| ObjectivesTo investigate the effect of frailty on chemotherapy toxicity and chemotherapy tolerance in patients with cervical cancer,so as to provide a basis for taking effective measures to reduce chemotherapy toxicity and improve chemotherapy tolerance.MethodsFrom July 2020 to December 2021,cervical cancer patients treated with chemotherapy in a Classⅲ Grade A hospital in Lanzhou were selected by convenient sampling for longitudinal study.The frailty,anxiety and depression,nutritional status and other data were evaluated before the first hospitalization and each chemotherapy.Chemotherapy toxicity and Chemotherapy tolerance were evaluated from the beginning of each Chemotherapy to the next Chemotherapy.Data of preoperative Neoadjuvant Chemotherapy(NACT)for 3 times and postoperative Adjuvant Chemotherapy(ACT)for 6 times were collected from cervical cancer patients.The questionnaire included the General Information Questionnaire,Tilburg Frailty Scale,Hospital Anxiety and Depression Scale,Mini-mini-Nutrition Assessment Scale,and Common Terminology Criteria for Adverse Events.CTCAE)4.0,chemotherapy tolerance evaluation form.Chi-square test,generalized estimating equation,repeated measures ANOVA,Cox survival analysis and other statistical inference methods were used.Results(1)A total of 287 patients with cervical cancer were investigated in this study,and 18 patients were lost to follow-up.A total of 269 patients were included,including 84 patients with preoperative NACT.170 questionnaires were distributed(84 patients with preoperative NACT receiving the first chemotherapy,74 patients with preoperative NACT receiving the second chemotherapy,and 12 patients with postoperative ACT receiving the third chemotherapy).A total of 830 questionnaires were distributed,including 241 cases of the first chemotherapy,235 cases of the second chemotherapy,190 cases of the third chemotherapy,113 cases of the fourth chemotherapy,31 cases of the fifth chemotherapy,and 20 cases of the sixth chemotherapy.Among them,56 patients received both preoperative and postoperative NACT.The incidence of frailty was 38.8% in 170 NACT cervical cancer patients before operation.The incidence of frailty was 39.3% in 830 patients with ACT cervical cancer after operation.(2)Among 170 patients with NACT cervical cancer before operation,82.4%(140/170)had chemotherapy toxicity,among which grade 1-2 chemotherapy toxicity accounted for 45.9%(78/170),grade 3 and above chemotherapy toxicity accounted for 36.5%(62/170).The top three toxic reactions were hemoglobin reduction(37.6%,64/170),nausea(35.9%,61/170)and vomiting(32.9%,56/170).The results of generalized estimating equation analysis showed that frailty had no effect on the total toxicity of preoperative NACT chemotherapy in cervical cancer patients,but compared with non-frailty patients,frailty patients with preoperative NACT cervical cancer were more likely to have decreased hemoglobin(OR=2.275,95%CI:1.161-4.459,P < 0.05),nausea(OR=3.183,95%CI: 1.293-7.836,P < 0.05),vomiting(OR=5.090,95%CI: 1.875-13.816,P < 0.05).Decreased chemotherapy tolerance occurred in 27.1%(46/170)patients,and the top three decreased chemotherapy tolerance were prolonged hospital stay(27.1%,46/170),delayed chemotherapy(8.2%,14/170),and reduced chemotherapy dose(5.3%,9/170).The results of generalized estimating equation analysis showed that frailty had no effect on the overall tolerance of preoperative NACT chemotherapy in cervical cancer patients,but compared with non-frailty patients,frailty patients with preoperative NACT cervical cancer were more likely to have longer hospital stay(OR=2.731,95%CI: 1.249-5.971,P < 0.05).(3)Among 830 patients with ACT cervical cancer after surgery,88.1%(731/830)had chemotherapy toxicity reactions,among which grade 1-2 chemotherapy toxicity reactions accounted for 44.2%(367/830),grade 3 and above chemotherapy toxicity reactions accounted for 43.9%(364/830).The top three toxic reactions were nausea(71.8%,596/830),vomiting(47%,390/830),and leukopenia(35%,290/830).The results of generalized estimating equation analysis showed that frailty had no effect on the total toxicity of postoperative ACT chemotherapy,but compared with non-frailty patients,frailty patients with postoperative ACT cervical cancer were more likely to have nausea(OR=2.855,95%CI: 2.087-3.924,P < 0.001)and vomiting(OR=1.939,95%CI: 1.435-2.619,P < 0.001)and leukopenia(OR=1.648,95%CI: 1.174-2.313,P< 0.05).Decreased chemotherapy tolerance occurred in 39.5%(328/830)patients.The top three decreased chemotherapy tolerance were prolonged hospital stay(26.3%,218/830),delayed chemotherapy(14.8%,123/830),and reduced chemotherapy dose(13.3%,110/830).The results of generalized estimating equation analysis showed that compared with non-frail patients,frail patients with postoperative ACT cervical cancer were more likely to have reduced global chemotherapy tolerance(OR=1.495,95%CI: 1.074-2.080,P < 0.05)and longer hospital stay(OR=1.577,95%CI:1.086-2.291,P < 0.05).(4)The results of repeated measurement analysis showed that the white blood cell value and hemoglobin value of frailty group were lower than those of non-frailty group(F intergroup effect =4.172,P=0.043;F intergroup effect =6.589,P=0.012),and the white blood cell value and hemoglobin value of patients in both groups showed a downward trend with the increase of postoperative chemotherapy times(F time effect =7.274,P < 0.001;F time effect =14.033,P < 0.001).(5)The results of Cox analysis showed that the risk of chemotherapy total toxicity,nausea,vomiting and reduced overall chemotherapy tolerance in frailty patients with postoperative ACT cervical cancer was 5.423 times(95%CI:3.260-9.023,P < 0.001),3.967 times(95%CI: 2.446-6.433,P < 0.001),3.081 times(95%CI: 1.921-4.942,P < 0.001)and 1.681 times(95%CI: 1.041-2.713,P < 0.05)respectively,compared with the non-frailty group.Conclusions(1)Frailty has no effect on the total toxicity of preoperative chemotherapy in NACT cervical cancer patients,but compared with non-frailty patients,frailty patients with preoperative NACT cervical cancer are more likely to have chemotherapy toxicity including hemoglobin reduction,nausea and vomiting.Frailty has no effect on the overall chemotherapy tolerance of preoperative NACT cervical cancer patients,but compared with non-frailty patients,frailty patients with preoperative NACT cervical cancer are more likely to have prolonged hospital stay.(2)Frailty has no effect on the total toxicity of postoperative chemotherapy in patients with ACT cervical cancer.However,compared with non-frailty patients,frailty patients with ACT cervical cancer are more likely to have chemotherapy toxicity including nausea,vomiting and leukopenia.Frailty patients with postoperative ACT cervical cancer are more likely to have reduced global chemotherapy tolerance and longer hospital stay than non-frailty patients.(3)The white blood cell and hemoglobin values of frailty patients with ACT cervical cancer after operation were lower than those of non-frailty patients,and the white blood cell and hemoglobin values of patients in both groups showed a downward trend with the increase of postoperative chemotherapy times.(4)Compared with non-frailty patients,frailty patients with postoperative ACT cervical cancer have an increased risk of total chemotherapy toxicity,nausea and vomiting,and an increased risk of reduced overall chemotherapy tolerance. |
PDF Full Text Request