Frequency of adverse side effects of doxorubicin and factors influencing patients' experience
Abstract
Introduction: According to the definition by the US National Institute for Occupational Safety and Health, cytostatics are a group of drugs classified as hazardous medications.Cytostatics are used in cancer chemotherapy, and doxorubicin is considered as one of the most effective cytostatics in breast cancer chemotherapy in women. In addition to its effect on destroying malignant cells, doxorubicin chemotherapy also causes damage to healthy cells, leading to a range of side effects.
Objective: To examine the frequency of side effects experienced by patients during doxorubicin chemotherapy and the factors that influence their experience.
Methodology: The study was conducted at the General Hospital in Požarevac. It included 30 female patients undergoing doxorubicin chemotherapy. The research instrument consisted of a specifically created questionnaire for this study.
Results: The most frequentside effect of the drug that was reported is alopecia. Most patients are satisfied with the information received about doxorubicin, but only 10% regularly receive information update about their therapy. All patients agree that they are satisfied with the approach and communication with the nurses, around 90% highlighting the support from the nurses, while a slightly smaller percentage (twothirds) emphasizes their compassion and understanding.
Conclusion: Based on the research, it is concluded that several key factors influence the experience of patients during doxorubicin therapy. The majority of patients report the significant impact of hair loss during treatment. Although patients receive adequate information and support, the side effects of treatment and their impact on daily life still pose a difficulty.Satisfaction with the work and communication of the nurses is high, still there is room for improvement in the frequency of information and materials that patients can use at home.
References
Dušak N. Kvaliteta života bolesnika na citostatskoj terapiji – doktorska disertacija. Bjelovar: Visoka tehnička škola u Bjelovaru, 2016. [pristupljeno 08.01.2025.].Dostupno na: https://zir.nsk.hr/islandora/object/vtsbj%3A11/datastream/PDF/view
Šupić V, Despotović M, Hadživuković N, Kulić V, Bogdanović G, Živanović. Kvalitet života pacijenata koji se liječe hemioterapijom. Sestrinska reč, 2017;21(74):18-21. [pristupljeno 08.01.2025.]. Dostupno na: https://scindeks-clanci.ceon.rs/data/pdf/0354-8422/2017/0354-84221774018S.pdf
Common Terminology Criteria for Adverse Events (CTCAE) [Internet]. Version 4.0. 2023 [pristupljeno 10.01.2025.]. Dostupno na: https://dermnetnz.org/topics/common-terminology-criteria-for-adverse-events-due-to-cancer-therapy
Tepavac A. Prognostički značaj mijelotoksičnosti u toku hemioterapije za preživljavanje bolesnika sa uznapredovalim nemikrocelularnim karcinomom bronha [doktorskadisertacija]. Novi Sad: Univerzitet u Novom Sadu, Medicinski fakultet, 2014. [pristupljeno10.01.2025.] https://nardus.mpn.gov.rs/handle/123456789/4711
Reeve JL, Szegezdi E, Logue SE, et al. Distinct mechanisms of cardiomyocyte apoptosis induced by doxorubicin and hypoxia converge on mitochondria and are inhibited by Bcl-xL. J cellular and molecular medicine. 2007; 11(3): 509-20.doi: 10.1111/j.1582-4934.2007.00042.x. PMID: 17635642; PMCID: PMC3922357.
Snedec T. Biosinteza, razvoj in uporaba antraciklinskih protirakastih učinkovin v medicini. [diplomski rad]. Ljubljana: Univerzitet v Ljubljani, Biotehniška fakulteta, Študij biotehnologije, 2017. [pristupljeno10.01.2025]. Dostupnona: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=slv&id=95654
Seke M. Uloga dva nanokompozita fulerenol/doksorubicin i fulerenol/gvožđe kod toksičnih efekata izazvanih doksorubicinom [doktorska disertacija]. Novi Sad: Univerzitet u Novom Sadu, Prirodno-matematički fakultet, 2017. [pristupljeno 10.01.2025].Dostupno na: https://nardus.mpn.gov.rs/handle/123456789/18061
Radonjić T. Uloga tiamina u inhibiciji oksidativnog stresa mitohondrija i endoplazmatskog retikuluma u animalnom modelu doksorubicinom indukovane kardiotoksičnosti [doktorska disertacija]. Kragujevac: Univerzitet u Kragujevcu, Fakultet medicinskih nauka, 2021. [pristupljeno15.01.2025.].Dostupno na: https://nardus.mpn.gov.rs/handle/123456789/18705?locale-attribute=sr_RS
Johnson-Arbor K, Dubey R. Doxorubicin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan– [pristupljeno 16.01.2025.]. Dostupno na: https://www.ncbi.nlm.nih.gov/books/NBK/NBK459232/
Radić JP, et al. Cardiotoxicity of doxorubicin: Causes, diagnosis, consequences and possibilities of prevention. Hosp Pharmacol. 2022;9(1):1143-1151. doi: 10.5937/hpimj2201143R.
Islamčević S. Profesionalna izloženost medicinskih sestara antineoplastičnim lijekovima[diplomski rad]. Zagreb: Sveučilište u Zagrebu, Medicinski fakultet, 2022. [pristupljeno 16.01.2025.]. Dostupno na:https://repozitorij.mef.unizg.hr/islandora/object/mef%3A7129/datastream/PDF/view
Jungić S, Lazić B. Neželjeni efekti specifičnog onkološkog liječenja – Priručnik namijenjen specijalistima/specijalizantima onkologije i specijalistima porodične medicine. Univezitetski klinički centar Republike Srpske, Klinika za Onkologiju. [pristupljeno 18.01.2025.]. Dostupno na:https://www.porodicnamedicina.com/images/vodici/Nezeljeni-efekti-specificnog-onkoloskog-lijecenja-Jungic.pdf
Kučan N. Poteškoće i komplikacije kod liječenja kemoterapijom [završni rad]. Varaždin: Sveučilište Sjever, 2020. [pristupljeno 19.01.2025.]. Dostupno na:https://repozitorij.unin.hr/islandora/object/unin%3A3689/datastream/PDF/view
Oikonomou E, Anastasiou M, Siasos G, Androulakis E, Psyrri A, Toutouzas K, et al. Cancer Therapeutics-Related Cardiovascular Complications. Mechanisms, Diagnosis and Treatment. Curr Pharm Des. 2018;24(37):4424-4435.doi: 10.2174/1381612825666190111101459. PMID: 30636595.
Luu AZ, Chowdhury B, Al-Omran M, Teoh H, Hess DA, Verma S. Role of Endothelium in Doxorubicin-Induced Cardiomyopathy. JACC Basic Transl Sci. 2018;3(6):861-870.doi: 10.1016/j.jacbts.2018.06.005. PMID: 30623145; PMCID: PMC6314956.
Pipicz M, Demján V, Sárközy M, Csont T. Effects of Cardiovascular Risk Factors on Cardiac STAT3. Int J Mol Sci. 2018;19(11).doi:10.3390/ijms19113572. PMID:30424579; PMCID: PMC6274853.
Kameo S, Ramos MJ, Lima R, Amorim B, Costa J, Marinho P, et al. Hematotoxicity and functional impacts related to chemotherapy with doxorubicin and cyclophosphamide for invasive ductal breast carcinoma: a study in clinical records. J. Health Biol Sci. 2021;9(1):1-8.doi: 10.12662/2317-3076jhbs.v9i1.3864.p1-8.2021
Dong C, Chen L. Second malignancies after breast cancer: The impact of adjuvant therapy. Mol Clin Oncol. 2014;2(3):331-336. PMID:24772296 PMCID:PMC3999127 DOI: 10.3892/mco.2014.250
Soares S, de Sousa JT, Boaretto FBM, da Silva JB, Dos Santos DM, Garcia ALH, et al. Amantadine mitigates the cytotoxic and genotoxic effects of doxorubicin in SH-SY5Y cells and reduces its mutagenicity. Toxicol In Vitro. 2024;99:105874. PMID: 38851604 DOI: 10.1016/j.tiv.2024.105874
National Institute of Diabetes and Digestive and Kidney Diseases. Doxorubicin. In: LiverTox: clinical and research information on drug-induced liver injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2018 Jan 15 [pristupljeno 19.01.2025.]. PMID: 31643176. Dostupnona: https://www.ncbi.nlm.nih.gov/books/NBK548622/.
Žuntar I, Jadrujević M, Galić I. Citotoksični lijekovi - odgovoran i siguran rad zaštita zdravlja i okoliša – uloga ljekarnika. Zagreb: Farmaceutsko Biokemijski fakultet, 2020. [pristupljeno 19.01.2025.]. Dostupno na: https://urn.nsk.hr/urn:nbn:hr:163:124754
Knežević B. Sigurno rukovanje lijekovima koji sadržavaju citotoksične tvari u zdravstvenoj skrbi. Zagreb: Medicinska naklada, 2018:38-42
Republika Srbija. Zakon o bezbednosti i zdravlju na radu. Službeni glasnik RS. 2023;(35) [pristupljeno 21.01.2025.]. Dostupno na: https://www.paragraf.rs/propisi/zakon_o_bezbednosti_i_zdravlju_na_radu.html.
Republika Srbija. Pravilnik o preventivnim merama za bezbedan i zdrav rad pri izlaganju karcinogenima ili mutagenima. Službeniglasnik RS. 2011;(96), 2017;(117) [pristupljeno 21.01.2025.]. Dostupno na: https://www.paragraf.rs/propisi/pravilnik_o_preventivnim_merama_za_bezbedan_i_zdrav_rad_pri_izlaganju_karcinogenima_ili_mutagenima.html.
