chemotherapy (n = 4,278, January 2016 to March 2020). Eligible patients were divided into those receiving warfarin (n = 557) and DOACs (n = 3,721). We conducted a 1:4 propensity score matching analysis to adjust for measured confounders. The primary outcome was VTE recurrence requiring hospitalization. Secondary outcomes were major bleeding requiring hospitalization and inhospital death from all causes within 6 months. Results: The propensity-matched cohort included 557 patients in the warfarin group and 2,278 patients in the DOACs group. The proportion of VTE recurrence requiring hospitalization was lower in the DOACs group (5.3% vs. 7.5%; odds ratio [OR], 0.69; 95% confidence interval [CI], 0.48–0.98). The proportion of recurrent deep vein thrombosis was 6.3% and 4.4%, while that of recurrent pulmonary emboli was 1.3% and 1.3% in the warfarin and DOACs groups, respectively. No statistically significant differences were found in the proportion of major bleeding events requiring hospitalization (1.6% vs. 1.1%; OR, 1.47; 95% CI, 0.62–3.50) or all-cause inhospital mortality (11.1% vs. 9.9%; OR, 1.14; 95% CI, 0.84–1.56) between the DOACs and warfarin groups. Conclusion: Our findings suggest that DOACs may be more effective than warfarin in terms of VTE recurrence requiring hospitalization and that these medications may be equivalent in terms of safety.

Association of HLA-G 3'UTR Polymorphisms with Response to First-Line FOLFIRI Treatment in Metastatic Colorectal Cancer.

Microenvironmental factors such as non-classical human leukocyte antigen-G (HLA-G) have been associated with cancer invasiveness and metastatic progression. HLA-G expression has been associated with specific single-nucleotide polymorphisms (SNP) in HLA-G 3'untranslated region (UTR) in several diseases. The primary aim was to investigate the predictive role of HLA-G polymorphisms on treatment efficacy in metastatic colorectal cancer (mCRC) patients homogeneously treated with first-line FOLFIRI (irinotecan, 5-fluorouracil, and leucovorin) and their association with soluble HLA-G (sHLA-G) plasma concentration. HLA-G 3'UTR was sequenced in 248 patients. A set of eight polymorphisms and related haplotypes were analyzed for their association with best tumor response, overall survival (OS), and progression-free survival (PFS). sHLA-G was measured by immunoassay in 35 available plasma samples and correlated with HLA-G 3'UTR polymorphisms/haplotypes. Our results showed that carriers of rs371194629 (+2960)-Ins allele were at risk for lack of complete response (hazard ratio (HR):0.29, pBH = 0.0336), while carriers of rs1710 (+3010)-G allele (rs1063320 (+3142)-C allele in linkage-disequilibrium), and rs9380142 (+3187)-G allele had a higher chance of complete response according to additive models (HR:4.58, pBH = 0.0245; HR:3.18, pBH = 0.0336, respectively). The combination of rs371194629-Del, rs1710-G, and rs9380142-G alleles forms the UTR1 haplotype. Patients who were carriers of UTR1/UTR-1 diplotype had a greater chance of complete response to therapy (HR:10.59, pBH = 0.0294). The same three beneficial alleles showed a trend toward higher pre-treatment sHLA-G plasma levels, supporting a functional role for polymorphisms in protein secretion. In conclusion, genetic variants of HLA-G are associated with treatment efficacy in mCRC patients treated with first-line FOLFIRI. This finding shed light on the combined effect of this immune system factor and chemotherapy in cancer patients.

Acetylcholinesterase Inhibitor Exerted Neuroprotection Against Trastuzumab‐Induced Chemobrain

AbstractBackgroundChemobrain has recently gained attention as a serious neurobehavioral consequence of chemotherapy in cancer patients. Even well‐recognized among conventional chemotherapeutic agents, trastuzumab (TRZ), an oncogene‐targeted therapy for treating breast cancer, has been shown to intricately caused symptoms of chemobrain elicited by impaired cerebral glucose metabolism and long‐term cognitive function. Noticeably, the inhibition of acetylcholinesterase using donepezil (DPZ), a medication widely used to treat Alzheimer’s disease (AD), possesses several pleiotropic effects including mitochondrial protection and immunomodulation. However, the mechanistic insights regarding the pathophysiology and therapeutic benefit of DPZ have never been holistically determined in a rat model of TRZ‐induced chemobrain.MethodFifteen male Wistar rats were randomized to receive either a 0.9% normal saline solution (Control; n=5) or 4 mg/kg of TRZ via intraperitoneal injection for 7 consecutive days. Then, TRZ‐treated rats were subdivided into 2 groups to receive either drinking water (TRZ, n=5) or 5 mg/kg of DPZ (TRZ+DPZ; n=5) via oral gavage as co‐treatment with TRZ for 7‐day duration. After cessation of the treatment paradigm, cognitive performance was assessed using the novel object location task (NOLT). The brain tissues were obtained for further molecular investigation.ResultTRZ‐treated rats showed impaired long‐term spatial memory as demonstrated by a reduction of preference index in the NOLT (Figure A). Systemic TRZ administration compromised mitochondrial anti‐oxidant capacity (Figure B) and potentiated the activation of mitochondrial‐fission related protein. Furthermore, the upregulation of neuroinflammation was observed in TRZ‐treated rats presented by increased TNF‐α mRNA level (Figure C) and microglial morphological changes into neurotoxic amoeboid‐shaped (Figure D). Additionally. Administration of TRZ triggered the phosphorylation of Tau protein (Figure E) and reduced dendritic spine density in CA1 region (Figure F). Strikingly, co‐administration with DPZ effectively rescued cognitive performance of TRZ‐treated rats by improving mitochondrial anti‐oxidant capacity, reducing mitochondrial fission, mitigating neuroinflammation and microglial polarization, attenuating Tau hyperphosphorylation, and preserving dendritic spine density (Figure A‐F).ConclusionThese findings suggested that DPZ exerted neuroprotective effects against TRZ‐induced chemobrain. Our findings pave the way for parasympathetic activation using DPZ as a therapeutic approach in the prevention of chemobrain in patients who received chemotherapy in the future.

Baicalin suppresses the migration and invasion of breast cancer cells via the TGF-β/lncRNA-MALAT1/miR-200c signaling pathway.

Metastasis is the major cause of death and failure of cancer chemotherapy in patients with breast cancer (BC). Activation of TGF-β/lncRNA-MALAT1/miR-200c has been reported to play an essential role during the metastasis of BC cells. The present study aimed to validate the suppression of BC-cell migration and invasion by baicalin and explore its regulatory effects on the TGF-β/lncRNA-MALAT1/miR-200c signaling pathway. We found that baicalin treatment inhibited cell viability and migration and invasion. Mechanistically, baicalin treatment significantly downregulated the expression of TGF-β, ZEB1, and N-cadherin and upregulated E-cadherin on both mRNA and protein levels. Additionally, baicalin treatment significantly downregulated the expression of lncRNA-MALAT1 and upregulated that of miR-200c. Collectively, baicalin significantly suppresses cell viability, migration, and invasion of BC cells possibly by regulating the TGF-β/lncRNA-MALAT1/miR-200c pathway.

Candida albicans Reactive Oxygen Species (ROS)-Dependent Lethality and ROS-Independent Hyphal and Biofilm Inhibition by Eugenol and Citral.

Candida albicans is part of the normal human flora but is most frequently isolated as the causative opportunistic pathogen of candidiasis. Plant-based essential oils and their components have been extensively studied as antimicrobials, but their antimicrobial impacts are poorly understood. Phenylpropenoids and monoterpenes, for example, eugenol from clove and citral from lemon grass, are potent antifungals against a wide range of pathogens. We report the cellular response of C. albicans to eugenol and citral, alone and combined, using biochemical and microscopic assays. The MICs of eugenol and citral were 1,000 and 256 μg/mL, respectively, with the two exhibiting additive effects based on a fractional inhibitory concentration index of 0.83 ± 0.14. High concentrations of eugenol caused membrane damage, oxidative stress, vacuole segregation, microtubule dysfunction and cell cycle arrest at the G1/S phase, and while citral had similar impacts, they were reactive oxygen species (ROS) independent. At sublethal concentrations (1/2 to 1/4 MIC), both oils disrupted microtubules and hyphal and biofilm formation in an ROS-independent manner. While both compounds disrupt the cell membrane, eugenol had a greater impact on membrane dysfunction. This study shows that eugenol and citral can induce vacuole and microtubule dysfunction, along with the inhibition of hyphal and biofilm formation. IMPORTANCE Candida albicans is a normal resident on and in the human body that can cause relatively benign infections. However, when our immune system is severely compromised (e.g., cancer chemotherapy patients) or underdeveloped (e.g., newborns), this fungus can become a deadly pathogen, infecting the bloodstream and organs. Since there are only a few effective antifungal agents that can be used to combat fungal infections, these fungi have been exposed to them over and over again, allowing the fungi to develop resistance. Instead of developing antifungal agents that kill the fungi, some of which have undesirable side effects on the human host, researchers have proposed to target the fungal traits that make the fungus more virulent. Here, we show how two components of plant-based essential oils, eugenol and citral, are effective inhibitors of C. albicans virulence traits.

Research progress on the effect of gut and tumor microbiota on antitumor efficacy and adverse effects of chemotherapy drugs.

Chemotherapy is one of the most effective methods of systemic cancer treatment. Chemotherapy drugs are delivered through the blood circulation system, and they can act at all stages of the cell cycle, and can target DNA, topoisomerase, or tubulin to prevent the growth and proliferation of cancer cells. However, due to the lack of specific targets for chemotherapeutic agents, there are still unavoidable complications of cytotoxic effects. The effect of the microbiome on human health is clear. There is growing evidence of the potential relationship between the microbiome and the efficacy of cancer therapy. Gut microbiota can regulate the metabolism of drugs in several ways. The presence of bacteria in the tumor environment can also affect the response to cancer therapy by altering the chemical structure of chemotherapeutic agents and affecting their activity and local concentration. However, the underlying mechanisms by which the gut and tumor microbiota affect cancer therapeutic response are unclear. This review provides an overview of the effects of gut and tumor microbiota on the efficacy and adverse effects of chemotherapy in cancer patients, thus facilitating personalized treatment strategies for cancer patients.

Diabetes is associated with high risk of severe adverse events during chemotherapy for cancer patients: A single-center study.

Diabetes mellitus (DM) is a common comorbidity among cancer patients, but its impact on chemotherapy tolerance has not been widely studied. We aimed to compare the occurrence of severe grade 3/4 adverse events (G3/4 AEs) within 90 days of starting chemotherapy between patients with and without diabetes. We conducted a retrospective single-center study in Lille University Hospital Oncology Department, France. Patients who received the first cycle of chemotherapy for gastrointestinal, gynecological or cancer of unknown primary source between 1 May 2013 and 1 May 2016, were included. Overall, 609 patients were enrolled: 490 patients without diabetes (80.5%) and 119 patients with diabetes (19.5%). Within 90 days of starting chemotherapy, patients with diabetes had a significantly higher occurrence of AEs G3/4 compared to those with no diabetes (multivariate odds ratio [OR]: 1.57 [1.02-2.42], P=.04). More frequent G3/4 AEs in patients with diabetes were infection (26%), hematological disorders (13%), endocrine disorders (13%) and deterioration of the general condition (13%). In the year following the beginning of chemotherapy, patients with diabetes were twice as likely to be hospitalized as those without diabetes (univariate OR: 2.1 [1.40-3.15], P=.0003). After multivariate adjustment, diabetes was no longer significantly associated with the risk of hospitalization (P=.051). There were no differences between patients with and without diabetes regarding dose reduction and chemotherapy treatment delays (P=.61 and P=.30, respectively). Our study suggests the need for better consideration of DM in the personalized care plan to improve chemotherapy tolerance and quality of life of patients with DM.

A REVIEW OF THE ANTICANCER NATURAL PRODUCTS: ALKALOIDS, FLAVONOIDS

According to the international agency for research on cancer 1 in 5 people develop cancer during their lifetime, suggesting that more than 50 million people are living within five years of a past cancer diagnosis (World Health Organization (WHO, 2020, para. 1). Despite novel approaches like nanomedicine, targeted therapy, and immunotherapy in cancer treatments during the last decades, chemoresistance has remained the chief hurdle in eliminating cancerous cells (Elgendy , Alyammahi & Alhamad, 2020, p. 103095). About 9 out of 10 cancer deaths are due to spreading of cancer cells from the primary tumor mass towards close and far tissues (a process called metastasis). Treatment failure followed by consequent recurrence of cancer cells and metastasis is the leading cause of death. Many survivors suffer from serious acute or chronic complications after cancer therapy (Qian, Mei, & Zhang, 2017, p.38). Furthermore, chemotherapy commonly induces a variety of side-effects in patients as a result of nonspecific action against both normal cells and cancerous cells. For instance, chemotherapeutic drugs result in alopecia by affecting not only fast dividing cancer cells, but hair follicles as well. Nausea and vomiting are the most common symptoms induced by chemotherapy, with gastrointestinal symptoms including diarrhea (and in some cases constipation) being another common side effect. Chemotherapy is also known to impair immune function and bone marrow activity (Li et al., 2020, p.599073). The identification of approved doses of anticancer drugs is another point to be given careful attention, especially those with higher cost and administered for a longer duration. Larger doses of chemotherapeutic drugs may increase the risk and severity of the aforementioned side effects, and are not cost-saving. Therefore, phytomedicines should be considered as an option not only for adjuvant therapy, but also in view of their comparatively low toxicity and ability to diminish adverse effects of chemotherapy in cancer patients. Natural products and their derivatives can be used as novel therapeutic interventions with improved pharmacological properties targeting tumor cells (Meriggi & Zaniboni, 2020, pp.1–11).

1600P The role of C-reactive protein/albumin ratio in predicting 90-day mortality in patients with febrile neutropenia

The MASCC score is widely used to predict the prognosis of febrile neutropenia after chemotherapy in cancer patients. The MASCC score does not use any laboratory data and has low sensitivity. Therefore, the search for markers to predict the prognosis of febrile neutropenia continues. Albumin(alb) and C-Reactive Protein(CRP) are acute phase reactants, besides albumin reflects nutritional status. In this study, we aimed to evaluate the effect of CRP/alb ratio on the prognosis of febrile neutropenia. The files of patients admitted with the diagnosis of febrile neutropenia between January 2018 and January 2022 were reviewed retrospectively, MASCC risk score, CRP and albumin levels at admission were collected. All patients who were followed up by the medical oncology department, received at least 1 course of chemotherapy and presented with the diagnosis of febrile neutropenia were included in the study. A total of one hundred and fifty-six (n=156) episodes of febrile neutropenia were included in the study, and 55 (35%) of these patients died within ninety days. While the 90-day mortality rate was 45% in the group of patients with MASCC <21, this rate was 26% in patients with MASCC >21 (p = 0.007). The median of the CRP/alb ratio was determined as 58 and the patients were divided into two groups according to the median value. The 90-day mortality rate was 24% in the group with a low CRP/alb ratio, and 45% in the group with a high CRP/Alb ratio (p = 0.004). In patients with a MASCC score of >21 and a CRP/alb score of <58 (n=47), the 90-day mortality rate was 21%, compared to 55% in patients with a MASCC <21 and CRP/alb >58 (p= 0.001). In conclusion, high CRP/Alb ratio worsens the prognosis of febrile neutropenia independently of other factors. The combined evaluation of MASCC risk score and CRP/Alb ratio is beneficial in predicting the prognosis of febrile neutropenia and increases the prognostic power of the MASCC risk score.

Analysis of risk factors associated with common terminology criteria for adverse event in cancer chemotherapy patients

Background: Chemotherapeutic drugs are commonly associated with various harmful consequences which can remarkably reduce quality life of patient and lengthen hospital admission. The objective of this study was to evaluate the frequency and its associated factors affecting cancer chemotherapy-related side effects in cancer patients. Methods: Patient case report form was used to gather information on the patient's demographics and adverse drug reactions (ADRSs) to chemotherapy medications. ADRs were analyzed for toxicity grade using National Cancer Institute Common Terminology NCI-CTCAE version 4.0. Causality Assessment and Predictability of ADRs were analyzed using World Health Organization' (WHO) Causality assessment scale and Council for International Organization of Medical Sciences (CIOMS) method respectively. Utilizing the chi square test and descriptive statistics, the relationship between the grade of ADRs and the patient's characteristics was investigated. Results: A total of 120 patients were included in the study. Mean age of participant was 46.87 (SD-10.1). Majority (60%) participants were female. 81.7% of total patient received poly-chemotherapy in their treatment modality. Total 412 numbers of ADRs were noted. The most frequent adverse drug reactions were observed to be nausea and vomiting (17.7%), neutropenia and alopecia. On NCI-CTCAE grading maximum number of ADR was assessed as “Grade 2” ADR (33%).

P74-5 Evaluating 5FU plasma level in colorectal cancer chemotherapy patients through continuous 5FU infusion

5-fluorouracil (5-FU) dosing has traditionally been based on body surface area (BSA) in colorectal cancer treatment. With regimens having undergone multiple refinements, including the addition of molecular targeted agents, positive prognosis has been reported for colorectal cancer.

ANALYSIS OF TOTAL COSTS OF BREAST CANCER CEMOTHERAPY PATIENTS BASED ON USE OF CHEMOTHERAPY REGIMEN ON JKN PATIENTS IN SANGLAH RSUP

&#x0D; Breast cancer is the first sequence of most attacking women in Indonesia. The high cost of care and old services is a major problem in the prevention of breast cancer. This study aims to determine the relationship between the total cost of the Sanglah Denpasar hospital with the chemotherapy regimen of breast cancer of JKN patients at Sanglah Hospital Denpasar. Test homogeneity using Levene test method. Test normality using Kolmogorov-Smirnov. One way ANOVA test results showed a significant relationship between chemotherapy therapy regimen (FAC, FAC + PAXUS, FEC, AC, AC + PAXUS) with total real cost in breast cancer chemotherapy patients (p = 0.001). The total rill cost was greater in the group receiving FAC + PAXUS, FEC, and AC + PAXUS regimens than the group receiving FAC and AC therapy regimens. This can be caused by a large pharmaceutical cost component in the FAC + PAXUS, FEC, and AC + PAXUS groups. Pharmaceutical costs account for 76.84-85.80% of the total real cost of breast cancer patients receiving chemotherapy. More drug combination factors can lead to higher total rill costs in patients receiving FAC + PAXUS, FEC, and AC + PAXUS.&#x0D;

Aprepitant, fosaprepitant and risk of ifosfamide-induced neurotoxicity: a systematic review.

Ifosfamide is one of the chemotherapy regimens which potentially causes neurotoxicity in patients up to 30%. Aprepitant is administered as an anti-emetic agent in chemotherapy and regarding the inhibitory effect on CYP3A4, aprepitant can increase the risk of ifosfamide adverse effects. This study aims to systematically investigate the relation of ifosfamide-induced neurotoxicity and aprepitant or fosaprepitant in chemotherapy cancer patients. Four databases including PubMed, Scopus, Web of Science, and Embase were systematically reviewed without language restriction and hand searching was performed until December 2021. Total 1639 publications were retrieved and nine studies fulfilled the eligibility criteria. For quality assessment, we used Newcastle-Ottawa quality assessment scales (NOS) for retrospective cohort studies and Cochrane Collaboration tool to assess the risk of bias for a randomized controlled trial. Overall, the results of our systematic review indicated a positive enhanced trend between neurotoxicity and concomitant use of ifosfamide and aprepitant or fosaprepitant, but the association was not statistically significant. As indicated by our findings, several studies identified low albumin as a risk factor for ifosfamide-induced encephalopathy. However, further clinical studies with a larger population of patients are required to evaluate the clinical significance of ifosfamide-related neurotoxicity and aprepitant or fosaprepitant.