.
Pharmaceutical and Biomedical Sciences Journal Volume 6.
, 2024,152-160 ________________________________________________________________ Comparative Utility of Doxorubicin.
Cyclophosphamide, and Docetaxel in Breast Cancer Treatment in West Sumatera.
Najmiatul Fitria1*.
Intan Nur Rahmadani2.
Dita Permatasari1.
Fitri Handayani3,4 1 Department of Pharmacology and Clinical Pharmacy.
Faculty of Pharmacy.
Universitas Andalas.
Padang.
Indonesia, 25163 2 Bachelor Program Faculty of Pharmacy.
Universitas Andalas.
Padang.
Indonesia, 25163 3 Postgraduate Program Faculty of Pharmacy.
Universitas Andalas.
Padang.
Indonesia, 25163 4 College of Health Science Samarinda.
Indonesia, 74123 *Corresponding author: najmiatulfitria@phar.
Received: 15 August 2024.
Accepted: 03 December 2024 Abstract: The large number of breast cancer cases in Indonesia and the high cost of treatment cause the need for utility West Sumatra province ranks second with the highest prevalence of breast cancer in Indonesia.
This study aimed to determine the quality of life of breast cancer patients at the national referral hospital Dr.
Djamil.
West Sumatra, who underwent chemotherapy.
This study used a cross-sectional design from January to April 2024.
Data collection was done prospectively by filling out questionnaires at the Chemotherapy Unit.
Utility value was obtained from filling out a questionnaire with the EQ-5D-5L instrument.
Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests.
The data obtained was 47 respondents who received Doxorubicin and Cyclophosphamide chemotherapy regimen .
and a Docetaxel chemotherapy regimen .
, all of whom met the inclusion criteria in this study.
The average utility value obtained for the doxorubicin and cyclophosphamide regimes is 0.
637, and the average utility value for the docetaxel regimen is 0.
Age did not affect utility .
>0.
, while recent education, occupation, and patient origin affected utility .
<0.
Both regimens provided similar perceived quality of life and overall health status as measured by utility and VAS scores, suggesting comparable patient-reported quality of life outcomes between these chemotherapy Keywords: Breast Cancer.
Quality of Life.
EQ-5D-5L.
Doxorubicin.
Cyclophosphamide.
Docetaxel DOI: 10.
15408/pbsj.
INTRODUCTION
Breast cancer is one of the most common cancers affecting women in the world National Cancer Control Committe.
In 2018, the WHO noted that there were two million cases of breast cancer diagnosed globally.
It is estimated that 30% of the total breast cancer patients are HER-2 type breast cancer, which is an invasive and aggressive type of breast cancer (Desriani et al.
, 2.
Breast cancer is the cancer with the most cases in the world and in women, with a percentage of 11.
7% or around 2.
2 million cases in 2020, according to the Global Cancer Observatory (GLOBOCAN) (Adanu et al.
, 2.
According to Histopathologic data from the Cancer Registration Agency of the Association of Indonesian Pathology Specialists (International Academy of Pathology.
Indonesia division.
IAPI) and the Indonesian Cancer Foundation (ICF), breast cancer ranks first with a relative frequency of 18.
6% with an estimated incidence rate in Indonesia of 12/100,000 women (Ministry of Health.
Republic of Indonesia, 2.
Based on basic health research data in 2018, the prevalence of cancer in Indonesia reached 1.
79 per 1000 population, with the highest prevalence in the province of Yogyakarta, as much as 4.
8 per 1000 West Sumatra occupies the second position at 2.
4 per 1000 population (West Sumatera Riskesdas, 2.
153 Pharmaceutical and Biomedical Sciences Journal, 2024.
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Fitria et al.
Breast cancer treatment uses chemotherapy bases a chemotherapy regimen can be expressed or calculated in Quality Adjusted Life Years (QALY.
This combination shows a significant Quality of life utility values have a scale of 0 to 1, increase in breast cancer death and recurrence rates.
where 0 means death and 1 for a perfect life (Fitria.
Chemotherapy regimens containing anthracycline are slightly better at reducing recurrence and mortality The use of the EQ-5D Instrument in this study is Intercalation of anthracycline with based on the Indonesian Technology Assessment DNA stops topoisomerase II, leading to DNA damage Guidelines published by the Ministry of Health of the and cell death.
If cyclophosphamide is added as an Republic of Indonesia in 2017, which stipulates the alkylating agent, it can form cross-links in DNA, use of the EQ-5D instrument for utility measurement which stops DNA replication and leads to cell death.
in Health Technology Assessment in Indonesia Compared to chemotherapy regimens that do not (Ministry of Health.
Republic of Indonesia, 2.
The contain taxane, adding taxane can help the regimen EQ-5D is a generic instrument developed by a European research team (The Euroqol Grou.
since depolymerization, and stopping cell division.
This 1990, designed to be self-administered and short lowers the risk of death and long-term relapse (Dipiro enough to be combined with other measurement tools et al.
, 2.
(Andayani, 2.
The EQ-5D has a simple approach that has been validated in various countries to This measure a person's health status based on clinical and cyclophosphamide, and docetaxel is based on their economic assessments.
This instrument consists of 2 widespread use in breast cancer treatment protocols, the first part is the EQ-5D-5L sheet, which particularly in combination regimens.
Doxorubicin describes a 5-dimensional system .
obility, self-care, and cyclophosphamide are commonly used together activity, pain/discomfort, and anxiety/depressio.
in the adjuvant treatment of early-stage breast cancer.
with five levels.
The second part is a 20 cm Visual At the same time, docetaxel is frequently included in Analog Scale (VAS) sheet with the top endpoint chemotherapy regimens for both early and advanced being 'best health status' and the bottom is 'worst breast cancer due to its effectiveness in improving health status'.
survival outcomes.
These three chemotherapy agents are integral to the standard treatment for breast cancer Breast cancer is the most common cancer in in Indonesia.
They are thus relevant for evaluating Indonesia (National Cancer Control Committee, 2.
, their cost-effectiveness and impact on patient's with a rising number of cases, making it crucial to quality of life in the context of the country's assess the effectiveness and cost-efficiency of healthcare system.
treatment options.
Given the high cost of treatment, especially in advanced stages, utility analysis helps to Breast cancer patients also experience depression and determine whether the benefits justify the financial decreased quality of life, which includes the ability to burden, enabling informed decisions on the most walk, early treatment, usual activities, pain or cost-effective use of healthcare resources.
West discomfort, anxiety, or depression (Dipiro et al.
Sumatra province ranks second with the highest Utility or the level of satisfaction after getting prevalence of breast cancer in Indonesia.
This study 154 Pharmaceutical and Biomedical Sciences Journal, 2024.
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Fitria et al.
aimed to determine the description of the quality of breast cancer patients who refused to become life of breast cancer patients at the national referral respondents and did not complete the research form.
hospital in West Sumatra, specifically Dr.
Djamil Padang Hospital, who underwent chemotherapy.
3 Time This study was conducted at Dr.
Djamil Padang
MATERIAL AND METHODS
Hospital from January to April 2024.
1 Research design, target population 4 Data analysis This study used prospective techniques in data All data were inputted into Microsoft Excel form for Data collection was carried out using data Each data filled in the EQ-5D-5L value was collection sheet forms.
EQ-5D-5L, and EQ-VAS of converted into health status as a 5-digit number.
The the Indonesian version of the EQ-5D-5L instrument health status values were then converted into utility on the website https://euroqol.
Each patient was values using the Indonesian Value Data Sheet (Purba asked to fill in the EQ-5D-5L form consisting of 5 et al.
, 2.
EQ-VAS values were converted from a 0 questions in 5 levels according to the health condition - 100 data scale to a 0 - 1 data scale.
Data analysis that day.
Respondents were also asked to mark and was performed using the IBM Statistic SPSS 26 self-assess their health on the EQ-VAS form.
Data normality tests were performed Sociodemographic using the Kolmogorv-Sminorv and Shapiro Wilk Register Form The test results showed that the EQ-5D and EQ- Chemotherapy Unit of Dr.
Djamil Hospital VAS utility data had an abnormal distribution, so the Padang.
The data collected included gender, age, analysis of utility against sociodemographics was education, domicile, occupation, marital status, carried out using non-parametric tests, namely the presence or absence of other comorbidities, length of Mann-Whitney Test .
or two group.
and Kruskal chemotherapy use, disease stage, chemotherapy Wallis .
or more than two group.
cycle, and therapy regimen.
Quality of life data was EQ-5D-5L
EQ-VAS
questionnaire forms.
This study has received ethical approval from the Research Ethics Committee of Dr.
Djamil Padang Hospital Number:
DP.
03/D.
XVI.
XI/55/2024.
Respondents signed an informed consent form before the study began as proof of agreement to be involved in this study.
RESULTS AND DISCUSSION
The target population for this study consisted of 59 breast cancer patients from the chemotherapy unit in February-March 2024.
After applying the inclusion and exclusion criteria, 47 patients were selected as the final sample.
The excluded patients did not receive the chemotherapy regimens of doxorubicin, cyclophosphamide, and docetaxel, had incomplete 2 Inclusion and exclusion criteria data, or were unwilling to participate in the interview.
Sampling was determined by inclusion and exclusion The final sample included 47 respondents: 24 patients The inclusion criteria were female breast who received the doxorubicin and cyclophosphamide cancer patients at Dr.
Djamil Padang Hospital regimen and 23 patients who received the docetaxel with an age range Ou 20 years and who were willing to be respondents in the study.
Exclusion criteria were 155 Pharmaceutical and Biomedical Sciences Journal, 2024.
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Table 1: Frequency distribution data of respondents' sociodemographic characteristics .
Respondent Data Age Young adult .
-40 year.
Elderly (Ou60 year.
Educational Attainment Low Intermediate High Occupation No Income Earning Income Domicile Padang Outside Padang Chemotherapy Regimen Doxorubicin and Cyclophosphamide Docetaxel Data on the sociodemographic characteristics of respondents involved in this study.
Based on the respondents in this study used data from 47 research results in Table 2, more than half of the respondents, presented in Table 1 above.
The data respondents have no problems with walking ability, included age, latest education, occupation, origin, and as many as 80.
In the self-care domain, more chemotherapy regimen obtained.
The data were than 50% of respondents did not experience grouped into 2 groups according to the chemotherapy difficulties in self-care.
In these two domains, there regimen obtained: doxorubicin, cyclophosphamide, were also no respondents who could walk or perform and docetaxel.
All patients or respondents received self-care.
Generally, cancer patients will experience several side effects, such as fatigue, weakness, and chemotherapy regimens as additional information.
unbearable pain.
However, in this study, most Still, the regimen was divided into doxorubicin and patients had undergone surgery and recovered from cyclophosphamide regimens in cycles I-IV and the their cancer, so patients had less difficulty in walking docetaxel regimen in cycles V-Vi.
self-care (Altun Sonkaya.
Doxorubicin.
Cyclophosphamide, and Docetaxel can cause various adverse drug reactions (ADR.
such as involving physical and psychological activities.
Three nausea, vomiting, myelosuppression, cardiotoxicity, domains on the EQ-5D-5L instrument involve neuropathy, alopecia, and mucositis, with specific physical activity, namely walking ability, self-care, risks associated with each agent like heart damage and usual activities.
The results of filling out the EQ- 5D-5L questionnaire have obtained consent from the cyclophosphamide, and peripheral neuropathy from The EQ-5D-5L Table 2: EQ-5D-5L domain response of breast cancer patients Ability to walk Level 1 Level 2 Level 3 Level 4 Level 5 Self care Normal activities Uncomfortable Anxiety/depression Domain 156 Pharmaceutical and Biomedical Sciences Journal, 2024.
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Docetaxel (Altun and Sonkaya, 2.
However, we relationship between the presence of pain and did not explore the ADR on this study.
anxiety/depression in cancer patients undergoing chemotherapy (Arora et al.
, 2.
In the domain of usual activities, it was found that almost 50% of the respondents experienced some The anxiety/depression Through interviews conducted, most respondents is because cancer is still the most feared respondents experienced difficulties due to surgical disease in society and is known as the disease that wounds that sometimes hurt and were prohibited by takes the most lives (Gautama, 2.
Therefore, the respondent's family to do heavy work such as respondents often feel anxious and depressed because housework or work.
This was also due to the side of their illness and also worry about their families, effects of chemotherapy, such as fatigue and such as husbands and children.
But not a few patients weakness, so respondents could not do heavy work as think positively and optimistically in undergoing usual (Arora et al.
, 2.
treatment in order to recover.
Based on the results of the study, there were 13 respondents .
66%) who Pain/ discomfort and anxiety/depression are the other EQ-5D-5L did not feel anxious/depressed.
Pain/discomfort that respondents often feel is in the form of headaches, breast surgery scars, and nausea after chemotherapy.
The results showed that only seven respondents .
89%) did not feel any pain/discomfort, and 40 others felt pain.
This is in A sociodemographic analysis of utility variables was conducted to find out which variables have the potential to cause differences in utility in this study.
By knowing this, it can be estimated which variables need to be considered to increase utility.
line with previous research where out of 393 patients, 5% experienced moderate to severe pain, 20.
Table 3 shows no significant difference in utility values .
=0.
p>0.
between adults and older Table 3: Relationship between sociodemographic characteristics and utility of breast cancer patients undergoing chemotherapy at Dr.
Djamil Hospital Padang Respondents Sociodemographic .
Age Adult Elderly Education Attainment Low Intermediate High Income No Income Earning Income Domicile Padang Outside Padang Median Utility value Min.
Maks.
p-value a Analysed using Mann-Whitney b Analysed using Kruskal-Wallis This means that the utility value in adults is It can be concluded that there is a no significantly different from that of older people.
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However, the average utility value in elderly patients value than the low and middle education groups, was higher than in adult patients.
This result is not in These results are in line with research line with the results of a study conducted by Leinert conducted by Ngo et al.
, where it was found that a et al.
, where their study stated that there was only a higher level of education provided a better quality of small difference in utility in patients aged <65 years life to patients (Ngo et al.
, 2.
This is because compared to patients aged 65-70 who received patients with higher education have better knowledge Younger patients may experience a about their health conditions and are better able to decrease in quality of life compared to older patients communicate with doctors so that it helps them make because they have more social, work, or family better decisions for the treatment they undergo.
commitments that are disrupted due to the patient addition, patients are also able to manage the side undergoing chemotherapy.
However.
Leinert et al.
effects of chemotherapy better, thus improving their study used the European Organization for Research quality of life (Ngo et al.
, 2.
and Treatment for Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C.
instrument, allowing There is a significant difference in utility value this difference in results.
The unbalanced number of .
=0.
p<0.
in the employment variable.
This adult and elderly patients may also cause a difference means that the utility value in the non-income in results (Leinert et al.
, 2.
Kouwenberg et al.
respondent group is different from the utility value of stated that the EQ-5D-5L questionnaire can be used the income respondent group.
Judging from the to assess and compare the quality of life between average utility value, the group of patients who earn different patient groups (Kouwenberg et al.
, 2.
income has a higher utility than those who do not.
Alava et al.
demonstrated that the EQ-5D-5L These results are in accordance with research questionnaire has the potential to capture smaller conducted by Binotto et al.
, where the results state changes in health status and improvements in quality that socioeconomic factors such as income affect the of life more accurately (Hernandez Alava et al.
quality of life of breast cancer patients.
Higher- Battisti et al.
, conducted research related to the income gives patients a better quality of life (Binotto effect of chemotherapy on elderly early breast cancer et al.
, 2.
patients in 56 UK hospitals.
The result is that chemotherapy has a negative impact on patients in the There is a significant difference in utility value first 6 months, thereby affecting the patient's quality .
=0.
p<0.
in the origin/domicile variable.
of life.
However, this negative impact will disappear This means that the utility value of the respondent in the 18th month (Battisti et al.
, 2.
group from Padang differs from the value of the respondent group from outside Padang.
Judging from The results of utility statistical calculations showed a the average utility value, the group of patients from significant difference in utility values .
=0.
outside the field had a higher utility than those who p<0.
in the last education variable.
This means came from inside the field.
This is not in line with that the utility value in the low-education respondent research conducted by Ligt et al.
, where the results of group is different from the utility value of the their research state that the further the distance from medium and high-education respondent groups.
the patient's home to a health facility or hospital will Judging from the average value of each education make his utility or quality of life lower .
e Ligt et al.
group, the higher education group has a higher utility However, the research of Novianti et al.
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that environmental factors such as living outside the encompassed a wide range of sociodemographic city provide life satisfaction, thereby improving factors, the use of the validated EQ-5D-5L instrument quality of life.
This is in line with the found utility to ensure the reliable and valid quality of life value in patients who come from outside Padang, assessments, and comparative analysis between which is higher than in patients who come from different chemotherapy regimens .
oxorubicin and Padang (Novianti.
Wungu, and Purba, 2.
cyclophosphamide vs.
, providing insights into treatment impacts.
Detailed sociodemographic Table 4 shows the value of utility and VAS of the chemotherapy dosage form.
The comparison between the Doxorubicin and Cyclophosphamide regimen and the Docetaxel regimen revealed no statistically significant differences in utility values .
=0.
or VAS scores .
=0.
among breast cancer patients receiving chemotherapy.
Both treatment regimens yielded similar results regarding perceived quality of life and overall health status, as indicated by utility and VAS measurements, suggesting that patientreported quality of life outcomes are comparable between these two chemotherapy options.
The Doxorubicin Cyclophosphamide regimen and the Docetaxel differences in utility values .
=0.
or VAS scores .
=0.
among breast cancer patients receiving Both treatment regimens yielded similar results in terms of perceived quality of life and overall health status, as indicated by utility and VAS measurements, suggesting that patient-reported quality of life outcomes are comparable between these two chemotherapy options.
income on quality of life, and the significant sample size of 47 patients added robustness to the findings.
However, the study also had weaknesses, such as potential sample selection bias due to the reduction from 59 to 47 patients, unbalanced age groups, limited geographical scope as it was conducted at a single hospital in Padang, and potential recall bias from patient interviews.
The cross-sectional design limited the assessment of long-term impacts, and the lack of longitudinal data made it difficult to evaluate changes in quality of life over time.
Future research can build on these findings while addressing these limitations to enhance the understanding of the quality of life in breast cancer patients undergoing These results are in line with the results in this study where the utility of the Docetaxel regimen was higher than the Doxorubicin and Cyclophosphamide regimen (Saptaningsih et al.
The cyclophosphamide, and docetaxel in this study is based on their prominence in current breast cancer The study on breast cancer patients undergoing insights highlighted the influence of education and effectiveness in various stages of the disease.
Table 4: Calculation of utility and VAS values of chemotherapy regimens Doxorubicin and Cyclophosphamide Regimen Component .
Median Utility value VAS value a Analysed using Mann-Whitney Docetaxel Regimen .
Median p-value Doxorubicin and cyclophosphamide are standard 159 Pharmaceutical and Biomedical Sciences Journal, 2024.
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drugs used in combination chemotherapy for early- Fitria et al.
15/UN16.
D/PJ.
/2024.
stage breast cancer.
At the same time, docetaxel is often included in regimens for both early and metastatic breast cancer due to its proven efficacy in improving survival rates.
However, while these treatments are widely used, this study aims to assess whether these chemotherapy regimens are the most cost-effective and beneficial in terms of overall health outcomes, quality of life, and the financial burden on REFERENCES Adanu.
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CONCLUSION
Comparing the utility and VAS values between the doxorubicin and cyclophosphamide regimen and docetaxel regimen groups revealed no significant differences, although the docetaxel regimen group had slightly higher average values.
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ACKNOWLEDGMENT